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0058 PHEASANT WAY
67$ Town of Barnstable Building - xa Post�Thisx.Card SoThat,it:.is,Visible;From<the Street., A , ;roved;Plans Must�be Ret'a�ned on:Job andthis.Card Must,be Kept.;- ;• Hs`BeenMade "p Posted °' f, " ertificate._af�Oecu anc ,Is�Re u�red°such Buldm shall Not�be®ceu ied.unt►IaxF.�nal,lnspect�on�has beenmade Permit Wher>.e a C, p y q Permit No. B-18-1492 Applicant Name: ALTERNATIVE WEATHERIZATION, INC. Approvals Date Issued: 06/06/2018 Current Use:. Structure Permit Type: Building-Insulation-Residential Expiration Date: 12/06/2018 Foundation: Location: 58 PHEASANT WAY,CENTERVILLE Map/Lot: 207-161 Zoning District: RC Sheathing: Owner on Record: CANEY,JOHN J&DEBRA M � Contractor Name° ALTERNATIVE WEATHERIZATION, Framing: 1 Address: 55 PHEASANT WAY „"; f n INC. 2 `,,` r" is- CENTERVILLE MA 02632 �1• Contractor icense; 175683 t; Chimney: Description: Weatherization Es`t` Protect Cost: $5,467.00 u s PermitFee: $85.00 Insulation: Project Review Req: Fee $85.00 Final: i; Date:" 6/6/2018 Plumbing/Gas Rough Plumbing: s r _ ... : 757Final Plumbing: Building Official Rough Gas: This permit shall be deemed abandoned and invalid unless the work authonzedby this permit is commenced within six months after issuance. Final Gas: All work authorized by this permit shall conform to the approved application and theyapproved construction documents forywhich this permit has been granted. All construction,alterations and changes of use of any building and structures shallabe in compliance with the local zonmg£by lawsand codes. This permit shall be displayed in a location clearly visible from access street or road nd shall be,maintained open for public irispectii n for the entire duration of the Electrical - work until the completion of the same. g Service: s. The Certificate of Occupancy will not be issued until all applicable signatures by thei3ild gandFre Officials are provde on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: ' ." •- - -� " 1.Foundation or Footing Final: 2.Sheathing Inspection ` 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: /4-Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final; Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "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 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application Number... MAS& 8tJ1LD1iVG Permiffee..... ..........................Other Fee._....,...,......,...... 1639- "Fotal Fee Paid............... ...... ........ ...... MAYJ 4 2018 TOWN OF BARNST*BK3AN,,7 Permit Approval'by... On,...A L LE BUILDING PERMIT Map............. .............. APPLICATION Section 4—Owner's information 4hd P t!L rojec, ocation. Project Address P,Q S Village- Owners Name I.Owners Legal Address J !City__ State zip 64�7 L lOwners Cell# E-mail dc" -Fli, Section 2 — Use of Structure Pse Group F1 Commercial Structure over 35,000 cubic feet Commercial Structure under 35,000 cubic feet Single I Two Family Dwelling Section 3— Type of Perini! 'New Construction F] Move/Relocate ❑ Accessory Structure ❑ Change of use Demo/(entire structure) F] Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild Deck Apartment Sprinkler System [D Addition F] Retaining wall ❑ Solar Renovation Q Pool Insulation 6ther- Specify Section 4 - Work Description 38 f S. -Ar hag�� - AltrtvlL j . dl&4� 41te-L n"CST. U C/ Last update&3115/2018 T ra Application Number....................................... ..... Section 5—Detail Cast of Proposed ConstructioO_Y&7-er Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method (] MA Checklist ❑ WFCM Checklist ❑ Design Section b-- Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors F] Plumbing F] Gas n Fire Suppression. ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On.Site :historic District ❑ Hyannis Historic District Old Kings Highway Debris.Disposal Facility: I am using a crane ❑ Yes. ❑ No Section 7--�Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8--Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the.Zoning Board in the past? ❑ Yes ❑ No Last updated:3/15/2018 r� Application Number............ .............................. Section 9— Construction Supervisor Name Telephone Number,— -�7- La,V® Address City el' State Zip License Number l(���5 License'type Expiration Date /7 Contractors Email ��i���1,9� l�i�i'za fi t1� Cell ## 77y I understand my responsibilities under the rul ar�ulations for icensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required b 0 CMR and a ow o Barnstable.Attach a copy of your license, Signature Date 5l o� Section 10—Home Improvement Contractor Name { e-We&Mejr 7__a_ht_A� elephone Number ,6_n JL7- Addres ' C5h city eall /A& state_ Zip Registration Number /'7 Jp_ Expiration Date 5 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code., I understand the construction inspection procedures,specific inspections and documentation required b J the owniof arnstab Signature le. Attach a copy of your H.I.C... €' � Date /pp Section 11 —Home Owners License exemption Home Owners 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 o.fBarnstable. Signature Date Signature Date �/� Print Name ; Telephone Number&l�, E-mail permit to: 've w @ Cc-oll Fast updated:3/15/2018 Section 12 --Department Sign-Offs Health Department 171 Zoning Board (if required) Historic District Site.Plan review(if required) Fire Department Conservation ❑ For commercial work,please take your plants directly to the fire depurt>'ent for approval. Section 13 — Owner's Authorization as Owner of the subject property hereby authorize // to act on my behalf, in all matters relative to wo , authorized by this building permit application for: dd ess of job) Signature of Owner date Print lame Nast updated:3/1.5/2018 of THE ra Town of Barnstable r. y Regulatory Services B RNS'ABLE, Richard V. Scali,Director MASS. w ao 1639. Building Division ATQMN Paul Roma Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, JOHN J CANEY , as Owner of the subject property hereby authorize M, WmL act on my behalf, o-p',152C' in all matters relative to work authorized by this building permit application for: 58 Pheasant Way Centerville, MA 02632 (Address of Job) y 30 Af Signature of O r Date KJ Fri Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form. I C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXP.I,ESS(2).doc 01/25/17 The Commonwealth of Massachusetts _ Department of Industrial Accidents 1 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 Legibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC. Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): I. I am a employer with 16 employees(full and/or part-time).* 7. New construction I am a sole proprietor or partnership and have no employees working for me in '-�� 8. [:] Remodeling any capacity.[No workers'comp.insurance required.] 3F�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10 Q Building addition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.[]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.E]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. 14.0 Other INSULATION 152,§1(4),and we have no employees.[No workers'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. *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:STAR INSURANCE COMPANY Policy#or Self-ins.Lic.#:0849257 00 Expiration Date:4/4/19 Job Site Addres :,fd � City/State/Zip: 0"le, AST Attach a copy of the workers' compensation polifly 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 D1A for insurance coverage verification. I do hereby certify under t e pains and pen 'es of jury that the information provided above is truer and correct. Signature: Date: J /�ItU Phone#:508-567-42 0 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#: ✓-- ""'""1 ALTEWEA-01 SNERCINHA DATE IMMMDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 0312372016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 1 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 j 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. 1 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 endorsements. PRooucER CT Christina Costa i Mason&Mason Insurance Agency,Inc. PHONE 458 South Ave. ,£x=,(781)447.5531 Fc N,1:(781)447-7230 I ` Whitman,MA 02382 ccosta@masoninsure.com INSURE S AFFORDING COVERAGE NAIC0 .____.....___....._._._........_................___.._-.-- INSURER A:Evanston Insurance Co. 36378 INSURED INSURERB:Safe Indemnity 33618 Alternative Weatherization,Inc. INsum c:Star insurance Com an _ 18023 2 Lark Street INSURER D Fall River,MA 02721 INSURER E: I 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. 3 INSR ADDLISUBR POiJCY EfF POLICY EXP i I TYPE OF INSURANCE POLICY NUMBER i LIMITS A X !COMMERCIAL GENERAL LIABILITY j EACH OCCURRENCE I s 1,OQti'i)001 .._..