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HomeMy WebLinkAbout0175 OLD POST ROAD (CENT.) � . - „ ., .. � R. `, 4 .. - .. '; .. - r+ a .. ,. - � ., .. .. _ ... - P r t of r Town of Barnstable Permit# OErpi s 6 mont ro e to Regulatory Services antnvsrnei.E. v� Mass. Richard V.Sca1i,Director 039. Cos - ,, a� wilding Division Sip 27 2011 Tom Perry,CBO,Building Commissioner C 200 Main Street,Hyannis,MA 02601 NS ���L www.town.bamstable.ma.us Fax: 508-790-6230 Clf�coww_01510 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY qi U -lot ; ithout Red X-Press Imprint Map/parcel Number /� n(�0 .,( Property Address /7, QU 1065r �Lo residential Value of Work$ (a / Z — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor'sName W Do . W0 JGFF tb�L Telephone Number 7irf�"�y�Z �� OF axIVA Horne Improvement Contractor License#(if applicable) /&6 OZ,J' Email: Construction Supervisor's License#(if applicable) 87 Z:7 7 Z Ymorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner (X I have Worker's Compensation Insurance Insurance" Company Name �4&XT 6PFL `f I RF- IAAUA0fnPqAY_. Workman's Comp.Policy# aZ W F_C- -T Z6 34 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ side [�Replacement Windows/doors/sliders.U-Value •Z9 (maximum.32)#of windows D #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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&Construction Supervisors License is equired. SIGNATURE: C:\Users\Decol t •ta\ cal\Micros mdows\Temporary Internet Files\Content.0utlook\2Pl0I DHR\EXPRESS.doc Revised 040215 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 UV, www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Let7ibly Name (Business/Organization/Indi«dual):��jlp/d Address: /5'A C n,.,-.:r► S r IC City/State/Zip: v A olga I Phone#:'. -78 1 —9 S Z - qR 0 5— Are you an employer?Cbeck the appropriate box: Type of project(required): I.C511"am a employer with_TO employees(full and/or part-time).* 7. New construction 2.F1 I am a sole proprietor or partnership and have no employees working for me in $. F-1 Remodeling any capacity.(No workers'comp.insurance required.l 11F Ian,a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition � 4.D I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensue that all contractors either have workers'compensation insurance or are sole. 11.❑Electrical repairs or additions proprietors with no employees. 12.QPlumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof rep airs These sub-contractors have employees and have workers'comp.insurance.t 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other lnl 1/1 O t.� C10t1 152,§1(4),and we have no employees.[Ne workers'comp.insurance required.] F-f pl C f/yt Errs *Any applicant that checks box#].must also tali otn 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. $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. If the sub-contractors have employees,they must provide their workers'comp.policy ntmmber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ( ' Insurance Company Name: ��ru l-*-�a J'e+ f`P Tn S•�R�1�L �p . Policy#or Self-ins.Lic.#: Z Z wr C L �2 Expiration Date: /- Z 7 /9 Job Site Address: 1 r 5— 6 I'"0 ST /t cam. City/State/Zip: '/a!'✓,-//-e-y- HA . Attach a copy of the workers' compensation policy declaration page(showing the policy number and eapirdtiou date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 tc$250.00 a day against the violator.A copy of this ement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi on. I do hereby cer, under a pai erjuU that the information provided above is true and correct. Si mature. Date: 9-2 - - -3 Z.