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0450 MAIN STREET (COTUIT)
m� l J� I -_ +•�-,tia' w+s�K -� yr�r.<a�,Y�--1,,.:,,.ki �+�t• :• ,vim.-•,a': s.f+-/. Assessor's map and lot number ....... ... ook.. 3 ,,P ge 5�1� Barnst4ble tleg ul ueW.v� Sewage Permit nu_ tuber. f"+ 5 ! ' rt r g .. .. ..... ...... ........ ...,. ........ /, .;.. �ofTHETo 'T`O�WN' OF BARNSTABLE I MAWSTSDLE, i gay e y mum p� } " ° o;,pya�•` B.UILD�ING - t INS�PEC�-OR APPLICATION. FOR'PERMIITT'•TO :.. '11G1A.S.O. parakt 0 an APPLICATION. �.V�.XI ,..1'�AA9.:. ... Y TYPE OF, CONSTRUCTION WOOd� .... ... .... ..F.. . .. ..... ......................................................Jan. 2 _ .... . M1 4 ....................................7 ....19......... TO" THE yINSPECTOR OF BUILDINGS permit acc rdm to the follows information. - y The undersigned hereby applies for-'a pe o g � ng ' Location ....45Q,..� In. .asfiraeti.i...9-0.tklts..: .SAft............ ....................Proposed yse ... . .Zoning District ......:.Fire...:.... .... .:............. ....................Fire District'....C.0.luiZ'a.� . ......:.. .;....... ... Acct 3 20 � 6�k, bl5*-Pt,ge #09 Name of Owner ....QUX. ... �.!�ik� :................:...................Address 1918.,.C.eX1tY!'�11...zt. ..:$t.Q.L �11W.Qii� ,P�A.S,sa Address .,'. Wt1Se:71f. frtrl a...S"�i.w.. �tAug�lt.OZyf..:lt'Idsb�- Name of Builder ..J.Qseph...R,..... F.l't}x!�1.. ....:....:........ �}.�... 7�• 41 Name nof:Architect .. . W.e erh0: er..:Hotas•e,: PlariAddress C&1Fif. �.1 Enclose fr n p0>ecY , W .Number"of Rooms ............ ..%.............................. ....... ..,Foundation ..... . ClE'tY1ti t � F Exterior 00,fing + ' , Floors .. ......... ................ 3 , ......,Interior ..:.:..: Fireplace .. .... . . ....... ... ....... ..., ...Approximate Cost ... Q0�.QO .. Definitive Plan Approved by Plann}ng Board _ _______________:____ - _19 ____:: Area :..... :..:: Diagram of Lot and Building with.FDimensions Fee .... SUBJECT TO APPROVAL `OF 'BOARD,01' HEALTH vt - j - -k -k Jt • I hereby agree to conform`to all the Rules and Regulations of*the Town of Barnstable regarding the 'above, construction. ti : 6 t Name ... ,. ................. ......... .... ................ Klund, Olive 17585 enclose porch No ................. Permit for .................................... ............................................................................... Location .........450...Main-Stmet...................... ........................cot.0 ......................................... Owner ...........01imp...Uund............................... Type of Cons-tructio frame ........................................... ................................................................................ Plot ....................... Lot ................................ Permit Granted .......F.e.bruA:Ky.. 19 75 Date of Inspection ....................................19 Date Completed ........... ............................19 PERMIT REFUSED ............................................. . .............. 19 ........................................... ................................... ........................................... . ................................... ....................................../................................... ............................................................................ Approved -19 ............................................................................... .................... .......................................................... x Assessor's map and lot number ..... .:4 � �oFTHE rod' Sewage Permit number .ezzi,.....av��*�1� ../� �v �.. • SEPTIC SYSTEM MU � STABLE, • ° ._.o.......�',1 �..... .ram...... �. INSTALLED IN C®MPL House number ...... aea 163 WITH TITLE 5 �i°�E war Ar, TOWN OF BARN A[� " � TONS BUILDING ;�I�HSPEaCTOR r f F APPLICATION FOR PERMIT TO ........a .................... .......-G9.r..,,. ................................. l TYPE OF. CONSTRUCTION .....Lle ';a2, ........ .-)........................................................ a ..........f... .. ..( f... .., .19.. f TO' THE INSPECTOR OF BUILDINGS: / The undersigned hereby applies for a permit according to the following information: . a Location .....-,... ,�..........�e� C� .....;,�,.Ll6z ........... ..... .......... .... :........:.....:.................................... ProposedUse .... .................................... ...................... ... ......................................................................... ZoningDistrict ........... .......... ................................Fire District .............................................................................. VName of Owner ..044,G..... . . .. .... .................Address ...... .. .. e.......s z....................... Name of Builder /. .,. ,.."�e,, ?,�F ..............Address .......,......................... 1.tiL., � 7...J���ef� � V / Nameof Architect ............S...al........................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ............. .......I..............................................Roofing .................................................................................... Floors ......................................................................................Interior ...................................................................................... Heating ........................................................... ..................Plumbing :.... ..... Qtir..a�l�✓........Zrs�:. ,. .l�.rt!htiLJ Fireplace ..................................................................................Approximate Cost .......... ...P...d.. ............................... .. 3 . . Definitive Plan Approved by Planning Board ________________________________19________. Area .........�.. ..l.... '.... . .� Diagram of Lot and Building with Dimensions Fee ........... . .......... . . SUBJECT TO APPROVAL OF BOARD OF HEALTH . BD � � v C /off � i a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......0-jacar............2LC!u..` ................ XLUND, OLIVE '1 No U,3152... Permit for ADDITION ...............................:::. . i e F mi Dwellin ...1�.