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0171 OLD POST ROAD (CENT.)
t !7� C,�ic� ��'as=� � ' �f -} �. �< - p i. ., .. .� o - � A .. � �� - C .. o .. B. .. G _ o 4 _ S y .. _ _ _ ,. Town of Barnstable Building t Post This'Card So That it is Visible From the`Street-Approved Plans.Must bo Retained on Job and this Card Must be Kept MASS Post ed'Until,Final Inspection Has Been Made. << � yam :e Where a Certificate of Occupancy`is R6auir`ed,-such Bu�ldmg shall Not be Occupied until a,Final Inspection#has been made Permit Permit No. B-20-365 Applicant Name: Matthew Hogan Approvals Date Issued: 02/06/2020 Current Use: Structure Permit Type: Building-Stove' Expiration Date: 08/06/2020 foundation: Location: 171 OLD POST ROAD(CENT.),CENTERVILLE Map/Lot: 209-052-004 Zoning District: RC Sheathing: Owner on Record: HOGAN, MATTHEW R&JENNIFER L Contractor Name`,HOMEOWNER IS APPLICANT Framing: 1 Address: 364 Old Forge Xing )- ContractorLicense: EXEMPT I. 2 Devon,.pa 19333 '` Est Project Cost: $2,000.00 Chimney: Description: Existing wood stove need permit and inspection. " Permit Fee: $35.00 Insulation: Fee Paid r $35.00 Project Review Req: Date: 2/6/2020 Final: k 'f12_0 z Plumbing/Gas Rough Plumbing: Official This permitshall be deemed abandoned and invalid unless the work authored by p termit is commenced within six months aftepl�4R�'e. Final Plumbing: All work authorized by this permit shall conform to the approved application and thelapproved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures`shall be in compliance with the local zoning by-laws and codes. Rough.Gas: This permit shall be displayed in location clearly visible from access street or'road and shall be maintained open for public inspection for the entire duration of the work until the completion of the a same. ' = Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and.Fire.Officials are_provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue.lining is installed Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Low Voltage Final: Where applicable,separate permits are required for.Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: a Application number.-1.....4..........1...`..T? Q� Fee........................�].........1Z... JUIV 1 ®r Building Inspectors Initials... ... .............Va... ik LEDate Issued...�.-J.J,.—Iq... .... ................................ Map/Parcel.............:................................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: ;?/ O Q ^&� NUMBER STREET VILLAGE Owner's Name: /fin A4u. Phone Number eia Email Address: Cell Phone Number Project cost$ Check one Residential ,/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Siding 0 Windows (no header change)# Q Insulation/Weatherization 0 Doors(no header change)# Commercial Doors require an inspector's review la"Roof(not applying more than 1 layer of shingles) Construction Debris will be going to__-�✓ ��vti � `, CONTRACTOR'S INFORMATION " Contractor's name &-A-46 Home Improvement Contractors Registration(if applicable)# (attach copy) M Construction Supervisor's License# (attach copy) Email of Contractor ®w,a i kA-e. i hone number. ALL PROPERTIES THAT HAVE STRUCTUkES OVER A YEARS OLD OR IF THE SUBJECT PROPERTYIS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ i *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No " (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or> Yes No____,if yes, a gas permit is required. Natural Gas Yes No ,if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANTS SIGNATURE Signature Date +,"11-Ao 9 All permit applica ons are subject to a building official's approval prior to issuance. HUML lMrKUVLMLN15 z PH. 508.328.1633 Exterior Remodeling Experts BBB' Web: www.thomashomeimprovements.net Fully Licensed & Insured P.O. Box 177 Construction Supervisor Lic#99913 Centerville, MA 02632 Thomas Home Improvements LLC.Proposes to perform the following work: Location of proposed work: Mr.&Mrs. Hogan 171 Old Post Road Centerville,MA 02632 Date on which construction should begin: June 2019 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known.to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation is not to be considered a violation of this contract. Cost for labor and materials under this contract: $9,692.00 30 yr.GAF/Elk Timberline HD Architectural shingle Oyster Grey(Life Time Limited Warranty) Proposal to install Velux non-venting FSM08 skylight would be $1,395.00 Proposal to install SBC Cape Cod Grey,single coat white cedar shingles on back upper section &entire cheek line gable of main home would be $4,820.00 .y. Thank.You for Giving Us the Opportunity to Help You Improve Your Project In the event that while stripping the roof or siding we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$45.00 for a carpenter and$30.00 for a carpenter's laborer, plus the cost of materials. -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier,Synthetic roof underlayment,and installed with Timberline architectural shingles using galvanized nails. (Storm nailed) -All new 8" drip edge and pipe flanges to be installed -6x8 aluminum flashing to be installed along all cheek lines -Cobra ridge vent to be installed on all ridges & include back bump out roof -Front bow window to match main roof color -Timberetex premium ridge cap to be installed -Velux skylight to include interior trim primed ready for paint as discussed -Strip& install SBC Cape Cod Grey cedar siding in accordance to manufacturer's warranty -1 Vinyl gable vent to be installed as discussed -A 10-yard dump trailer will be needed on site;and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start;and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form, content,and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance, only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: ✓�V JAI Homeowner Contractor r OINCB Oi COf184it1ET�ifBlrS dc848iR8�RCp--ct1 HOAAE IMPA01(EM MT f:ONFRACTOR f�egistratlon valitl for indlvleluau use,only TYPE:£groom n before the exp*o*04te K found retum to: �gtstratkin OHic®-of Consumer Aifalra and-t3lreiness RegWation 185YEN O6/0812020 OneAshbttton:Place-Su1#e1 1 TROY THOMAS HO F CENTS,iNG &>stori,`taAA 021di 'TROY THOMAS: � R 499 NOTTINGHAM IJR � - CENTERVIILE.MA o2b2 Not AW d wt�iOXlt ignetufe Undersecretary Cohonwealth of Massachusetts DAftston of ard professional licensors Bo of guiltling Regulations antl St pdards .Goncfloastr Specialty CSSt,49913 lres 0 #� 13/2020 m �f TRpy A TMAS� F six 499mNt s IUTrRvvlt,� { Gorrltt�issi©ner f s; Aco® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYr) 04/30/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder isian ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT E. Jeri Davis Mark Sylvia Insurance Agency,LLC PHONE 508 957-2125 Fax e• 508)957-2781 404 Main Street E-MAIL mark marks Iviainsurance.com Centerville,MA 02632 INSURER(SI AFFORDING COVERAGE NAIC# i INSURERA: Farm Family Casualty Insurance INSURED i INSURERS: Thomas Home Improvements�LC INSURER C: PO BOX 177 INSURER D: Centerville,MA 02632 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE A DL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR PREMISES(Ea occu en $ 100,000 i MED EXP An .one arson $ 5,000 A N 2001X1416 5/01/2019 5/01/2020 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PEOT- F LOC i PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT $ fEa accident) ANY AUTO I BODILY INJURY(Per person) $ A OS ONLY SCHEDULED i BODILY INJURY(Per accident) $ AUTOS HIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY j Pea 'ant $ $ UMBRELLA LIAR d OCCUR i EACH OCCURRENCE $ F�EXCESS LIAS CLAIMS-MADE I AGGREGATE $ EXCESS RETENTION $ WORKERS COMPENSATION START OTH- AND EMPLOYERS'LIABILITY ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN i E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLUDED7 Q NIA N 2001W8053 5/01/2019 5/01/2020 (Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yyes,describe under DESCRIPTI N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 i I I DESCRIPTION OF OPERATIONS[LOCATIONS I VEHICLF6(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Carpentry ' i Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street I AUTHORRED REPRESENTATIVE Hyannis MA 02601 y Fax: Email: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo,.are registered marks of ACORD I l The Commonwealth of Massachusetts Department of Industrial Accidents — —UW Office of Investigations _ 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 6 r vote Address: �d' City/State/Zip: Phone#: Are you as employer?Check the appropriate bog: Type of project(required): 1.2-fam a employer with y� 4. ❑I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working forme in any capacity. employees and have workers' � 9. ❑Building addition [No workers'comp.insurance comp.insurance. 10.❑Electrical repairs or additions 5. We are a corporation and its P required.] ❑ rP 3.ElI am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12.R-16frepairs insurance required]t c. 152, §1(4),and we have no employees, [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state Whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. , I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AlI S Policy#or Self-ins.Lic. Expiration Date: 1,``I- V oil Job Site Address: j / W& j&k. City/S /k No Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains penalties ofperjury that the information provided above is true and correct Signatme: Date: �`/� Phone#: �2-? 263E Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: Infor mation and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined'as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced'acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to-your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLQ or Limited Liability Partnerships(UP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city-or town that the application for the permit or license is being requested,-not the Department of ;f--—Prs-mlrF-A to fnin a wnrkeTS' Industrial Accidents. Shouldyo-ahave a:Fy a —J-- —__ compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant, Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Addregs"the applicant should write"all locations in (city or town) 'A copy of the affidavit that.has been officially stamped or marked by the city or town may be provided to the is or licenses. A new affidavit must be filled out each is.on file for future permits applicant as proof that a valid affidavit P year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said.person is NOT required to complete this affidavit, The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. T .-Commonwealth];of Massaahusetts Department of Industrial Aer�dents Office oflnvestagatims , 600 Wasb gtan SUet Rosbn,MA E 2111 TeL#617-727-4900 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 4-24-07 Wm=,gov/dia r 6.Z� .(.6Application number....... ........ .... D63 ate Issued......j .°. .L. ................................... OM ' MA • DEC 0 J Alie- p s634� �0 ' J � Building Inspectors Initials.... IHt3 �........5 00 f�tilV �� Map/Parcel..... O Z.............`. ................... . 3 TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 17/ O/d o54 2d ced-Ary ile— NUMBER STREET VILLAGE Owner's Name: f4o�i a✓1 Phone Number Email Address: Cell Phone Number Project cost$ Check one Residential ✓ Commercial OWNER'S.AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: wee +-\4.cl 4 c qntr c 4 Date: TYPE OF WORK 0 "IV header char e # a Insulation/Weatherizattion Sidingdows (no g ) �- _ , Doors (no header change)# Commercial Doors require an inspector's review F-1 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to cJa5fe CONTRACTOR'S INFORMATION Contractor's name �' �1., — G,l�:.