- CS only. Do notwrite 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 S.Plumbing Inspector ' 6.Other Contact Person: Phone#: WINDO-2 OP ID: HI CERTIFICATE OF LIABILITY INSURANCE DATE(MMrDDrYYYY) 0510412017 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 is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,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 endorsement(s). PRODUCER qOA Carli Witcher CISR,CBIA,CIC Marsh 8 McLennan Agency-GSO PHONE 336-272-7161 (FM,No 336-346-1397 3625 N.Elm St AC,N Ext Greensboro,NC 27455 A�ESS:Carli.Witcher@marshmma.com C.Timothy Ward,CPCU,CIC INSURERS AFFORDING COVERAGE NAIL 9 INSURER A:Hanover Massachusetts Bay 22306 INSURED Window World of Boston,LLC INSURER B:Allmenca Financial Benefit 118 Shaver Street North Wilkesboro,NC 28659 INsuRERc:Hartford Fire Insurance Co. 19682 INSURER D: I _ 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: DUSUBRI POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE I IMSD'4WD! POLICY NUMBER i MMIDDIYYYY MWDDIYYYY A ; X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE i.-s 1,000,000j IED CLAIMS-MADE X ' OCCUR OD6790252708 04/01/2017 04/01/2018, °RA�Nt Es�F�Eo��ccurtence, 500,000 MED EXP(Anv one person) S 5,000 PERSONAL E.ADV INJURY S 1,000,000 GEM1I'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,0001 O 2,DO, 00 POLICY JECT LOC PRODUCTS- OTHER:— S I AUTOMOBILE LIABILITY •COMBINED SINGLE LIMIT' S 1,000,0001 (Ea accident) B X ANY AUTO AW68757615, .06/16/2016 06/16/2017 :BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident)..S i NON-AUTOS PROPERTY DAMAGE S NON-O HIRED AUTOS AUTOS (Peraccitlent) I X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 2,000,OOOI A Excess uAB CLAIMS-MADE: ;OD6790252708 ; 04/01/2017 04/01/2018 AGGREGATE S DED RETENTIONS 5 i WORKERS COMPENSATION r X PER :-OTH- AND EMPLOYERS'LIABILITY -STATUTE ER C ANY PROPRIETOR/PARTNERIEXECUTIVE YIN NIA 22WECLJ2635 -' 0112712017'01/27/2018 EL.EACH ACCIDENT S. 500,0001 IOFFICERIMEMBER EXCLUDED? 500 000 (Mandatory in NH) E-L.DISEASE-EA EMPLOYEES a 1 I if yes,describe under - 500 OOOI DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached It more space Is required) I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE :EXPIRATION DATE THEREOF, 'NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-072772 Cons?ruciion Suoerriscr JEFF C STEELE DASHERS MAD019 3 Expiration. Commissioner 04/07/2018 T ° office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 166025 Type: Expiration: ,411212018 LLC WINDOW WORLD OF:BOSTON,:LLC. JEFF STEELE 24 CUMMINGS PARK.SUITE 15-A WOBURN,MA 01801 Undersecretary License or registration valid for individual use only before the expiration date. If found return to:Office of Consumer Affairs and Business Regulation 10 ParkPlaza-Suite 5170 Boston,MA 02116 A�ot valid without signature ' .as Window World of Boston,LLC MA HiC Registration Offices&Showrooms Number: wlLtG ❑15A Cummings Park 0295 Old Oak Street 166025 Wobum,MA 01 B01 Pembroke,MA 02359 Federal ID# (781)932-4805 (781)826-6281 27-1481685 "SimptytheBestforLess" www.WindowWarldofBoston.com Customs: 1✓/.� / Phone Install Address:17,67 0422 Rzgr,Z Phone A A/L R3_ 7'3Z$7 City:<aA�,--oxr; ,E State:MA Zip Q d E-mail WINDOW WORLD GLASS OPTIONS _1000 Series Single-hung All-Weld $1a9 10 SolarZone Elite $11 9 RIO _2000 Series DH Mech/Wefded Sash $215-�— —Tiiple Glazed TG2• $195 _4000 Series DH AINNeld $225: 25 (*Series 6000Only) _6000 Series DH All-weld $260 WiNDOW OPTIONS _2 Ute Slider $354 Glass Breakage Warranty $151NCLUDED _3 Lite Slider (113,113.,n) (1N,lnt14) $545 1/2Screens $91NCWDED / Picture/axed Lite $354� #Doublee Foam Insulation on Jambs and Head $11 INCLUDED _Awning $280Double Strength Glass $15INCLUDED _Casement $310 Locks(>26") $5 INCLUDED ` _2 Ute Casement $595 Full Screens $22 _3 Lite Casement iva,in,im pfavalro $880 7-Colonial Grids(ContouredlFlat) $45�o _Basement Hopper $334 —Prairie Grids $51 Bay Window-Soffit Mount/INS Seat$2660 —Diamond Grids $69 _ Bow Window-Soffit Mount/INS Seat$278 Simulated Divided Lite $182 _Tempered DH Sash(BSO)(FSO) $65 _Garden Window 50 _Obscure Glass(BSO)(TSO) $35 _Speciialiy Window $ Oriel Style(40/60 or 60/40) $30 ` —Beige/Almond $40 —FoamEnhancedFrame $35 _Wood Grain Interior(Series 9dool6ad0 only)$100 PRE 1978 BUILT HOMES(EPA LEAD SAFE RENOVATION) (Light Oakl Dark oakl Cherry l Fox wood _Lead Safe Practices Required $30 ' Rich Maple) MY HOME WAS BUILT IN THE YEAR�Initfal�� Brown Exterior(Arch.Bronze/American Terra)$100 Designer Color Exterior $175 MISCELLANEOUS Arm QCustom Exterior Aluminum Cladding Window Color 0`77 1 AVIO ❑Textured$75 Smooth$75 $%52 Inside Outside Facing Color J; NON CUSTOM DOORS —Metal Window Removal $50 Vinyl Railing Patio Door SR.craft. $1095 —New Construction Vinyl Removal $175 c _Vinyl Roiling Patio Door Sit. $1195 _Specialty Window E detior Trim $ C _Add to base price for Custom Rolling Patio Door$1250 —Mull to Form Multi Unit $30 �� French Rail Slldng Patio Door Sit.or Eft. $1395 —Install lnterlorlFxterfor Stops $50 F —French Rail Sliding Patio Door 8tt $1495 —Install Interior Casing Starts At $95 French Rail Sliding Patio Doer ft $1595 _Insulate Weight Boxes $20 =Custom Exterior Cladding $15o O -Rooffor Bay/Bow Windows $500 - - / Solarzone Site or ETC Glass $205� _Existing New Const.Ext.Retro Fit , $ISO / ,4 Grids Patio Door $149 Removal of Existing Bay/Bow $25D _Woodgrain Interiors $295 —Repair Sill,Jamb or replace sill nosing $50 Exterior Designer Colors $395 �Interior Casing 21 n $175 —Full Sub-Sill(Single)replacement $ 0 _Mullion Removal $3 a[ $30 _Handleset Options $ _Bay/Bow Conversion Ext.Retro Fit $350 $ (New Siding Will Not Match) Door Color A4#11AZ rLV �r tINO FOwRNftFlW;1.11 D(' �f S• � inside QUrslde f�Y $ti tar:v � 9,�'�I!„yfe(irE ll � µetprliY Customer declines exterior wrap and understands painting and/or repair may be required Initial Customer declines grids on windows/doors Initial DISCLAIMER:Cuslamer is responsible for the following in connection with this contract:Palming,Staining,Alarm System dlsconneclheconfiect Building Permittees in excess of$25.00,Homeorinar and or Condo Association Approval,Historic District Approvel.Chy of Boston parking&sidewalk PennN fees m connection with instalbtlon. NO EXTRA WORK IF NOT IN WRITING! Customer agrees to the terms of payment as follows: Extra Labor&Materials $ 4,64(? Site Set Up,Permit,Disposal&Delivery Fees$ $389.00 Total Amount $�9j32' Custom Order Deposit SO $3YA6 Ck# Balance Paid to Installer upon Completion $,?#66 /1 Amount Financed $ Window Wodd of Boston anticipates starting this wads on 'p and being substantially completed in days.Security Interest Yes FJo Any deposit squired in advance of Ste start of the work SHALL NOT excee 33113%of the total contract price or a actual cast of any material or equipment of a special order or custom made nature vholimustbeorderedinadvanceofthestartoftheworktoassurethattheprojectwillproceedanschedule.Nofinalpayment shall be demanded unfil the contract is completed to the satisfaction of both parties. Ali home impmvemsld contractors and subcanbactars shall be registered and that any inquires about a contractor subcontractor relatfrig to a registration should he directed to:OUfce of Consumer Affairs and Business Regulation,Ten Park Plaza,suite 5170 Boston,MA 4211 S.Phone:(617)973.8700 No work shall begin prior to the signing of the contract and fransmfnal to Ike owner of a copy of such contract. Window Wodd 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 this agreement caused by regulatory,permit granting agencies,authorities or individuals. Notice:If the PURMSERIS)obtains his*wit