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0196 EISENHOWER DRIVE
9G �sr.�ha� d� \ __ ��taa r Application number.... .J.1..�.....1..1. Date Issued. i1xin `•M P NAM 1639. ,0� APR 042019 Building Inspectors Initials...........a............. f OWN 1DrFon��° O� BARNSTABU Map/Parcel........03.2..A,.9................................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHEMATION PROPERTY INFORMATION Address of Project: /I& Fi Se,1 A o W e 1- ��i Cd�v;f NUMBER STREET VILLAGE Owner's Name:_Camay Dve/e elfe Phone Number 5 y 9-- z12 f -0D 5/ Email Address: �;r�nvov ( �co,.-,c4s�.net Cell Phone Number Q 7�- 9 3 s=8 71 Project cost$ �q q 8 Check one Residential v11 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: S e A4E c. Q C' -k -�- Date: TYPE OF WORK Ll Siding U Windows (no header change)# Z ❑ Insulation/Weatherization Doors (no header change)# Commercial Doors require an inspector's review J Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION _771 Contractor's name (�t�an `��n.��so� - So 2�n 4k1J IFrSIrva �i'�dows Home Improvement Contractors Registration if applicable)# 17 12-Lh (attach copy) Construction Supervisor's License# O J S`7 07 (attach copy) Email of Contractor 0&Jee- 9 q.5(6 Phone number L10I XDD ALL PROPERTIES THAT HAVE STRUCTURES bVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS.11V A HISTORIC DISTRICT, YOU MUST OBTAIN H15TORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. A 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 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-4:30prn. Commercial events may require Fire Department approval _771 *WOOD/COAL/PELLET STONES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEIv PTION 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 PLICANT9 S SIGNAATUUML Date Signature All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document and Payment Terms .' byAndersen. dba:Renewal B Andersen of Southern New En and y gland Ginny Ouelette Legal Name:Southern New England Windows,LLC 196 Eisenhower Dr ���i RI#36079, MA#173245,CT#0634555, Lead Firm#1237 Cotuit,MA 02635 WINDOW pE IACEMENT 10 Reservoir Rd I Smithfield,RI 02917 - N:(508)428-0051 Phone:866-563.2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:(978)935-8171 Buyer(s) Name: Ginny Ouelette Contract Date:_03/22/19 Buyer(s)Street Address: 196 Eisenhower Dr, Cotuit; MA 02635 Primary Telephone Number: (508)428-0051 Secondary Telephone Number:.(978)935-8171 Primary Email: 9lnnyou 1 @c6mcast.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 incorpporated herein by reference(collectively,this"Agreement"). , Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: .$3,498. 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: $1,165 Balance Due: $2,333 Estimated Start. Estimated Completion: .6-8 weeks 6-9:weeks Amount Financed: $0 Method of Payment: Credit.Card We schedule installations has on the date of the signed contract and secondarily on Cash/Check 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: Permit in Barnstable 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.B Iyer(s)hereby ackn.owledges 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 blank.You are entitled to a copy of the.contract at the time you sign.. o YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT. OF 03/26/2019 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:RenePyAndersen of Southern New England Buyer(s) Signature of Sales Person ' Signature Signature Jim Passasnisi Ginny Ouelette Print Name of Sales Person Print Name Print Name UPDATED..03/22/19 Page 2 /9 9 , Y Office Of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS. LLC Expiration: 09/18/2020 10 RESERVOIR ROAD SMITHFIELD, RI 02917 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Sumlement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Reo_uiation 173245 09/18/2020 1000'1Uashington Street-Suite 710 SOUTHERN NEW ENGLAND W INDOW S.LLC Boston,MA 0211r8 BRIAN DENNISON - 10 RESERVOIR ROAD SMITHFIELD.RI 02917 Undersecretary vvt van Without signature F V o 1m`V'n 4'{eall".7, of I,!�1d..✓�3'J:���✓J���4..J oar ¢ t�=� 9; ? E ulations and �-andai lj u011S : i •JU 0Jai.. S99.'`-`w.rlv1 50I I RIAN ® ®E NISON Mfr 8 BLACKWELLDRIVE F ti CHARLTON MA. 0 1507 ��� The Common wealdt of Massachusetts �'- Department of Industrial Accidents I Con;ress Street,Suite 100 a Boston,MA 07114-2017 www.mnss.gov/dia lVorkers'Compensation Insurance Affidavit: Builders/Contractors/Blectricians/Plumbers. TO BE EILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leaibiv Name(Businesslorsaniration/Individual): Address: City/State/Zip:&q t -�elc ,??! 0ZQ 17 Phone#: 40/—ZZ1 R-- ? ff-0 y Arryaa i:employer?Check the appropriate boLType of project(required): a employer with �-t employees(full and/or part-time).* 7. New construction 2.�I am a sole proprietor or partnership and have no employees working for me in S: Remodeling any capacity.[No workers comp.insurance required.] 3.711 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9• ❑Demolition 4.0l am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.Q Electrical repairs or additions proprietors with no employees. 12.[]Plumb ing repairs or additions 3.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.' 13. Roof repairs 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.,610J Other &j,i t C//,o 152,§f(4),and we have no employees.[No workers'comp.insurance required.] r&e/Q c<,-. P�►'1-� *Any applicant that checks box 91 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. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. lain an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. /J 11 ee rr//)� Insurance Company Name: (lrSLell L2AAP C.O , O YVf�, !�, (, , Policy#or Self-ins.Lic.