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"''+u,� ",,y, ,c,.. .:...*r x. `l _, �, ,r -- 4x, * +xs u`z.. .t-c...::' so'w"• 4 „ .."` :.' r `-` I. z � _ t w& ,�'� :' - _ �,'L: Mr''� Sat„ 4k- '•y""*..fir _ t, .. b r r an t 5• � a :not:.soon, to owns"poll my M. 05 MY CIO M1 `. who up S .l l�hoj ir p Town of Barnstable 'Permit;,2OI b�ZlExpires �O� Regulatory Services Fee = 6mondisfronrissrredate a snarrsMBI _' MASS. � Richard V.Scali,Interim Director rE1 3 -& X1J'ftESSpEjVt Building Division OCT Tom Perry,CBO,Building Commissioner 3 02015 200 Main Street;Hyannis,MA 02601 ®WN OF BA I www.town.bamstable.ma.us RNSTA E Office: 508-8b2-4038 Fax:508 6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL NTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number_:;2,0.1 i. Proper[ Address /.� d hi/I/hy� ZaAP (Residential Value of Work S_�� Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address' r 5a nr�ev �s--Lance �y/tf,�rl/il� A 016 32 Contractor's Name 53AVIrt 0.I C.0;r�n�,S f gr;G,,t ( -6 ni snel Telephone Number( 0111Z29-q kl7p Home Improvement Contractor License--.-(if applicable) /7 2 y S Email: Construction Supervisor's License 4(if applicable) 0 ci_5 7 n 2�Workrnan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Pam the Homeowner I have Worker's Compensation Insuranc: Insurance Company Name A rft rn G ur Tn-s urg vi Ge— Workman's Comp.Policy a V\(Ccj7_88,- 352 .3qjtj Copy of Insurance Compliance Certificate must accompany each permit.. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑ Re-roof(hurricane nailed)(not stripping. Goinj over existing layers of roof) ❑ Re-side replacement Windows/doors/sliders..U Value (maximum 35)4 of windows of doors.�_ - ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. .Separate Electrical&Fire Permits required. *bt'here required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. +'Note: PropertygOwner must sigon Property Owner Letter of Permission. A copy o the Home Improvement Contractors License&Construction Supervisors License is required. - SIGNATURE: Q.%TFILESIFOnlMuilding permit fomulEXPRESS.doc Revised 06I313 .� F. Renewal at oiW 173245 � RENEWAL BY ANDERSEN wtua�xai�sz�9 cr uoaae aors,sss byArx 26 Albion Road • Lincoln,ICI 02865 Phone 866.563.1135 Fax 401:653:6602, Q n $mnhea New Eaglapd MRadoiva:LLC d/h/i "i f Renewal by Andersen of Soathera New F.aglaad U CUSTOM WIIVDOW AND DOORREMODE UNG AGREEMENT' , euiert,) Date e/Apeernene 14Z "- e r a,�MdsQee��we�eu,agsaoe,�aao:eoe.ira,� - - , 6d 6iAddr�a t �1 HO-T*pAeiro Numaer. �/Nb�kTelphais Warm :, Buyec{s):hereby joind and:ieveially agrees fb purchase the products and/or semces of Southern New England`Windows,U[,C-d/b!a Renewal,' by Andersen of Southern. w.England C':Conftactor"),in atcoidattce with the terms and condipons described on the front and the reverse o(;, this agriementand on the attached spe44tioa sheet(s).(collectively,this.'AgreemcnC'):, bills". D Condo-. O 1010i Total jobAmounti _� Esitrriaeed Starting Date:, Method of Payment Cld dt *Cssb 0 financed .. Deposit'Ret elved,(ll.Xj l Cmk Cards are ace epud for deposit ony=maxirnurri I13 of d+e, 8alanee at Siam of job(��%) ���/���,�, proltxi con(Please see ucort Caid Rrymdrc Form)By,ilping tnb' ' Estimate0 Gompletton Data Agreemeirc you admm*Aettge that die llabrtce at Sort of job and the Bahrtce on Subsi ii F /� f3aktnce on'Subsantl l dwq;ikd'on of job rnvt be made by 4i eel /,�Y/ lard ui8 must be trade by persaW ditch bank fixk or Lash: ;Ctxnpletlon:oi job(339G)�� Btrya(a)'agrees astd aadeataads.dwt this>Agreesaient cons tales cadre uaderbtsinding.between the parties,and ttiat fhers..are-no verbsl gadeertandings e>tanging anyof theaerma of tltas Agsrsmcat."BayerO acjmoavtdges Chit Bayer(s), (1)like read thisAgreen enq aadersttiada the twain of iiis Agreement,and 1w received a coanpletcd,.dgued�noel dated copy of tbasA e.ment,Incladiag the two attached Nodi:6 of Cancellstioa,,oa the date first written above and(2)was orally, iafaemed of Buyers might o ca eel this Agreement:DO NOT 1116N TIUS CONTRACT IF THERE ARE ANY BLANK SPACES; U (Rl ko&lafaad Soles Owfy)Notice toon"j-.(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the client of tom avrNilable infoi matder are teR iolank (2)'Toa are gadded to a oopyof this Agreement at the dine you sign -it.(3)Ytin may ninny date pay o8 the full Unpaid lt'alaaee else wader ibis Age cement,sad in so"doing you may lie'enaoed to L rb' 1-9 partial rebate of the®mace and Insurance charges.(4)The seller ha.no sight to nnliwfaBy enter yang premises or tomantt any baeach of the peaee;to repossess goods purchased larder this Agreement.(S)Yon okay cancel tbas Agreement =if a has not bceu`signed at the main office or a I aarh office of the"seIIer;"pitividC. you not�lPy-the seller at his ar her main oBl ee o`>•brsec4:oflnee shown in tfie.Agrecu�ent by registes�ed or cerdfied mail,which shall be-posted not later tlaa miaoight of the third tealendar day aker ttie day of aids the bnyersigas the Agreement eiciading Sunday and any holiday on which' marl deli�+erles nee not>anaiae $ee the acooatpasying aotaoe of'eanee l"a-n'fosus for as explanation of b iIiies rights. Buyet{s)raceivedilie consuiucr education materials praKtled by the Rhode Island Ctjittattits Rtgistratifori Board: (Bieyerr InrkattJ Rene Ad by New:Eiiglaad' Bnyei{s) Biayer(s)'- gnatur!eof Product Man Signature, Signature. K13' f 6TS/ S AoikkeY A TYzclHcl SiNI _ '.Pont Naine,of pcotiutx Managers Print Name ;Print r'ame YO[);"THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANYL.TJMZ PMOR TO 1►MM61iT-OF THE THMD BUSIIVBSS DAY AFTER 1'EiE DATE&TEDS TRANSACTION:SEE TItB AITACIIBD NOTICB:OF CANCELi�►TION FORMS. FOR AIV E]�LANATIOLY,OF ThII8 R1G1dT; x — — —'- _ x- - - - - - x IY!?21 NOTI ON a,^ C;C E OF CANCELLATI Date of,Trauaactton .You matt'cancel .l Oate'oPTrarrsacdon You may cancel thin trainatddon,wkho' penalty or obligadon;within 1, this transacdon,without arty penalty or obligaidon,within; °three business days from:the above date H.yota cancel,awry free businii days front.dse'`above,date:If yoti cartcel,;s4, property;traded. n;riot',payments made,!ht you under the•.J property tended in,ainjr paymet><s niauie by you,under•the Contract or,Silt;surd,any.4e�otrable,tnitrttment.exeeuted I Contract or:Sale;and arty rte8odable,instrument.