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HomeMy WebLinkAbout0083 MARINER CIRCLE Town ®f Barnstable *Permit# 17 11 - N✓ rV Expires 6 months from issue date Regulatory Se> U ki Fee k BARNSrABM 9$ t . Richard V.Scali,Interim Director pr� �a MAY 2 7L � �� • �� Building Divi Tom Perry,CBO,Building om"mis i n i BA H iV S TA B L F 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION R+ SIDE+ANT AL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Z 3 04 7 Property`Address 3 Ma rill e.r [°Residential Value of Work$1!�,f Z — Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address�(Z r d AnA Mg/'if 3,e fctMAA^ f-r C'�'r. Co4uif /`1/4 Dig S BteiA4J, Contractor's Name t 1v5 1501✓ Telephone Number 401-ZZF—fSZ Home Improvement Contractor License#(if applicable)_f 7,3 Y Email: Construction Supervisor's License}(if applicable) Q 7S7d 7 Morkrha'n's Compensation insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name &&0A)At4- Workman's Comp.Policy 1 - QoZ g�rg 9 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) ❑ e-side LI-r Replacement Windows/doors/sliders.U-Value U maximum�5 of windows ( ) !3 #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.perrnit 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: QAWPF1LESIFORMS\building permit fon-hslEXPRESS.doc y Revised 061313 enewal Rl nrce M#36079 - {� RENEWAL BY ANDERSEN MAlicenm#173245' "J o!'U Ide a n.mnndmmCaopun s // CT License Finn#123i 26 Albion Road • Lincoln RI 02865 S—I�'�L b Phone 866.563.2235•Fax 401.633.6602 1 �y Federal Tax ID#46-0566630 Southern New England Windows,LLC d/b/a l©,J�1 Renewal by Andersen of Southern New England CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name: ,4L, I 1t ✓'`L Elk Date ofAgreemenc � Buyers)Street Addrea.Ciry Snte,and Zip Code I P.O..Box: 7y/ ; A Q Q-4;-3 T �l31�Z2 S c� 7s. Cm 6`a�j E-Mail Address: T J7 A 'Q. 21 C N I/"'" T.{ome7elephone Number. �?��lE-40 kTelephone Number, Buyer(s)hereby joindy 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 on the front and the reverse of this agreement and oKp at c ed specification sheet(s)(collectively,this"Agreement"). ❑Historic ❑ Condo ❑ HOA? Total job Zulnc LtTEEstimated-Starting Date: Method of Payment: 0 Check O Cash J inanced Deposit Received(33%): Credit Cards are accepted for deposit only-maximum 1/3 of the Balance at Start of Job(33%): Estimated Completion Date: project cost(Please see Credit Card Payment form.)By signing this Agreement,you acknowledge that the Balance at Start of Job and the Balance on Substantial I���^ f fi - f .2 w( Balance on Substantial Completion of Job cannot be made by credit Completion of job(9356):�C t / card and must be made by personal check,bank check,or cash. Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agreement. Buyer(s) acknowledges that Buyer(s) (1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK:SPACES. (Rhode Island Sales Only)Notice to Buyer.(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you ssign it.(3)You may at any time pay off the fall unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. Buyer(s)received the consumer education materials provided by the Rhode Island Contractors Registration Board. (Bu}er's initials) Renewal Andersen of Southern New England Buye Bu 4(s) B Si a[ure of P ct Manager Signature ure Print\ame of Product Manager Print Name Print Name y YOU;:THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS s FOR AN EXPLANATION OF THIS RIGHT. k= =' - - - sue- - - - - - - --- - - - - - - -�- - - - - - - - -sue ' NOTICE OF CANCELLATION X NOTICE OF CAN �.r -Date of Transaction You may cancel Date of Transaction u may cancel `� thistransaction,without any pen ty or obligation,within I this transaction,without any pengation,within three business days from the above date.If you cancel,any three business days from the above date.If you cancel,any property traded in,any payments made by you under the I property traded in,any payments made by you under the Contract or Sale,and any negotiable instrument executed I Contract or Sale,and any negotiable instrument executed by�you will„be returned within ten business days following I by you will be returned within ten business days following receipt bar the Seller of your cancellation notice,and any 1 receipt by the Seller of your cancellation notice, and any security interest arising out of the transaction will be I security interest arising out of the transaction will be canceled.if you cancel,you must make available to the Seller canceled.If you cancel,you must make available to the Seller at pour residence;in substantially_as good condition as when I at your residence,in substantially as good condition as