consifuclion related permits for the work described under this agreementordealswithunregisteredcontractors, life PURCHASER(S)Is hereby advised that In the event at a dispute,judgement and nonpayment,toe PURCHASER($)will not be entitled to make a claim or collection from the guaranty ipnd established by chapter 142A,M.G.L You the Bayer may cancel IhtS 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 Ibe following third business day. ---=IS A CUSTOM ORDER NOT FOR RESALE , This Window Wodd®Franchise is Independently owned and operated by Window World of Boston,I.I.C.under lfcfo from Window World.Inc. 4-AAA -11117 Owner.Do not sign II there are any blank spaces. talle Q Setesmarc Do not sign if a are any blank spaces. ate owner.Do not sign 11 there are any blank spaces. Data ae.mnsam white copy-Original YeIWw Copy-Fire Pink Copy-Customer Na,ee Potl4ry a6a00)-1116 � _ - i1 FINE Town of Barnstable *Permit-4 ti 0� Expires 6 n hs -•ue r . e} Regulatory Sery ices Fe � 1AEIVSTABMAM LE � + %a4 d V.Scali,Director Aim Ma d��►� m. Building Division Tom Pe r CBO,Building Commissioner U Street,Hyannis,MA 02601 www_town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Inrpr irrt Map/parcel Number ZQ�'! 0.�2 OU. Property Address er IOU, e -- ❑ Residential Value of Work S,0.,3 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Da,-I,'C i ( '/QiYt° — / 7 Ce,4-,,d,-Ifie M/4 .rl.L& 3 Z Contractor's Name ndo( -j13Wel f W11tso/f Telephone Number(q0 f 2— Home Improvement Contractor License#(if applicable) S Email: Construction Supervisor's License#(if applicable) 5 7 0 7 [B]Workman's Compensation Insurance _. Check one: ❑ I am a sole proprietor ❑ m the Homeowner I have Worker's Compensation Insurance Insurance Company Name FA r°e,fie i"1 i su r&-N c;e Workman's Comp.Policy# r l/C A 1 S a 7 Z 9 2 0 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going-over existing layers of roof) ❑ side / v Replacement Windows/doors/sliders.U-Value �j0 (maximum.32)#of windows (O #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit,does not exempt compliance pith other town department regulations,i.e.Historic,Conservation,etc. ***Note: - Property _.Owner must sign Property Owner Letter of Permission. A copy the Home Improvement Contractors License&Construction Supervisors License is require � o SIGNATURE: C:\Users\DecollikWppDala\LocallMicrosoft\Windows\Temporary Internet Files\Content.0utlookLP101 DHR\EXPRESS.doc Revised 040215 Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Daniel&Claire Perrin Legal Name:Southern New England Windows,'LLC. 175 Old Post Rd RI#36079,MA#173245,CT#0634555, Lead Firm#1237 Centerville,MA 02632 26 Albion Rd I Lincoln,RI 02865 WINDOW RE LACENIENT - - H:(SO8)534-9080 Phone:866-563-2235 1 Fax:401-633-62 1 sales®renewalsne.com C:,(781)733 5909 60 Buyer(s)Name: Daniel:& Claire Perrin Contract Date: 06/29/17 Buyer(s)Street Address: 175.01d Post Rd, Centerville, MA 02632 Primary Telephone Number: (508)534-9080. Secondary Telephone Number..(781)733-59.09 Primary Email: claireanddan@cruisebrothers.com Secondary Email; . Buyer(s)hereby jointly and'severally agrees to.purchase`the products an services of Southern New England Windows,LLC d/b/a.: Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions:described in this Agreement. Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorpporated herein by reference(collectively,this "Agreement"). . Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount•. $10,344 By signing this Agreement;you acknowledge that the:Balance Due,and the Amount - Financed must be made by personal check;bank check,credit card,or cash:. Deposit Received: $5,172 . Balance Due: $5,172 Estimated Start: Estimated Completion: Amount Financed: 7-9 weeks 7-9 weeks $10,344 , Method of Payment- Financing. , - , y . Financing , . We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date.Rain and extreme weather are the most common causes for : delay. Notes: 500/w deposit by bank,balance on completion by bank Buyer(s)agrees and understands that this Agreement.constitutes.the entire understandings between the:parties and that-there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without.the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyers) 1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,_on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do,not sign this contract if blank.You are entitled to a copy of the contract at,the time.you sign. YOU,THE BUYER,'MAY.CANUL THIS TRANSACTION AT ANY TIME NOTLATER THAN MIDNIGHT OF 07/03/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC. dba.,Ren %al y An rsen bf Southern New England Buyers} . Signature of Sales Person' Signature Signature Paul Sandrey ,Daniel Perrin Claire.Perrin PrinrName of Sales Person Print Name: Print Name. UPDATED: 06/29/17 . _ Page 2 / 11 - _ Massachusetts Department of Public Safati Board -of rd f Building Regulations and Standas License: CS-095707 BRIAN D DENNISON 7 LAMBS POND CIRCLE CHARLTON MA 01507 , S 3 I'3tiCi1: Co missionef 09i08i2018 ,mac a i�Jasumer a_�a rs i�d Business ?.eauiat c-: -_ PEa-za -S',.iilte 170 ,I I = i;OStoIl,lir',tb'SaE:tltiSeLtS'•f--- Home Improvement-catract•-oor R—, C S Tat10£_ Registration: 173245 _- Type: Supplement Card Expiration: gilw018 SOUTHERN�IEvNI ENuLAND�/1i\IDOV!1S`L L _ BRIA.N DENNISON -. -- ----- -25 ALBION RD -- LINCOLN,RI 928-15 = ---- -- __ . Lodnte.,A&—_ssand=.emrnairdw 1,431::702sun or.:haoSe. .address 3enewal _Employment = .oSt�-:'rd :.—'.Orrice of Consur er.Uraitc•Y;3asiuess Regulation Re strrtiun valid for adi<•iduai use Dori;•before Ute Nam;, expiration:late. ifra®d retmm Eo: E10ME IMPROVEMENT CONTRACTOR OM,-of�ansnnar.a;Tair.:and Business Re-iauoe Registration:5.T,3245 T:me: 10 Park PL•ret-Snite 5',0 E.-pira0on::,'91.19/2013 Supplement Card Boston.NLA 02116 SOUTHERN NELN ENGLAND WINDOWS ULC. RENaVAL 3Y ANDERSON > BRIAN DENNISON - 26 ALBION PO ,;�_� ,;� -- U\ R COLN.RI 02865 ',Undeterewrp nt We The Commonwealth of Massachusetts Department of Industrial Accidents e I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le 'bl Name (Business/Organization/Individual): e Lo outs Address: .2& AL& O ld _ City/State/Zip: p Phone#: Are you an employer?Check the appropriate box: Type of project(required): l.XI am a employer with Zo femployees(full.and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.(No workers'com .insurance required.] 3Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 Q Building addition 4.❑I am a homeowner and will be h firing contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ // 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. then lN��Q 152,§1(4),and we have no employees.[No workers'comp.insurance required.] relel(1-,M f 5 *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 ndicating they are doing all work and then hire outside contractors must submit a new 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. 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: Fire inn' S Policy#or Self-ins.Lic.#: ( , �11�V ! Z q — Z'0 Expiration Date: ! h O Job Site Address: 1 75 Old (RS4 /(?J- City/State/Zip: C-en lera. Illy Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 the airs and penalties of perjury that the information provided above is true and correct. L � e Si ature: Date: 7-1 -17 Phone#• 401- 2-2,en T OPP Official use only. Do not write in this area,to be completed by city or town offrciaL City or Town: Permit/Licedse# 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#: r ESLERCO-01 SANDERSO CERTIFICATE OF LIABILITY INSURANCE D 06107/20/YY) 06/07/2017 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 is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, 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 endorsement(s). CONTACT PRODUCER N CoBiz Insurance,Inc.