#: VV(2 A 3 [5 g -]Z.cl L Expiration Date: !' I—2-0 Z.O Job Site Address: Cc,�Pn`i�wer /Dr City/State/Zip: �Tv,' /17A Attach a copy of the workers'compensation policy declaration page(showing the policy number and ex iration date). Failure to secure coverage as required under MGL c_ 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. f do hereby certi under the poi d penalties of perjury that the information provided above is true and correct Signature:.- Date: Phone#: r7��7gU 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#: i ..ACC?Ra CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) 1 12/28/2018 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 CONTACT CoBiz Insurance, Inc.-CO NAME: 1401 Lawrence St., Ste. 1200 W N o xt: 303-988-0446 ac No:303-988-0804 Denver CO 80202 E-MAIL ADDRESS: COMail@cobizinsuran(;e.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:FlremenS Insurance Company of WA,D.C. 21784 Southem New England Windows, LLC. dba Renewal by Andersen of Southern New England INSURERC:Homeland Insurance Company of New York 34452 10 Reservlor Rd INSURER D: Smithfield RI 02917 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:787175890 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLISUBR WVD . POLICY NUMBER MMLDD�Y MLDDNYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a OCCUR PREMISES Ea occurrence $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 MX 'L AGGREGATE LIMIT APPLIES PER: PRO GENERALAGGREGATE $2,000,000 POLICY❑JECT 17 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ 4 AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 EOMBIIN�ED SINGLE LIMIT $ent) 1 000000 X ANY AUTO I BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Par.... $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15.000,000 EXCESS LIAR CLAIMS-MADE' . AGGREGATE $15,O00,000 DED I X I RETENTION$ $ B WORKERS COMPENSATION INCA315972924 1/1/2019 1/1/2020 X H- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ NIA E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 Ii yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 7930073340000 1/1/2019 1/1/2020 Each Occurrence $2,000,0D0 Claims-Made Policy Aggregate $2,00D,000 Retroactive Date 06120/2013 Deductible $2,0000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN r ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD * l Town of Barnstable Permit# 20 b 1� u J (q Expires 6 months from issue date Regulatory Services Fee snst M131.E KAS& Richard V.Scali,Director Building Division ' 3vt� Tom Perry,CBO,Building Commissioner JUL 17 2015 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us f®WN OF BARAISTgi c Office: 508-862-4038 Fax:508 79:0-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 0 3 y % ' Not Valid without Red X-Press Imprint Map/parcel Number Property Address �I. t7w ey ❑Uesidential Value of Work$ QU0 vd Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address O a n G A1,4 4. v e Ile H,e, 5 CIJ-eh lieu>Pv Al. ('o-uo41 N4 0Z6d.' Contractor's Name 14 r Z 5 ' % '-)1Nq /'Mh OZ- Telephone Number C, A P i.11 Wnvvii-:Tkn P0Je 1RP1'i TAIL Home Improvement Contractor License#N(if applicable) ! U yt 7 y® Email: �7i m L Cap' ZZl do we� C u P% Construction Supervisor's License#(if applicable) C IzWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑,I am the Homeowner [�( I have Worker's Compensation Insurance Insurance Company Name A Al G U At?u a d d l)AA I& L Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side [I]r Replacement Windows/doors/sliders.U-Value 0,2b (maximum.32)#of windows rIvia r Lld sI'de IijV1,pfdoors: .2, f4l�Af e ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: ce, C:\Users\Decollik pData\Local\Microsoft\Windows\Temporary Internet Files\Content.OUtlook\2PIOIDHR\ExPRESS.doc Revised 040215 t Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORff,ZATffON TO APPLY FOR A BUILDING PERMIT I/WE,61\t4 yc ��.l�`� , OWN THE PROPERTY LOCATED AT IN , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT.TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FORA BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: . - OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: - APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: . - .. The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 1 Congress Street,Suite 100 Boston,,.M 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians. lumbers Applicant Information Please Print Legibly Name(Business/organization/individual):'CAPIZZI HOME IMPROVEMENT,INC. Address:1645 NEWTOWN ROAD City/State/Zip:COTUIT, MA Phone#:508-428-9518 Are you an employer?Check the appropriate box: Type of project(required) 1. I am a employer with 40+ 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 orpartner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors.have g, ❑Demolition . , working for me in any capacity. employees and have workers' : 9.1 Bu1 'din additi on. [No workers' comp.insurance comp..insurance.# ❑ i g 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`. . ' l 1.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.SZther7 pairs insurance required.].t c. 152,§1(4),and we have no employees. [No workers' 13: D 66 comp.insurance required.] ; *Any applicant that checks box 41 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. lContractors 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 isproviding workers compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AmGuard Insurance Company Policy#or Self ins.Lie.