*='Cured' ' by you will be eeturned widen ten busii>ea dajri:foQowing i by you will bn rotumed with n ten busjitess days kllowing racerpt.b�yy'dss Seller of.jratu pntelladon.,nodce,orad.any'l rgcdpt�y t1te.Seiler of your cancellation notice,and a searnRy intesest`ariang,;Out of.the transacdon,will be: l stieu_►ity,lneerest aiidng out,of the;erantaefion will be. sattceled,If you cancel,you nntsat ersalr. available to-'the ttie Salle canceled If you canKt,yeu mu"stmaloe available oar fire Sallee 'at your rostdenee;in substsntialy ai good condidon as when l at your resldenca.in subttanddtjr aft goad corididon as'when received,aray goods delhp&id to your under this Contract or I eeeeived,aryl foods.dellvered to.you'under this Contractor, :Sale;or yoti may,H you wish,compl�i walk the instructions o!'I •Safe'or you nw%if you wisly eomply the iris6 uctlons of else Seller regarding the.riWm shipment of the goods at tfi—- the Seller rogs:rdiiig the retuM shipment of the goods,at the Seller4'xpeIse,and rink:if you do make-the goods available K:Selter6s.expense artd risk.lf you do make the goods available bo the Seller and the Seller does not pick etiem up within to the,Seller:nand the:Shct r`does not'pick titees�up wilhiri; aweraty days of the date of cancellation;)roar may retain or, ! twenty d S of the:date of cancellation;you majr;rotail or di se o the goods with arty;furdierobligadon:If you I in' the goods without soli further obflgatioru If)roar make die goods available to the Seller,or if you agree, I htl to maids the goods syailable Ro die Seller;or if you agree bo return the Roods to the.Seller and fail do do op.. sen you. I toes' die ggoo`ods to'ihe Seller.W fail:to do so,then you 'remain liable Tor pe09-rote of,all obligations under,the: nrinWn ilable.Tor rmance of all obligation under the Contract To cancel this bansocgon,mail or deliver'as196,60 Contra ttVianceledns transicdon,mail or deliver a signed and dated copy of thli.canceltatfon notice or aury odte • ! arid.dated copy of this cancelladon:notice or airy. other written nodca;or send s tel. uo PAndi n of I. written nodce,or"nd a eefegra to Renewal bjrAndam"of Southern New Etapland at:2 Albion R . 21165 I Southern New and at 2 Albion Road,Lincoln,RI 02865; NOT LATER THHddN MIDNIGHT.OF j. Now LATER-. MIDNIGHT OE �D ) 1 HEREBYCANCELTHISTRANSACT[ON. IHER�EBY,CANCELTHiSTRANSACTION. says! somas. wrM tense•.. sea; auy.w uena+n , "PAR u.0 RW1:Copr l lift. Buyer Copy:Yellow Buyer Cop?':pink Southern New England Windows : d.b.a Renewal by Andersen of SINE Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License:CS-09FM7 . n•s BRIAN D DVIMON 7 LANIRS POND .'+ T Charlton MA 01507 ,l,tt Expiration Commissioner 09108►2016 �> P 0 Office of Consumer Affairs d Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration t Reglstratlon: 173245 X ? Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LLT' Expiration: 9U19U2016 ; DENNISON BRIAN 26 ALBION RD LINCOLN,RI 02865K F 'Update Address and return card Bark reason for change. SCA t O 2W65M ,Q Address 0 Renewal 0 Employment C3 Last Card �ho�oaoamowaud�a��,axtaa4uacQ3 flee of Conserver ARaus A Business Regulation License or registration valid for individul use only E BAPROVENIENT CONTRACTOR before the expiration date.If found return to: Office of Consumer Affairs and Business Regulation eghrtradon: 173245 NIB. 10 Park Plaza-Suite 5170 . Explratlon: iryir, Supplement•--ard Boston,M1�A 02116 SOUTHERN NEW ENGIAND NIINDOWS L&C. RENEWAL BYANDERSON,- ° DENNISON BRIAN 26 ALBION RD p LINCOLN,RI 02865 Uaderseerepry Not valid without signature' The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 S www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 ' Are you an employer? Check the appropriate box: Type of project(required): a>1.0 I a employer with 20+ 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 8. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their, I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs §14 152, ,and we have no insurance required.] t c. ( ) 13.[�Other dDv� 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. 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:ARGONAUT INS. CO. Policy#or Self-ins. Lic. #:WC 928058352394 Expiration Date:8/21/2016 Job Site Address: " 1 , City/State/Zip: (Pd&-y"f rl2. MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration datc). Failure to secure coverage as required under Section 25A�f1wfGL 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\nsurance coverage verification. I do hereby certi under the and penalties of perjury that the information provided above is true and correct. c Signafore: Dat e: Phone 9. 4.012289800 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#: SOUTNEW-01 SHETTYSHT . lllft " CERTIFICATE OF LIABILITY INSURANCE DAT/19/2DIY5 �� 8/19/2015 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 CONTANAME:CT Willis Certificate Center Willis of New Jersey,Inc. PHONE FAX c/o 26 Century Blvd A/C No Ext:(877)945-7378 (A/C.No):(888)467-2378 P.O.Box 305191 ADDRIESS:certificates@willis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC A INSURER A:Selective Insurance Company of Southeast 39926 INSURED - INSURER B:OneBeacon Insurance Company 21970 Southern New England Windows LLC INSURER C:Argonaut Insurance Company 19801 D/B/A Renewal by Andersen INSURER D 26 Albion Road Lincoln,RI 02865 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 ADDLISUBIR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDNYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S 2029459 08/10/2015 08/10/2016 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1;000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY[X]jECT N LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 A X ANY AUTO S 2029459 08/10/2015 08/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Peraocident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S 2029459 - 08/10/2015 08/10/2016 AGGREGATE $ 5,000,000 DED I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER. B ANY PROPRIETOR/PARTNER/EXECUTIVE a N/A 0000068028 08/21/2015 08/2112016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $. 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Workers Compensation C928058352394 08/2112015 08/2112016 See Attached DESCRIPTION OF OPERATIONS/LOCATIONS/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. AUTHORIZED REPRESENTATIVE Evidence of Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 'I i'V06/01/15 13:27 FAX 508 362 ,0213 BARN CLERK'S OFFICE I 01 DOCKET O. achusettsTrial Courtof MassI,jR 'I;pD l , I0525 CR 000159 District Court Department ° DEFENDANT NAME COURT NAME&ADDRESS MARIANNE MORRISSEY IBARNSTABLE DISTRICT COURT DEFENDANT ALIAS(ES) ROUTE GA, P_0. BOX 427 BARNSTABLE MA 02630-0427 (508) 375-6600 DEFENDANT ADDRESS CITY/TOWN STATE ZIP CODE 45 DAVIS ST IPLYMOUT14 MA 02630 SEX CITY OF BIRTH STATE OF BIRTH F BROCKTON MA MOTHER'S MAIDEN NAME FATHER'S NAME OUNIER, MAAY IRVIN F • NO. SID NO. UCENSE STATE PC5hir I" I ,i�, IA I'Q I plirl�'r'ell! �!i f' '!IPIII'�' !lel i.l�Ill'L .!IIlil hPdlill.',illilll',IIIIIIIIIII"!X i I Ir; I l;l,;l r III Il.ii. 14111 I 'C�I!IIII;Gir rrl',!III CIASE�11'rORM I t Mlrl l;,r i IP,61; Il11I NO.COUNTS POLICE DEP POLICE INCIDENT NO. OFFENSE LOCATION ARREST DATE MV CITATION NO. 4 BAR BARNSTABLE BAR6917.2 CURRENT DEFENSE ATTORNEY - ATTORNEY TYPE . . GEORGE E LANE JR PRIVATE COUNSEL CURRENT PROSECUTOR COMPLAINANT MORSE, DETECTIVE RICHARD S- ;f'!'I a I; !I'Illa r'4'!I''' "I'!IOFEENS!E ARD.�UUDI IMEt47'II'NFORM/ATiil1ON'!'!I...;'I 'II!li Irl"'.I ;IIII I'I IlJlil "!.L, I. P COUNT: 1 OFFENSE DATE: OCTOBER 20, 2004 666666 MISCELLANEOUS MUNIC ORDINANCE/BYLAW VIOL ' JUDGMENT DATE: 5/06/05 JUDGMENT JUDGE: HON. 