�►.a� Wor (rQ , �oSton Home Improvement Contractors Registration(if applicable)# 0-2 S (attach copy) Construction Supervisor's License# 07 Z-? 7 L. (attach copy) Email of Contractor Phone number 7 t;'1 — � 3 Z- '- ?0 5 ALL PROPERTIES THAT HAVE STRUCTURES OfIER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT,, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER........................................................... l *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a:for profit • - non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s)of each tent _ If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pnL 'ommercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer 4 Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side ROMMOWNEWS LICENSE EXEMTTION Homeowner's Name: Telephone Number Cell or Work number I understand nay responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date C��LICANT9S SIGNATURE Signature _ Date /Z - - l S- All perms a �Fonsare subject to a building of trial's approval prior to issuance. Window World of Boston MA HIC Registration Offices & Showrooms Number: ❑15A Cummings Park ❑295 Old Oak Street 166025 Woburn,MA 01801 Pembroke,MA 02359 Federal ID# (781)932-4805 (78 i)826-6281 82-4848432 www.WindowWorldolBoston.com Customer. /✓Urr Phone(h)7�y Install/Address:/7/ QL� S7", Phone(w) City:G�, AIA—F=71,9*. jcr State:MA Zip 42Z6�E-mail WINDOW WORLD 1000 Series Single-hung All Weld $199 /0 GLASS OPTIONS SolarZone Elite-Dual Pane $1191/90 2000 Series DH All-Weld $215 Triple Pane/Krypton569 1 4000 Series DH All-Weld '$240 Senes 6000 Only) yI 000 Series DH All-Weld $260 2 Late Slider $g74 WINDOW OPTIONS �3 Late Slider (1/3,1/3.IM (1/4.112.1i4 $575� Glass Breakage Warranty(4000/6000) $151NCLUDED Z Picture/Fixed Lice (0-83 l I $365 730 1/2 Screens $g INCLUDED Picture%Fixed Late (84-130 U0 $445 Foam Insulation on Jambs and Head $11 INCLUDED Awning $310 / Double Strength Glass(4000/6000) $15 INCLUDED Casement Plus$49(DH Sash Rail)$330 Double Locks(>26") $5 INCLUDED 2 Lite Casement $595 - Full Screens $25 3 Lite Casement (,a 1/3,113) (1/4.1/z 1/4) $910 _Colonial Grids Contoured Flat) $$5_�.`� Basement Hopper $434 Prairie Grids Bay Window-Soffit Mount 1 INS Seat $2660 $75 S / Bow Window-&sffit-Meet/INS Seat$2785 785 Simulated Divided Lite $182 Garden Window Bay, Bow,Garden Oversize (+i09 UI) $975975 Tempered DH Sash(BSO) (TSO) $75 1 $$ Obscure Glass(BSO) (rSO) $75 ► —Beige/Almond $40 Oriel Style(40/60 or 60140) $75 1 Wood Grain Interior(Series 4000/6000 only)$100 Foam Enhanced Frame $35 1 (Ug*Oak/Dark Oak/Cherry/ Fox Wood PRE 1978 BUILT HOMES(EPA LEAD SAFE RENOVATION Rich Maple) Lead Safe Practices Required 30 1 Brown Exterior(Arch.Bronze I American.Terra)$100 MY HOME WAS BUILT IN THE YEAR Designer Color Exterior $175 Initial Speciality Window MISCELLANEOUS $ 3 Custom Exterior Aluminum Cladding(Two-Bend) Window Color / / 0 Textured$90 3_8 Smooth$90 $ 710 inside outside Facing Color 7,E t NON CUSTOM DOORS Metal Window Removal $75 li Vinyl Rolling Patio Door 5ft.or eft. $1095 _ _New ConstructionUnyl Removal $175 ZS Vinyl Rolling Patio Door 81t. $1195 Multi-Bend Cladding $20 Add to base price for Custom Rolling Patio Door.$1250 Mull to Form Mufti Unit $30 1 French Rail Sliding Patio Door 5ft.or Eft. $1395 Install Interior/Exterior Stops/ $50 1 French Rail Sliding Patio Door aft. $1495 Install Interior Casing t; Starts At $95 Zf� French Rail Sliding Patio Door 9ft. $1595 Insulate Weight Boxes $20 1 Custom Exterior Cladding $300 Roof for Bay/Bow Windows $500 ao— SolarZone Elite or ETC Glass $305 Z Existing New Const.Ext.Retro.Pit $150 104 Grids Patio Door $210 / Removal of Existing Bay/Bow $250 woodgrain Interiors $395 Exterior Designer Colors Repair Sill,Jamb or replace sill nosing $75 1 $595 Full Sub-Sill g A 1 Inrterior Casing 21� 31� 275 (Single) replacement $175 Handleset Options Mullion Removal $50 l Bay/Bow Conversion Ext.Retro Fit $450_3n;F (New Siding Will Not Match) Door Color / Inside V ROUND-UP FOR WINDOW WORLD CARES St Jude Childref6 Research Hospital $ 1 �.u5witler uet:unes yrlus ui wmctuws/ciours i"mal D AI ER Customer is responsible for the following in connection wit this contract:Painting,Staining,Alarm System disconnect/reconnect Building-Permit fees In excess of$25.00,Homeowner and or Cando Association Approval,Historic District Approval.City of Boston parking&sidewsik Permit fees in connection with installation. NO EXTRA WORK iF NOT iN WRITING! Customer agrees to the terms of payment as foil vfis: Extra Labor&Materials $ { Site Set Up,Permit,Disposal&Delivery Fees$ 389.00 Total Amount $ ,� Custom Order Deposit 33% $ Ck* Project Start Payment 33% $ C Balance Due Day of Installation $ Amount Fi arced $ l Window World Boston anticipates starting tft h work on / and being substantially completed in Any deposit days.Security Interest Yes Idepositrequiui red in advance of the start of the work SH L N exceed 331/3%of the total contract price or the actual cost of arty material or equipment of a special order or custom made nature,which must be ordered In advance of the start of the work to assure that the project will proceed on schedule.No final payment shag be demanded until the contract is completed to the satisfaction of both parties. I All home improvement contractors and subcontractors shall be registered and that any inquires about a contract or subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170 Boston,MA 02116.Phone:(617)973.8700 I No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. i Window World of Boston under provision of Chapter 142A of the general laws is required to apply for and obtain all construction-related permits.Window World of Boston shall not