#:R2WC527200 :Expiration Date:12/30/2015 Job Site Address:. r City/State%Zip: 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 orie-year'imprisonment; as well as,civil penalties in the forrri of a STOP WORK ORDER and a fine of up to$250.00.a day against the violator. Be advised-that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u er the pal s and penalties o perjury that the information provided above is true and correct, . Si mature:', Date: Phone#: 508=428-951.Y Official use only: Do not write.in this are to be completed by city or town official City or.Town:' Permit/L icense,#, 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#: .31 42•-2014 16:49:00 Gwrd Insurance Guard Insurance Group 1/1 acaRo� CERTIFICATE OF LIABILITY INSURANCE °�'�'��°°"'"" 12 30 014 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 policypes)must be endorsed. H SUBROGATION IS WANED,Subject to the teens and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER COMACT NAME: ROGERS&GRAY INSURANCE AGENCY,INC- PHONE IFU o (AM,No); 434 Route 134 INSURER AFFORDING COVERAGE NAIL 8 South Dennis MA 02650 INSURER A: AmGUARD Insurance Company INSURED INSURER a CAPI22I HOME IMPROVEMENT INC INSURERc: 1645 NEWTOWN ROAD INBURERD: INSURER E: COTUTT MA 02635 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 YV"GH 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 DF SUCH POLICIES.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ LTR TYPEOFINSURANCE POLICYRUMBER MMN PMIDD L9NIT8 GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL UALeLRV DO RErITE PREMISES oecurrenw S CLAINS•MADE OCCUR MEO EXP(Any one pv ) $ PERSONAL BADVINJURY S ° GENERAL AGGREGATE 3 GEML AGGREGATE UMUT APPLIES PER PRODUCTS-COMPIOP AGO S POLICY PRO. LOC S AUTOMOBILE LIABILITY COMBINED I G I S M N� ANY.4UT0 WDILYINJURY(Per oemon) $ ALL ONNED SCIffOULED AUTOS AUTOS BODILY INJURY(Perawdenl) 3 HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOSS acddmll S UVORELLALIAB HOCCUR EACH OCCURRENCE 5 EXCESS LIAE CLAIM&MADE AGGREGATE 5 DEO RETEIMON3RS 3 A AND�PLOI�ERSEU IurNSAMpr YIN R2WC527200 >a/25/2D14 12/zs12T15 X Y�BUMrrTATU OgR TH ANY PROPRIETO"ARINERiEXECU IME NIA EL EACH OCCIDENT S 1,000,000 OFFICERMEMBER EXCLUDED? (Mandatary in NH) E.L.DISEASE.EAEMPLOYEE S 1,000,0011 ! ude Des FP E EL DISEASE S 1,000 OOOS6ONO f k i 1 r E L DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Atlach ACORD 191.Addllim l Remarks Schedule if mare coca Is m Wred) Thomas Capizzi It is covered by the workers compensation policy. i 1 i CERTIFICATE HOLDER CANCELLATION - s Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hyannis,MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. j AUTHORMO REPRESENTATIVE i k 9)1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201010S) The ACORD name and logo are registered marks of ACORD < .. ... . -- - -- --- -- ---- -- -- -. - -- ... . _ard Of 6trfld,nr Requ?aiio-s and ConSCrt,�t`tYun Jallcrci•rn�, License: C5-076261 M i �`"'I t'T s Gl JAMES MCCORIVI•ACIC, 73 FEARING I LL RID 4 West Wareham MA 02576 1 :�3 t(31ss:on 11113/2015 �e n�ie�nn�eruealr/-laKlr.tac%areCf o lee 0i Consumer Affairs&-Business)Regulation ]License or registration Valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office,of Consumer Affffairs.and Dusiness Regulation .egistration: 100740 Type: 10 Park]Plaza-Suite 5170 Expiration: 6/23/2016 Supplement turd ]Boston,PAA 02116 CAPIZZI HOME IMPROVEMENT,'INC. JAMES MCCORMACK 1645 Newton Rd. Cotuit,MA 02635 'Undersecretary Not valid without slana`ure f s W� K *Permlt# Fs, Town of Barnstable o Expires 6 months f .m issue date Regulatory Services Fee uxirsTnsLE, Thomas F. Geiler,Director v Mass.. �p 1639. Building Division rEo May° �i( Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA KM I www.town,barnstab le.ma.us Office: 508-862-4038 ~ y Fax: 508r790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number r Pro 4Address 1 � ` 5o'\� Residential Value of Work_ Minimum fee of$25.00 for work under$6000.60 Owner's Name &Address 'l Contractor's Name MObv\ W bC __ Telephone Number Home Improvement Contractor License# (if applicable) �, a k .�R � .> 11P11CI,6 ' ❑Workman's Compensation Insurance Check one: S E P 1 1 2008 ❑ I am a sole proprietor RI am the Homeowner TOWN OF B/ RNSTABLE —I have Worker's Compensation Insurance Insurance Company Name Workman's Comp: Policy# Copy of insurance Compliance Certificate must be on file. Permit Request(check.box). ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ side Replacement indo sMoors/sliders. U-Value 3( (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 11ome Improvement Contractors License is required. SIGNATURE: cw� Q0,TFILES\FORWS\building permit forms\EX?RESS.doC Revise020108 I The Commonwealth of Massachusetts Department cf Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ww•tv.mass.gav/dia Workers' Compensation%snrance Affidavit: Builders/Contractors/Electrician.s/Plumberg A licant Luformataien Please Print Le 'bl a1rie (Business/Or�aniT�tion/Individuap: (�6 Y� '-I S S Z)c j;,1 G 6 Address: �� 7 ear K C�S�— City/StatelzYp: �D��ot r—,2 t y2 mpnone.#: 7/ AM you an employer? Check the appropriate box: 'Type of project(required): 1. I,am.a employer with 1 4_ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have lured the sob contractors 2_❑ I am a"sole proprietor or pactntr- ]istcd on the attached sheet 7. ❑Remodeling ship and have no employees 'These suh-contractors bave g• Demolition loyees and have workers' working far ma in any capacity. cmp 9. ❑Building addition comp. [No workers' cOp.'m�ttranrC insm Ill -anct%t S. [] We arc a corporation ct and its 10.❑Electrical repairs or additions rtquiml] officers have exercised their ILL]Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself [No workers' comp. right 6f exemption per MGL 12 ❑goof repairs ir,cnrancc r 1 c. 152, §1(4), and we have no egnzred] employees. [No workers' 13. Other comp, inmmr-ance rcquired_] (,tf F/�tNS *Any applicant that checlo:box#1 matt also fill out the section below sbowing their work='coroprnsef?on policy infornation_ t Hon=wnc s who submit this affidavit indicating Huey=doing RE work mid thca hire outside contractors must submit anew aEdavit indicating such" tConfractors that cbxk this box mast atiacbed an additions]sheet showing the name of the subs mtrctnrs a and state whcthcr or not those entities have anploycrs. 