��........ ...... Y......................g................ Location ....4.5 Q...M ij.,..5U e t..................... g" .......... ....C.o.-tu.i t............................................. # r Owner ...Q1 .Y.e................................................... a ' 1 Type of Construction ....F'.IrPAQ............:.......... Plot .......... .. .`.G!...... ' ... Lot ............................... ff M. 2...$.........-.......... 81Permit Granted ..........ax... t- f , Date of Inspection ....................................19 + Date Competed ............ ...........19 PERMIT REFUSED � rt' ............°` ..... r ................. .. y Y ••- . ma's m1 t.. c t'r ,r !.. • �. � y j J ' . ,n t ................y. ........ .................... .. .. ....... ............... .. .................................f?�tt .. ............. " k.�'.... .................................... ± ✓ .............I4: ... .................................................. 4 { 1 ' Assessor's map and lot number , ��.t............................... �FTHET� a . •' �„"' �' fit• _ Q . , Sewage Permit number .,.fit.�... ;.A �y ../ -ae .�•4 ..... E t Z 33AUSBTAMLE, i �, House number 7/ � :,'?C.�:�.�........� �... �• f�� r a �;... .:...:.............. 16 0� � 39• 9 'FO jul a� TOWN OF BARNSTABLE BUILDING INSPECTOR r APPLICATION FOR PERMIT TO ........1 /�,. 1`:` ...............•/. ...................................er� . TYPE OF CONSTRUCTION ......-.,.:::....:..:..c. :....:_........................:.....:.:.....,....................... 19. - TO-THE INSPECTOR'OF'BUILDINGS:--„ The undersigned hereby applies for a permit according to the following information: Location ....;�. �.a.......... .... ! :z C G .......... ?.�� c-� ................................................ ProposedUse faz1.Q.!...............4......... . ...... ...................... .,. ......................................................................... ZoningDistrict ..........�......................��............................... ......Fire District ............................................................................... !/Name of Owner .. ..... `lr.+! !? .•.. ''.......... Address ......�. •l rr.a r.e�y ...........L...........:�. t�;__, Name of Builder ... /f A A i' ..............Address ..........................P--., Nameof Architect .:.:........::...:..;...:.........................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ......................................I............................................:.Roofing .................................................................................... Floors ...............................................................4.............. Interior .. ....... .............................:...................................... Heating ........................ ... ................ ........ Plumbing..,. Ste+ -. .. . ..�... '.....: Fireplace ................... ..... Yt .................Approximate Cost ............ ..!. ?.U................................ ..... .s .. ..__t .,.. Definitive Plan Approved by Planning Board ----------------------------19--------. Area ......... .f'. :../. Diagram of Lot and Building with Dimensions Fee ' .........../ .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 iU �° p SS pig .-ry, `�. , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..................j: ............... :�fi*_E '........................ I{LUND, OLIVE 2:2-1 D5 No —2-3l5-2'.. Permit for --D —ION — — ------- � Gi l FamilyDwelIi ' --.�����...�— --.. ----,—.�q�----. � . Location —4-5—O--Ma—ioS—t� ����r-----..— — .. / . toi -----..{�g--..t--------,--..---.. - � Owner .....OliMe_Klond______...___.. - ^ ' . . Type of Construction. ..KKAM(P............................ ' ----.---------------------- ' Plot ............................. Lot ................................ ` � . � l ^ Permit_ Granted_ — 7 ` . ` Date of | � ' PE MIT REFUSED ............... .. lP ' � � - �L~~ -----"=�*�° �—''v~°�'^p''°�..______.. � . � '—~--,-.~--.—..—...--.,'-------. '—''-----------'--^^---''~---'—^ ' � ----'--.—..—....—_----..—.-----.. ' � Approved � --.-------------. l9 � ------------~`—^—^---------' ----'_-------------..—.,~.—.. �� r- -4-�- Book jj,1 4 Page 544 Barnstable Reg of Deeds 8/19/66 Assessor's map and lot number F s ysr- Sewage Permit number .................... ................................... 17 dell"" A;S THE T a TOWN N OF BARNSTABLE.. NAUSTABLE, i 9� 0Ya.•� BUILDING INSPECTOR APPLICATION FOR PERMIT TO :...:FaI]CIQs.9IR..pfJmala...to...aaarga...liA.ing..room..................... TYPE OF CONSTRUCTION KoRd .......... ................................................................... ................................:....................... ................... an.f 27,..........1975.. TO'THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....450...i` 41ja...Stze.A.t ............................................................::..................................... ProposedUse ..TJQAQ.............................................................. ...................:............................................................................. ...:.............:......Fire District ...C:o.lult............................................................ Zoning District ........k'IX'Q..........:.................. Acct # 0220150 Bak 615-Ptge #09 Name of Owner Ol;LV.a..Kjand.....................................Address .191&....0 antral...Sct.....S.toughtan'...Naas. Name- of Builder .Zos.eph..R.-Gabra.1........................Address ...Wash1ng.to11...$t.....Stoug. tan,..-Xass. Name of Architect .......Weyerhous.er...Hot e...PlanAddress ......!C&I-if................................................................ Enclose fron 1poech Numberof Rooms ..................................................................Foundation ......C,eme;lt.:...........................................:..... ... f Exierior ...........................................................................:........Roofing .............................:....:................................................. Floors ......................................................................................Interior. ..........................................:.......................................... Heating ..................................................................................Plumbing .......................I........ .................. ................ Fireplace ..................................................................................Approximate Cost ...... ...80.0s0.0......................................... Definitive Plan Approved by Planning Board __._'__________________________19________, Area ........................................... Diagram of Lot and Building with Dimensions Fee„ ............... .. .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH J t I hereby agree to conform to all the. Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... :...- .................. .............................................. Klund, Olive No ..1..7..5$S Permit for enclose porch ............ ; .................................. ......................................... • rY 3 Location .....450-k A..StKAM.t...................... I� ....................Cotui.z.....:........................................ - i! Owner .........Q�.�Y.�..Klund................... i. Type. of Construction .......... xatR4�..................... t ........................... ................................................. Plot ....... ............. .. Lot ................................ February Permit Granted .........F. ....... ..........13 75 .........19 -Date of Inspection ........................ .. 19 Date Completed .... •f....j..:.... PERMIT REFUSED ................................................................ 19 ................ ................................................. ; ,t ........................................... ............................................................................... .............................................................. ... ; Approved 19 ........ ........ ..... .:.......... _ t ..... .............. .................................. ................ .... ........ ........... r ` v\� �'16nsi�� Y_��/.— /��,/�. Assessor's map' and lot num er ........ �� °� TO Sewage Pern?it: ,number 0 s A p •�� e��9H.H Z B STA i House number4 ............... ..........:��.�....'l w........ .. rp aBa t E, M ¢ 0A( 4 �8pypYa TOWN� OF BARNSTABLE BU11DIH�G AS-PEWOR I 9 .8 APPLICATION FOR PERMIT TO .... .. � � C .... .-........` TYPE OF CONSTRUCTION ......... ...... ......................... .................................................... .................................... ...19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the.,.following .information: Location ......... ...... aC�l�r4.........:................................................. .......... �.............. ............................ ProposedUse ........ � :1......:................................................................................................. F Zoning District ..Fire District ..... / .............. ............ ........... .....1� ....... Nameof Owner .... u. .... .....................................Address ......... ..... ......................................... . Name of?Builder .....�. ................ ..... ..... ....Address ................... ........ ........ ........ .... Nameof Architect .......... .... ,. ......3 .................. ..Address ...........................................................� ........................ Number of Rooms .......................... ..._............. ...................Foundation ....... P.�C.er ........................:.......................... Exterior ................k ..... .............................:............Roofing .......,... :�/..).-zeZ............................................. Floors .: ..� ►1. ............................................Interior :.......................................... Heating .....:.Plumbing :......... ...................... Fireplace ... .................... .. ....... .. .. ............... .. .Approximate- Cost ........... J ......... ......... ....... i Definitive Plan Approvecl'by Planning Board _--------------_______________19________. Area , ..........:...............: Diagram of Lot, and Building with Dimensions m -'� Fee .....:�. SUBJECT TO APPROVAL OF BOARD :OF HEALTH ti { 1. • . � - I ,` FIB' � .. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS y 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......... >G KLUND, OLIVE t 26590; BUILD GARAGE ' No _-.:.Permit for �. Accessory to Dwelling +.. .... .............................................................. A� Location 5.Q..,Main.Street. ....... .................. .. * r .............Atuit............................................. Owner Q r Type.,of' Construction Exame. .......... ................. - � y�<,R ,, ,1 _,.- f - • � � i 4. = '�^.jlT-I4+-+--r,-.r.+-+^'-++.•yw.+-'rw"�r.`w`^-"..rrv_ .. .... ....... .... ......... .. r ........ ...... .......... 1y. ' - • -r,� ,,. r Plot ................. ..... . Lots . t June 15; 84 ^ermit Granted ......................... ..... 19 "`,ate of Inspection ...... ......... ......19 )ate Completed s '._".:....19 .. 4 ; 7' mot_ --i++...-•---w a...........W ,r, AV ,e T Assessors map and lot numberr� Sewage Permit number / Q ... 1�.... .................. .. 3 d STNE na e 1 BAUSTADLE, i House number ...........................:...:!u ...... ro Maea �E'p MPy a' TOWN: OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..........I :r �(° "t�:x-� �r f�-c' �,,,,, ; . ,,,,,,,, 1 TYPE OF CONSTRUCTION ............ �,',• !Jt?:.:��--.............................. ................................................19........ f TO THE INSPECTOR OF BUILDINGS: r ' The undersigned hereby applies for a permit according to the following information: '77— Location ......... �.,. ��.........)1..?,1.,�.c<..z.........J.................................................... ................................. ................................... ProposedUse ........................................ ........:'.:.: ...............1.. ....................................................... ............. ......................... ZoningDistrict .......................................................................Fire District .............:..................................................... Nameof Owner ..........:a...............'a::L.......:..... ...............Address ...................................................... ........................ ' Name of Builder ...... ....Address Name of Architect ..................................................................Address G Number of Rooms Foundation ................................................................. .................:. Exierior ...Roofing' " Floors ...........................Interior ...................................:�.................... Heating ........... .......... ........ ...... ............ . ..... . .........................0....................... . .. t. Fireplace ................................:............:....................................Approximate. Cost ........... .a........ Definitive Plan Approved by Planning Board ---------------____-----------19________.' Area .......Q.IJ............................. Diagram of Lot and Building with Dimensions � Fee ....... ............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Jly 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 ..... f, c:�:.:..... ... �li� f�, .......... Construction Supervisor's License '��i..iY ......... IOJ]ND, OLIVE A:--22-15 ~ ' . Nb —.. Permit for --Boila Garage .............................. . / � Access6ry . to Dwelling ---------'---------'—^-----' . , ' 45U Main StreetLocation -------_--_____.______. . . , . ` Otuit ----`--..������-------.^------.. , ' . ` OIi\na K]uod , Owner —.---'.--______________. . ' Type of [pnstroch Fcz Construction' --an—e............... ' . - -------------------------' ' l4o* ............................ Lot ................................ ' ' . . . . Permit G,ono*6 .....................l9 84 ' Dote of Inspection ............. ........................lP ` Date Completed ------------lg ` ^ ' ' ' ' - , ' ' . . . . � . ^ ' . ^ | ' | a ea'a � e Cape Save Inc. tea• � - as- �� 7-D Huntington Avenue South Yarmouth, MA 02664 ; Tel: 508-398-0398 Fax: 508-398-0399 . 3/25/17CD -r Z Town of Barnstable Thomas Perry CBO c Building Commissioner 3-4 200 Main St.Hyannis,MA 02601 - ' RE: Building Permit B-17-338 TO: Building Inspector(s), This affidavit is to certify that all work completed for 450 Main Street,Cotuit-has been inspected by a third party Certified Building Performance Institute (BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, z William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Z—M Ac i 1 A n UILDINO DepT _ G Map Parcel d 5 Application #` I Health Division FEB Q 7 2017 Date Issued TOWN OF BARN Conservation Division STABL& Application Fee Planning Dept. Permit Fee e5.00 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village co Owner `� �� � � i &,vfir Address S n n'1 Pl Telephone_ II i Permit Request A�� �' i� an� °3� c e 111 [05e, q J U1 u A R'.� o ��er4 `c�f_S � nn ` I r T C ! i S e e G G Yt i.0 h n , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 TOO 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 ❑ No On.Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ` Ikm C l �e YkOt �vt_tA c- Telephone Number S 328 n 1 'Address 3 11 4t'n(-IN 11 kv e, License # f I ry krm[IJ& 6 Home Improvement Contractor# Email Worker's Compensation # kA C 0$5 510�-d b ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO . rM o n SIGNATURE Z DATE I a 6 _ FOR OFFICIAL USE ONLY PAPPLICATION # DATE ISSUED IN MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. n t r , r 't • . t� �r A!J ,te , .The;Cvinsn6hW alth'of Massachusetts'). ,F _!_ 1. :.try .�_ i'. — ..-. I� iq. .tyK "h. at, ; - 'Department of Industrial Accidents a • • .. +. -Y'+ 1-'� ::. • , a.o,r.. '=3. t« _ ' 4� �. .al' c,,,l 'cL. }:F l„� 1 Con ess Stree j Suate'1:0.0 *'. _ *' ., ;: �^_ » a+1 1T A gr 1 - - - �" Boston;AMA 021 4=2017_ ,t " ;4,0 :. ;�:• . `� w1C,.y"° iti..:t J,�! - t r+%•'t cd d. i^:. ,-,*rt, , " ! 'r 7Y.r.t l: }F +nee � 'r".:t� _ xfYf 7�l.. C. ww» mass gov/dia # F - W . _.a, _ _�. �fi`aikers'Compensation.Iiisurane'e`Affidavit Builders/ContractorslEleciij. ans%Plumbers. s TO BE FELE_D WITH THE PERMITTING AUTHORITY: Please Print Legibly 1 • Applicant Information. 'T '_ •a. �� „ • f Save Inc Nam.a(Business/Organization/Individual) C.a Pa `" • =' i it Address:77-D Huntington Avenue ,• ,. ,,, Y . ' ' _. ; ^ y , • City/State/Zip:South Yarmouth, MA 02664� Phone#:508-398-0398 i Are you,an employer?Check the appropriate bok Type of project(required): L I am a employer mth.`15 'employees(full and/orpart � � � . 7 Q New construction j t �j .�• ,,, ,;.. s ..- „.'" .� l �} .�! t r- 2.❑I am a sole propnetor or paitnershrp and have no employees working for me m ,+ , ,! �r g , 3 Remodeling an capacity.-[No come insurance required.) ,' F ;-i ' • Y P ty•LN. P• H :..,. , 3.a I am a homeowner:doirng all work myself.[No workers',co "t w 9:[]Demolition 'a G f ��. mp,insurance regwred.}t T _ 1 .t° 10'0 Building addition _ 4.0 I am a homeowner and will be hiring contractors to conduct�all work on my property:�I wilt �' , t ,' t ensure that all contractors either have'workers'compensationansurance or are sole 1 L❑Electrical repairs Or43dd1t1onS w } ,+ proprietors with no employees. ' t 12.❑Plumbing repairs or addition-s 5.❑I am a general contractor and I have hired'the sub-contractors listed on the attached sheet. 13.❑Roof repairs m 4 + ^ _ These.sub-contractors have employees.and have`Workers'comp insurance.- w 4 6.❑We are a:corporation and its officers have exercised their right of exemption per MGL c 14. Other Ir1SU11tlOn. t• IS2,§1(4j,and we have uo employees.