-CO O (aC,No)_(303 1401 Lawrence St,Ste.1200 (PHLuc,NE No,Fxt:(303)988-0446 )988-0804 Denver,CO 80202 n RILESS:COMail@cobizinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 Southern New England Windows,LLC.dba Renewal by INSURER c:LibertSurplus Insurance 10725 Andersen of Southern New England 26 Albion Road,Suite 1 INSURER D: Lincoln,RI 02865 INSURERE: 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 ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS L INSD WVD M D MM/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE ❑X OCCUR CPA3158728 01/01/2017 01/01/2018 DAMAGE (aEo« nce ED S 300,000 MED EXP(Any oneperson) S _ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S- . 2,000,000 X POLICY❑PEe7 LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: EBL AGGREGATE s 2..WQ;000 A AUTOMOBILE LIABILITY COMBINED accident) LIMIT S 1;O0fl OOO X ANY AUTO CPA3158728 01101/2017 01/01/2018 BODILY INJURY Perperson) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident S HIRED NON-OWNED PerOa.denDAMAGE S AUTOS ONLY AUTOS ONLY S A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 1,000,000 EXCESS LIAB CLAIMS-MADE CPA3158728 01/01/2017 01/01/2018 AGGREGATE IS DED I X I RETENTIONS 0 Aggregate S 1,000,000 B ND EMPLOYERS'LWBILnY X STATUTE A ERH YIN WCA3158729-20 01/01/2017 01/01/2018 1,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EA ACCIDENT S WFICER/M�MBER EXCLUDED? 1,000,000 (Mandatory m NH) E.L.DISEASE-EA EMPLOYEE S It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S B Worker's Compensatio CA3158730-20 01/01/2017 01/01/2018 1,000,000 C Pollution Liability TIEDE654299117 01/01/2017 01/01/2018 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 17-18 Workers Compesnation Includes-All states except ND,OH,WA,WV,WY - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE PQL16'r PROVISIONS. AUTHORED REPRESENTATIVE InformationalP ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .ram x ..,,� :••-�i,�a{��ri r�3'�..::•,�,-�-`.ah ,.7.s.1=`1'- 'X"_5}�a�`.4j✓.�R-�""-ss�.wv�',,ys��. -�.-G57�-s',«-_FP*r."'•�., ia�gc-�,�,n�;�s•-e-..•�;.�,-r"�.' iSr.�:,.;�.ti'T"..,. Nil TOWN�e TOViTN 'OF; B9RPISTABLE Permit No _2$186 -- - { URNn.� i Buildwg-Inspector cash a _- BASIL OCCUPANCY ' PERM.IT. Bond,,. . . ------------- Issued to Coletti Development Txust. :Address a. f. lot #1 , 175 Old Post Road. Centerville Wiring Inspector / Inspection.date Plumbing.Inspector Inspection date s9// � /Gas Inspector j y e Inspection date.' ri a 11 { r� (EEngineering Department,_ Inspection date Board of Health �• �C � 1 ` � ' Inspection date -.`''. -�J' �,. v t. THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL- NOT-BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR, UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE t.. BUILDING CODE. r� Building :Inspector - 4n e.-v. R �y f . TOWN OF BAR NSTABLE BUILDING DEPARTMENT ! sRN"a : TOWN OFFICE BUILDING ru gab i639' HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for' the building authorized by . E BuildingPermit $k....... 0 .......... ...... ....................................................................................... .. ...»......................... ...» issued to G! G........G. !' .........oc17-........... '71" Please release the performance bond. i �O (� OVfl 10Z.Qa+ �t 1`7 3A 2 svi: m -fo � 32 r 1 q � OT 1 -�� 85-03'7I CE-�E?T/F'/�'D SLOT �LA/V P�EPAJeE.D :.Pole: L 0CQ -io.v: OLD 2>011-12'�, C NT0P-ylLJ—,C RWE5�5IDC Cat t5-r2uCr(0 .e EFE�C.c/CE: I �I _ /-/EAEBY CEeT/FY 7"Ag7- TAME 6UII-VI.V�► 0PA-1 TA-//S PLAN /S L.00.0977Ea O.c/ T.NE yBOCJVZ7 F75 SA�OW.