1f the sub-eontmeton have eroployccs,.they must provi&the r r�rkris'camp.policy number. l am an employer thod is providing workers'compensation insurance far my employees Below is the policy and job site ' enfarmafwn. .. • Insurance Company Name: Policy#or Self-ins.Lic.#: . � Expiration Date: ` y Job Sitr- Address_ ` I li � �r r ° city/statc/7sp: C o �� `C 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 rri,,,irial penalties of a 'E up to S 1,500.00 and/or ont-year imprisonment, as well as civil pcnaltics in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised Hiatt a copy of this sta ma y ay be farwardcd to the Office of In_vmti unar the pafns•andpenalda ofperjury that the inform lions of the DIA for 7ns,Tranre coverer e veiification. Ido,hereby cerfrfy nddationpravidPd above is trete.and correct Phonc#k O fuial use only. Do.not write in this area, to be completed by city or town offccercL City or Town: Permit/License# Isstdag Authority(circle one): 1.Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector 5.Plnmhiug Inspector 6. Other Phone#: Seta 0:_' 06 C7:5Ba Michael Bedard 1-401 -2,` 28 S �. - „w_._„,._a_.,.., 9r17:'07 1:`..:'.PW 1:,.1..-' .' F;om.Shan--na=3ti IsOn:hl-rtt:r Insurance f\t:Hunter Insurance,Inc. FaxID: To:Denise _ r-� -- -fl P ID C. -- ax ;l � �.>�� . GI ' -FIFIG TE OF LIABILITY INSURE M'_31H _ N: .. , - TH15 C3ERTIFICATE 16 ISSUED AE A MG:TT'GiR OF a`uucan ONLY AND GONFER6 NO RIGHTS,UPC-N'I''r1E CERTII iC.''.T F -- - - _— _- - HOLDER.THIS CER-nFICATE DOES NU'T',NJAEFIG,EX:EI CI ill'. sr.te.- 2->vrarcF Inc. ALTER THECONJERAGEAFFORDEE)By r HEPOUCA`7 i.l'1:I' 99 Old 7.1%,e Rr,:rac;. $.G, sox i _......__ tf.�nv`l.le ZI 028:1:3--000_'. ?hon..t 41 f;9._g ..]) H'3:""[:401--769-9502 fNSURERSAFFORDINv'COVEiFiAGl3 --.-'—_'.—---- --- -- IINSl1RERA tt.Elon•1 ar.nR. am I m. q USUREO C)N INSURER B H�aeen tlu:�.l IneuYan c_. .... :.18.4 Ou ti::•=T FIo%1L''."-°!� INSURER C' - :.a;?; Lune ua b, Xnde=sen of R= rvstraERD. --' I1:TOCk^t P-T C 289E INSURER E: ; :IE . I-s ED BEL vl'WAVE BEEN ISSUED TO THE INSURED NNAEO ABOVE FOR THE POLICY PERIOD'INDIC }P ryT,+' ATEO.NOTVVI;TiSTA+IJIW�: IIr ANV R=:x:,E�.__It%FWJC�'IPIT n.7tl D4:.(":NDR10N•.1P/YJYC-.07RACTOR OTHER DOQ?.IC-NTWTH RESPECT To THIS CF37TIFt�Ei' MAY BE ISSUE!J OR 66:Y EH AR --IE vEl,uxur c.+F FOP.OEGpti TF+E?DLICI'c50F5CFtlBED HET:EIN IS SUBJELTTO ALL TETERMS,Exn_USIONS ANri CoNOITIOPhi OF S.ICL•- --_--- - POUL C . A.[o£ 7 Ll it' ?H)WN 1dA e I IAVE.BEEN Pc0VCED BY PAID CLAINLS .RCpEtF,1fZAY1DF L0[' 5R CrE — POUCY NUMBER DATE I WMDDIYYI DATE 0WIDD1Yr - �_TF< N...C 'YFE�F0.aU9A�NCE FACri OCC JF:rlWCE GE2.Rf1'. .f �Ufl.7 IA }C _DI::.(-ad v,•<;.'T'r-1mt.lver.lTY LQBS26619 09I16/07 09/16/DEI PRFD.tISE:(Et-.-.c l_-_ r,F3)EXP pw pwu:x:nl i ICI[I•l it PEF50NN;&^dIav IlUA;r ; .1 f-I Il 10 CIIERAL Ap.-?ISrp.TE t ?'.0'.7_1 C C7 ...... - - U1 1 .. GE La. I _ — _. __. kCT_1.1 jl_E tIArvi:-n' GCIkrB`.NEI�51.^;L4 UIdU 09/16/07 09/16/011 (E.-,nc lEenll 1. N.`A'JTI) 81$26619 .._.—.— .- .°Ll T.vA4:J•;l^OS BCY7 f ILY IPJW°' tear pMson) 'lIR- BDJILY ,DALR0$ IM.4.,'.—__.__.. ........... .. BO ecciEnnl RFt3FK_RT'r C;tluA'aE ' i I�rr a¢cknMJ _—j..— -- — -- AUrO ONLY-6.1CCIICENi -G FAGLi LJIBILITY _ O'rdEl?TrIAT: .NI nnD ,WJTDOM.Y• :.C}Lll E?-r'i st xj.7BRE1.:.:.L'ABIUTY 09 16 07 09/16/0S AaGREGA.TE T A 2C nc:Lr I_�Clp.n-W o.V+DEi CLl$26619 / / l 0E)LCfU3LE _ - S .. .i _Ix_`RE:'E:Nntw ,510'004 - ' '-- � 1lrrt�CCM' NmT1t.NAbtD-- 70R LII-IIS L_.1 - _ .- E'tf-CIE;?�IP.EIILT! 28G86 10/01./07 10,1DI/09 E!. EAC tACCLENT B J!r P9)r TIF.'C%NP,N''N[X1'xE',Iff ve O ExCL---.]E':37 E'_ D16E.aE-EA EMPLO*I ! p 0- J .._ ,c rra,duscntu wnl�r E.�_.615E:A;'E FC>1.IC)LII,.I- f -aL SIJOLW.=RO'd IuIJIaS b:.l,�r DESCF P•T'ON C�O:-ERAn-0hb:LL'nD:1S I VEHICLE.(EXCLUSIDNs ADDED BY NDp 6EMENT!SPEClkL PRDASF i GtR".'1='CD'EI nl"L'Er; CANCELLAT.'iON. •-- ""— - MORASS SHOULD ANY OF THE AB OVE DESGRIBEU POL1C 2S 912 CAIJCELIY_':Bh if I q i x I DATE THEREOF,THU ISSUING IWSVREFt VALL FHDTdrVORTO hSIt!L �tC011 =Iz0ai81;0S r Inc - - . dt. Ou;:,'P-.r I�:':T.T11et NOTICE TO THE GERSIFII AT1?Fi1LDEli N1 aIED TD Tiii LEFT.BVl dia TC4?1:BT4Z5�. `-.)g I d¢=Se1h IMPD6,E NO OBLIGATION OR LIABILITY'OF AM I':W7 J•JT17F,E 114E 3I 14AGL - [ 1-a 1 5 a_. Za•ot Mi've: WEortsr,::[DC RIC 020p$ A EPRESENIATNE 7 — �- .t tl t;t finilding Resufations:;nd StandardsHOME- IMPR I CJVEMENT CQN ' RACTOR k6giStratio119535 1.may, ,�, i 11953 7/24/2009 . Tr# 130185 TYPO Private Corpc,'ration �.., JAME 1 1 PARK f"i-AST opm i I f Adininistrator rf A PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 09;11/08 TIME: 12:24 PERMIT $ PAID 25.00 AMT TENDERED: 25.00 AMT APPLIED: 25.00 CHANGE: .00 APPLICATION NUMBER: 200805042 PAYMENT METH: CHECK PAYMENT REF: 363 L - �a�7 Doi vv." oa ✓�n6iy�,9 t, 0U,&Le-rzT7r Customer Name b�A.7 L Year Built Renewal Address: 194 91 J JCA Nd V&2 Dh. Customer ID#: Renewal by An Driveersen of RI&Cape Cod Sales Agreement i l37 park Ease Drive bYAndeTSen. City,State,Zip: C 0 ✓ %`70 11�?!� Order Number. Woonsocket,RI 02895 WINDOW REPLACEMENT —And—Compdsy Phone-Homo��' �/��`-ODr/. license#RI 12259-MA 119535-Cr Phone-Work: Page: of Date: ZZ"d� 0562725 Email: UNITS T«hnical Measure, GRILLES DimeraioM _ o ��5e Qe D m.-._ Qa .L e g S �ie1 #S g °F" v. ; 9�. �! FI tC S k t �_ c `e5 0a og a f� �a yep� . DlSQI � # Enu m 9 Ore. N _ ri E '�a a A Qa E' S fr. N$- N7 N7 VIAL7 CI E PRICE E Jr s ,L . x l D13 I T o. 1 Coe »Yrw I S S . c 1 DB I )�p 0., cow ikp -ST9 '3 3 Yg p ll T7 P ? 