'JOAN E. - LYNCH JUDGMENT METHOD:. NOLLE PROSEQUI JUDGMENT: NOLLE PROSEQUI COUNT: 2 OFFENSE DATE: OCTOBER 22, 2004 666666 MISCELLANEOUS MUNIC ORDINANCE/BYLAW VIOL JUDGMENT DATE: 5/06/05 JUDGMENT JUDGE: HON. JOAN E. LYNCH JUDGMENT METHOD: NOLLE PROSEQUI JUDGMENT: NOLLE PROSEQUI COUNT: 3 OFFENSE DATE: OCTOBER 25, 2004 666666 MISCELLANEOUS MUNIC ORDINANCE/BYLAW VIOL JUDGMENT DATE: 5/06/05 JUDGMENT JUDGE: HON_ JOAN E_ LYNCH . JUDGMENT METHOD:. NOLLE PROSEQUI JUDGMENT: NOLLE PROSEQUI , COUNT: 4 OFFENSE DATE: OCTOBER 26, 2004 666666 MISCELLANEOUS MUNIC ORDINANCE/BYLAW VIOL JUDGMENT DATE: 5/06/05 °JUDGMENT JUDGE: HON. JOAN E_ LYNCH JUDGMENT METHOD: NOLLE PROSEQUI JUDGMENT: NOLLE PROSEQUI ---------------------------------------------------------------------------- SAIL/BOND INFORMATION -------------------------------------------------------------------------------------- BAIL TYPE BOND AMT SET CASH AMT SET DATE SET JUDGE PERSONAL RECOG 3/02/05 MON. DON L. CARPENTER PAGE DATE RECORD PRINTED il!I'P11119 'CLERK-MAGISTRATE l�lk RUE, 1 6/01/].5 IliAlPlll CRF21A 6101nS 2:17 PM ' 06/01/15 13:27 FAX 508 362 0213 BARN CLERK'S OFFICE Z 002 dq i,i I'ii II'n;' 'I' Ii';i; .';'I. ,'i'I'I.,I•DOCKETNO. I I.,. ','i'i li, I i'i IIiI l+�I,ll;!II''' Pi,,II�IIllI�I'iI1,111 lI 111,I'lIl�'Ii�III'i ii ll,llj'IlI''l 111 I llI�'i chuse tts 0 25 CR 000158 Trial Court of NassaDtrict Court DepartmentRiOID 5 qp" Jy ------------------------ DOCKET ENTRIES ------=------------- --------- ___ _ DATE CODE DOCKET ENTRY JDG/MAG ACTION DATE' 11/10/04 AC APPLICATION FOR COMPLAINT FILED 11/10/04 CH CLERK'S HEARING ON COMPLAINT APPLIC SCHED FOR WFE 12/16/04 12/17/04 C CONTINUED RJD 12/16/04 12/21/04 CH CLERK'S HEARING ON COMPLAINT APPLZC, SCHED FOR RJD 12/31/04 12/22/04 RID SESSION CLERK: RJD 12/22/04 CONTINUED TO 1/6/05-NOTIFY DEF. RJD 12/31/04 12/22/04 C CONTINUED 12/22/04 CH CLERK'S HEARING ON.COMPLAINT APPLIC SCHED FOR RJD 1/06/05 1/04/05 CORRESPONDENCE RECEIVED FROM DEFT- 1/06/05 AFTER HEARING, FOUND RESPONSIBLE ALL COUNTS 1/06/05 $300 EACH FOR TOTAL OF $1200. IF NOT PAID IN 1/06/05 10 DAYS, COMPLAINT TO ISSUE. MONIES DUE ON 1/06/05 OR BEFORE,1/17/05 PER RJD. T 1/06/05 DATE FOR PAYMENT 1/18/05. RJD 1/06/05 , 1/06/05 C CONTINUED 1/06/05 CH CLERK'S HEARING ON COMPLAINT APPLIC SCHED FOR RJD 1/18/.05 1/11/05 NO ACTION TAKEN ON CORRESPONDENCE RECEIVED ON 1/11/05 1/10/2005 PER RJD 1/19/05 SEE ENTRY ON 1/6/05-NO PAYMENT AS OF 1/18/05' 1/19/05 COMPLAINT TO ISSUE 1/19/05 ZCI COMPLAINT ISSUED JBS 1/19/05 ARR ARRAIGNMENT SCHEDULED FOR 3/02/05 1/19/05- PI PROBATION INTAKE FORM PRINTED JBS 1/19/05 SUM . SUMMONS ISSUED FOR DEFENDANT JBS 3/02/05 WFE SESSION CLERK: WFE 3/02/05 NGP NOT GUILTY PLEA ENTERED DLC 3/02/05 TO GET OWN ATTY x 3/02/05 ARRH ARRAIGNMENT HELD DLC 3/02/05 3/02/05 PT PRETRIAL HEARING SCHEDULED FOR 4/21/05 4/21/05 CJA SESSION CLERK: CJA 4/21/05 C CONTINUED JJR.- 4/21/05 4/21/05 PT PRETRIAL HEARING SCHEDULED FOR JJR 5/06105 4/21/05 PCD PRIVATE COUNSEL FOR DEFENDANT 4/21'/05 285240 LANE JR, GEORGE E 5/06/05 SHM SESSION CLERK_ SHM 5/06/05 TN TAPE; "NUMBERS: 05-133 JEL. 5/06/05 NOLLE PROSSE - INTEREST OF JUSTICE 5/06/05 ADA C. PALKOSKZ JEL 5/06/05 NP NOLLE PROSEQUI FILED JEL 5/06105 5/06/05 ZZZ CASE CLOSED i. JEL St06/05 5/06/05 JE JUDGMENT ENTERED Jam' s i PAGE DATE DOCKET PRINTED I,"I I,;I II Cl ERK-MAGISTRATE '•ArFt19F� �'�COP�U 2 6/01/15 il�¢rr� 1• IE CRF215 5101M 5 217 PM J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4 C� Map ;pq Parcel © � Application # 3 "1 Health Division Date Issued i Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Z I- Village Owner CIA Y Address Alyl� Telephone Permit Request Square feet: 1 st floor: existing s-- `proposed �'`� 2nd floor: existing&6 proposed­-"'- roposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation qL>f� Construction Type Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ® Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes Lb No On Old King's Highway: ❑Yes d4o Basement Type: ❑ Full Iltrawl ❑Walkout LXOther Basement Finished Area (sq.ft.) Z-9 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new �-- Number of Bedrooms: V existingew Total Room Count (not including baths): existing new — First Floor.Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ffNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ BarnA existing -Q newt size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other,!,0 r, Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# f Current Use Proposed Use - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Tele hone Number �� p Address e) ft, License # (6-eo Home Improvement Contractor# A Email Worker's Compensation # VK� �/ �� ALL CONSTRUCTION DEBRIS RESULTING F THIS PROJECT WILL BE TAKEN TO I�fl�tC a J SIGNATURE DATE /� o � ` FOR OFFICIAL USE ONLY ;_ •► APPLICATION# DATE ISSUED MAP/PARCEL NO. F ADDRESS VILLAGE 4 OWNER DATE OF INSPECTION: FOUNDATION { FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL y, GAS: ROUGH FINAL FINAL BUILDING 5 )95 DATE CLOSED OUT ASSOCIATION PLAN NO. rxSMOKE'V TE T E C ORS REVIEWED ' — - b fy N L0011DING DEPT. DATE _ V" FIRE DEPARTMENT DATV l5 801W SIONATURES ARE R?QU El 6 L�U v{` �6e v C° I e L ►5� �l�r �l�� Town of Barnstable Regulatory Services • �F THE Tn. - - o Richard V. Scali;Director IMA s BARNMBLE. ; Building Division BA7toD MASS. winch i639. ,0 Thomas Perry, CBOBuilding Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 July 9, 2015 Michael Deluga 568 Santuit Rd. Cotuit, Ma. 02635 RE: 123,Phinney's Ln., Centerville, Map: 209 Parcel: 054 Dear Mr. Deluga, This letter is in response to application number 201503591 submitted to do work at the above referenced address. Unfortunately,the application can not be approved at this time because of the following: 1) The application contains conflicting information with the construction documents submitted. 2) Required smoke detector upgrade not shown on construction documents. Please do not hesitate to contact this office with any questions. Respectfully)l fry L. Lauzon Local Inspector Jeffrey.lauzongtown.barnstable.ma.us (508) 862-4034 i t �l��l►� i . . WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 40959 POLICY NO. �CC5oo-5ooO7114-2o174APRIOR NO. 006114-2013A ITEM 1. The Insured: Michael Deluga DBA: Village Craft Building & Remodeling Mailing address: 568 Santuit Road FEIN:"-'"'2146 Cotuit, MA 02635 Legal Entity Type: Sole Proprietor Other workplaces not shown above: 2. The policy period is from 12/23/2014 to 12/23/2015 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers' Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ _ 100,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. i Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTEA 355380 INTER SEE CLASS CODE SCHEDLI E Minimum Premium $500 Total Estimated Annual Premium $2,923 GOV GOV Deposit Premium $768 STATE ,CLASS MA 5645 State Assessments/Surcharges $2,575.00 x 5.8000% $149 This policy, including all endorsements, is hereby countersigned by 10/24/2014 Authorized Signature Date Service Office: Malcolm& Parsons Insurance Agency Inc 54 Third Avenue 6 Freeman Street-P 0 Box 527 Burlington MA 01803 Stoughton,MA 02072 WC 00 00 01 A(7-11)_ Includes copyrighted material of the National Council on Compensation Insurance, used with Its permission. r f t c 1 i s s r c. . Massachusetts Department of Public Safety • Board of Building Regulations and Standarq,. Contcuctioti Supervis;or� License:.CS-050234 MICHAEL'DELUO`A' 568 SANTUIT Rlog - i COTUIT MA 02635 ' )ri Expiration , 07/09/2016 . I ,* :Commissionet ' .. V`L6" 0972/IYGO�t!