when r ecaved;any goods delivered to you under this Contract or I received,any goods delivered to you under this Contract or a3a5iita;or;yoii may,if you wish,compfy'with the instructions of.1 Sale;or you may,if you wish,comply_with the instructionss-of the Seller regarding the return shipment of the goodsat the the Seller regarding the return shipment of the goods at the Seller's expense and risk.If you do make the goods available x Seller's expense and risk.If you do make the goods available to the Seller and the Seller does not pick them up within to the Seller and the Seller does not pick them up within twenty days of the date of cancellation,you may retain or 1 twenty days of the date of cancellation,you may retain or dispose of thegoods without any further obligation.If you I dispose of the goods without any further obligation.If you fail to make the goods available to the Seller,or if you agree I fail to make the goods available to the Seller,or if you agree to return the goods to the Seller and fail to do so,then you I to return the goods to the Seller and fail to do so,then you remain liable for performance of all obligations under the 1 remain liable for performance of all obligations under the ContracLTo cancel this transaction,mail or deliver a signed Contract.To cancel this transaction,mail or deliver at signed and dated copy of this cancellation notice or any other I and dated copy of this cancellation notice or any other written notice,or send a telegram to Renewal byAndersen of I written notice,or send a telegram to Renewal byAndersen of Southern New England at 26 Albion Road Linco ,RI[0286S, I Southern New England at 26 Albion Road,�L-nc�o n,�RC102865, NOT LATER THAN MIDNIGHT OF +L l% G— I NOT LATER THAN MIDNIGHT.OF Date)f HEREBY CANCEL THIS TRANSACTION. ! 1 HEREBY CANCEL THIS TRANSACTION; nate • t Southern New England Windows d.b.a Renewal by Andersen of SN E. Massachusetts-Depat ameai of Public Safety Board of Building Regulations and Standards Conslrucdon Supen-isor I License:CSAW57"_t IT" ]BRIAN D DN = _ 7 LAMBS POND'- : s Chariton MAL 97 s y ab txpi.- on C.�TT�:7755i4t3ef 09108=6 I V/i I��FLLJ' Office of Consumer Affairs!lane d Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration ReglsVAM IM45 Type: Supplement card F.�iraliort: 91t 912016 SOUTHERN NEW ENGLAND WINDOWS LL DENNISON BRIAN 26 ALBION RD LINCOLN,RI 02865 Updm Addrm and ream card Mutt tsawa for scA:6 anwy+t Address i`Rtaevsi r-1 Employment 0 Last Card tLor of Conferrer wlislrs dt llosiueo Betularion License or re isaadon valid for indfvidnl me oats IMPROVEMl3aTTCONTRAt:iOR beforeibeezlfuaDoadste.Iffoandrsmmro: F .office OrCowLmerAfftftand Bmiora liegnintioa t gbdratlom WIMS TYfta IO Pars:Pura-Side 5170 Fsp►ratldn 9l19R01S 'Suppl!§nerd�atd Barra,S1A 02116 SOUTHERN NEW ENGLAND WINDOWS U:C_ _ RENEWAL BYANOERSON DENNISON BRIAN t _ 26 ALBION RD n—=- -� _ \ UNCOLN.RI 02865 U Yot valid witboat sigaamre c * ' ,—. Department of IndustrialAccidents 0iffice of lav 4aft-ons r 11 Congress stre9t ,duke 100 1 � Boston,MA 02114.2017 c r y www wass eov1dYa Workers' Compensation Insaarance Affldavi'B ders/CoiatraetorsiElec'3ielsms/Pluml,ers Applicant Information Please Print Leylaty Name (BusineWorganiz3tion�ndiviauatl: SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, Rl 02865 Phone#:401 228-9800 Are you an employer? Check the appropriate box: general contractor and I Type of project(�tiirred): - I.M I am a employermith`20+ 4. I am a Q employees(full and/orpart-time�*` have hired the sub-contractors 6- Q New construction 2.0 1 am a sole proprietor or partner: listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g_ Q Demolition workingfor me in capacity. employees and have workers" any p ty 9. ❑Building addition [No workers' comp_insurance . comp.insurance.} required.) 5. Q We:are a corporation and its- 10.❑Electrical repairs or additions 3.0 1 am a homeowner doing ail work officers have exercised their 11.Q Plumbing repairs or additions myself i o workers' comp- right of exemption per MGL (N , P 12_171 oof renailq insurancerequired.]r c. 152,§1(4).and we have no employees_[No workers' 13. Other tJ t✓t Do comp. insurance required.) re P14c e r+l 0,' S *Any applicant thatchecla box Rl must also fill out the section below showing their 1.%rorkmf compensation policy information_ r Homeowners who submit this affidavit indicating they are doing all kvork and then hire outside contractors must submit anew affidavit indicetmg sacb- Contr actors that check this box crust attached an additional sheet showin_Q the name of the subcontractors and state whether or not those entities have . employees_ If the sub-contractors have employees they must provide their_xvorleW comp.poficy number. -ram an employer that is providing workers'compensation insurance for my employees Below is tree policy and job site ' information- Insurance Company Name:ARGONAUT INS. CO. Policy if or Self-ins.Lic.