be deemed responsible for delays in the work described in this agreement caused by regulatory,permit granting agencies,authorities dr individuals. Notice:If the PURCHASER(S)obtains his own construction related permits for the work described under this agreement or deals with unregistered contractors, the PURCHASER(S)is hereby advised that In the event of a dispute,Judgement and nonpayment,the PURCHASER(S)will not be entitled to make a claim or collection from the guaranty fund established by chapter 142A,M.G.L. You the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Notice of cancellation must be in writing postmarked no later than midnight of the following third business day. I I A T M RD N T FOR RESALE! This Window Worrd®rianchise is"',pendently owned and o erated b L&P Boston O em n ,Inc.under license from Window—World,Inc! Owner.Do not si If there are any blank spaces. D to Salesman:Do not sign a the any blan spaces. to Owner.Do not sign if there are any blank spaces. Date easroa,wis White Copy-Original Yellow Copy-File Pink Copy-Customer MOU3I of paaU aM'noA ro HayesPfh tg336a7-ms aq noA lua!uanuoa lou sj sjyl if •uonaidwoo;o awn ay;le luawAed leug anew pue qor ay;enoidde.o;algellene zeta iise aM•qof eta;o uolieldwoo eyl to eoueleq 6uipuels;no ail halloo pue wio;uo-uft a 186 siapelsul ino letp Aagod ,t o81213ll4461 Iep si eletp se 6uor se)porn Apw am aseo yo!L m ul'qor el)-e Jo Z e eq film if sselun'euop st qor etil lily ltels Allejeuao eM noA LP! qe lletsur eta do las am awil ell le meio ino ioi ewl;renwe pa;oecixa ayi;o noA eslnpE film aM•sawLL 9intiedaCl pue'Ienlrrb•g l ! ic of a6ewep Aue io;elglsuodsai lou are aM Aziedoid inoA uo 6urdl salone effyM i(laies ono pue smopulM inoA �t�oMa no ousnooi ogaje saq oeid ino inq'u0ilel968n pupae 6u!>tjom uayM Igla eq of enai;s aM'wail aAiessid of luem noA pue uo peddals 6ulaq aAlAins louueo Aeil 11 Peleoolei Alirerodwal aq pinoys MopulM a Molaq li6li seem ul sgniys pue slueld aleallaa•smopuim inoA of ssaooe sn eA 6 of Noeq psurud eq o;paau seysnq sn0106IA pue seer;awog•swalgold lelluelod eo;Mool pue 6u!Apm sn of loud pieA inoA Aemns meld-sloop pue sMopuaM ayi o;luaoefpe eee ley;ewoy inoA to seeie padeospuel retao pue sialueld ul�iiom of paau aM Alreuoisepop•saisng pus�slueid't► 6ulr2noa iutopulnn liar;rot aiglsuodsar lou are os e a 'wail Ileisulai of Pe unbai aq Aew leil suolleiaiie i io uo, I M'U01leite;suaai pue IeAowai eyi ul Buagnsw a6etuep io;elgisuodsei tou are pue swell asa 4 11181Mu!ai ro 6u!Aowar ro;algisuodsw lou are eM•uoliege;suf ino of loud penowei 6uuanoo Mopuim ieyio Augpue sadeip'siegnys'sepeys dn-lloi'spugq Imgian'spugq!uw lie peau am,smopulm etil;o iolialu!ay;of sseooe ule6 01.moP ranoD 1i Aug PLii; •noA sasse i Alpea6 IQM ann'Aysea avow of Aneay ool are swan arrgjwni Aue i!'Niom ino io Aem.ayi ul vie letµ s6ulys!wn;Aug splse avow eseeld•AI!ieiodwal paleoolei eo paieno0 eq pinoys wowdinbe o!uo4o is o PUB sialndwoo weyl eleooaai pue puiM ayi Aq pegi%srp eq ueo letµ swell hews iatµ0 pue'seeded lualiodwi iayla6ol iey;e6 of elgesaApe s! 11•ewoy inoA i6noitn mog Alleaidfl puim;o sisn6'penowei eie smopurm Pic,etµ uar.IM•iiioM ino wioped of Aiesseoau stool pue stµop doip ino eoeld um am os'awoy inoA ep!sur mopulm Luca;o luou ul lee;Z Alelewixoidde paau film aM•sioo(l pue sMopulM ayi of s,aood•Z •s318eM aaiLµ uetµ eiow el isenbei noA Aelap ayi 0 uogeflelsu!aioiaq a0uefeq 6u!ulewai ayi loagoo of paau film eM*noA Lµmm)tom of Addey aq IIM am iapio inoA ll%sui of Apeei eie em leyt uorleoyr;ou ia}}i s>saact o aldnoo a ueyl aloes ioi llco l psesu!inoA Aeiap of paau noA uoseai awos ioi;i clap uogegeisu!ue las of noA goo film am;uiod amyl jV'Smeem g of 9 4BOICIAl s!peeweien6 lou y6noy; 'Pelfelsul aq of Apeai ere smopuim ay;uatam pue paoeid si iapio inoA ueym usem,a*q awi;ayi•suolteool ppoM moAu!M OOZ taro ino;o Aue of peddiys pue Ailunoo eLn puno,e paleool slueld 6uunloe1nuew ino io eu0 le apew woisno eie smopulm ino;o gy•ewiy Aianilap paloadxg•; •aAl ue siapelsul ino uayen loadxa of 4e4M LWm noA luienboe of inopuey$ly;peleaio alley am`algissod se Alyloows se eaeld aifel of uollellelsul atp algeue pue juaiulsenw molt azlwlxew of'awoy inoA;o eousieadde pue anion ganea iro;woo ayi asearoul of uolsloop inoA uo suolleinmBU03 . a00a aN i SMOaNIM M3N anox u0J JNiadd3ad Commonwealth of Massachusetts Division of Professional Lrcensure Board of Building Regulations and Standards Construction Supervisor CS-072772 Expires: 04107/2020 JEFF C STFFI E 24 SHERWOOD AVE DAWERS MA 0"23 Lis c.y Commissioner CIL Office of Consumer Atfairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Realsitratiorr Exoerobo' n. 165=2 04/11/2020 WINDOW WORLD OF<BIDSTON,LLC. JEFF C.STEELE 15A CUMMINGS PARK WOBURN,MA 01801 Undersecretary I ` The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, ALL 0211 A-2017 D www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders,rContractors;'Electricians,Tlumbers. TO BE FILED N'ITD TB(E PERM=G ALtTHORTTI'. Anulicant Information Please Print Lecibiv Name (BusinesslOrganizationMdividual): �„/,nda LJ G✓�rl� �� �S�p�l ��L C - Address: Civv!State/Zip: Liu n OWL Phone w: ;g ► — G S 2 - i-(,s o 5 Are you an employer?Cbeck the appropriate box: Type of project(required)- 1-Eg"J'am a employer wither 0 employee:(frill and/or par-time).' 7. New construction j 1 art,a sole proprietor or partnership and have no em loyees working for me in ❑ p € 8. I]Remodeling a":�•capacity.1_?a worker comp.insurance required.] j Demo!" tion ;T_1 i art a homeowner doing L work mvseii Nc worker'comt• irst_r2rlce recutrec.;' j 4.O 1 am a homeowner and will be hiring contractors to conduct all work or,my property. 