//CQGGi6 O��GlldllL1/1114C�1 I t Office of Consumer Affairs be 13usii ess Regul loon UME IMPROVEMENT-CONTRACTOR,` egi5tratio ,905�548_ Type: xpiratipni Z1t712016, DBA VILLA .E_CRAFT BUI IN &RE gDELING i Michael Deluga °1 568 SANTUIT.RD. COTUIT,MA 02635 • Under5cr�ct;ir-y / }s ' f ..... .- Y Licenke or.,regi$t1VPtion,;Yaljd for jndividul use onl before the expiration date: If found return to Ofrce of Consumer Affairs and Business Regulation TO P�r14 plaza i SuitW. e f Boston,MA 02116 y:I i �b ... ' l r .I i '7•' t 'Not li Y d W'1 th ou ,t si ' A tore. ., . ;I SELLER'S LIMITED POWER OF ATTORNEY STATE OF FLO A COUNTY OF I, MARIANNE C. HUGHES F/K/A MARIANNE C. CROSBY, of 2176 Shanewood Court, The Villages, FL 32162,hereby appoint BERNARD W. KLOTZ of 1645 Falmouth Road, Centerville,MA 02632, my true and lawful attorney in fact(my"Attorney"),to do all things necessary with respect of the sale of property situated at 123 Phinney's Lane, Centerville, MA 02632 (the"Premises"), as set forth in a Purchase and Sale Agreement dated April 2015 (The "Purchase and Sale Agreement"), for not less than$281,000.00 ("Sales Price"), hereby ratifying and affirming that which our Attorney shall lawfully do or cause to be done by virtue of the powers herein conferred. WITHOUT limiting the foregoing, the following powers are specifically included: To execute, deliver and acknowledge and make corrections and additions to all deeds and other documents necessary to effectuate the transfer of the Premises; to receive and disburse proceeds of the sale;to execute all documents required by the Buyer's lender in connection with the granting of a mortgage and related matters, including,but not limited to, Settlement Statements, Affidavits regarding mechanics' liens, tenants and compliance with State and Federal Laws; and other affidavits required by the lender in connection with the issuance of title insurance or compliance with the requirements of potential assignees of the mortgage. THIS Power of Attorney shall not be affected by my subseque disability or incapacity. EXECUTED as a sealed instrument this '� day of U 2015. MARIANNE C. HUG S F/K/A MARIANNE C. CROSBY STATE OF FLORIDA County of June 2015 Then personally appeared before me, the undersigned notary public, the above-named MARIANNE C. HUGHES F/K/A MARIANNE C CROSBY, proved to me through satisfactory evidence of identification, which were F,L. L , to be the person whose name is signed on the prece attached document, and acknowledged to me that she signed it voluntarily for its stated purpose OWLY K REES Notary Public -� MY COMMISSION#FF 112818 7 g EXPIRES:August 14,2018 My commission expires: zj/ 4P„t4°g Bated T1n Notary Pubre Undembis Depart nod afhzdrzr6*dAceiderrtr . Office oflmestigafiions 600 WirshhVton Street Bostor4 HA 02M www,mdssgovldra Workers, Compensation I inwance Aff davit Btinders/Contractorsfnectdciaus/pltm hers A 'cant Information Please Print Le ib br Name( �Oxg� on/lndividnal): C�' A Tdiii _ City, T.ip: �tU Phone r u an employer?Checktiie appropriatebo� " Tyge afproJect(required): ` I am a etxPIoyer with I - 4. ❑I�a gr�eaal contra�d I employees(RM and/or port time;).'* have hired the sob-coufractors 6• El New construction 2.❑ I am a sole proprietor or partner- listed on the wed sheet: 7. ❑Rmaodelmg ship and have no =npIoyees n=e suh-eomfra S hx 8. []Denol tiaa working for me in any capacity employees and have work®' [No workers'comp.; SM—d= camp.insurenrr t 9• ❑Btddmg addition �) 5. [] We are a corporation and its 10.[]Bl=td'calrepaizs or additions 3.[] I am a homeowner doing aI1 work officers have exercised their I1.[]ph>Dabingrepairs or additions myself No wogs'comb. xi&of exeolption per MGL insurance ra Ffird_]t c.152,§1(4),and we have no 12-E]Roof rapairs employees.[Na workncs' 13.[]OfEer COEIEP-ksorence reInhi%L] *Any.applimatthatcheckbox#lmastakofMontthereetioabolowshawmg&cirW slms'eoaspeasationpoIiCpinfhnaatiott. t I3ottrcawacts who sttbmitthis emdavit iadicatmg they sin doing in walk and thm hire aaiside ors ttaut submit anew aiadavit ia8icdiagsuch. k-zutredts thatebxlk&h box ttmstetteched m mUiliDnd shortshowingthe acne of the suh-wahactm and stet whetherornotthose cdities have etapIopecs Ifthe sat-mataseiors brn czap1a5'ees,thel tagstprovide their wmk=,co PAY=orba I am rue an player that is prmriduzg x�orkers'comperrsatiort bumrance for tnp a nPlayers• Beloit/is the porky and job site hzfbrmafion, Isarance Company Name: + + + Policy#.ar Self-ins.Lic.# a � � f 1 f� BxpizationDafe:ikvqv rob Site Address: )^ aty/� : Attach a copy of the workers'compe usaix policy declaration page(showing the policy number and expiration date), Falnae to secum coverage as rminuedmodes Section25A ofMM o.152 can lmdto the imposifim of crhnmalpenalties of a fine V to$1,500.00 and/or one-year ioipriscment as weR as civl penalties in the faun of a STOP WORK ORDER and a fine of uP to$250.00 a day against the violator. Be advised that a cagy of ibis shftnerd may be,forwarded to the Office of Investigations of the DIA for insurance coverage vedf cation, Ida hereby certify the parrs afpm�zo3'that the information provided abav is correct s• Date: 1. ,Phone#: FIc-0 use orrl}t Do not write in Phis area,to be compkted by city or tMM q�rL own: Per duLicense .uth?a Yy(Ckge one): of Health 2.Bn�ldingDcpartment 3,CitylTown Clerk 4,EIechiralluspecior S.Plumbinglnspector _ Person• Phone Information and Instructions tTa M&%WchmetLs , Laws chBpfrr 152 regoaes all cnTIU=to provide wmkea'compensation fur tip MVIcyees. Pursuant-flo this s ,an employee is defined as"_.every person,in the service of another under any contract ofhh expr=or implied, or writtru." An.rnpky,u is "an individual,partnemhip,associatiom,cmporation or other legal entity,or any two or more of the foregoing a joint euferpase,and inchulmg the legal rep¢eseoiaf mw of a deceased employer,or the receiver or trmtee of ari in par�iivp,association or other entity,employing employers. However the owner of a dweIlinghous0 natmore than three apartments and who resides therein,cu the oceapant of the dwelling house of anofer who Toys parsons-to do maintenance,construction or repair on such dwelling house or on the gron ods or building app thereto shall not because of such empl a deemed to be an employer." MGL cbapter 152,§25C(6)also states "everystato or Iocal licensing agency all withhoId the issuanep or renewal of a license or permit to op a business or to construct buildings' the commonwealth for any applica utwho has not produced accepva Ie evidence of cdmpfia ca with the cc coverage required." Additionally.MGL cJlap 152.