- .S._. ! DAMAGEORCLAIMS-dADE X OCCUR 3C42088 06/07/2017 061072018 ExNcTuErDra nce) 1 s 100,000! I i ! r I MED EXP one !s 5,000; 1,000,0001 PERSONAL&ADV INJURY i s 'I GEN'L AGGREGATE LIMIT APPLIES PER: i 1 GENERAL AGGREGAT E is 2'000'Q00' i X I POLICY _— ECT ! �i LOC ( I 3 ! PRODUCTS-COMPIOP AGG $ 2'000'0001 �.... _ i i OTHER, i s BI AUTOMOBILE LIABILITY I i •COMBINED SINGLE LIMIT 1,000,0001 1 tEa=IN,t.mi 5 ANY AUTO X 16237702 04/08/2018 04/0812019 BODILY INJURY Per pe_row)S OWNED j JJ SCHEDULED AUTOS ONLY i =AUTOS i 1 BODILY INJURY(Per accident) 5 ��pp t" p�pyy� ! PI�2OPERTY DAMAGE X AUTOS ONLY rX�AllTOS ONi Y i er aocldent) 5 3 I 5 A i UMBRELLA LIAB j X'OCCUR ' 3 1,000,0D0' I 1 EACH OCCURRENCE i S j X EXCESSLIAB CLAIMS-MADE! X 1 X OBW7126517 06/07/2017 1 06/07/2018 j AGGREGATE 15 1,000,00O i i DEO RETEtJTION$ s C WORKERS COMPENSATION j ? X e STATUTE AND EMPLOYERS'LIABILITY 3 �ANY PROPRIETOWPARTNER:''EXECUTIVE Y �' I UVC0849257 04/04/2018 i 0410412019 j E.L.EACH ACCIDENT ;S 50010 Ip fr CE>�FIMF�)EXCLUDED? N N I A' ! } —' Menlo, n N 1;" I 500,000 }E.L,DISEASE-EA EMPLOYEE!S ..._..._.__.3t yes,descrice uncer i ? ----•----- i DESCRIPTION OF OPERATIONS below I i !E.L.DISEASE-POLICY LIMIT 'S 500'000; i I i I DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schaduie,may be attached i/more space is required) 1 :Action Inc.and NGRID USA,its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary& :Noncontributory basis per the terms and conditions of form CG2001(04113),for Ongoing Operations per the terms and conditions of form CG2010(04/13),for I Completed Operations per the terms and conditions of form CG2037(04/13)and Waiver of Subrogation applies per the terms and conditions of form MEGL0241-Ot(04-11). !Additional Insured for Automobile Liability applies per the terms and conditions of form SCA005(02116). Excess Liability is a following form, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NGRID USA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 40 Sylvan Road ACCORDANCE WITH THE POLICY PROVISIONS. Waltham,MA 02451 ------ AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ti •1 tfiC. e' It1l' 'Lt' ��.j4 Rif/C,/ ✓{ii/��.1.. Office Of Consumer Affairs and Business Regulation 1.0 Park Plaza Suite 5170 Boston, Ma,, chusetts 02116 } Horne ImprovemeratCoritractor Registration F h Type: Corporation Registration: 175683 ALTERNATIVE WEATHERIZATION,INC. Expiration: 05I28I2019 2 LARK ST FALL RIVER,MA 02721 t Update Andress and return card. Mark reason for change, „A- as __ _.... ._.,.... .4,... 17I.Address Renewal t C rs± Office of Consumer Affairs&Business Regulation w HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only' } TYPE:C 'atian before the expiration date. If found return to: R ion ExWra3lan Office of Consumer Affairs and Business Regulation 175M 05/28/2019 10 Park Plaza-Suite 5170 r ALTERNATIVE WEATHERZ TION,INC. n,MA 02116 TIMOTHY CASRAA rFAARK ST MA 02721 � ti—V O Si BitUrB Undersecretary • r -ALTERNATIVE -7bdr� %*PWWEATHERIZATION Date 11 JU� �6 Town of Barnstable TowNOF �0,® Zoo Main St. Hyannis,MA 02601 Re: Permit a3 z V — The insulation work has been Completed in accordance with 78"R. Agency work performed for i�eeards .• Timothy Cabral, PPesident CSL-105454 rdArNEwF�n18RYaaTION®cMAY�.coM 58 DICKtNSON STREET FALL RIVER,MA 02721 1 (�1567-a2ao I A�7eR Town of Barnstable Buildin Post--Thrs;Card'So��That tt°is�,VrsrbleFrom_the Str.,eet-A , royed'Plans;;<Must,be Retained on lob and�thrs�Card Must,be.Kept + 1AR21S['ABI.L '. � , ...�..� . ..•�=� „ ,Pp:' �� & � '�` e�'c,�r �r �� z"'„� � '`+� o • M Postemi d Urittl Final lnspectron Has Been Made Where:aFCertlficate o#Occupancy"rs,Requred;such,B.urldingxshall,Not-be Occupied:until a Fina[Inspectron�has�beenmade h er Permit No. B-18-1656 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals Date issued: 05/23/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/23/2018 Foundation: Location: .58 PHEASANT WAY,CENTERVILLE Map/Lot: 207-161 _ Zoning District: RC Sheathing: Owner on Record: CANEY,JOHN J&DEBRA M b Contractor`Name ",.SOUTHERN NEW ENGLAND Framing: 1 WINDOWS LLC. Address: 55 PHEASANT WAY , 2 ,Contractor-License: 173245 CENTERVILLE, MA 02632 Chimney: Description: Replacement Door(1) N EstProfect Cost: $3,769.00 Permit Fee: $35.00 Insulation: Project Review Req: a Y Fee Paid $35.00 Final: 445 Date: 5/23/2018 Plumbing/Gas Rough Plumbing: Final Plumbing: Building Official Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized byrthis permit is commenced within siz months3after issuance. Final Gas: All work authorized by this permit shall conform to the approved application andthe approved construction documents for which thi"s permit has been