1 wil` 10 Building a6ditior, � P.,that all contractors either have workers compensation insurance or are sole I I 11 ❑Electrical repairs Or addition: j proprietors with no employees. ! I j 2. Plumbing repairs or additions I 1 am a genera contractor and I have hied the sub-contactor!lister on the attached sheet. I lr i_.FRoof b repairs ese sub-contractors have empiovees and have womers'comp insurance.- �- q.llir>'`rther fit (Y.�t,. ^.I I-;vE'a-f:::.OTL,ordt7oL ar1G its Of{1Cer have eXEfClueC il]eLT P.€hi 0;E%emptiQ pC?MG-1 - u 1(4),and we have no employees. LNo workus�comp.insurance rmwrec: I I r �P la C�r''1-�A its '.4rn appiicant that check,box*l must also fill out the section below showing their workers'compensation policy information:. Homeowners who submit this affidavit indicating they are doing all work and ther.hire outside contractor mast submit a nm affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractor`and sot whether or no:those entities have emplovees. If the sub-contractor`have employees,they must provide their workers camp.policy number. I am an employer tha;is providing workers'compersarior insurance; )r mr entpiel.ees. Below-is the policy and iob sire in�ormaiior Insurance Company Name: 1-4 ai-I-CD4-d F,Cf 7-n S R q/�C�E Cep . Policy# or Self-ins.Lic.*: Z Z�WF_ C L 3.2fin` Expiration Date: Z 7 //— 3 n eb Sate Address: 17 t Old i o 5J 'sip: n ✓% I /"l/-! attach a copy-of the workers' compensation policy declaration pace (showing the policy number and erpira ion dazel. Failure to secure coverage as required under MGL c. 152. E25A is a criminal violation punishable by a fine up to S1.500.00 and/or one-year imprisonment_as well a< civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this s tement may be forwarded to the Office of Investigations of the DLA for insurance coverage verifi on. 1 do hereby cer under a pai - erjun.That the information provided above is true and correct 1 Si gn azure: Date: 2- - Phone : — 3 C 5 _. a use only. Do not write in this area to be compleied by cin;or Town official I Croy or Town: Permit:License' Issuing Autbority(circle one): 1.Board of Biealtb 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other j Contact Person: Phone#: f 4 TZD� CERTIFICATE OF LIABILITY INSURANCE �r�als _ THUS FICA E DOE 15 ISSUED R A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE:IOLDER.THIS CER77FICATE DOES NOT AFFIRMATIVELY or% NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW. THIS CEI21'ROATP VF 'JgSIURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER ),ALITHORIZED REPRMENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder js an ADDITIONAL]NSUREP,the PONCy(ies)must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION 1S WANED,subject to the terms and con+fifions"of-the this certificate does not toner;rights to the certificate anti CoD in fieu of the policy, semen poh�s may require an endorsement A statement(m PRObUCER CO, AC7 Marsh&McLennan Agency LLC J]A"JE Carr Witche CIC,CISR.C61A 8525 N.i_h71 St. PHONE Groensboro NC 27455 A C No :336 544 fi850 Am Suo):212-607-651E nPOESS: Carli.IAlltche. mershmma.corn INSURER(S)AFFORUgVGCDVF-RAeE 1 _ PJA(Cp INSReD ,M tNsuRmA Aholen a Financial Benefit 1 J00 VAndow World ce Boston-LLC E:Hartford=ire Insurance Company 13682 11.8 Shaver Street WSURER c-I•Massachusefts Bm,Insurance 223DE Corn North VTlkesborc NC 28659 i trslt�D: " I',SUREP_E- COVERAGES CERT'IRCATE NUr-A3lrR'!09G(157i Z REVISION lBUMBI-P CEF7IFY TKAT THE POLICIES OF INSURANCE1ISTEC•Bh101N}IA\!E BEEN lSS' IiVCICATC-D" NOI�JILi NST,ANDLNG Ap7 P.E�vUIP.LWEW,TERV,OR CONDITOL OF ANY CO�'TRAG7 OR�t1EP,Lh7CUMER;AWlT\h P,E T TO iM 1J H THIS S CERTIFICATE MAY BE ISSUED OR p1V:Y PE7-.AIK THE DJSURADICE AFFOJ-DEi} BY THE POLICIES DESCRIBED H2Rt�IN IS SJWFCT TQ ALL THE-ERplS, EXCLUSIONS AND CONDITIONS OF sJcr aOUCIES.LIMUZ SHOW 1 MAY 1AVE BEEN F,EDUCEQ BY PAIC CtAIP,15. - es Dom 'aR TF i '.'YP£aFL•JSURANCE , POLICY EcF AO:.t(^.'EX? C i( `C'OStiNERt7AEGENE PD:.ICYNUe1H6'. S�DD.^:YyY)!fryfi7DFYyYYI rJ rrs ' R9iIJASFL1?Y OUE SC2x' cr7 2J1F I2D7E �-- -c i j C•,.AYNS'a7.4]E C O.^.CUR i ';• _ EACHOCC:b?RcMC_ - i - I VAIKIP, ETO REN?� Er:(Am Wr;peu oN r S.UOL _ L ! PERSONALhA77'INJJPY L".GGF',C-GA-,E JWf A'P?LIES PER: RRG 6c fR C-T1:Afl CA?E PCLIC'/ _ E2000.L^[ — `D JeCT ---- OTHER: I j ?ROL'JCTS-CCtA?OF.1G: SEU000ti1t• i- AUTOfiVOB1-ELIAH)i.tn' i Al'U6B75ME E.,,.1Z07i Ery(3,c'Q',E • X :AVYAI;?O d I ! eODllMYIN�Y Pe"cerscrr; ` -? HIRED 05 ONL'! i>r j soa--�r (P<aeecerl;.l _ 0 ONO! HON"-OmED AUTOS M. N ^+•-cR„DAMAGc 1 � Ll?°"B:CigeMl j i;; UPAt3REI LLIAB I O.^,CJP. :00E79Y'527 1r120:i i d!i29E D i FACHO„^CURgE,'VC� L113c . EXCESS:JAF3 i CI,g1M5-IAA�i I ! -m- A6GR'cGASE cUAU.txO I E REraMoNs 1WORFSZ:RS COPJIPENSASlOJ! jAYtDEMPLt71'ERf'iIAUtUTY YtT; 71"LbZ.:Ji23E 11272DSE 7l27 F i( PER;UTE c IANYP.�OPRIE-0j27PAFTPrcR(c�CEti_WF -70 EL"Fr1C}SAOCIDEtdF - Ffi7CEPJAgErdeEREXCLUtK^^ lleaaggatory ir.NH! --1; !L`yyes gesc(ibEundor ! 1 E,;..DI561SE-Eh E+1FL0'/EEi;,bOp.pCO �D6aCRIP?70N OF OPE:ATI01ISkeWA: EL_OFSEASE-POLICY LIPAr. ;5:C.ODD j • r ESC.ifPpD?;OFOP=_RC,TIr)NSrLOCpri.'7PIS:yEE3rC' (ACOYM1ZIj_AtId;iwwlRemark--Sct:9qute:maybe mulled i`more :ER'TFICATE HOLDER CANCELLATION , SHOULD ANY OF THE ABOVE-DESCMEr POLICIES BE CANCr"L m BEFOM THE EXPIRATION DATE rHEREOF, NOTICE WILL 8E DELIVEPED IN I ACCORDANCE IBJIT14 TFIE PULICY PROVISIONS. I AU'rH0RrZEr,rEPRF.SENTA'r1UE f Jim- 0- ( 1988-2015 ACO_RD CORPORA7t ioN. All tight*rese:.red.' CORD 2E(20161(12) The ACORD name and 1090 arE registered n-tarks of ACORD Town of Barnstable *Permit# oDy 1-13/�{ S, Expires 6 months jrom issue Ante Regulatory Services Fee _ Z� BARNb-rA$[.E, Thomas F.Geiler,Director - M ESS PERMI g q � Buildin Division �fD Tom Perry,CBO, Building Commissioner AUG 12 2008 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508TO HY BARNSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press imprint Map/parcel Number(9Qq©S@03Li Property Address Residential Value of Wo: (�,�� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address�X�\r ` 2k-�4 OD Contractor's Name , NO(��5� �� �1(1_ _Telephone Number�� �p��.5a Home Improvement Contractor License#(if applicable) _11-AUl k 0 I,Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation.Insurance Insurance Company Name ( co T�'�( Q �C'�r C 0- Workman's Comp.Policy# WQ. lJ5_1 1&5(D Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.44) .