#:WC 928058352394 Expiration Date.8/21/2016 Job Site Address: ., 3 ! 1�.1 rt rl e r Cr City/StaWZip: Cz)4v Attach a copy of the workers' compensation poliey declaration page(showing the policy number and=Pkation date). Failure to secure coverage as required under Section 25Aref-MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S I,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 Loa insurance coverage verification. I do hereby cerhjy under theairs and penalties of'perjury that fire information provided above is true and correct. Si Date: Phone#: 4012289800 Official use only. Do not write rh fids area,to be completed by city or town officiaL City. or Town: Permit/License#f Issuing Authority(circle onto): r 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.PlIImbbilig YMpCCb_ 6.Other t^na4art PerSlm_ Phone* _ SOUTNfEW-01 SHETTYSHT DATE 0011DWYYYY) CERTIFICATE OF LIABILITY INSURANCE 8/19/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER.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 INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policyjies)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). KADDRESB�- 1fItillis Certificate Center Willis of ew Jersey,Inc_PRODUCER :(87T)9A5-73T8 '� (8881457-2378 clo 26 Century BlvdP.O.Box 305191 cert(fICates WHIIIS.com Nashville,TN 37230-5191 INSURERS AFFORDING COVERAGE NAIC 6 A:SeleCUVC Insurance Company Of Southeast 39926 INSURED a:OneBeacon insurance Company 21970 Southern New England Windows LLC c:Argonaut Insurance Compan 19801 DISIA Renewal by Andersen D• 26 Albion Road ` Lincoln,RI 02865 ES: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD CERTIFICATE MAY BE ISSUED OR MAYSTANDING ANY PERTAIN. THE INSURANCE AAFFORDED OR CONDITION F AkryBY THE POLIC1 S DECT OR SCRIBED HEREIN ISSUBJECT70ALLTHETERAAS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WOK EFFtLTR I TYPE OF INSUAN RCE WVO POLICY NUMBER V I POLiD E70' Lamm AX COBA1dERRCWLGENERALLIA81lJrY EACHOCCURRENLid $ 1.008.0 19 CLAIMS-MADE X OCCUR S 203459 08/1012015 08/1012016 PREki S s 110,000 MED EXP(Any o-Pelson) I S 1 0,000 PERSONAL'&ADVINJURY S 1,000,00 1 GEHc-RnLAGGR- S 3.000.000 GEN'L AGGREGATE LIMIT APPLIES PER 3,000,000 POLICY® RP Ex—]Lac PRODUCTS-COMP/OPAGG i S OTHER i OMBDNEDSINGLEUkrr Is 1,000,00 . AUToraoa¢E LIABILITY a .en A X ANrat)ro S 2029459 08/1012015 08/1012016 EMILY INJURY(PuI�) Is ALL OWNED SCHEDULED i BODILY INJURY(Pe:aeadetlt)I s AUTOS AUTNONOS ` PROP'RTY DAMAGE is X HIREDAU'COS E -AUTOS IPeraccidenit Is x UMBRELLA LIAR X I .. 5,000,00 OCCUR EACH OCCURRENCE 5 A EXCESSLIAB CLM4S-MADE. is 2029459 O8H0f2015 OS110i201& AGGREGATE {5 5,000,000 I DED RE IEN'IONS E S WORKERS coMPENSAnoN X STATIrM PER AND EMPLOYERS'L1aaILIrY 0000068028 0812112015I 08121I201fi E L EACH ACCIDENr S 1,0U0=000 B ANYPROPRIEIOR/PAR7NERIEXECUnVE Y!a. NIA OFFICERIMEMBEREXCLUDED? I� El DISEASE-CAEMPLO $ 1,000,000 (Mandatory in NH) 1,000,00 1tyes,1"a" undo• I EL olsEASE-PoucYue4R s OESCRIP170N OF OPERATONS tndrn+r C Workers Compensation WC928058352394 08121/2015 08/2112016 See Attached DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES(ACORD 101,Add'dional Remarks schedule,nay be attached iE more space Is mqulmd) CERTIFICATE HOLDER CANCELLATION y SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE .THEREOF, KMCE WILL BE DELIVERED IN ACCORDANCE VLRTH THE POLICY PROV1510NS. AUTHORIM REPRESENTATIVE Evidence of insurance ©1988-2014 ACORD CORPORATION. Ali rights reserve& ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable- *Permit Expires 6 months from issue date Regulatory Services Fee ��, Thomas F.Geiler,Director Building]Division X-PRESS PERMIT � Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 ,f UN 2 6 2006 www.towmbarnstable.ma.us Office: 508-862-4038 T(DWWVF VAKftt�9LE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number y 022® / 7 10,M Property Address �J � �e'G� y � T esidential Value of W orl �0 U Minimum fed of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) l l� r y o r S i M= ggliral�le) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑_L=the Homeowner ' I have Worker's Compensation Insurance Insurance Company Name Workmen's Comp.Policy# WCy 02& �-3 C?c) Copy of Insurance Compliance Certificate must be on file. Permit Request(ch k box) ' Re-roof(stripping old shingles) All constriction debris will be taken toL— ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maw=•44) "Where required: Issuance of this pera it does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. H Improvement Contractors License is reauired. SIGNATURE: ✓ Q:Forms:expmtrg Revise071405 Board of Building Regulations and standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR befor6'the expiration date. If found return to: Board of Building Regulations and Standards Registrations; 116064 One Ashburton Place Rm 1301 Exptrat�on 5/15/2008 Boston,Ma.02108 sfype Ltd Liability Corporation TYNDALL ROOFING PLC ROBERT TYNDALL 30 JILLIANS WAY Not valid without signs ure MARSTONS MILLS,MA 02648 Deputy Administrator Department of fridustrial Accidents ' X . Office of Investigations' ' . 