granted. All construction,alterations and changes of use of any building and st uctures shall be in compliance with the local zornngby laws and codes. This permit shall be displayed in a location clearly visible from access streetorroad and shall bernamtamedopen for public inspection for the entire duration of the Electrical work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by,theXgUilding and fire Officials are prodded on this permit. Rough: Minimum of Five Ca11 Inspections Required for All Construction Work.:: ,. R'ZIA, 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final_ 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "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 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT P Application number.......................................J... p DateIssued......:.....:..:.. o.................. .................. sARNSTABLB, 169. 0� Building Inspectors Initials........ /z r 0 7`f T MAY23 10 Ulu EXPEDITED PERMIT APPTOVff OYU E LICATI ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION. PROPERTY INFORMATION Address of Project: /75- Kcl(vey Cr �-Cety,"I�� NUMBER STREET VILLAGE Owner's Name.Zen c' A e 4 Jok n 'e r a- Phone Number S 08- q Z4-1i S 4 Z Email Address: Cell Phone Number Project cost$ / 7. Check one Residential Commercial —r 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: C'6-4-c" Date: TYPE OF WORK ED Siding Windows (no header change)# ❑ Insulation/Weatherization Doors (no header change)# Commercial boors require an inspector's review Roof(not applying more than 1 layer of shingles) _ Construction Debris will be going to CONTRAcCTOW S INFORMATION Contractor's name I�t�un `7Rn��so✓� - So,. ern �e.�l Fr�(" Home Improvement Contractors Registration(if applicable)# 17 � q 5 (attach copy) Construction Supervisor's License# 01 S 7 01 (attach copy) Email of Contractor Phone number qoI- L 2 R -1900 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY I5 IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *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 I 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-4:30pm. 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 CMIt 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 APPLICANT'S SIGNATURE Signature Date 61 l All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Zenaide&John Vieira Legal Name:Southern New England Windows,LLC 175 Hickory Hill Circle RI#36079, MA#173245,CT#0634555, Lead Firm#1237 Osterville,MA 02655 WINDOW NE LACEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)428-9542 Phone:866-563-22351 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Zenaide &John Vieira Contract Date: 05/10/18 Buyer(s)Street Address: 175 Hickory Hill Circle, Osterville, MA 02655 Primary Telephone Number: (508)428-9542 Secondary Telephone Number: Primary Email: Secondary Email: . Buyer(s)hereby jointly and severally agrees to purchase the products and/or 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 incorporated 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: $17,488 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: $5,828 Balance Due: $11,660 Estimated Start: Estimated Completion: Amount Financed: $0 6-10 weeks 6-10 weeks Method of Payment: Cash/Check 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: 5828.00 deposit-CHECK; 5830.00 due at start; 5830.00 due upon completion-CHK; 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 Buyer(s) 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 CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT. OF 05/14/2018 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:Renewal By Andersen of Southern New England Buyer(s) /ill e%., ✓-:.,-...._ Signature of Sales Person Signature Signature Chris Hutson Zenaide Vieira John Vieira Print Name of Sales Person Print Name Print Name UPDATED:,�05/10/18 Page 2 / 14 office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS.LL BRIAN DENNISON - 26 ALBION RD LINCOLN, RI 02865 Update-Address and return card.Mark reason for change. Address Renewal Employment Lost Card __::—office of Consumer Affairs&Business Regulation Registration valid for individual use only 1Defore the —_ expiration date. If found return to: HOME IMPROVEMEN CONTRACTOR office of Consumer Affairs and Business Regulation Registration: 173245 Type: 10 Park Plaza-Suite 5170 Expiration: 9119/2018 Supplement Card Boston.MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON L/ BRIAN DENNISON ; 26 ALBION RD �:�-- LINCOLN, RI 02B65 k-Undersecreiary Not valid without signature fo .. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-095707 C Si °�i%iirn S.uperV,sJ; ; BRIAN D DENNISON _ 7 LAMBS POND CIRCL ' CHARLTON MA 0150% Expiration: Commissioner 09/08/2018 The Commonwealth of Massachusetts r Department oflndustrialAccidenis 0 1 Congress Street,Suite 100 Boston,K,4 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 'blv Name (Business/Organization/individual): Address: -2 AL1, e City/State/Zip:ILAWO 1u Phone k -�,p _ 2 PA re you an employer?Check the appropriate boa: I anti,a employer with ZO temployees Type of project(required):(full and/or part-time).x I I. ❑New construction. 2.❑I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] - 8. Remodeling I I 3.[]l am a homeowner doing al!work myself.Poo workers"comp.insurance reouirec.;; 9• ❑Demolition I 4.LJ I am a homeowner and will be hiring contractors to conduct all work on my property I will 10[]Building addition i ensure that ab contractors either have workers'compensation insurance or a-sole 11.Q Electrical repairs or additions proprietors with no employees. 12.❑Pltumbing repairs or additions ! :.❑I am a general contactor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have worker comp_insurance.< 13 T,, RRoof repair 6.❑We are a corporation,and it o�cen have exercised their righ_of exemptior per tv1GL c 1? LJ tether w�%1 tL0-t.✓ I S_,E 1(4),and we have no employees.[No workers comp.insurance required.] rye P 14 'Anv applicant that checks box;".must also fili out the section below showing their workers'compensatior,policy informaion. t Homeowners who submit this affidavit indicating the•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 o the sub-combactor and state whether or not those entities have employees. Ythe sub-contractors have employees,they must provide their worker coop.policy number. _ I am an employer that is providing workers'compelzsation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: Irk P1e ill S Policy f or Self-ins.Lic.Ir: W C— /SZV7 Z,q — Z 0 Expiration Date: l f Job Site Address:_ 7 eJ j r 1�; ( � Cr City/State/Zip: Attach a copy of the workers'compensation poi ey declaration page(showing the policy number and expir Lion date'). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$],500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. 1 do hereby certify under th tiros andpenalties ofperjury that the information provided above is true and correct Signature: Date: S - L —I Phone g: QD I- 2Z Q . Official use only. Do not write in this area,to be completed by city or town official i City or Town: Permit/License k Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector_ 5.Plumbing Inspector b.Other Contact Person: Phone;`: �+ACo' CERTIFICATE OF LIABILITY INSURANCE DATE DIYYIY) `� 1 y29/2017 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 INSUR"(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 CONTACT NAME: CoBiz Insurance, Inc.-CO E FAX 1401 Lawrence St, Ste. 1200 N •303 988-0446 AIC No),303-988-0804 PHON Denver CO 80202 ADDRESS: COMaiI cobizinsurance.com INSURE S AFFORDING COVERAGE NAIC 8 INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC. dba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1252851165 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 ADDL SUBR POLICY FF POLICY EXP LIMBS LTR TYPE OF INSURANCE POLICY NUMBER MM/ODIYE I MM/DD A X I COMMERCIAL GENERAL uAsiurY CPA31587213 I 1112018 1112019 EACH OCCURRENCE S 1.000.000 CLAIMS-MADE I OCCUR PREMISES Ea ocwrrenre S 300.E MF-D E(P(Any one person) S 10,0DO I PERSONAL 8 ADV INJURY 51,ODD,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000,000 X I PRO- LOC I i PRODUCTS-COMP/OP AGG I S 2.000.000 X II POLICY Cj JJECT _ 1 I S OTHER: A �AUTOMOBILE LIABILITY I I N CPA3158728 I 1112018 1/1/2014 COMBINED SINGLE LIMB S Ea accident) 1 ODD 001) ANY AUTOBODILY INJURY(Per person) S .ALL OWNED ❑AU SCHEDULED BOOBY INJURY(Per accident) S I AUTOS PROPERTY DAMAGE S HIRED AUTOS ' X I X I Per accident) f A X UMBRELLA LIAB X I OCCUR (CPA3158728 I 1/12018 1112019 EACH OCCURRENCE S 10.0DD.00D EXCESS LIAB CLAIMS-MADE I J I AGGREGATE $10.000.00D DED X RETENTIONS I is B WORKERS COMPENSATION WCA3158729-20 1112016 '1112019 X I STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT 51,000,0W OFFICER/MEMBER EY.CLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLO S 1.000.000 6 yes.describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY uMn 51.000.000 C Pollution Liability 7930073340000 1/12018 1/1Occurrence019 EachOccurrence51.000.000 ' I Claims-Made Policy Aggregate 51,008A00 Retroactive Date 06202013 Deduchhle S10,000 , DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule.may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE t i ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 'tl4E Y . U�. lY O� 0 Application number.............................................. b Date Issued..........5 L3. (.Q... ...................... sxsrnats. 