[No workers'comp:insurence'requred.] !Any applicant that checks box 9l musralso fill out the section below showing their workers'compensation policy information: t t Homeowners who submit this d.Mdavit indicating they are doing all work and then hire outside contractors:must submit a new affdavit:indicatmg;such ! l *Contractors that check this box must attached ran'Additional sheet.showing the name of the I.sub_contractors and state whether or not those entities have - Z' i } employees. If the sub-contractors:bave a to ees,the ymust rovide their workers:coin . o ac `number: 1 mP y Y P PP y I am an employer tha$.4s providing workers'compensation insurance for my employees. Below is the policyand iob site t +. s ,'infoPm~ado n.rV.:�_ , ,,.` a..R,r 31 - i Insurance Company Name:-'.Star Insurance Co. .9g ►, '' } 4 t Policy#or Self-ins Lie.# ::WC085540700 _~-�=r'« +' Expiration Date- 4/9/2017. 1 Job Site Address 450 Main Street"'.-` �•t' �° t City/State/Zip:Cotla<it i Attach a copy of the workers compensationr policy declaration page(showing thepohcy number and;expiration date). . Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by afine 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. t •..tx>. r.x•s xa P: c , r . ,y- +, .: Cli A. ..r.r ., ., _ 3! + I do herebyeertify under th :pains andpenaldes ofperjury that the information provided.above:is true and.correct ! r Si .atume Date: 2 17 Phone M 508-398-0308 i • _ _ l Official`use:only Do not.write.'rn this area;;to be completed'by ctty oor towK,officiat By,, " r a , y C►t `or Town,- hel z , +_ _,�s y+t 'v€t,: !{ I'ermit/License# M _ Jti S. "t ....• ,. - .,r;...: .r_;e s�'•>E.r ...:,t •. .s. s+, a.:;. .`.`{rf. Issuing Authority(circle one) ' =•'~ '^ °' t" ,�" ;" j ;r!•''�:9 _i ;t;r£ + ' ' i Board of Health,2.Building Department 3 City/Town'Clerk 4.Electrical.Inspector 5 Plumbing nspecto`r . d_ 6.Other . r x s _ Contact Person. Phone;#• t��9'�.3u�sCY. 3',F*f,`. t'�Y� i'> , •Gjrt}��« , ;;F,t.,'Cry'' '� l.s r,3 r5"a i_ .d"��_ I - - A66ZO CERTIFICATE OF LIABILITY INSURANCE 44.� 1 10/24/2016 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(les)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 endorsements. PRODUCER A NME: Colleen Crowley Risk Strategies Company PHONE No e : (781)986-4400 FAX No: (781)963-4420 15 Pacella Park Drive ADDRESS:ccrowley@risk-strategies.com Suite 240 INSURER(S)AFFORDING COVERAGE NAICaF Randolph MA 02368 - INSURER A:LibertyMutual Insurance Co INSURED INSURERS Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc INSURERC:Ohio Casualty/Peerless Insurance 24074_ 7 D Huntington Ave INSURERD:Star Insurance Co - INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL16101422377 - 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MW MM/DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE X❑OCCUR PREMISES Ea occurrence $ 100,000 SLO1757246490 10/16/2016 10/16/2017 MEDEXP(Anyoneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: : GENERAL AGGREGATE $ 2,000,000 X POLICY �� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIM= Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS Ix AUTOS AUNA46796600 11/6/2016 11/6/2017 BODILYINJURY(Peraccident) $ X HIRED AUTOS PTO N-OWNED PPROPERT YD AGE $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE r-r c, t AGGREGATE $ 2 000,000 DED I X I RETENTION 10,000 US057246490 10/15/2016 10/16/2017 $ WORKERS COMPENSATION Officers included for r r� X STATUTE ERH AND EMPLOYERS'LIABILITY - ANY PROPRIETORIPARTNERIEXECUTIVE YIN— I N coverage E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? N❑NIA I D (Mandatory In NH) I1. NCOSSS407 4/9/201.6 4/9/2017, E.L.DISEASE-'EA EMPLOYE- $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 , DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) Evidence of Insurance / Insulation Specialists . . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Barnstable County ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact , 460 Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02061 1 • Michael Christian/CLC � 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) i v r 1! J; Office,of Consumer Affairs an€I Business ReguYatior: 10 Park Plaza- Suite 5?t 70 . Boston;Massachusetts 021 I6:, Horne ImproyementContractor Registration Registration 17138q; . s TYpe Corporation Expiration 3114/201:8 Tr#. 419291 i CAPE SAVE INC. . WILLIAM MCCLUSKEY , 7-D HUNTINGTON AVENUE SOUTH=YARMO`UTH; MA 0266.4. M� Update Address and return card Mark reason for'ehange: Address G.RenewaL Employment Lost Card. SCA t +:•"26W-05111. UlG6�Q,OIIU17L6ttt!lCCL��II�C�/��CfJdCtCfGlG:i¢� - _Offiee ofConsnmer Affairs,&Buslness Regulation License or registration valid for mdlvtdul';use only HOME`IMPROVEMENT-CONTRACTOR before the expiration date,'If found'return fo Registration r 1713g0 Type: Office of Consumer Affair§'and Business Regulation Exptratloq 31a4/2018' Corporation 1Q Park Plaza:-Suite 5170' k�w' Boston,.MA 02116 CAPE SAVE INC_ Y WILLIAM McCLUSKEY 7-0 HUNTINGTON AVENR SOUTH'YARMOUTH MA 02ti64 Un.derseeretsry Not valid i `signature . Massachu-efts '.Department W PubliC Safety Construction Supervisor Specialty Restricted to: Board of'Bui.idin:g.Regulations and Standards CSSL-IC-Insulation Contractor l.11 tlltl LII/:1{J[I IICI':Y 1111 JIICl1Yl1tV- Y=Y:fifffiiFJ6"y9 eir� ups.; - License. CSSI-902776 WILLIAM.J MC- ,gtU 37NAUSET ROAD West Yarmouth MA ����p�.i ` Failure to possess a current edition of the Massachusetts J.�...�/ .; Expiration State Building Code is cause for revocation of this license. Commissioner 06128/20.1.7 DPS Licensing information visit:WWW.MASS.GOV/DPS HQME gMia NATH ,RIMIQU ORN PERMIT PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. I L-U-a-a, ereby consent to and agree that weatherization work may be done by go Weatherization Program of Housing Assistance Corporation on the property . located at, . G Tv/`r The weatherization work done will be based on programmatic prioritles and availability of funding and it may include all or some of the following measures: Weather stripping;air sealing; attic&basement insulation;exterior wall insulation;ventilation measures In consideration of the weatherizatlon work to be done at my home I agree to the following: 1. 1 give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. . 