600 Washington Street Boston,MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/JElectricians/Pluarabers Applicant Information ]Please Print Legibly Name (Business/Organization/Individual): %Y'10Af - - K061 Ixt 6, Address: �20 -ji City/State/Zip:/W gywC MUSC,1*4 0°2 Co Phone#:�D =�f�� ' q qS G Are yo employer? Check/he-appropriate box:. Type of project(required): 1.BI am a employer with . 4. ❑ I am a general contractor and I ' 6 ❑ATew construction employees (full'and/or part-time).* have hired the sub-contractors 2.❑ 7•I am a sole proprietor or partner- listed on the attached sheet $ ❑ Remodeling ship and have no employees These sub-contractors have 8. El Demolition working for me in any'capacity. workers' comp. insurance. g• ❑ Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or.additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11-0 Phunbiag repairs or additions myself•[No workers' comp, c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t erixployees.[No workers' 13 ❑ 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 anew affidavit indicating such tContcactors that check this boa must attached an additional sheet showing the name of the sub-contrabtors and their workers'comp,policy infor imfi . I am an employer that is providing workers'compensation insurance for my employees- Below is the policy and job site information. - Insurance.Company Name: ff l C %1 Policy#or Self-ins. Lie.#: l C61 Q Expiration Date: Job Site Address: ` I �f �12 (t(%E (, City/State/�ip: 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 oriminalpenalties of a fine up to$.1,500,.00 and/or one-year imprisomnent, 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 statemenf may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, un r the pains and penal• �ury that the information provided above is true and correct Si afore Date:-- Phone#: .S q2 D' Official use only. Do not write in this area,to be completed by city or town official: City or Town: PermitUcense# Issuing Authority(circle.one): 1.Board of Health L.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Information and. Instructions General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Massachusetts Gen person in the service of another under any contract of hue, Pursuant to this statute, an employee is defined as' every express or implied,oral or written." ' association,Farporation or other legal entity,or any two or more An employ ° ' er is defined Wan indivi�t •:P . A the foregoing engaged in a joint enterprise,and inchiding the legal representatives of a deceased employer,or the receiver or trustee of an individual,pa rtnership, association or other legal entity,employing employees. Howrv..er:tlte- nt of the owner of a dwelling house having not more to three ma�n�ean,construction od who resides r repair wo kvn serein,or.the uch dwelling house dwelling house of another who employs persons 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( )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 ofthis chapter have been presented to the contracting authority." Applicants Please fill out the workers' corrpeasation 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 certificates)of insurance. Limited Liability Companies(I-LC 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 of insurance coverage. Also be sure to sign and date the affidavit. The affiidavit 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.. S'e1f-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 an affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the app ense number which will be used as a reference number. In addition,an applicant Please be sure to fill in the permit/hc 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"th'e applicant should write"all locations in ' (city or Iowa). copy A of the.