*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:buildingpermits/express Revised 123107 Find a Licensee Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Public Safety Mass.Gov Home DPS Hnnie EOPSS Home Mass.Gov Home State Agencies State Online Services Department of Public Safety Licensee Lookup The list is current as of Thursday, August 07, 2008. You can search/filter the licensee list by any of the criteria below. License Businesses Individuals - Home Im rovement Contractor Select a License Type p Search by License Number,100740 Search 1 Select a License Type Home Improvement Contractor I - , I Search by Business Name I Search by Contact Last Name _T— First _-T� Search by City Zip Code ( Search I 1 f j Select a License Type Select One " , � I t , Search by Last Name # First L � Search by City Zip Code Search Search Results -_• _ ,� � - .. r -- T .,.�_- y __° . _ . ,...., _�. LICENSE TYPE BUSINESS NAME CONTACT NAME LICENSE RESTRICTIONADDRESS Home Improvement Capizzi Home Improvement, Capizzi, Jr., 100740 1645 Newton Rd. Cotuit, Contractor Inc. Thomas - .- 02635 Af http://db.state.ma.us/dps/Iicenseelist.asp 8/12/2008 Cllient#:47298 CAPIHOM DATE ACORDTM CERTIFICATE OF LIABILITY INSURANCE 06/12/2008 ' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers 8r Gray Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 434 Route 134 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: NGM Insurance Company Capizzi Home Improvement, Inc. INSURER B: American Home Assurance Capizzi Enterprises, Inc. INSURER C: 1645 Newtown Road INSURER o: Cotuit,MA 02635 :INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MMIDD/YY LIMITS A GENERAL LIABILITY MPB1075H 06/08/08 06/08/09 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES $50O 000 occurrence) CLAIMS MADE 51 OCCUR - MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY 7 PEC0j LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE U (Per accident) $ GARAGE LIABILITY AUTO ONLY.EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CUB1076H 06/08/08 06/08/09 EACH OCCURRENCE s5,000,000 X OCCUR 7 CLAIMS MADE AGGREGATE $5 000 000 $ DEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND WC6716562 12/25/07 12/25/08 X WC STATu• 0TH- T IT EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500,000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE.EA EMPLOYEE s500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $50O OOO SPECIAL PROVISIONS below , OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL Hyannis, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S36540/M36539 KW 0 ACORD CORPORATION 1988 • � Board of Building and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: .�\ Registration:, 100740 Board of Building Regulations and Standards _EXpira2io_n:6 j23/2010 Tr# 267955 One Ashburton Place Rm 1301 " Boston,Ma.02108 Gte Corporation CAPIZZI HOME IMPWVEIVEL+1T?J1VC. t-1,, Thomas Capizzi, 1645 Newton Rd. Cotuit,MA 02635 � Administrator Not valid without signature / J ri i �� a Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor.Registration , Registrat B • Ype: Sur) eme Car Expiration: 6/23/2008 CAPI=I HOME IMPROVEMENT, INC.. : GARY GUSTAFSON f 1645 Newton Rd. COtU It, MA 02635 Update Address andrreturn card.Mark reason for change. F] Address Renewal Employment Lost Card Board of Building Regulations and Standards Construction Supervisor License License: CS 74640 Expiration: 11/29/2008 Tr# 6430 Restriction: 00 GARY GUSTAFSON 8 SHORT WAY SANDWICH,MA 02563 Commissioner ' The Commonwealth of Massachusetts Department of Industrial Accidents Offzce of Investigations a 600 Washington Street �< Boston,MA 02111 www.mass.gov/dia ' Workers`Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name(Business/Organization/bdividual):� rmp \_\)M 11.6(� Address: N.c�T PI:2R� City/State/Zip: �c�t'_��(�rJ Phonet Areyou an employer?Check the appropriate box: :Type of project(required):. 1,R I am a employer with _to er 4. [] I am a general con�tractor and I � 6. New construction . employees(full and/or part-time).* have hired the sub-contractors 2.[� I am a'sole proprietor or partner- listed on the'attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition employees and have workers working for me in any capacity. 9. ❑Building addition [No workers' comp.insurance comp. insurance. $' 5. 7 We are a corporation and its. 10.❑.Blectrical repairs or additions required.] ' 3.❑ I am a homeowner doing all work . officers have exercised'their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]uire t c. 152, §1(4), and we have no . - q ] employees. [No workers' 13�Other_r comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub contractors and state whether or.not those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.potidy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.thepolicy and job site information. Insurance Company Name: 0 152m Policy#or Self-ins,Lic.