0 0 q Oro .l 2-7 61, 6/ A'i wc*rl ZY 10 a � 7 Sub Total stern Proposal•Au of the above dooa to for me toftt anromt ataud its roe ale _ Payment propoad valid 3o v sub' by both Customer snd Renevml t nr.e.8ee a (So+na,geaCOp,RoC epaira°promodm;arc) Y►n .Method tal P A,S C Desaipdm/Noaen /� / Epnce� SuSub Total 0Few LDaft . ,� SubTofalunrp s. ❑ � Cl S.. •Yon ne berby nwbo�d to lumiab all vnndovm.od Boats m9 m Mice Credits or EltpetKK Credit Card - .gie®mt forvrbib agrees ft Par the omwm suftd is ddr aygcmeor.od rrnadmg to re®a bueoL D See Reverse Side for Terms and Conditions of Sale.You,the buyer,may cancel Total ❑ F..dny this transaction at any time pptior to midnight of the third btasiaeae day ashen the date of this transaction.Please see ap4ched notice of cancellation for an Sales Tax dBm dears®y explanation of this fht. Toni Miardlanmw CreditsE or . lJ � (oe,T wv mml m mLc ardir exPeox aol dg6t) Work Perndt Cost / AdmtlmY Order remsAtesdad Dnee paoval Signaoue (WasvdrdaastAstrrppl» ,, , Special Order Noes TotalAmountofAgreenent - Z Pasooaar sarmooar Ea"War noap� Daft R-malby And—MeagerSignanae S[�XA /494 Q k,-9 yl n. ALL LA&-J.'Z_ Deposit Required / 7 asp d nrrr"— f painena stakdrg Orr PnreerbyAndeam ReawMardminnobt- reaareantaeweasblefthid an rtpafias ry 2'/A LS /9AQ /,}/�'.�un 7 Balance Due on lotion . "vwl''Ipapahg.mdr aay Oros:no"t tee the drAnaovr Ore ay meeardarege Hwvexr,H aryseseea da�age �7' K; �ro be nad�Vhmthdudrd flt of wgow whitlow taleo'Mensprs6Aar al hdtraoreM duag heteOaCw,wewN aanplea in adsa)eeaa�udaa mrea�arm�uda rase oammaaiess end dregp you brae rtpe6swmyae appoal. C-CLq l.0 R Price includes labor,nonerlais,instsBadon, spedsmry naed abm Oreawated oaindse rated At NerM orthelrb e0 arubud6n dearb vAl Ore - - rer—d ad we A deanyac—i duas a d VVlnift•Renewal by Anderson Ygow-trt;W ation Pink-Ha reowner ��.atd disposal of prod—replaced, . tLstonrer „ Cusboma customer _r�. the I saaadm r M f s x " a 11A TO TWO iLIv < j Ill ... r', L � ` WIN Town of ]Barnstable .*Permit# �plqess r w Expires 6 months from ' e date E 1r Regulatory Services Fee c 2OX 'Thomas F.Geiler,Director OP Building Division omPerry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Addressnit ®,Residential Value of Work 40 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address dW 1 ` off, e q— Contractor's Name Telephone Number 35 Home Improvement Contractor License#(if applicable) 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 Workman's Comp.Policy# 7 i 40 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. 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 Fetter of Permission. Impr _ ent actors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 Fraser Constru c t l®n Roofing & Siding Specialists P.O. Box 1845, Cotuit MA. 02635 Email: fraser constructiongverizon.net www.fraserroofing.com Phone 1-508-428-2292 & FAX 1-508-428-0123 RE-ROOFING PROPOSAL DATE: June 12, 2006 NAME: Mr. Robert Ouellette PHONE: 508-428-0051 ADDRESS: 196 Eisenhower Dr. , Cotuit, Ma. r .� 02635 FRASER CONSTRUCTION herby proposes to perform the following services in a neat and professional like manner and in accordance with the manufacturer's specifications and local building code. -Remove and Haul away all of the old asphalt roofing shingles -Re-nail all plywood sheathing as needed. Supply and Install - CERTAINTEED XT AR- 30: 30 Year Warranty, 5 year sure start protection, CLASS A FIRE RATED, ALGAE Resistant, Extra Heavy Weight, Self Sealing, Multi- Layered, 3 -Tab, Fiberglass Based Asphalt Shingle with New England's Exclusive COPPER/CERAMIC Stones with a Full 10-year Warranty against ALGAE Containment. Color: Supply and Install - CERTAINTEED LANDMARK AR 30: 30 -Year Warranty, 5 year Sure Start Protection, CLASS A FIRE RATED, ALGAE Resistant, Extra Heavy Weight, Self Sealing, Multi- Layered, Architectural Style, Fiberglass Based Asphalt Shingle with New England's Exclusive COPPER/CERAMIC Stones with a Full 10 Year Warranty against ALGAE Containment. Color: Supply and Install - CertainTeed Winter- Guard: (ice & water shield) Waterproof Underlayment System (3ft. on eves and valleys, 18" on rakes, walls, and skylights) Supply & Install - Roofer's Select Underlayment Paper (recommended by CertainTeed) Supply & Install - Hick's Ventilated Drip Edge. Supply & Install -Aluminum & Neoprene Soil Pipe Flashing Supply & Install-Air Vent Ridge Vent (recommended by CertainTeed) Clean & Remove - Debris from work area daily. TOTAL INVESTMENT: XT AR 30 $7,600 LANDMARK AR 30 - $7,800 2% discount if paid by cash or check 2.5% senior discount X4 Star Warranty Upgrade will be applied if proposal is signed and returned within 10 days. (see enclosed-brochure) Payable immediately upon completion NO MONEY DOWN - NO Payment at the start or part way thru Payments accepted are: CASH - CHECK- MASTERCARD -VISA-AMERICAN EXPRESS * Any payments not made within 30 days of completion will be charged 1 '/2%for every 30 days the payment is late. Possible Extra- After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation is not up against the plywood sheathing preventing ventilation fr e es to the ridge. If it is, ventilation panels will be installed by; remov' ood sheathing, installing the panels, turning the plywood over an r -installing the plywood. If needed, this would be charged for as an xtra at the rate of$4.00 per panel including Materials & Labor. There are 6 Panels per sheet of plywood. Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other needing replacement will be done and charged for as an extra at atet$45.00 per hour, plus materials, plus 20% overhead mark-up on total extras. Y Y FRASER CONSTRUCTION Warranties the labor for 10 years FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. CERTAINTEED Warranties the shingles and labor 100% for the first 5 years, and then on a pro rated basis for 30 years total if the shingles become defective. CERTAINTEED Warranties the shingles to be ALGAE resistant for a full 10 years. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not-accepted within thirty days may withdraw this proposal. , FRASER CONSTRUCTION: Carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: SUBMITTED BY: H meowner Fraser Construction Board of Building Regulations and Standards License or registration valid for individul use only HOME IM.,7AOVEMENT CONTRACTOR befos i the expiration date. If found return to: ` Beai,.I of Building Regulations and Standards Registrafiii i 12536 One Ashburton Place Rm 1301 Ira�l04=312-W2007 Boston,Ma.02108 FRASER CONSTR17to DEAN FRASER � � r 71 TARRAGON CIR COTUIT,MA 02635 Administrator Not valid without signature CNN i e uommonwevim oj massacnusens Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, M4 02111 ••` www.mass.gov/dia Workers' Compensation insurance Affidavit: builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/lndividual): Address: ox City/State/Zip: - Phone #: ' Are you an employer? Check the appropriate box: 'Type of project(required): 1.EYT am a employer with 4. ❑ I am a general contractor and I 6. employees(full and/or part-time).* have hired the sub-contractors 7. ❑ New construction 2.El am a sole proprietor or partner- listed on the attached sheet. $ El Remodeling ship and have no employees These sub-contractors have 8. CI Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner do;ng all wor1. k right of exemption per MGL 11.[] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12,❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.' t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their wormers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and,pob site information. II Insurance Company Name: l r Policy#or Self-ins.Lie. #: yX 6 lO S� Expiration Date: le,) U� Job Site Address:_ �� SG Sf City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500..00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unde ains and enalties of perjury that the information provided above is true and correct Signafore: Date: l/ Phone#: Official use only. Igo not write in this area,to be completed by city or town official. City or Town: PermitlLicense# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.4CitylTown Clerk 4.Flectrisai inspector 5.Plumbing Inspector 1� 6. Other j Contact Person: Phone 717: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or . renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. United Liability Companies q—LQ or T imited Li6bility Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fixture permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture t to burrs leaves etc. said person is NOT required to complete this affidavit. i.e. a do license or error ) p eq mp ( g P The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. : 617-727-4900 ext 406 or 1-o77-MASSAFE Fax #, 617-727-7749 6-05 Revised 5-2 ww-w.m2ss.gov/cia CERTIFICATE OF, LIABIL TY I��� 4 CE o9/22/20 5' PRODUCER (508)588-1260 FAX (508"588-Y236 THIS CEF�=IFICATE IS ISSUED AS A MATTER OF INFORMATION Wise & Quinn 16sur.ance ''Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 449 Pleasant St. HOLDER, NiIS CERTIFICATE DOES NOT AMEND,EXTEND OR I ALTER THE :OVERAGE AFFORDED BY TIME POLICIES BELOW_ Brockton, MA 02301 "— CISR, Paul Crowley INSURERS AFFORDING COVERAGE NAIC# INSURED Dean Fraser INSURFRA: Hartford Insurance Company DBA: Fraser Construction Co. ;INSURER 71 Tarragon Circle INSUR'I—R C - Cotuit, MA 0263E-2443 [INSURERD; 1 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T HE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT`dIIITHSTANDIN( ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUNIENT'WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHO;NN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDIL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONNSRr LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL L"ILiTY � DAMAGE TO RENTED S ( PRFMAPq. CLAIMS MADE Q OCCUR MED EXP(Any one person) 3 PERSONAL a ADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1 ALL OWNED AUTOS I BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS I ") BODILY INJURY $ NON-OWNED AUTOS ( (Per accident) I PROPERTY OAMAGE (Per accident) GARAGE LIABILITY ( AUTO ONLY-EA ACCIDENT $ ANY AUTO I OTHER THAN EA ACC S I AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR !_.__.I CLAIMS MADE AGGREGATE S DEDUCTIBLE S RETENTION S 3 WORKERS COMPENSATION AND 6560UR-794X619-1-05 09/26/2005 09/26/2006 X WCSTATLM OTH- EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT_ 3 500,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under SPECIAL PROVISIONS kelow E.L.DISEASE-POLICY UMIT -S 500.000 OTHER ) DESCRIPTION OF OPERATIONS I LOCATIONS I VEP+lCLES I EXCLUSIONS ADDED BY ENDORSEIP.ENT!SPECIAL PROVISIONS in the operations usual to carpentry. CERTIFICATE R Aid L TI N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA-TION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 D WE WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Fraser Construction Co. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 71 Tarragon Circle OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Cotuit, NIA 02635 AUTHORIZED N� vE c' ACORD 25(2001/08) FAX: (508)428-0123 OACORD CORPORATION 1988 CAA /TAAM- Assessor's office(1st Floor): C Assessor's map and lot number o 9 -r I f' ` ' c� �,; Qyoi TwE toy` Board of Health(3rd floor): /_ ���� ®�� d� w Sewage-Permit number r Yj COMP IAA Engineering Department(3rd floor): e ��i +µp��®F,•�7,� WITH TITLE 5 � Dsa1639- L Z y. [ �DiiV�@i'4�u irk v.z�.���. 