•affidavit that has been officially stamped or maxked by the city or town may be provided to the applicant as proof that-a valid affidavit is on file for.future permits•or'liceases..Anew affidavit must be filled out.each citizen is obtaining a license or permit not related to any business or commercial ventare owner or c� g year.Where a home o . (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lie 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 nvestigations . r: 600•Washington•$ reet� . Boston,MA 02111 : Tel.#617-727-4900 ext 406 or•1-877-MASSAFE Fax#617-727-7749 Revised 5-26,05 wwwmass.gov/dia V1/ORKLYR h� ��' �or�afo " eFSRANC POLCY Atlant1C Charter Insurance Company VDAC Cl Co. No.:29211 INSURED: Policy Number: WCV00643001 Robert Tyndall Prior Policy Number: WCV00643000 30 Jillians Way Producer: Marston Mills, MA 02648 Federal ID Number:174560293 Fredericks Insurance Agency, lnc. Risk ID Number: Business Type: Individual 1046 Main Street Osterville, MA 02655 Other Named Insured:See WCE106 SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Work Places: See WCE107 POLICY PERIOD The Policy Period Is From: 4/6/2006 To. 4/6/2007 12:01 A.M. Standard Time COVERAGES: at The Insured Mailing Address Workers Compensation Insurance: Part One of the policy applies to the Workers compensation here: MA p n Law of the states listed Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits liability under Part Two are: Bodily Injury by Accident $ 100,000 is of our Bodily injury by Disease $ 500,000 each accident Bodily Injury by Disease $ 100,000 policy limit Other States Insured: Part Three of the policy applies to the states, if any, listed here: each employee COVERAGE.REPLACED BY ENDORSEMENT WC 20 03 06A All states except Monopolistic State Fund States This policy includes these endorsements and schedules: ;ee WCE105 OVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates Rating Plans. All information required below is subject to verification and change by audit. & Classifications Code Premium Basis Total Rate Per No. Estimated Annual $100 of Estimated - -=—_ Remuneration Remuneration Annual -- - --- --- Premium WC 00 00 01 imum Premium: Deposit Premium: $516 ?rim Adjustment: Annually ' vicing Office: Estimated Premium (Minimum Premium) qew Chardon Street ; Surcharge(s) $500 ton, MA 02114-4721 16 Total Premium ao Surcharge(s) --- 5516 e 03/29/2006 Countersigned B Jational Council on Compensation Insurance _ �a R 2+9-200U Form:loom TYNDALL ROOFING 4 3 0 J�`GL�'�i-NS ul�' 1<7 Proposat 1(508) 420-4456 Dew CCU- Page No. of Pages PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME ,S EAI DZ 1_ ANAIA* ff L fKG,4f,+A1 CITY. STATE AND ZIP CODE JOB LOCATION o ? o5,3 AN lN� G';�¢ct� ARCHITECT DATE OF PLANS JOB PHONE I.FJ/ u iT 0o2&Q ,5 .J We hereby submit specifications and estimates for: Furnish and install new Class-"A" Roofing as Follows: A. Strip existing roofing and remove debris. B. Check all boarding and nail as necessary. C. Check all flashing. D. Install aluminum drip edge. VFwAh E. Includes ice and water shield to be adhered to roof 18 along entire lower edge of roof to prevent ice leaks also around chimneys, skylights, roof stacks; and roof valleys. F. Apply shingle under layment'-, (felt paper). G. Includes new flashing around all roof stacks. H. Apply customers choice of shingle. t y M/,,VZA. U006 3 OVA, AC iffI 1 Fill7-14,+L I. Apply continuous ridge ventilation. (IGLD — powl-gg 6t 00i Any unforeseen rot that may be uncovered during construction, the owner will be informed and made aware of the extra cost. �"�� SD�• o� Ord S� YI�. S�In.tG-!�. Payment to be ma vs follows dollars($ �J Q P 0 Q) /3 ` i All checks to be made payable to TYNDALL ROOF All work to be completed in a sub- stantial workmanlike manner according to specifications submitted, per standard Authorized practices. Any alteration or deviation from above_specifications involving extra Signal-, r costs will be executed only upon written orders,an will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or Note:This proposal may be delays beyond our control. Owner to carry fire, tornado and other necessary in- withdrawn by us if not accepted within days. surance.Our workers are fully covered by Workmen's Compensation Insurance. ACCEPTANCE OF PROPOSAL The above prices, specifications and cond" tions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outline above. �Signatu / g Date o1 Acceptance: Si nature Assessor's office (1st floor): • SEPTIC SYSTEM Na111ST BE ofTNEro CAssessors map.and lot number ........lJ.l.. .'..`.p. ...... 4. y ard of Health (3rd floor): INSTALLED IN C®MPLIAIN 6 • Sewage Permit number .:........:................ �.......:.... ....... WITH TITLE 5 2 BABasTSBLE, Engineering Department (3rd floor): 3 rJ,�- _ EG��/il�®NNIENTAL CODE A `'r0o 169 .......