#: k 6�11C9 � Expiration Date: job Site Address: n City/State/Zip P&.Tit,cnkQei� Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as.required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK,ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the'bIA for insurance coverage verification. I do hereby certify under the pains-and penalties of perjury that the information provided above is true and correct. Si afore: Date: _ Phone# -LA ' Q-c Official use only. Do not write in this area, to be completed by.city or town official. City or Town: Permit/License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engag"a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an in,'vidual,partnership,association or other le a1 entity,employing employees. However the owner of a dwelling house ving not more than three apartments and ho resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building ap enant thereto shall not because of uch employment be deemed to be an employer." MGL chapter 152, §25C(6)also state t"every state or local lice an g agency shall withhold the issuance or renewal of a license or permit to oper e a business or to construe buildings in the commonwealth for any applicant who has not pro.duced�accepta le evidence of complianc with the insurance coverage required." Additionally,MGL chapter..152, §25C(7)s. ' s"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of bUc work until aceel table evidence of compliance with:tlie insurance• requirements of this chapter have been presente o the contracting avithority," Applicants Please fill out the workers' compensation affidavit co pletely,by hecking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(e and phon number with their along w their certificates)of insurance. Limited Liability Companies(LLC)or Limit d Liabili Partnerships(LLP)with no employees other than the members*or partners, are not required to carry workers' c In �'on insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affid it m be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also b sur to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pe or license is being requested,not the Department of Industrial Accidents. Should you have any questions regardin the law or if you are required to obtain a workers' compensation policy,please call the Department at the numbe isted below. Self-insured companies should enter their self-insurance license number on the appropriate line. r City or Town Officials Please be sure that the affidavit is complete'and printed le bly. Th Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office o Investiga ons has to contact you regarding the applicant. Please be sure to fill in the permit/license number which ' 1 be used a reference number. In addition, an applicant that must submit multiple permit/license applications in y given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site ddress"the appliLant should write"all locations in (city or town)."A copy of the affidavit that has been officiall stamped or marke�by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for tore permits or license Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a cease of permit not rented to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)sai person is NOT requires o complete this affidavit. , The Office of Investigations would like to thank ou in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax n ber.. The C onwWth ofM.assachusO is pep went of lndust :a1 Acazc�euts Office of Investigations 604 Washington Street BQston,.MA 021 H . . TeL 617-727 4900 ext 406 or 1-877-MASSAFB Revised 11-22-06 Fax#617-727»7749 www.mass.gov/dia Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STAVE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, ERIC KRASNOO, OWN THE PROPERTY LOCATED AT 171 OLD POST ROAD IN CENTERVILLE, MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: jOWNER'S ADDRESS: 1017 COOLIDGE STREET, WEST FIELD,NJ 07090 OWNER'S TELEPHONE: 908-654-1921 / 908-500-5886 LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: ' 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: �S � r 9 N r C,=-A?T/F/�D pL 07 /�L�4/V Ply E PH R E D FOR: L o cATio,v: 1,01 9 M Ba ROLD, CENTERVILL E lll= �ol 2 /-/EBEBY CE,C�T/FY T/-I�4T T.4E B(J/LD/�c/r.. SNON/�/ OA-1 7-AW S PL.X?.V /S LOCFiTEa OAS/ T.NE _ y.eOc%VD AS 3'No W.�/ f/EBEoti/. ���`�N OF.41g5��y go ARNE- g H. i OJAIA N vown cam er,9irreerir,9 $ ` #263 o C/\//L E.VG/,VEEGS •^��s!owG. E0.���q ROUTE 6A^-Y�=�,eMOcJTH, MA53. afiTt .e��.. L�4•va suevtti'oe c AN It I_ 1 2- n', SEPTIC SYSTEM MUST n wssessor s map and' lot num�Y.°.....�:0...9..;.�-..5..�. .-.,�... S•Jf. ... THE T 'INSTALLED IN COMPLIANCE �oF o� v Sewage Permit number ................................!:� WITH TITLE 5 ... ............ ENVIRONMENTAL CODE ANF, 1 BAESSTABLE, House number 17.�.......r��" .S . TOWN REGULATIONS 900 .... ...... ........................"........... TOWN OF BARNSTABLE W . t ' BUILDING INSPECTOR APPLICATION FOR PERMIT TOV.. .............. ....................................... TYPE OF CONSTRUCTION .....................................0� : ..................................................................... ................/Z/� ........... TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for a permit according to the following information: Location .1pt-ngr....�t....... .5' ' � �...............C& ,K)M &O I L.« ` .................................................�,........................ Proposed Use .l. q,�.er..... .....w?:1.. .:....rC.S?.L ........................................................................: Zoning District /............ ::......./......................Fire District ...........G�.. .U........:.......................................... Name of Owne ...............................................�`�f... /T"`ZAddress ... `.0.t.. .... Name of Builder CT`{rT.T !.. + !. �if.WAddress ... .`.' `..' '.Y'.....!�..N....... . .V�..�. --� Nameof Architect ...................................................................Address ....................................... ............................................ Number of Rooms .........4....................................................Foundation .........,.. � e ..............,:.......................... Exlerior �Aw( ,yam �,,/ ......................... %Erb✓.... . .'..`'^'.......