§25C(7) `2Teifhar the commonwealth any of ifs political subdrvisions shaII enter into any contract for the perfou ance o ublic WOXkuntl acceptable e ' ce of caanpliancevrith the insurance.• requirements of this cbapferhave be=pres to the contracting Safhoiity Applicants Please fill out the workers'compensation affidavit c levelly,by the boxes that apply to your situation and,if necessary,supply sub-cm actors)name(s). address(es) phone es(s)alongwithtluir certificate(s)of insurance. Limited Liao ity Companies(LLC)or city artnerships(LLP)withno employees other than.the members or patters,are not roqu i ed to carry worirers' ens . insoxmmce. If an LLC or LLP does have employees,a policy is mquired. Be advised that this affidavit be submitted to the Department of Industrial Accidents for confumafion of insurance coverage. Also be sign and date the affidavit The affidavit should be ratmned to the city or town that the agplicatim for the p or 'cerise is being requested,not the Department:of Industrial Accidents. Should you have any questions re the Ia or if you are regZxed to obtain a workers' compensationpolicy,please call the Department at the listed bolo Self-insured companies should eater their self-fimraance license number on the appropriate line. City or Town Officials Please be sere that the affidavit is complete and p " 14AIy. The Department has provi a space at the bottom of the affidavit fur.you to fill out in the event the O e of Investigations has to contact you the applicant Please be sure to MI in the pe�/lice se number 'ch will be used as a reference nombei In addition,su applicant that must submit multiple permitMcense appIicati in any given year,need only sabmit one ,davit indicating current policy information(if necessary)and under"Job ire Address"the applicant should write"all to 'ors in (city or town)."A copy of the affidavit that has been o stamped or muked by the city or town may- a provided to the applicant as proof that a valid affidavit is on for fzrtae pmmn s or licenses. A new affidavit m Abe filed otrt each year.Where a home owner or=I,CiaS,Vr,-)S " ' a license or permit not-rcIdDd fin any business or commeacial venture (Le.a dog license or peonit to ,-)said person is NOT regrmed to complete this affidavit The Office of Investigations wo-ddlilm thangyou inadvance for your cooperation and shouldyonhave any questions, please do not hesifatn to'give ups a call_ The Depmtamfs address,telephone an�faxnumber: The CZMManWed&of Mamachusetfs Department Qf I&mtriA Awidenta mice cxfvvegatio�s 6w wawmgtun Stm d Boston.MA 02111 ' Tel.#617 727-4900 at 4-06 Qr I477 MASSAFE Fax#617 27-7749 Revised 4-24--07g��a _ ,o'FTME Town of Barnstable Regulatory.Services , ` MAIN $ Richard V.Scali,Director ----... ._._.._..._..._ Nu►y" Building Division , Tom Perry,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 , WI, ,as Owner of the subject property hereby authorize 'Wic 4,,!t to act on my behalf, in all matters relative to work authorized bythis building permit application for. ( dress of job) a Pool fences and alarms are the responsibility of the.applicant. Pools . are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature o S1gIIatUre of Applicant Print game *Ann Date I QT0RMS:0wNWERMISSMNP00LS .1.own oizarnstable Regulatory Services opTHE rOYyy Richard Y.Scali,Director , Building bivision , "�R''c'•—;_ Tom Perry,Building Commissioner L 200 Main Street; Hyannis,MA 02601 www town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 j: HOMEOWNER LICENSE EX MWnO DATE: JOB OhL• number street village "HOMEOWNER . name home phone# wodc phone# CURRENT MAMJNG DRESS: --• •--- •------- ---- crtyhnwa ------------a�• -------•--- up code The current exemption fo "homeowners"was extended to include weer-oce ied dwellings of six units or less and to allow homeowners to engage an' 'v'dual for hire who does not posses a license,provided that the owner acts as supervisor_ DEFINITION F HOMEOWNER Person(s)who owns a parcel o d on which he/she resides or nds to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or de d structures accessory to ch use and/or farm structures. A person who constructs more than one home in a two-year period shall not considered a homco er. Such"homeowner"shall submit to the Building Official on a form acaeptable to the Building Official, elshe shall be re ible for all such work performed under the building ermit. (Section 109.1.1) The undersigned`.`homeowner"asmrnes rev ibility fo compliance with the Staff Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that helshe ds the Town of Barnstable Building Department minimum inspection procedures and re emeaft and that he/ a will cc 1 m said procedures and requirements. Signature o o eo Approval of Building Official Note: Three-family dwellings co 35,000 cubic feet or Iaug 1 will be required to comply with the State Building Code Section 127.0 Construction Control. . . - HOMEOWNER'S EXEMPTION The Code states that: "Any homed er performing work for which a building permit is required shall be exempt from the provisions of this section(Section 09.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such wo that such Homeowner shall act as supervisor." Many homeowners who use this emption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly 1when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner/is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a formlcertification for use in your community. Q.\WFnESIFORM51bufi&gpermitfmm MMRESS.doe Revised 061313 Town of Barnstable *Permit 00 6 6 Expires 6 months from issue date Regulatory Services �p-PRESS PERMIT Thomas F.Geiler,Director / is SEP 2 2007 Building Division Tom Perry,CBO, Building Commissioner LAe TOWN OF BARNSTASLF— 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTL&L ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 Property Address "l F�►�,N ti7 S �� L -t-Z'YC j t, [Residential Value of Work 0`1 S_ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address " Contractor's Name Telephone Number:5 p 7 1 S -('I T V Home Improvement Contractor License#(if applicable) lZ�dj S Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name L t I&Z Workman'sComp.Policy# C,2`�iS?j`� (),taw, Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) l Lj� Ke-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping.. Going over existing layers of roof) ❑ Re-side' ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: - Q:Forms:expmtrg Revise061306 :!1 OS:18 RA3 506 862 9 i 17 FINANCE 0001 OLIVER SLY :? ''HUCYRM LANE 5s.