2; The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five(5)years after the weatherization work is completed. have read the provisions of this agreement and give my consent. Home Owner(saneturv) t Home Owner email: '1Y C11! d1' c14 Date: Agent,(stneture) Date: Weatherization Contractors: Adam T Inc Cape Save All Cape Energy Frontier Energy Solutions Alternadve Weatherization Lohr(dome Improvement Building Science Construction Tupper Construction Cape Cod Insulation . CQ Town of Barnstable *Permit# - - 33 i Regulatory Services Fee 6mof-m; eS s aeewsrAMM M"M i634• �' Richard V.Scali,Director �� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 D www.town.bamstable.ma.us NOV 09 2016 Office: 508-862-4038 �— Fax:5088-790-6230 y� . EXPRESS PERMIT APPLICATION - RESIDENUALr&���p� BAR N STAB L` Not Valid without Red X-Press Imprint Map/parcel Number _ -/ ��AA Prope Address y5-0 /��t'�? Sf Cel&f— � /Y* Residential Value of Work$ i 717 O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ����� [r>(��yL.� GG/1 3 '!�/P(/, �c�i Al /Y* Contractor's Name {/ Pif'L�/ �C�� �t o Telephone Number s B 'G 21 - J G 7 Home Improvement Contractor License#(if applicable) /Z�' 98 Email: 4'v5 0./k 6 12t • �� Construction Supervisor's License#(if applicable) /0 ❑Workman's Compensation Insurance Ch_eck one: eI am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Regis c eck box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE• C:\Users\DecollHAAppData\LocxlUVlicwsoft\Windows\Temporary Internet Fiies\Content.0utlook\2PI01 DME7PRESS.doc Revised 040215 1 1 vii Commminveam ofMamachmgft DqA&*wmta,fIndm&WalA I Corte S&e4 Sate I0# Britons MA 02U4-2.O17 wwacusaV-gw/AS TO=FMW WrMMU P.f3RWMNGAUTHOMY. • mat .•an.A► Name AgoEvgerry Sushko A 41 Rmwood Rd - City/St IW23p:W.Yarmouth, MA 02673 Phone#.. 1-M4)M 2054 TRW of pr ojeet(iegdred)_ I.Qramawi®c emplayees�ael` 7_ ❑Newel Z�amasdeI andlmmw wadit#ormai[L mw I i4 (Nowadawa'c mp h mma ugnim .] &. ❑Rmadd- 3Q1mn'ahumwww4ftaffwadcuvj=XlNo 'anmp m�aed]t 9-QDemDm m 4.❑IamahOwoawm•aadvMbchjft, tu000dvixaQwakaamypmopedy 1vm 100 ema; dwaIlemI Iaseiderhm campemmfinhMmmarawsole :ILE]Ekcbicalxcpa'moredM= wiffim - SI]Iamagmudomkackw edlhwchiedffie fismdondmat3ehedsbed IZ❑ Or addWm bmempbryeesamdhmwadwecamp msmama= 13.p4faaMairs fiowcaios 14•00&w M§I(4),=dwehwem [No 'o®p.mwmmewqubea.] •Aayapplcmd9mtd-dmboa#1mrtabolMoutdo 6 bdowshowi a irwa&Woo tH vdosabm3fbisa�avit' p 9 - �y��E atlwa��asd�n hae ao�e omtmetas mast�t a aatr a�av$i �. �at�tbbr6mrma�at�$od�add�Isbeetsbwv�gt�na®sal�es�oo�mtae�sodstatewhed�aora�&aseert�baQe empluyee;L.1f8ieadr-omtrae6m0=cmOopmrdoymmtpwn&&-wm&'comp-pu jrn ►=djvbs1e _ hMMMCOmponyNmc Policy#ofSelf i.Lim#: Job Site Address: Attachaeopyofibew=*Ns'= Pow FSV( 1ihepd1y- ), Fayme to secte eoveta#e as rogoxcd uRdffbdG L c.157,NSA is a cdmbW ViObAmpaddmble by afore up to and/or ono-yewi as weR as cavt1 'M.�pe�ies in tbefonm Of STOP WORKORDiiILmdafine afupio ALSO OO a day againsttbeviolator-Acopyoftbis skftmmtmybc hrwadedw9cof iceofbmsdpdmof&eDIA£ori oe covemp verification._ Ido 6eneby ear�tify aordertfrepaixtsmrdpofPerjr�ry�� eeboae�heeaxd avnaet & 4WCWJmCM&L Do natmileinfibmow,tobe bi►`,*arimm MrSdA Chya®rTaww -P w# 1mdO9Aaffwy(fie m* Fbffldfthmpecior LBand efRamM z. Dearbnemt 3�.C1ty/Tawn C wk a �, 6.t>� ContAPersm f 1 Whasschusafts De{wkneAtof PuurccBaFetg i Hoard of BetMag Regions and MandWs ivakwGumm . 41ROW Exptrabom i CsOI1Iti=1155iY3A1BY (29 m� 0,v 0 n eve i L rs�.L�LZ'Yii��f Office of ConsamerAds and.Bum 1©F°arkPl= 5170 BOARD,lltlas. huse s 02116 . Home Improvement Contractor Registration TyPM DM SUS HOME IMPROVEMENT EUGENY S: SASHKO- 41 PINEWOOD RD. - WEST YARMOU rK MA 02673 T1pbftAddem and s cw&merfwcb am ,Oi�ra�C���A�sBc�Y Iacea�e�r�n6ee�dToaraseedjr 1R. A. T IRAG70R low dare foe d eeteea�c 1 - TEWBmbm6- OffetafCo A sa®dB GMZM DM SEiSt�WI� 1&o1w �31f S S 41 P - t WESTYARUMI1K# AQRbT3 9 - SUS HOME IMPROVEMENT 41 PINEWOOD RD. W. YARMOUTH, MA 02673 PHONE 1-(774) 521-2054 CERTAINTEED LANDMARK LIFETIME-ALGAE RESISTANT ARCHITECTURAL STYLE RE-ROOFING PROPOSAL September 4, 2016 RALPH GIARDINI 450 MAIN ST COTUIT, MA TEL: 508-681-8167 SUS HOME IMPROVEMENT herby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and haul Away All of the Old Asphalt Roofing Shingles (one layer) from the Barn. Supply and Install CERTAINTEED LANDMARK AR: COLOR: BIRCHWOOD. Supply and Install 8" WHITE ALUMINUM DRIP EDGE on All of the Eaves. Supply and Install #15 BLACK SATURATED FELT ROOFING PAPER. Supply and Install CERTAINTEED WINTER-GUARD (Ice & Water) WATERPROOF UNDERLAYMENT SYSTEM Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT Supply and Install 8" WHITE ALUMINUM DRIP EDGE Clean and Remove Debris from work area after job is completed. TOTAL INVESTMENT -----------------------------$ 59400.00 PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final payment for the Balance is Due Immediately Upon Completion. Normally Scheduled for Completion Within 45 Days of WORK SCHEDULE: All Roof Work is No y P Acceptance and Receipt of Deposit Providing the Materials are Available. SUS HOME IMPROVEMENT Warranties the Shingles and Labor for 10 Years. CERTAINTEED Warranties the shingles and labor 100% for the first 10 years and the shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the shingles up to CATEGORY III HURRICANR-130 MPH WIND WARRANT. CERTAINTEED Warrants the Shingles to be Algae resistant for a Full 10 Years. SUS HOME IMPROVEMENT Carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: ACCEPTED BY: �S. RALPH GIARDINI EVGENY SUSHKO HOMEOWNER SUS HOME IMPROVEMENT � 1�II5 -TIME Tp� Town of Barnstable *Permitov oc? Expires 6 mo s. o ' u e Regulatory Services Fee BAMSTABLE, *` 9� '""SS'1639. Richard V. Scali,Director ♦e ATED MA't A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXP SS PERMIT APPLICATION - RESIDENTIAL ONLY I L Not valid without Red X-Press Imprint Map/parcel Number J ;Residential e Address q�O /0.h S4. C� �GLI �= Value of Work$ .� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1 � G'A('d0i Contractor's Name___Rv+rlcy_ t s'dl' Telephone Number ,`jok 4',461 -01G7 Home Improvement Contractor License#(if applicable) '73 1 j 2 Email: ---- ---- Construction Supervisor's License#(if applicable) C9S Q S 1 ❑Workman'sCo ensation Insurance �e� � . Che one: - S 0� - I am a sole proprietor (J ❑ I am the Homeowner MAY Q L �O'� ❑ I have Worker's Compensation Insurance T Insurance Company Name � TOWN OF BARNS ABLE , Workman's_Comm Policy# Copy of Insurance Compliance Certificate,must accompany each permit Permit Reques check box) — -__.. - e=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 03;t ❑ Replacement Windows/doors/sliders.U-Value ' (maximum.3;;)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission: A copy of the Home Improvement Contractors License&Construction Supervisors License is required Jvo SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 ,i a �• .. ..i - .., , r,23538 1. /12/2015 MON 13 .55 . FAX 50899 southeastern IA. ".` �001/001 CO® DATE(MMIDDM*M CERTIFICATE OF LIABILITY.INSURANCE ,. .' ;1i12i2D15 HIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATIOWONLY AND CONFERS NO RIGHTS UPON THE-CERTIFICATE'HOLDER. THIS CERTIFICATEDOES NOT,AFFIRMATIVELY OR NEGATIVELY.AMEND, EXTEND,OR`ALTER THE COVERAGE AFFORDED>BY•THE.POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES.,NOT:'CONSnTUTE A`CONTRACT BETWEEN THE:;ISSUING INSURER(S)_AUfHORIZED w REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATEHOLDER r IMPORTANT: If the certificate holder.is an ADDITIONAL INSURED,the policy(les)must be endorsed. If.SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain poilcies mey require an'`endolsement. A statement on this'certiflcate"does noEconfer.'rtghts to the`. certificate holder In lieu of such endorsement s PRODUCER - r - CONTACTJoanne Bretton NAME: . . Southeastern Insurances'Agency, Inc'. PHONE {508)997-ti061 FacNo:.lsoe)s9o-z7as 439 State Rd. jbretton@soutlieasterninsccom '. P.O. Box 79398 • >INSURER(S):AFFORDING COVERAGE`. NAIL i' North Dartmouth MA 02743 INsuliEliA Arbella Protection Insuraace.; 1360 INSURED INSuRERB AEIC All,Cape Exterior Remodeling: INSURER 12 .Baldwin Itioad INSURERD: : ..' } `t, _ :w-' ,� ,�:. ..,•r. V�URERE: b: Dennis Jr• ba 1,02638 INSURERF, y. COVERAGES` CERTIFICATENUMBERt2015 REVISION NUMBER THIS IS TO•CERTIFY THAT THE POLICIES OF INSURANCE-LISTED BELOW HAVE BEEWISSUED'TO THE>INSURED:NAMED ABOVE FOR THE POLICY:PERIOD'' INDICATED. NOTWITHSTANDINGANY:REQUIREMENT,TERM:OR CONDITION OF ANY CONTRACT OR OTHER'.DOCUMENT:WITH":RESPECT TO WHICWTHIS CERTIFICATEMAY"BE ISSUED ORYMAYIPERTAIN,THE INSURANCE'AFFORDED BYTHE'POLICIES DESCRIBED,HEREIN:iS`SUBJECTTO ALL'THETERMV, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES:,LIMITS SHOWN MAY HAVE BEEN,. EDUCED..BY PAID CLAIMS., INSR 'TYPE OF INSURANCE ": POLICY EFF POLICYEXP , L POLICY NUMBER' MIDD "MMIDDIYYYY "x: •LIMITS GENERAL.LIABILITY EACH OCCURRENCE 000,:000 ` X COMMERCIAL GENERAL LIABILITY; PREMISES aodcunence $ ;'100,000 CLAIMS-MADE X OCCUR k*.' S00041933*' ` 1.4/2015,; /14/2036•. �. ,r �- MED 6(0(Any dne person). 5,000 PERSONAL&ADV INJURY .°;$ lr;OOO;000 GENERAL AGGREGATE,. :`$'� :t`_2'000,000 ' GEN'L AGGREGATE LIMIT APPLIES PER� i `tr PRODUCTS,COMP/OP AGG .$ t ,2,000 .000`V ` ,..:. - PRO• ::_ - ,. _ f X POLICY .' JFCT = LOC: T t $ r 4 AUTOMOBILE LIABILITY '•'+"� ,� ;c� .,: r ...y ,, COMBINED N LIMIT . Es accident ANY AUTO $ ' BODILY INJURY(Per person) .- • ALL OWNED -SCHEDULED ; t: BODILY INJURY(Per.accident) $ AUTOS AUTOS. - HIP,ED AUTOS NON OWNED ' - AUTOS ..t$ i Peraccident UMBRELLA LIAB `� OCCUR- .!{ c 3" EACH OCCURRENCE r '$ r E7(CES5LIA9 DED ,I'. RETENTION$ r B WORKERS COMPENSATION x a r TORY LMITS �TR`- + AND EMPLOYERS'LIABILITY. y r ANY PROPRIETORIPARTNERlFCUTIVE E.L.EACH ACCIDENT' ` ;$ l -OOO '.00O OFFICERIMEMBEREXCLUDED7 ;� NIA :/9/2015 /9/2016 ' • {...'story In NH) i C50078962014A` a ..., E LDISEASE-EA EMPLOYE $ ' `1;'000 '000 : - hiyes;describe under - 6, DESCRIPTION'OF OPERATIONS bb16W E. DISEASE•;POLICY LIMIT'$ ':1'':000 A00 r. n ".: DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES(Attach ACORD 101 Additional Remarks Schedule;irmores ace.is re uire '.CERTIFICATE HOLDERIx- CANCELLATION s+ Y SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE`EXPIRATION' DATE`;THEREOF, NO CIE WILL <BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS:.' 3 . Home`Advisor 4 �.14023'I'Denver West'Parkway "" AUhpR12EDREPRESENTATVE, Golden;.CO; :80401 I Iu Joanne Bretton/JB ACORD,25(2010/.05) = O 1988-2010 ACORD CORPORATION. All rights reserved. INS025 p01o0s),oj The ACORD name and logo are registered marks of ACORD . -- - -- ---- _ .. 4 The ComwonweaM of Massadlttrsetts .... .... .. .. Department ofIndus&ialAccidaits trace oaf`Investigations 6#0 Washington Street Boston,MA 02111 mvmma�mgmldia Workers'Compensation Insurance:Affidavit:Bu'dders/Contractwm/ElecfticianwTlumbers Name Information Pieaso Print Legibly lam �Bi15lt1ESX ItIt�(�Jf�13�}= �P��P��/ G1�901 (i /�C.! �FiM'SI�/�G�{�17 Addrew: 1-2- 1� 'h-V\ ( d ity/State'Zsp Phone#:, 'I7z4 ,2 Are you an employer?Cheek the appropriate box- T of project 4. am a general contractor and I Type prof (id)- . l_❑ I am.a employerwith. � 6. ❑New�nstrirction. employees(full and/or part timze* have hired the sub-ccmtractofs 2.❑ I am a sale pxaprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no emplaym These sub-mritractors have 8. ❑Demolition woricing forme in any employees and ha me worms' �� I 9. ❑Budding addition [No workers' .insurance camp.insurance. required-] 5. ❑ We are a corporation and its 101-1 Electric I repairs or additions 3.❑ I am a homeowner doing all work offrcers have exercised their 11.❑Pl " �repairs or additions myself[No workers'camp_ right ofexemptimperMOL 12. ofnepairs insurance required.]F c-152,§1(4)�and we have no emp -[No w" s' 13.