•:•••'••:.............Roofing .......... . ................................... ..... Floors / (/52 ,.. ...........Interior .....c!f.v ..................................................... Heating ` ZL .................................................................... / y Fireplace Cost-�.................. ...... ............... Approximat ... ...�. .�... .:„ ................,..................... Definitive Plan Approved by Planning Board R_`Q----- -----------19S Area �. ... .... . Diagram of Lot and Building with Dimensions. Fee �.. ..... SUBJECT TO APPROVAL OF BOARD OF HEALTH Z $ �s /IV OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To n of Barnstable regarding the above construction. Name .. .................!............................................................ Construction Supervisor's License 6O.'�22 MICHAEL REALTY TRUST 1 4. t �4.... Permit for .....2.. .to rY............... Sin&le. Family..Dweiling — l Location ..... Lot 4 171 Old Post Road - x : .......................................... f Centerville............................... .. Owner' Michael Realty Trust........... Type of Construction ......Frame me ....................... � ..................................... ........................................•. Plot ............................ Lot. ................................ w ` February, 10.- 86 Permit Granted ..........................................19 Date of Inspection ✓y ... ..;19 Date Completed �........� 19d _. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I m A DATA BUILDI..N' TOWN OF BARNSTABLE, MASSACHUSETTS_ PERMIT ao� -sa-� �Sa �K ,�llj JOB DATE WEATHER CARD / � APPLICANT 19 PERMIT NO. ADDRESS (N0.) (STREET) (CONTR'S LICENSE) PERMIT TO (__) STORY NUMBER OF (TYPE OF IMPROVEMENT) N0, DWELLING UNITSV""" (PROPOSED USE) AT (LOCATION) (NO.) ZONING (STREET) DISTRICT_ I BETWEEN (CROSS STREET) AND (CROSS STREET) SUBDIVISION LOT BLOCK LOT SIZE BUILDING IS TO BE�FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION REMARKS: (TYPE) AREA OR yOLUME /� (CUBIC/ RE FEET) ESTIMATED COST $ FEE $ OWNER l.. £� `n L -y 7Z ( ADDRESS BUILDING DEPT. i B THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPER PROVED BY THE JURISDICTION. STREET TY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- I FROM THE DEPARTMENT OF OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR t. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 1. PRIOR TO COVERING STRUCTURAL ELECTRICAL, PLUMBING AND MEMBERS(READY TO LATH). QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FRO.AA STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS 1 ELECTRICAL INSPECTION APPROVALS IF 2 t Sc� �P61/1 3 — -- HEA .SPECTiNG APPROVLS RE I1 _ LS 2 ---- 2 F H! EA L - c- WORK SnALL NCT ?Pp•=EcO UNT,L THE ----_— -- NSPECTOR SAS APPRCVED -yF •;A".— PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION iNSPECTIONS iNDICATED ON THIS CARD STAGES OF CONSTRUCTION. WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ` ARRANGED FOR By PERMIT IS ISSUED AS NOTED ABOVE. CAN 9 RP TELEPHONE OR WRITTEN NOTIFICATION. ���•.� TOWN OF BARNSTABLE BUILDING DEPARTMENT »STAIM TOWN OFFICE BUILDING rua HYANNIS, MASS. 02601 ''�o r�r►' MEMO TO: Town Clerk FROM: Building Department DATE: 7 /a An Occupancy Permit has been issued .for the building authorized by Building Permit #...... _ ..y... ........................................................................._......................_ . .._........»....... .».»...... issued to�......................... ., y......r.......... �! ��...... / �....�!.�:» . 6.rr_ � �» Please release the performance bond. TOWN OF BARNSTABLE Permit No. 28924 1.� Building Inspector cash _ rua `�� Vol' OCCUPANCY PERMIT Bond Issued to Michael Realty Trust Address . Lot #4, 171 Old Post Road, Centerville Wiring Inspector Inspection date Plumbing Inspector Inspection date Gus Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date i TIIIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL J SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 194 9 Building Inspector 1 _ > _ SECTION, SEWAGE . . - -- _ _ -u,.�. ter• _ - , , O -SEPTIC TANK _ ,.D.,BOX - -LEACH�I t TOP.OF FDN -� • .".� ._ .- .": ..- - .. -- -. �-•��` 45 r : S _ j��VU�MSL)• _ "2..OF l(aT01h.".. - _ WASHED _STONE Aj - - - - r ' 1�M, 1N. 4 OUT. 2Z� IN• OUT• CWG� Q SEPTIC /� /�' TANK 1=jSG9 oleo ELEV. ELEV. ELEV. ELEV ELEV. ELEV. rop 1 may! ..... OFi4"-IA" 6 r r WASHED STONE ELEV , z� 6 TEST HOLE LOG /n a ".00TTOM OF 7-l~sT H®LE jO` TEST BY _16- 1MaFa J � wlTrvEss � � • TEST DATE DESIGN BEDROOM HOUSE q3.� �� 49 1 T.H. 2 ELEV. 44'2 ELEV. NO Q P DIS OSER DISPOSER P RATE MIN IN. 4�r 42,Z I6(GAL4DAY) / 2 � FLOW RATE IIOK 3 SEPTIC TAN K.4 ( . }. / f EPTI T 1 E - REQ D C ANK S Z S / O / • r / J - LEACH FACILITY SIDE WALL -r1IoA r'. 00A le.5} A71,0 G/D. BOTTOM t t.0} •. G/D. rr A�( ` cL.- TOT L 2(t(n ,q `'G _ 49.5 f. f•� , 144 USE: � LEACHING WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) A9 _ 1.DATUM(MSLJ L �TAKEN FROM •iL:U.LLl_> __-QUADRANGLE MAP 2.MUNICIPAL WATER ------AVAILABLE �>rd of 7 ( 4 7 Q5 3.PIPE PITCH:?A--PER FOOT �J 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- !`� -44 �� ARNE H. ,�-, t,46 S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(2)FT. _ OJALA 1=4 — l 6.PIPE JOINTS SHALL BE MADE WATERTIGHT 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH.COMM.OF MASS. CJ SANTATE ENV I.RONMENTAL CODE TITLES N tN Of CIVIL ,y O: 307 2 A SITE o.:-`�c �:_ ;,' � Ji...� . �E' - � `� $:- I:.OT G` ®L�U P� ?" 5 �'i .' r-JaT �.E tl_aEb r=OL r-7iZG7C-L� C l_.`1C; STd.�.r+ 1G .. . .. .. /�`�. LOCU _ .. - �` 41 •moo ARNE 6 RE(i.PR N L ENGINEE'1 O A ( - . • #J 34�8 ld®w�r REF: O 'cope engineering �Ef� GI PREPARED FOR: �1\Ifh' tC7 � -.CIVIL ENGINEERS AL # LAND SURVEYORS -- --- Q BOARDOF HEALTH on Mato REG. D RVE R �r,= QQ� I� (:) {> Y � SU YO CONTOURS (PROPOSED)-O-O-O- _ A�tJ` =..�1 MA AI SCALE O APPROVED DATE t f OATS 85