►TUM YARMOUTH PHIFAX 508 775 4498 NI L&REG.4129957 M A 02664 AL.dust 15, 2007 NSURM . "i,oposal submitted to Ms.Mary Ann Morrissey of 123 Phinneys Lane Centerville MA We propose to supply all materials and labor necessary to remove and replace the ;xisting roof at the address above in the area around the existing cerner fuse Chimney including valley area to right of chimney t:Wtlash chimney. _-;lt d6bris'to be removed to town transfer. — `9 year limited warranty.Architect style shingle to be installed. (Similar to existing,) >.cR roof to be replaced also. i`r c t all walls, wiudews,decks, plants and shrubs etc. doing roof strip ^staining of town permit. r s,total cost of$"1075 .,yment Schedule;40%with signed Contract, balance upon.completion. :'espec"y submitted,Ol ver Ire >:rposal accepsed by, t RDate d 1.2 a 1"20r, .1cceptable,please sign and ret n one copy and keep on�our records. - I kis proposal is valid for 45 days from date above 01 � 01 ���� Board of Building Re 'ons and Standards . One Ashburton Place - Room 1301 Boston.Massachusetts 02108 , Home Improvement-Contractor Registration L Repiebndon: 12MW Type: IndMduW • - ExpinOn: 6/14=00 TW 131109 diver Kellk Oliver Kelly 9 Peregrine lane" S. Yarmouth, MA 02664 Up"Address sad rdara earl.Not reason for chi oPS-A, O.WW ❑ Address ❑ Rm -❑ Employment ❑Los 11eaM otBaNdiag Re�datloae sad 8taaduWuwmo.w vsUd lbr Endlvldal3ee on�j► MME Y M6NT COWMACTOR ORRO bel re Me=dalm U tbaad ret+srn Us a.428W Hoard of Sn�pg ib tloaa sad 8taodarde *PiItI6n% `BM4J2009 US 131109 Oao AebbU"w Plato RM 1301 BosomType: IndlWdual Ma.0E108 9lrine lane .. - �•fr��+:+�`. ' OW&YWMUIK MA 02064 Adedabtntor Not valid witboat eipature Liberty Mutual Group Liberty P.O.Box 7202 MLitUd1. Portsmouth,NH 03802-7202 Telephone(800)653-7893 Fax(603)-43175693 August 14,2007 SAM&SAM CONSTRUCTION ATTN:S.MCNICOLL 170 COMMERCIAL ST UNIT 164 " PROVINCETOWN, MA 02657- , RE: Certificate of Workers Compensation Insurance -- Insured: OLIVER KELLY 9 PEREGRINE LANE S YARMOUTH, MA 02664 Policy Number: WC2-31S-338804-026 Effective: 12/28/2006 Expiration: 12/28/2007 Coverage afforded under Workers Compensation Law of the following state(s): MA Employers Liability _mit Sole Proprietor/Partner Coverage Election: Bodily Injury By Accident: $100,000 Each Accident The workers'compensation Policy does not provide Bodily Injury by Disease: $ 100,000 Each Person coverage for: Bodily Injury by Disease: $500,600 Policy Limits OLIVER KEiLLY As of this date,the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions,and is not altered by any requirement,term or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right upon you,the certificate holder. This certificate is not an insurance policy and does not amend,extend,or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor-to notify you-of, such cancellation. AUTHORIZED REP�RESEq/NRT.ATNE LIBERTY MUTUAL INSURANCE GROUP This Certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those companies. cc: Insured: Producer of Record: OLIVER KELLY SANDPIPER INSURANCE AGENCY INC 9 PEREGRINE LANE 12 ENTERPRISE RD S YARMOUTH, MA 02664 HYANNIS, MA 02601 Lepartment of lndusftd Accidents Office of Investigations f 600 Washington Street Boston,MA 02111 www.mass:gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers Aipplicant Information Please Print Le 'bl Name (BusinesWorpmzationandividlw): L_yy E L_ 4&-Z , Address: C�-�LN city/state/zip:_ �r Phone#: O Are on an employer?Check the-appropriate box: L I am a employer with 1- _ 4. ❑ I am a general contractor and I Type of project(required): employees(fall and/or part-time).* have hired the sub-eontrackm" 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp. insurance, [No workers'comp.insurance 5. ❑ We are a corporation and its 9- Building Ilddttim Tequind.] officers have exercised their 10•0 Electrical n7afrs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ring repairs oar additions myself [No workers' comp. c. 152,§1(4),and we have noinsurance required.]t employees. 12. [NO wvorkers' repairs comp•insurance required.] 13•❑ Other 7-7 *Any appticaot that chedos box N 1 must alai)fill out the section below sho , t Homeownen who submit this affidavit they an a'i"s their worben MMP n policy information: ZCantracbors that check thin box mot attached an additional sheet oho work and than bus outside eontrachn must submit a new affidavit indicating such wing the name of the sub-contractors and their workas,comp,policy infairinetion. I am an employer that b providing worArersI eon pensddon Insurance for my employees: Below!s the po1lry iwdjob slate Infonnatlon. Insurance Company Name: L'S C:ex Policy#or self-ins.Lic. M 0 -C,e-) t{ A 0 t Expiration Date: .2 2G6 Job Site Address:_ ,, y� v- �� y�„`� City/StatelZip i(A 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 imprisonmen%as wen 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 Investigations of the DIA for insurance coverage verification �Y forwarded to the Office of I de hereby cerdft under the pains andpenaftla of r,Jury that the Information provided above h true and correct Siallature. D 2 Phone#: CJ Qfflcldl rise only. Do not write In this area,to be completed by city or town o,,dlclaL City or Town:. Permit/Llcense# Issuing Authority(circle one): I.Board of Health 2.Building Department.3.City/Town Clerk 4.Electrical Inspector S.Plumbing Ins actor 6.Other P Contact Person: Phone#: jlilVi AAA*0 J16 . ter 152 requires all employers to Provide workers' compensation for their employees . Massachusetts General Laws chap in Pursuant to this statute, the service of another under MY contract of hire, L an emPbJ'u is defined as ..every person express or implied,oral or written. corporation Or Oth egal entity,or any two Or more err is efined as"an individual,partnership,associatbn,oorpo Q,or the An employ joint enterprise,and including the legal representativ of a deceased employ of the foregoin8 god n a�° hying enrpbyeea. However the individual,partnership,association or other legal entity, receiver or trustee o not more than three apartments and who res' es therein,or the occupant of the owner of a dwelling ho a having cons ' n or repair work on such dwelling house dwelling house of anoth who employs persons s al maintenance,use t be.deemed to be as employer." thereto shall not because of such loymen or on the grounds or appurtenant _.) t.I -� 17(-- 25C 6 a states that"every state or local Ucensi g agency shall withhold the Issuance or MGL chapter 152, ( ) in the commonwealth for any renewal of a license or Permit operate a basiness or to construct uildings who has not produced cceptable evidence of compli with the insurance coverage required applicant ealth nor any of its political subdivisions shall MGL chapter 152, §2 7)states `Neither the co fiance with the insurance Additionally' cc of he work untU a table evidence of comp enter into any contract for the public r this chapter have been esented to the couVac ' . authority" requirements of Applicants to our situation and,if compensation a by checking the boxes that apply Y Please fill out the workers' s(e�� hone numbers)along with their certificate(s)of necessary,supply sub-coutractor(s)nan*8 invited Partnerships(LLP)with no employees other than the insurance. Limited Liability Companies(LLC) not required to carry wor ' co ation insurance. If an LLC or LLP does have members or partners,are be submitted to the Department of Industrial employ ,a policy is required. Be advised that this may for confirmation of insurance coverage. sure to sign and date the affidavit. The affidavit should Accidents application