�/ NEeEOA✓. _ VA OF o ARNE X H. OJALA down c-a� er�9iraeerir�9 4 #26346 0 Lq�c.ia sciev6Yoe3 `/��-�9G/, /ON �1 — ,ROUTE 6A�^-`,'�.eMOUTs-�, ML75S. aA45^t� �e�. Lq�va c�.ev�yoe 7� — �,0000011��e 7 Sy —67 6F 2 SIE"UST 13 Assesspr%�44p',ancl lot nu 4r . ........................ WSTALLED IN E Toy 5 Sewage Permit-. number .......................... . ...... (D t74 c . SAVIROWU E L CO AILE, pv,-s- : I 11AA& House number ............................................. ................. ....s - TOWN REGULATIO 1639- a Usk,! TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO .................................................................................46.......................................... TYPE OF CONSTRUCTION ........tj a .............................................................................................................................. ............................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according t the following information: Location .........;%,3 r Ea. ....................................... .......................................... Proposed Use 5ti *6ze.....74ft44 1. ................... e.................................................................................. ZoningDistrict ........................................................................Fire District ........ ...... )............................................................ Name of Ownei-CO/F-177Y ?71,d1re,s ............................................. .................................................................................. Name of Builder .......... ............................................Address ........... ..................................... .............. .... ................................... Nameof Architect ...............................................Address ................................................................................... Number of Rooms ........ .......................................................Foundation ............I.f..PLO.U j M. &..eOXA,MA ........... ..Exterior ......0... ...........Roofing ..... .................................................. Floors J.s%. jq-q..............4eur- Interior ...... ..uw.. 4........................................... .. ............ Heating ..... ..............Plumbing ................. ...... . ............................................. Fireplace .......0.7J-0-11.............................................................Approximate Cost ....... .... ..................................... Definitive Plan Approved by Planning Board ------VTib I--- ) --------19 Area ........ t------ Diagram of Lot and Building with Dimensions Fee ............ ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH SAY e.Fz_ 3&f 5R OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 0/ Nam ............................................................... 606 41 LS-0 Construction Supervisor's License .................................... A-209�052-001 _ COL`ETTI'DEVELOP TR. ' � •l No 2818 _... Permit for ...#s. ;1=:-st�ry��YrigTe 1 ' t` ng 4 :.. t ; Location .Lq ....1..............3.7.5.....Old...R03t...Rd -' -Centerville ........................ ....................................... Owner .....0 . � o1•�tti••BeuElopr�e�rt••Er�zst...... r :y Type of Construction ..........frame...................... ................................................................................ rPlot ............................ Lot ................................ _ . Permit Granted t :4 Date of Inspection ......19 2Date Com letel �................19 t � 7 �. M Co :�:k Cc 0 M n X M 'M �.` CcM :S M �F , b� rye