❑Other comp-insurance required_] #Any applscsat But c3edes box*I must aim Sll out to section below showing 6uir woders'compewation policy in€ormatem I Aumeoanecs wbo submit Bus affidavit indicating they ne daing all wasic and Bien hire ontude c outmaors must:submit a ne-w aiyidaeit indicating such- 1tontractcrs that rhea this Laic mnst attached an additional sheet slwsing the mane off a sub-contract 3 and staff whether ornot those entities bzve employees. If the sub-wntrWom line employees.ffiey mustpwvide their workers'comp.policy number. lam an ernployrr fhatisprovhUng workers'compensation insurance for my employe-es. Below is thepatrcy and job site information. Insurance Company Name: Policy 4 or Self-ins-Lic. _ Expiration Date: �L7V-Sitee Add P�Y N i eil 1 /l <4W.i (� a�k�-r �� Yx7t�tGf'ZO� Attach a copy of flue ivarkers?compensation policy declaration page(showing the policy number.and expiration date). Failure to secure coverage as mquired under Section 25A of I1+GL c; 152 can lead to the imposition of criminal penalties of a. fine up to$1,500.00 aad{or one-gear imprisontient,as well as civil penalties in the foisu of a STOP WORK ORDER and a fin of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ldoherebycertij5,underthe 'as and pg antes of Mat the informadarn prmi&d abzn z is true and correct Si e: Date: �_ y - t5 Phone#: .I'� �aZ. 05a�- tt ftial use only. I7o rat write in this area,to be completed by c4 or town officiaL City or Town: Perwitfi icense# Issuing.Authority(circle one): 11 1.Board of Health 2.$nffiFng Department 3.Cytyff own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 z A�- Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pin s mut-to this statute,an en playee is defined as"__.every person m the service of another under any contract of hire, express or implied, oral or written." An Moyer 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(�also states that every state or local licensing agency shall withhold withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicantwho 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' to contract for the performance of ubhc work until acceptable evidence of compliance with the ksurancd. m any P P a' eP mP 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. Limited Liability Companies(LLC)or Limited Liability 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 maybe submitted to the Department of Industrial Accidents for confirmation otinsurance 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 Indusfr 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 EE out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple pernuitllicease 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 future 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 (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit 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 Iadustual Accidents Offiice of Xnvestigatiom 600 wasbingtan steeet BaAon�MA 02111. Te,1.#617-727-4900 eat 406 or I977 hASSF Revised 424-07 Fax#617-727-7 49 www.mass_govldia A Jul, ssa6tisett§ Oeparfineht r f Ptitttrc's64 Yy Building egulatrgns and Stanistlrc�Sf T ��� �`onctrnctinri Supen tvrir S�rbrialft '� -� s License:CSSL 1059�] g:: f+ 4'MC.K eClFF"9';1 ` 2IBA,IDWIN DAD r z ., L a �� r�'� ,.a r '°'y'.:s`',iJr; i1 k �� '•r3 r1'� • X191!$tlOfl - r _� •'-' ' s°..�-:sue. ,.':'_ "�. 3' r... .,,..-...,,.' .eOl "s47 k, License or registration dated for indnrdul use only, O, ce.of Consumer Affairs&Business Regulation before the expiration date If found return to: 6pe` VOME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation 4 a7 registration: °173192 10 Park Plaza-Suite 5110 �• x Xpiration:. 9111/2016 DBA Boston,MA 01116 » CORE AND COREY CONSTRUCTION � . � f PATRICK CLIFFORD f'; 1• , 12 BALDWIN RD onature r DENNIS,'MA-02638 Undersecretary,' Not valid wikhbut e , } u k.. FF 4. • � � :i� �' -ice d } S-. xx � i t " u i . ' ORI - tCOREY , ., -.,.-. CONSTRUCTION 1672 FALMOUTH RD #1175 CENTERVILLE, MA 02632 - FHi01N1 E 1 01t -47 7 Si 8)2_140 C' EiITA;hNTEED LANzDL�IjAkRK LIF0TIM R ALG'AaE RES16TAHJT Y A ARC'HITE'CTU'RAL STYLE ` RE- � � � OOFI� M ;: PROPQ�SA�L April 10, 2015 ; RALPH GIARDINI `, - 450 MAIN ST EM: ralph2chipquik@aolxom ' COTUIT,MA - Tel: 508-681-8167 COREY & COREY hereby propose to perform the following services in neat and professional manner - and in accordance with the manufacturer's specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles from the Garage Only. _ Re Nail All Plywood Sheathing as needed.' Supply and Install. .CERTAINTEED LANDMARK : LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION,CLASS A FIRE RATED,COPPER/CERAMIC .:.h STONES for a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT,240 POUND,EXTRA HEAVY WEIGHT,130 MPH WIND WARRANTY,CATEGORY III HURRICANE.STORM/HURICANE NAILED • (6 NAILS PER SHINGLE). MULTI-LAYERED,LAMINATED ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT'SHINGLES. .COLORT BIRCH WOOD Supply and Install 8" WHITE ALUMINUM DRIP EDGE on All of the Eaves. Supply and Install CERTAINTEED WINTER-GUARD(Ice& Water Shield) WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves.. `. Supply and Install 115 BLACK SATURATED FELT.ROOFING PAPER Clean and Remove Debris from work area after job is completed. TOTAL INVESTMENT -=- =-= $r 17M.00 • tlt R(-.'E--,'j� 'y1 ..CONSTRUCTION. COREY C POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing;Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$'80.00 per Hour. PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the.Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Scheduled for Completion Within 60 Days of Acceptance and Receipt of Deposit providing the Materials are Available.Therefore Deposits Received are Non-Refundable After a Three Day Cooling Off Period from the Date of signing. This Proposal May Be Withdrawn By Us If Not Accepted&Deposited Received ' Within Thirty Days Or Before The Next Price Increase In Materials v Please Make Checks Payable to: t PATRICK CLIFFORD COREY & COREY Warranties the Shingles and Labor for 10 year's: { CERTAINTEED Warranties the shingles:and labor 100% for the First 10 Years . r and the Shingles your LIFETIME if the`shingles becomes defective. CERTAINTEED Warrants the Shingles up to a' CATEGORY III HURRICANE-130 MPH WIND WARRANTY. CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years.' , COREY & COREY 'r carries Workman's Compensation and Public Liability Insurance on the above work .DATE OF ACCEPTANCE: - ACCEPTED BY: SUBMITTED BY:-; � w R PH GIARDINI - . CHARLES COREY,CONSULTANT - HOMEOWNER COREY°& COREY CONSTRUCTION