7O YYi House number. TAL CODE AN c,��a}o.6\��' Definitive Plan Approved by Planning Board 19 . k' i:- ...m �pnn o Mtr APPLICATIONS PROCESSED 8:30-9:30 A.M.'and 1:00-2:00 P.M.only. j TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 01' j L Y 1 Q TYPE OF CONSTRUCTION � C� w6 C3 C� G(� t✓if `� S2 u(h C4 �y f�' S O fs Vj 6f OVA r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1 V L2 i� i_S 2 1n � D L4-, e P- J.J Y'. Proposed Use -)541 Zoning District ' ` r Fire District t�liel�U/ Name of Owner Q u L Le- -�e Address g �� i,.S e k-► C Av i t. Name of Builder, t Address �y t') FS ���'[ !"1 q-� PC Name of Architect Address Number of Rooms In Foundation CE vuC ref P Cje4 Y' � 1`f i h �1 _L S Roofing Q _S lL_A f 7- �,�� ti Exterior- _ � �� /r Floors �� � wee Cci r 'D e eel y Interior 131� s i`�`2 e �✓C Heating�n C �' y l!L G 'j Y� Plumbing Fireplace h w C- Approximate Cost #0 d c, Area—1 Diagram of Lot and Building with Dimensions Fee Lb 1b e � l LA 17 � P C i S e ►� Y l o t e.� V- i v e 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. Name Construction Supervisor's License b �S OUELLETE, MR. r+ ) CRC - ' No -34286 nPermit For Build Addition, Y r } rSingle}-Family:*-Dwellifig Location 196 Eisenhower~-Drive - - cotuit y Owner.-::Mr- -Ouel-lete Type of Construction, Frame'_ F Plot i Lot ..-.•. 1. 1 r , ". _ f. Permit Granted >• Apr i`:-,z 2 3 �., r 19 91 .r a 1 r '� ' Date of In '� ;19 . •.. 1 / , a _� . .f • `P Date Completed 17 s F..« A' • *"';o, •r.*, c,.. tf,n`�.-^*....a.r^"7 .:.-i,..+..r"ri ,,..:�.',�,k•r`"`-T--� �1^r+. - - .... � n-•.�,,,... ..a^�.+.5i�,.,.,..m+P..c^•,-,�... ,r•.-..ter u-%3y,4 }. v f . Assessor's office(1st Floor):, p Assessor's map and'lot num bar D 3 ! � Qyp*THE tp`` Board of.Health(3rd floor): Sewage-Permit number 17 J DASl9SdDL i Engineering Department(3rd floor): / .� Y nus House number 6 '� °o a6}9• Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:60-2:00 P.M.only TOWN OF BARNSTABLE . BUILDING INSPECTOR APPLICATION FOR PERMIT TO j L TYPE OF CONSTRUCTION WC>©C� C O h C it t-4: SG u In G LU I e S �U Vj q _i dt,\ V I L^ l 19 — , TO THE INSPECTOR OF BUILDINGS: `p The undersigned hereby applies for a permit according_to,the following information: Location 9��9 I J e VA b o (.v e ;- 1 J►" I� Tu t I�, AV Proposed Use Zoning District Fire District 0a77U/T Name of Owner M�• O f t L L e. E' Address I i S e in h D Gv Q _I J V", l.AL,1 Name of Builder Il Ut� V �4 e L Address M q_c ' Name of Architect t�;.2✓. �" Address Number of Rooms t (n e Foundation ran Ln C v -So V. � � y Le Exterior C'O!A V' ` S 'N :�`f1 L S� Roofing -1 N Floors � wow CQ r- Interior Heating n V C 2 �� - Plumbing Fireplace h © h Approximate:.Cost Area o� Diagram of Lot and.Building with Dimensions �V Fees 8 3,1 o ...- �� s. . ,V 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. t, 1 iName Construction Supervisor's License OUELLETE, MR. - A=039-119 No 34286 permit For Build Addition Single Family Dwelling Location 196 Eisenhower Drive Cotuit Owner Mr. Ouellete Type of Construction Frame Plot Lot Permit Granted April 23, 19 91 Date of Inspection 19 Date Completed 19 4 r � f9 TOWN OF BARNSTABLE Permit No. Building Inspector tauxan f Cash ---.. -- -----_--__ - - ♦ wa a OCCUPANCY PERMIT Bond ------ Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date 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. L- Building Inspector JOSEPH••D. DALuz % TELEPHONEt 775-1120 Building Commissioner EXT. 107 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department. '1 DATE: An Occupancy Permit has been issued for the building authorized by r Building Permit # ��� issued to Please release the performance bond. I •.: r }l,�a^ 4` ,fin ,x'- f'. L _ 4. I II kY r g.ar.•F R 13. ,y. 5 i - '� , y 1. '" y, r sa royp tax �3a 4 s c ; N 'c h i4V ; r. ' t va # G4' 4 sk:"' i r 11 iY` ' t � i., � s I 4 :.wr. 'L �< T. t 6 �+ 5 7z 'f is r •ta. , s. r�t'" ', 4 2 4 -g r { 1. r _x r '+r�, d _., 'k X ,s,_ ' k`k'^y s ''S` ,5,. Y f 1 k t#'".t 1"i r i s � l t s /'4 4: N .•- nit .,t- , }, R , ,� 3 } 7 r i.v �� r - a E t t.w �',sy�^fm a3 d� _ r. t t _. Y r : x 23 r b' Bch " k^' ai,`r+ra 5a� 'S /� iI;, ZSs `':. '. . ((j °()i �7 � r i r• u, j Y t 4 .+..> � r� ,,f '! +^ W:• •} a t �''y M� ., f ° e ,E .a 1S3 , '> r qk r�. 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'^"4''_�+ r y 'AI�f N`EER . r �f�tJRVEYOR •$: OR3 5Ti as :4. >C® 'OI�MW TAppg' JTHE. :ZOANId "LA �i if QA �''.,4` P T f•t c•y t fe, Y Ip '7 - .,v'v t}' ' y 4 y�q. ®Y N STA B L E �_.. ;� ` 3 �' 'Y'•y ` 7=1r2 AI!A 1 IV :S T.6 E ET � ; #O:iI Yf`. ;,�. �F.� � j�' �� `� aYa .. r,.�q ,}t5 l.' r.A,.a 4 ,. 3 1 ± I� 3:.'C$ 4'Y t `ri�i r z k ti� S;A MAS S{I . < v BSI T„��,'.�B�Y,�;;,, �' >}:; . ®.. I.Altl®'3URVEYQR r c «ENbf? 've.4t.3t1,P y�K *yadr flaI'u" f n'R,� d'", 1 cr4_9'P•f 4. ...., ,,L,7.! '�..-.♦ . "4 7 kY»•?`.:. ." F.�2>'i„'.�1' ,.,s e -. A ._ , e s .. +I 775-4020 AREA CODE 617 ` DRANETZ AND DUBIN ATTORNEYS AT LAW 456 BEARSE'S WAY .. HYANNIS, MASS.-02601 MARSHALL M. DRANETZ RICHARD S. DUBIN December 21, 1984 Mr. Joseph DaLuz , Building Inspector Town of Barnstable Main St. Hyannis, MA 02601 Re: Lot 17 Eisenhower Dr. , Cotuit, MA Dear Mr. DaLuz : This .office represents Robert J. & Virginia A. Ouellette, owners of the above described premises. Please be advised I have examined title to. Lot 17 and the two adjacent lots. I have determined that Lot 17 .and the two contiguous lots were not in common ownership at the time of the most recent zoning change. In my opinion this lot is buildable under the present Zoning By- Laws. Very truly yours, DRANETZ AND DUBIN -Die , Richard S. Dubin RSD/eas Ki RV Assessors map and lot number �/l9�°.:: .. .. .......u!2...... � . / y0F THE ropy . Sewage Permit. number ............................................ ... ..:..�:.1 ` IC'SYSTEM MUST HE House number li � " LL_� IN � ' NC ........... ./....... ..... BaaB9Tan E. •Z L • TITLESWITIA MAB TOWN OF BARNStiTABL.E BUILDING " INSPECTOR APPLICATION FOR PERMIT TO ... .JW5 6Ud...