1639. ���� o � i in Inspectors Initials.. .... .................... Map/parcel........::...............J..................................... MAY 213 2013 . 06 TOWN ® 135 EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: YJ Fh&aSaA-� �e�✓ /l-e NUMBER STRE T VILLAGE Owner's Name: . h re,.������ r"r,.-7 e y Phone Number S Od-3�C�—I D Z 3 Email Address: Cell Phone Number 5 4 - 367-tot 7 1 Project cost$ 3. 7 l Check one Residential V, 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: Sep A-4,,Ana 06,4-c,�c-E- Date: TYPE OF WOE Siding Windows (no header change)# Insulation/Weatherization Doors (no header change)#__J _ Commercial Doors require an inspector's review J Roof(not applying more than 1 layer of shingles) 1 Construction Debris will be going to c�/�s��-��Q rC�,�►�7 ' L%�c��h �� CONTRACTOR'S INFORMATION Contractor's name f�t�Gn`�R nn�so✓� - �, �cn ✓f2�J ��land c�C�uJ S __ Home Improvement Contractors Registration(if applicable)# !7 LPL (attach copy) Construction Supervisor's License# yI S-7 07 (attach copy) Email of Contractor Phone number 1101- z 2 8 -I goo ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *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 9 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-4:30pm. Commercial events may require Fire Department approval *WOOL)/COAL/PELLET STOVES x 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 APPLICANT'S SIGNATURE Signature Date gill permit applications are subject to a building official's approval prior to issuance. IxElnewal Agreement Document and Payment Terms Andersen. dba:Renewal B Andersen of Southern New England Y 8 Debra&John Caney ".1. Legal Name:Southern New England Windows,LLC 58 Pheasant Way Rl#36079,MA#173245,CT#0634555, Lead Firm #1237 Centerville,MA 02632 10 Reservoir Rd I Smithfield,RI 02917 H:(508)360-9023 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:(508)367-6171 Buyer(s)Name: Debra &John Caney Contract Date: 05/10/18 Buyer(s)Street Address: 58 Pheasant Way, Centerville, MA 02632 Primary Telephone Number: (508)360-9023 Secondary Telephone Number: (508)367-6171 Primary Email: dcaney@comcast.net Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or 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 incorporated 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: $30769 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: $1,256 Balance Due: $2,513 Estimated Start: Estimated Completion: Amount Financed: $0 6 to 8 weeks 6 to 8 weeks Method of Payment: Cash/Check 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: Deposit paid via check# 2123; ;Taxes paid in Barnstable MA 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 Buyer(s) 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 CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 05/14/2018 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:'Reneiv By A dersen of Sour n New England Buyer(s) Signature of Sales Person Signature Signature Josh Ocharsky Debra Caney John Caney Print Name of Sales Person Print Name Print,Name UPDATED: 05/10/18 Page 2 / 9 Office ar Consumer Affairs and Business b 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Hone Improvement Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS LL BRIAN DENNISON - 26 ALBION RD LINCOLN, RI 02865 Update Address and return card.Mark reason for change. Address Renewal Employment = Lost Card _..:.—office of Consumer Affairs&Business Regulation Registration valid for individual use only before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR ®ffice of Consumer Affairs and Business Regulation Registration: 173245 Type: 10 Park Plaza-Suite 5170 Expiration: 9/1 giol8 Supplement Card Boston.NIA 0.116 SOUTHERN NEW ENGLAND WINDOWS I I C. RENEWAL BY ANDERSON BRIAN DENNISON L�r 26 ALBION RD LINCOLN, RI 02B65 �aersecreiary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-095707 C'`,S�'uL�iGn Super vis0Y BRIAN D DENNISON _ 7 LAMBS POND CIRCtE " CHARLTON MA 01507_: -. Expiration: Commissioner 09/08/2018 The Commonwealth ofMassachusetts Department of IndusirialAccidenis r 1 Congress Street,Suite 100 7 Boston,MA 02114-2017 www.mass-gov/dia 11 orkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER-mn-mTG AUTHORITY. Applicant Information Please Print LeLriblv Name (Business/Organizatiomindividual): � e L 0w p Address: 2 v City/State/Zip: 1J Phone#: Are you an employer?Check the appropriate boa: Type of project(required): 1�I am a employer with ZO fempioyees(full and/or part-time).