for ermit or license is being requested,not the Department of be returned to the city or town that the Industrial Accidents. Should you have any questions re the law or if you are required to obtain'a workers' ensation policy,please call the Department at the er listed below. Self-ins�ued companies should enter their comp ' to line. self-insurance license m °n City or Town O icWa legibly. a Department has provided a space at the bottom Please be sure that the affidavit is complete and prin egr ly. the applicant. of the affidavit for you to fill out in the event the Offi of Inv tions has m contact you regarding Please be sure to fill in the Pe�CenSe number w `ch will be us as a reference number• In addition,an applicant ermit/license applications ' any given y ,need only.submit one affidavit indicating current that must submit multiplep and under Job Si Address"the app 'cant should write"all locations m (city or policy information(if necessary) ed or mark by the city or town may be provided 10 the town)."A copy of the affidavit that has been offi ' stamp each applicant as proof that a valid affidavit is on fie for tare permits°riot related to any busin lic a. A new affidavit ess or boommercial vtentnre year.Where a home owner or citizen is obtaining a tense or permit complete this affidavit. (i.e. a dog license or permit to burn leaves etc.)said erson is NOT required in The Office of Investigations would h'lce m thank y 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: The Commonwealth of Massachusetts Depmllneut of Industrial Accidents Office of investigadons 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-2"5 www.mass.gov/dia Message Page 1 of 2 Giangregorio, Robin From: Morrissey, Marianne Sent: Tuesday, September 21, 2004 10:37 AM To: Giangregorio, Robin Subject: FW: Housing Hi Robin- I am forwarding this email to you at the request of Katarina with Com Dev. with hope that there is something you can do. I have been a very good neighbor to the citizens on Phinney's Lane. I have brought not only mine, but their home values up, by maintaining the"old" look of the historic area, and by improving the yard and structure. I have brought my own value from $197,000. to approx. (reactors assessment) to $478,000. 1 would think they would be happy with me living there, but apparently not. I hope you are able to help me. I would appreciate your confidentiality as well. Thank you. Marianne TOB Phone 862-4658 -----Original Message----- From: Morrissey, Marianne Sent: Tuesday, September 21, 2004 9:01 AM To: Soldatov, Katarina Subject: Housing Importance: High Hi Katarina- I was hoping you could help me with a problem that has come up. I live at 123 Phinney's Lane, in Centerville. My cousin is living with me , in my home to help me do some work in the area over the garage, in preparation of my parent's moving back here, from California. When my parent's return, I will then move into the space over the garage, and they will live in my house. Their house is currently for sale, and has been for almost 4 weeks, there is no telling exactly when they will arrive. Well, I have been very concerned about appearances to the neighbors with my mate cousin living at my residence. I have told him to keep to himself, and not talk to any neighbors, because they are very concerned with everything I do at my home. He was approached yesterday, by a Housing Authority representative, who had received a call from a neighbor, and now would like to go in and inspect. This made him very uncomfortable, and he did not know what to say, since I have told him I do not want people to think he is living in my house, but only in the space over the garage. He told the Representative to contact me. I would never have built the garage or the living space for me over it, had the Town provided my parents the affordable housing they were promised by Mrs.. Stanley (with the town), but because I provided them 10/25/2004 Message Page 2 of 2 a place to stay while their Town housing became available, I also, without realizing, put them on less of a priority list for housing, by providing a roof over their heads. From the start of my building this place, I have been very open and up front that I was building it for my parents. The town has been very difficult to work with, and very suspicious of every phase, even though they have seen, approved, and inspected, each phase. I have been patient, now I do not wish to be anymore. Could you advise me? Marianne Morrissey Town of Barnstable Treasurer's Office 10/25/2004 Message Page 1 of 1 Giangregorio, Robin From: Morrissey, Marianne Sent: Tuesday, September 28, 2004 11:21 AM _ To: Giangregorio, Robin Subject: Response Hi Robin- I spoke to Katarina yesterday, and she suggested that there is something in my file that I should see, that will explain the reason and am being threatened with fines, due to my having a guest stay.with me. Is it possible to have a copy sent over to me to view? I am suggesting this because, it will be embarrassing to come to your department, without having everyone recognize me, and feel as you do, that I am doing something wrong. I am not doing anything wrong. I really don't even think I should have to explain anything. If this is a complaint from a neighbor, I can, at least, rationalize the objective of the building inspector. I am mostly just confused on what exactly I am doing that is suspect. I have asked my Dad to send a copy of his Real Estate agreement on his home in CA along with a letter of his intent to live with me in my home with my new additional living space, hoping that will prove to you that, from the get go, I have been making these improvements, to potentially create a place for either me or my parents to be comfortable in my home. Living alone, and working 3 jobs, does not allow me much time, even if I had the ability, to patch drywall and paint, which is exactly what is going on at my home while I am at work, because my cousin works nights. Quite frankly, it never occurred to me that a permit would be necessary to have my parents move into my home, and I still would like to see something that states that...but If they get a P If S contract on their home, I would still have months to apply for such a permit should it be required. If a neighbor is complaining, you may tell them that my parents won't be here for at least a month, and possibly longer depending on how long it takes to sell their home. I was hoping you would email me after speaking to John, the inspector who came out to do the final inspection. He was very nice, other than having me put up two forms of insulation because of the age of my home. He wilt remember me because he also had me redo some walls that rotted out do to a flashing problem, after my contractor went took off on me. I hope to get this resolved, but feel like the town has had me jumping thru hoops since I first got in incorrect survey showing me 4" too close to the property line (the Surveyor, made an error, and died before he could fix it), and Jim Lynch, my neighbor