�'J TYPE OF CONSTRUCTION "I/..V®fJ... .................................................................................. f ........ . ro.G..........f--lc.............I qk1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...�.d. ... �..1............. /..S.P!!!/.'!.G I ..... ayG............:�....V! ....... ProposedUse ..... ...................................................... ................... ........................................ .Zoning District ...../..�y. .. Fire District ....r�..7-`..i.l.1-1......... .................................... ................. .... ... . ... . .... ............. Name of Owner ...Address ........... 4 /. .. Name of Builder ....../S" . /..�. .................................Address ............Ce.1 iA.....:................................................ Name of Architect ..... :,. ,....., .....................Address .............� .:.................................. Number of Rooms ....... .......................................................Foundation ....f .e.:�,z.(.-. Exterior ... v W ...Roofing .:.....� ... . ...:............................................... Floorsi ....................Interior ....... .6 ............................................ Heating .....���. .... .f:. . ..... ........ .......... ...............Plumbing ..... .....1!...C......... �d �-� .......'?`... Fireplace ...... ......�:... l�C.........................Approximate Cost ......GP..�.. (/ .. ................ Definitive Plan Approved by Planning Board _______________________________19________. Area: ........................................... _ m� Diagram of Lot and Building with Dimensions Fee ..__-_ \. SUBJECT TO APPROVAL'OF BOARD OF HEALTH ��� 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. Name . ..................................... Construction Supervisor's License ...12 d lr.4�s........ ,y* 01 rELLETT, ROBERT 27450 N,o ................. Permit for ...... ....St. . _ ........S Single Fam..iY...P!.Z , i g .................... - r _ 7 ,, Location .. s.....19.6..Ej5exIh6We.E..Dx'1.vP_ . c' ..cQtuij;................................................ t �� ,`•. r '.'f h Y# J r'" fv Owner .......Bd?grt:QUW-left....... ? FrameTeofContruct .... .....y �` ...... ...... M ............ Plot ... :... ......... .................... LIV Permit Granted .....47c�11Li 21 �'� -'19 v� �� ax�r. j�... 85 Date of Inspections..A2':R2........:.......19 - Date Completed ....?��:.... .......................1 q f.01 irs j a ' oe zoo �50 ti f' ..Y n. 1,7 �` Jul• is _ .. sy,`• _~ '��Jam`, - � �l ' ` t Assessors map and lot number. .. �...J�..7. ..... 1.. I/ CFTHE TO� f. �7 �' ♦O Sewage Permit number ....... r ' Z B9BBST1IDLE, i li House number yo ./.............�...........;.f..................... MABB . psi 16 0� C L� f �F�MPS Ar ` TOWN s OF BARNSTABLE BUILDING INSPECTOR dzn f i16Jc.t —�/ z � of, /APPLICATION FOR PERMIT TO .............L.... . . ........ . ........., .......:�......,.. . .....:....`. ................... �i�'�e; TYPE OF CONSTRUCTION ................�................ ................................................................................. ........ X fn.r......... ...........19. • v TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: J If Location ��?.. ......!..y............ l .Pii 1..`�.C?Z! i ...... ........................ ................................................. �>.. .t. ly�.�.. ! .................................................................................................................................... Proposed Use ..... ` ZoningDistrict .....1� .!.................................................... ......Fire District .... ................................................. Name of Owner ... . ........................................Address .......... ............................... Nameof Builder ..... .h.., ./. 1.{.................................Address ............ ' .1........................................................ Name of Architect ......>...:.ja. <�.`.',r.. ......................Address G -f _' -.-.. ..........,... ................... ......................................... Number of Rooms -� :. "'" � .......Foundation .! / ..�. ?��LF ......�.r. . G<......'.................. ........ _. ..... . .... . .. .. Exlerior ... :4-401 !:��:�..,�../,,�"f,� /�`�.�5.....................Roofing ........�.�.:.�..f%�'L'��.:................................................. ... risi�. / l�/it(.G�:.� Interior ..........( .!?,. - 1- ?�p�`....................... Floors 7 �. /... Heating .. '!�5..........e.. �....r........................:.........Plumbing ........f V.c.....`....r'.�,... . ........ Fireplace ..... r� �1 °' i .. ...., %% f .......................Approximate. Cost ...... �.. ........... •� Definitive Plan Approved by Planning Board ---------------____-----------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH .lam I i 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. Name A��!?. ..... ................... ' Construction Supervisor's License .. f OU r,r.FTm, ROBERT A=39-11Y No ......7450.. Permit for. ..One Story............. Single, Family..Dwelling...................... T Lot 17 1 Location �.......96..EiSexalaower..Dri.Ve :......COt4l? ..........................:................... I Owner .........`.Robert..Q1el,.,lett....r.................. Type of Construction ...Frame....... ........ .......... ............ ............... ... .................. Plot ............................. Lot :............................... ; Permit Granted ......Janus 21r..........19 5 Date of Inspection,:.:................................. nspection,:.:................................. 9 Date Completed ......_...............................19 �U-07'o v► � LA 5n ;� Veh -t Ulle f ss . r s a fog 1. t /ram t LA ' 1 ' . SK-l'L�S�t - 1� u , I a I - I