* I 7. (]New construction. - 2.a I am a sole proprietor or partnership and have no employees wort-in forme in $. Remodeling I any capacity.[No workers'comp.insurance required.) ❑ g I 3.O I am a homeowner doingall work myself 4e wor' - 9- ❑Demolition i ys •_<? ter comp.insurance required.; 4.�I am a homeowner and will be hiring contractors to conduct all work on my n-operty. 1 wil; 10 ❑Building addition i ensure that ali contractors either have workers'compensation insurance or am sole 11. Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contactor and I have hired the sub-contractors listed on the attached sheet These sub-contactors have employees and have worke.--romp.msu-ance.t 13-7Roof repair 6.❑We area corporation and its officers have exercised their right of exemption per tviGL c. 14.[ Other Enq-4-� _/o o 4- i !:_,F1(s) and we have no employees.j?4o workers'comp.insurance required.; r e C/a 'Any applicant that checks box r'.must also fill out the section below showing their workers'compensation policy informan-on. T Homeowners who submit this a If idavit 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 sheer showing the name of the sub-contractors and state whether or not those entities;,Eve employees. If the sub-contractors have employees,they must provide their worker coop.policy number. _ I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: l l Zf ine n $ Ips. Ct�I�1 Policy f or Self-ins.Lic. : CA-31��7 4,9 — Z. Expiration Date: 6 ! f I Job Site Address '?heuSa,<f ('4y CiiV,StatelZip:�jl-le,,t/i tie ,ttA Attacb a copy of the workers'compensation p0liC§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 S1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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. 1 do hereby certify under th ains and penalties of perjary Thai the information provided above is true and correct Signature: Dfte: Phone#: 40 d- ZZ.e—T Pe - Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License k Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector b.Other Contact Person: Pbone : /ACOR CERTIFICATE OF LIABILITY INSURANCE DATE(M 1zrz9//2017 Y' ol7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE 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 INSURI�R(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 CONTACT - NAME: COBiz Insurance, Inc.-CO PHONE FAX 1401 Lawrence St, Ste. 1200 N .303-988-0446 ,uc No),303-988-0804 Denver CO 80202 ADDRESS: COMaiI cobizinsurance.com INSURE S AFFORDING COVERAGE NAIC B INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURERS:Firemens Insurance Co I mpany of WA,D.C. 21784 Southern New England Windows, LLC. dba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1252851165 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 ADDL SUBR POLICY EFF POUCY EXP LT R TYPE OF INSURANCE POLICY NUMBER I MMlDDA_rYY I MMlDD LIMITS A X I COMMERCIAL GENERAL LIABILITY CPA3158728 I 1112018 I 1/12079 EACH OCCURRENCE 51.000,000 DAMAGE TO RENTED CLAIMS-MADE XI OCCUR I PREMISES IE2 occurrence) S 3DD.DDD MED EXP(Arty one person) 510.000 1 I PERSONAL&ADV INJURY 51.01)D.000 GEN.L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE S 2.000,000 C X POLICY I—!JET LOC I - I I PRODUCTS-COMP/OP AGG 152.000,000 I OTHER: i 5 S 'A AUTOMOBILE LIABILITY I N CPA3158728 1/12078 7l72 COMBINED INGLE LIMIT 079 Ea accident $1 000 000 HxANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BOOICY INJURY(Per accident)I S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS I X AUTOS I Per accident I 5 A I x UMBRELLA UAB X I OCCUR I CPA3158728 ( 1/12018 1/12019 1 EACH OCCURRENCE S 10.000.000 EXCESS LIAB I CLAIMS-MADE AGGREGATE $10.000.000 DED X RETENTIONS I S B WORKERS COMPENSATION WCA3158729-20 1n2018 --1n2019 X I NTE ER AND EMPLOYERS LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE ❑ EL EACH ACCIDENT $1.000,000 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E1 DISEASE-EA EMPLOYEE 51.000.000 0 yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICv LIMIT 51.DDO,OOD