put a hold on the project. Thanks for your help so far. Marianne Morrissey Town of Barnstable Treasurer's Office 10/25/2004 ' Message Page 1 of 5 e Giangregorio, Robin From: Morrissey, Marianne Sent: Thursday, September 23, 2004 11:26 AM To: Giangregorio, Robin Subject: RE: Housing He is incorrect, the area is open to the rest of the house. It was required by John, (the last inspector), in fact he went in thru the garage, and out thru the main house after inspecting for insulation in a room adjacent to the breezeway in the main house. Please speak to him. As for being denied access, would you expect a relative to allow someone into your house when you are not at home? -----Original Message----- From: Giangregorio, Robin Sent:Thursday, September 23, 2004 11:22 AM To: Morrissey, Marianne Subject: RE: Housing Marainne, 1 have rechecked the plans and am not presuming anything. This unit is independent of the main house meaning one must travel outside to access it, according to the plans and local inspector. The Inspector was denied admittance and his letter indicates that you have until Oct. 1 st to respond. After that day he will issue non-criminal citations. You can cure the problem by filing for relief I identified previously. I sincerely hope things work out for you. Robin -----Original Message----- From: Morrissey, Marianne Sent: Thursday, September 23, 2004 10:19 AM To: Giangregorio, Robin Subject: RE: Housing Hi Robin- This is not an apartment, as you can see by the permit. It is an open space, allowing an area for me, my family, or my guests to use when the confines of the very small main house get too small to still enjoy each others company. It is an addition to my main house where I can do crafts, or send extended stay company (such as my cousin, my parents, and sometimes my niece) to allow me some privacy, and allows them to come and go without tromping thru my bedroom each time. It is connected by the breezeway, as you can see on the permit. As far as your original assessment changing, that is exactly where the problem stems. You are making an assessment based on presumption, and what people THINK they know, from s whom, I am not sure. Thank you for the offered assistance, and for your time. 10/25/2004 Message Page 2 of 5 Marianne -----Original Message----- From: Giangregorio, Robin Sent: Tuesday, September 21, 2004 11:54 AM To: Morrissey, Marianne Subject: RE: Housing Marinne, I am not judging you at all. I pulled the building file and checked the history. I know what zoning requires. Accessory apartments even for family members are not allowed as a matter of right. You need a special permit. Renting to 3 unrelated people is allowed but that means sharing the house including a common means of egress available to them and the kitchen. You should know that I would submit the same response to anyone who asked - I don't care about titles or wealth and/or prestige. The laws and zoning ordinance here are applicable universally, that includes you, the town manager, me and any other resident. I have the same expectations of all and therefore l offer the same advice. If you want the problem to go away, this is what you have to do. It's as simple as that. I have offered you my assistance but I can not change my original assessment. Please do not construe this to be judgmental on my part. I tend to be direct but I am honest. The property owner must apply for a special permit for the family member(s).of choice if the accessory dwelling unit is to be occupied as such. I don't foresee a problem with this and I fail to recognize why you are reluctant to apply. This is not asking you to prove yourself. It's asking you to comply and go through the process just like everyone else. My offer of assistance still stands. I'll help you in any way I can. Robin -----Original Message----- - From: Morrissey, Marianne Sent: Tuesday, September 21, 2004 11:23 AM To: Giangregorio, Robin Subject: RE: Housing Hi Robin, Without sounding harsh, you are doing just what everyone else with the Town seems to be doing. My Cousin (my Aunt's nephew) is staying in my house until the arrival of my parents. If you look at the plan that was submitted, I was required to put an opening from the main house to the space over the garage. He comes and goes out the front of the garage or from the side of the main house. This is not a zoning violation, that I can see. I could have said this was my 10/25/2004 Message Page 3 of 5 fiances, or my husband....but this is my cousin, or second cousin...whatever. It feels like I am constantly having to prove myself, when you could ask Mrs.. Stanley, Tom Lynch (my unhappy neighbor, who knows that my parents waited in my house for almost 2 yrs for their Town apt that got postponed because of my providing them a roof). Tom Perry knew that my parents were going in there but got sick of waiting after having the town put a four month hold on building. Because someone suggested to you that I have an illegal apt, you (the Town) seem to be forcing me to jump thru hoops for something other than what I have worked 3 jobs for 2 years to accomplish. I know this sounds harsh, I has to because of the topic, and the implications.:. sorry about that. how would you feel? Thanks for the quick response to my email. Marianne -----Original Message----- - From: Giangregorio, Robin Sent: Tuesday, September 21, 2004 11:07 AM To: Morrissey, Marianne Subject: RE: Housing Hi Marianne, I'll try to help you. The issue is not one of property values or unhappy neighbors. The issue at hand is you have what appears to be an illegal apartment. A Building Inspector visited the property yesterday - not a Housing employee. This is a zoning violation and you must take action to remedy it immediately. Although, your intentions may have been honorable and perhaps the issue was further compounded by a former Inspector with a more liberal attitude, ultimately you are left with what is an unauthorized apartment. The cat is out of the bag now and we must rectify the matter as soon as possible. You are entitled to seek a special permit issued by the Board of Appeals for a family apartment if you have a family member in residence. If you have an outsider (and you intend to continue to rent in this manner), you need to file for Amnesty. At this point, you must decide which way you are going and obtain the corresponding application necessary for that process. We can help you with whatever questions you may have. A site plan, floor plans and affidavits are required for both applications. A public hearing is scheduled and abutters are notified in either case. Sometimes there are complaints as a result of the public notification. That's just part of the process and should be anticipated. The permit, once issued must be recorded and excercised within a year. Certainly, your parents would be relocated by then. I will not discuss this matter with anyone until you have determined what you are going to do. You may call me directly at 862-4027 if you need to talk to me in the meantime. 10/25/2004