�.............................. ''rF a. House number ........................... .. .... �'CtNN I�EGI�LATICS�v�� eyar APPLICATIONS PROCESSED 8:30-9:30 A.M. and' 1:00-2:00 P.M. only ' TOWN OF ; BARNS-TABLE BUILDING 11S'PECTOR APPLICATION FOR PERMIT TO ..CC-^sdrL.c 2f�,1 �. r�1 c0 A v,-vk JI� .......... . .................... ................................... .f................................................. TYPE OF'CONSTRUCTION "................................................................................................................. ../ - 19...D..� TO THE INSPECTOR OF BUILDINGS: The"undersigned hereby applies for�a permit according to the following information: Location C-0 w , !� Proposed Use ....r✓ j ........................ �c ZoningDistrict . Fire District .........�.4. 1 .......... '.............................................. Name of Owner ..............................Address �Aeal... Name of Builder. .7.0L►..... � f ZZe..........................Address . Address ....................................................................................Name of Architect ......... Number of Rooms 1 ..�;L.. .Foundation .....�.t.G� �!�'..... � j..pOC(Y� Exterior `�d6.1r CS v ....Roofing .... ..i r IG�SS �?.. .......................... .......................... ......................... .... �5�.... Floors u'!h �. .. �!'`e .•�••"�!`r .0 1......................interior ... ..... `. j........................................... Heating ... .as ....1..! ..j./lN l !......r........................Plumbing e �4* .................. -2 Fireplace ... ..:...................................................................Approximate Cost ................ Definitive Plan Approved by Planning Board --------------------------------19-------- . Area ...... `�..d ..l....... Diagram of Lot and Building with Dimensions Fee ........f�....E......................... SUBJECT TO AP 0 Ot OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barns le gardin the above construction. � Name ...... ............................... �07 Cu�OiZZ Construction Supervisor's License ... .6S EARLY, KEVIN ct _ M J No . 29325 Permit for .Addition ' l Fl ................... Sing Dwelling .................. ................... ....:........ ^. 'l. • -i - -. c -.. � _ �._., �.__. _ ___�j • -I • r r Location 83 Mariner Circle ;, f. J -. j P `�' .r.e.. • t. COtUltr�.......................... ..�........ . ............. ...........................-.....r.'....... ''�.. r t .. _ v r Owner .,...Kevin °Early h . ... .. ...... -� -- ,-y i �,• �= -• - Tom` - - - ,.. • `Frame Type'-of Construction L ? r Plot ..... ................ Lot ....... ............... -May 12 86. -- Permit Granted ..... ........ .......`......19 Date of I s /./pection —,e/7� �.... . .... ......19. Date Completed .. ...... ....19 + Y } 1 .a • t � !Assessor's office (1st floor): i Q�Of T M E Assessor's map and lot number ........ ......6. .. k Y Board of Health (3rd floor): ` C (� r � ' Sewage Permit number ........................................::...... Z 33AHa9TaDLE, S Engineering Department (3rd floor): 3 `:S °o r6 9. •� 9 Housenumber ........................................................................ APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO` .............................� a �l f I �co?,.....U-- TYPEOF CONSTRUCTION ..................................................................................................................................... rk ..............................19-• TO THE INSPECTOR OF BUILDINGS: .x;t1 The undersigned hereby applies for a permit according to the following information: Location ��.,..........''f.....................................;.. '...... ................ . .... ................................................................................................... Proposed Use .... ............. G..........?s �`~� Zoning District ............. ................I......I..... Fire Distract ......... .. !....... .............................................. tlf /. .. Name of Owner f..............................Address p`. ►�`4 Gt!.9.U�... �.'..... �u�d-Pn J.. ...A.� .... '��� Name of Builder d ��'' ��^ I1 t �d � ��P w U �. ...........�.........................Address /....................... ........ ' :..........V.,t .t.l.;t..o...z+ t Nameof Architect .......... Address ....................................................................................E. ..... .... r `., Number of Rooms -.......................................................Foundation ........ C�,r-rj SC-- r� J "7 C W: ~ t' COY 9 c! Exterior ....... .....��.................... . ............... ....................Roofing .. i......... i...... .............................. t..Floors 1 .. e�.:.: !? ` e�^'!. :°r .Interior � ..� . ; . . Heating �S (�.+¢ i v .................... ...............L.�...........,............ .Plumbirig _�. tA�l-�,1'-:............................... r Fireplace ...r r tul.(........................................................................Approximate Cost f! ' �,. ,� � C� Definitive Plan.Approved by Planning Board _______________________________19________ . Area ......./............... .:.��........... Diagram of Lot and Building with Dimensions Fee ..•� .` SUBJECT TO APPRO_V,AL OE BOA,R.D OF HEALTH_--------..., ...� I . a i - i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnsta le-regard+ng.the above construction. ,�-�"' j� � t Name .... •!(,, ^.,'.................- ........................... Construction Supervisor's License 7 5 VS'l .......... :................. EARLY, KEVIN A= 047 Pa ORB -- O 34 7 No 29325 ADDITION .... Permit for Sin81e. Family Dwelling Location .:..83..Mariner Circle Cotuit : Owner ....Kevin Ear1X................. • Type of Construction ..._.._.Frame......................... ............ .................. ....... Plot ................. Lot .... ......................... t'• . 86Permit Granted .....:MaY12 .........:....19 Date of Inspection..................................:...19 Date Completed - /,/ P 7 f f° r4 - occ) Assessor's' map and-lot number �/�� ..`.. ��/r.......... THE ro 2 d • .. SEPTIC Sewage Permit number ....... ..... ..............................::..... SYSTEM MU� o 3 r NWALLEO IN COMPL Ouse number ...........................F..........................:................ WITH TITLE 5 90 rasa LE 9 ENVIRONMENTAL r;-� ': 6aYa.O� TOWN �OF BARNS' AB'LE BUILDING . INSPECTOR r APPLICATION FOR PERMIT TO .................: .i!..:.:."" ................................................................................... TYPE OF CONSTRUCTION .....�!L.-'/��. ..... ,i2??L ...a�!�ll/`s?C Pi .�Jy..................................................... + .............�� ?t� ................19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. ��... c' L id'''% '/.................................. ............................... �... . ...... .........G. `...............z.......... ProposedUse ...... ��2 '� ....................... ................................................ ................................................ Zoning District 'f �• ...................Fire District ....... 3 .................. ......... .... ....................................... ................................ Name of Owner ..� ..614 ........................... ........Address ............. ..... �,�...................... Name of Builder .... ............Address Nameof Architect :.................................................................Address .......�.. ................................. ......................................... Number of Rooms ...................�...........................................Foundaton ... .....................................1 -4 Exlerior ............. � .......... ::......Roofing .� X?� ........................................ LtJ .Interior Floors ..........,..................................... .... ................................................................ Heating �... .°.... ... .......4�" �....s.........::.............Plumbing ........../ ............................................................. // Fireplace ..:............ ......................cy ........................................Approximate Cost ......�:!). ........................................ Definitive Plan Approved by Planning Board _ __. ---------19 2�_. Area � .... . ................ Diagram of Lot and Building with Dimensions Fee .......... ................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH "'O III �Y f the T I hereby agree to conform to all the Rules and Regulationso e own of Barnstable regarding the above � construction. Name A W— . .. n .... ..... ./r '.......... THEO CONSTRUCTION 1 P ' t '�22675 `�No,Ro............... Permit for ..Q.1R.e...,9.t0x.Y.......... a. ,y f1 Single F ' r .......�...........ami] '...pw.�lli ng................ Location Lot... U... Ba...Mar mer...Ci-:e'le ... ........Cotuit.............................................................. Owner ..... heo...Construct .RTj................ Type of Construction .................. ...................................................... Plot ............................ Lot'.................. + November Permit Granted ..............................13 3.,....19 80 Date of Inspection ..................r . ... ..,..19 9Y ` `a Date Comp eted .............. .....� .. �.:19�C AXI PERMIT REFUSED low VA I . . ................................ ............ f to- ........ .0 ....................................................... ,i �•` . rs �. ................................................. _ f .......2..�.f....................................................... .' / n J Approved................................ r. ............................................................................... ............. .. ........................................................ .> _ .../`r7:J+ o Assessor's map and lot number'.,.•................... .............�,:.� ,*TNeT Q Sewage Permit number .....:` � .! ............................ Z DA"STAELE, i House number ........................... .. ..................................... 90O MAB �0 E YPY 639- A,- TOWN OF BARNSTABLE BUILDING INSPECTOR ,ram APPLICATION FOR PERMIT TO .................... ! ../ `... ................................................................................... TYPE OF CONSTRUCTION ..... r:!�:.,J!9f _ l. f/'FtC:: ........:............................................ .......................�.................. / / rJ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....:!f1,74........ !! f ` _�.***... ......�.�.�.. .... ....... .... ... .... '.. Proposed Use J!....:f:�L .................................`.......,..: ... ZoningDistrict ........ ..............................................................Fire District ,............................................................................... Name of Owner .........,................:...........................................Address ................ ........ .. Name of Builder .... / ti ............Address Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...................�'............................................Foundation ..:...... t..... .{.. ' ................................... Exterior .ff ............(..c F4r1 ...Roofing r? ,s'' r ?r !:: ..................... . Floors Interior .... ff t,t/e"all Ll1C ....................................................... l Heating ...'x........ .. ........Plumbing j ' J Fireplace ........................................Approximate Cost : ................................................... Definitive Plan Approved by Planning Board __ ___i _________19_ _. Area �.51� �'-.' .1 -.. .- .....J.................. Diagram of Lot and Building with Dimensions Fee _`?.t�............... .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH i I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ...................................................... THEO CONST'PUCVTONJ A=23-4 No Permit for ...2ne...Story ..............rSg. ......... ........... ..q...FMily..p��ipjj.inq ..... ..... .......... Location ..L.Qt ....... 83 'Aariner Circle ........ ............................ .................QQ tu-�t............................................... Owner T.jj.qQ..CQ.p.st.ruc.t.ig.n.......................... ....... .. .... .. Type of Construction ............................ ...................................... ......................................... Plot ............................ Lot ................................ Permit Granted 13 .........19 80 ................................ Date of Inspec . ................... ................19 Date Completed ................... ..................19 PERMIT REFISED .................................. ............................. 19 ......... ... k.1........... ........................... ........... ..................................... ....................... ..................................................... .................... ........ .........R. . ........................ Approved ............... ......... ..V7?;"/19 .................................I......., . ...IN........................ ............................................................................... r .a '?• �,1`r t-' r''�'"td'n,"i� -a ' s 3 p' Z :,y„�r i •r4ry :• '�'w.+ ?- ��y� s:icri.? •°' e 'r;..t. r`g} !w� +py�r•z.''r" ie,3' Yt t4e •,;Sr t :1•Y "kr' 'f' ¢�` .tpp'k# ra¢ lE y,i ! 1 ♦f ' Oil 3' a `T`1(7.A ti.. f>-y 'tii_ ry�'N '`f n +f t f Y .A*•.l f�� a'q^tii9 ,A ., ''' .S j t. r ♦1F Y�.Stig•!d J .wn wr, y_-saY.Aa,�.'i"+" e•._,. 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'•¢ �.a��.�..a `� r�,�.`�>'�` �•...�`x�t'�.m �.. �i��-ae�`� F.=oy=� .:s., �. „�': <:.. TOWN OF BARNSTABLE .`: •' Permit No. ---------------------- 1 Building Inspector »n.� ■... Cash --------------------- 00 OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department 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. 19...................................................... ......__ _ ......_........................ Building Inspector