C Pollution LiabTty 7930073340000 1/1/2015 1112019 Each Occurrence S1.D00.000 I Claims-Made Policy A99regate S1,008,000 Retroactive Date 06202013 Deductible S10.000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. For Informational Purposes AUTHORIZED REPRESENTATIVE I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I AA BE Assessor's office(1st Floor): ST'C SysT � MUST r Assessor's map and lot n b tS 7 f�e q,��� imSTALLFED 6N COArdp Conservation -9 WITH` ITL o�e Board of Health(Ad floor): ENVIR®MEMENTAL •. ��. Sewage Permit number TOW M REGULT- ia�•>> �ncc i y ru• Engineering Department 3rd fl o): °�i639. House numbers o Ysr Definitive Plan Approved by Planning Board f 4 --. 19 � APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only ram TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION -,U6a z!, 19 L1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use I Zoning District C— Fire District Name of Owner .0 �1 Address Name of Builder 44, / //e.�� Address Name of Architect Address Number of Rooms fit! Foundation Exterior �� / C - Roofing Floors �� Interior //�t�r 0 r Heating �' f 4J G -C y � Plumbing Fireplace Y Approximate Cost 0 G V11 v Area ��— Diagram of Lot and Building with Dimensions Fee 3 �yxz� A.!'°(y / 4 � 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. Namers•�i Construction Supervisor's License Z 1 NICKULAS BUILDING CO. No 35137 Permit For Two Story , Single Family Dwelling Location "68 Pheasant Way f _ Centerville Owner Nickulas Building Co. J1 Type of,Construction Frame Plot Lot _ r _ Permit Granted June 17, 19 92 Date of Inspection 19 at leted /® 19 i C V, ;, , , i i II I �N-r l.r� i K It C � N � F11TLl(ZE P.�21GK P�TiU � � � �'• � o Z A _ H. :u I=a 14 _ r i -It . WP fT- LLJ r - - ---- - _ -- - -- CeP -;4 z�' I I _ _ M�•S-rER - BEpRooM EDG I` _ DRooM Gam- _ - ----- - pelf _ I,,oll - tt, - --- - i Z - - - BHT E: ( N i�u - '-oil i LE L-L - tR ry.( PHEASANT WAY 69.06' 195.44' 20.2'T LOT- 26 22244± S.F. D ✓� CONCRETE (0.51 ± AC.) FOUNDATION �~ LOT 26 r j2 6 20.7'- 61.0 160.00' LOT 29 JOB # 91-364 CERTIFIED PLDT PLAN PREPARED FOR: LOCATION. LOT 28 PHEASANT WAY CENTERVILLE SCALE: I " =50 ' . DATE: 05/10/92 REFERENCE: L . C . C . #32290E NI CKULAS HOMES I HEREBY CERTIFY THAT THE STRUCTURE i SHOWN ON THIS PLAN IS LOCATED ON THE I GROUND AS SHOWN HEREON. ��Lt i ®�A N down cape engineering, inc . CIVIL ENGINEERS p ' I LEWD SURVEYORS �J( � ROUTE 6A YARMOUTH MA DATE REG. LAND SURVEYOR ,,T.f TOWN OF BARNSTABLE Permit No..,,,35137 BUILDING DEPARTMENT I TOWN OFFICE BUILDING Cash ► s�o• HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Nickulas Building Co. Address 55 Pheasant Warr Centerville, Mass. USE GROUP FIRE GRADING OCCUPANCY LOADT 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 BUILDING CODE. September 8, t9.:...92......... ......... ..... �,,,..... Building Inspector ^ TOWN OF BARNSTABLE, MASSACHUSETTS P����' A�207--161 June 17 ', 92 ' Nickulas HuildinTE 19 P MIT " APPLICANT g W.Warna` ,: ADDRESS — 2 E INC.) (STREET) (CONTR'S LICENSEI PERMIT'TO B11ild dWQliin7CI L ) STORY Single family dwellin MQER ''OF 1 (TYPE 9F,IMPR.OVEMENT) N0. ELL.ING UNITS.' (PROPOSED USE) AT (LOCATION) of Pheasant Ways C@Mery @, ZONING, RC. (NO.) (STREET) DISTRICT S. BETWEEN - AND .• ' (CROSS.STREET)' .' (CROSS STREET) SUBDIVISION LOT BLOCK LOT' : SIZE ` --lbUILDING.IS TO BE FT. WIDE BY_T_FT, LONG BY FT, IN HEIGHT AND SHALL CONFORty) IN'CONSTRUCTI 3T0 TYPE USE GROUP BASEMENT WALE'S OR FOUNDATION t.. .� (TYPE) REMARKS: Sewage #92-211 „I REA O 1696 sq. £t.'. $ ) h BOND ESTIMATED COST ,� 1Y001QOV a r:' PERMIT 175�75 1 (CUBIC/SOVARE FEET) - .,t '• FEE, r — OWNER" Nickulas: Buildi`ng Company '� RESS. OX e8 arn8 a @� BUILDING DE' a° BY s � ' Th - PE FR P US ? _ IC WORKS. THE ISSUANCE THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIOI F 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 ( .FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL'INSTALBIATIONS.D ELEC 2 PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL -N MEMBERS(READY TO LATH). 9 FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. {` V OCCUPANCY. r POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS'„ ELECTRICAL INSPECTION APPROVALS n 2` -- 31d HEATING INSPECTION APPROVALS . � I EN EERIN E�RTMENT OARD OF HEALTH OTHER SITE PLAN REVIEW APPROVAL' ^i i `i to WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN CONSTRUCTION. ARRANGED FOR BY TELEPHONE OR WRITT PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION.