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HomeMy WebLinkAbout0301 MARINER CIRCLE V W Town of Barnstable *Permit# of � i Regulatory S�CVICeS Expires 6 nto»11rs�r issue dote . ; 9$ 039. chard V.Scali,Director JUL 12 2017 Building Division TOWN J BARN`9ABorwPerry,CBO,Building Commissioner , +! `440 Main Street,Hyannis,MA 02601 www_town.bamstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number jQ.3 Property Address (1'1 ,n[r �'�r G�� 7✓r' [Residential Value of Work$ � , Z 5 7 — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address MA l t o d I'l a r C t G G Uq e-Ce_I/U 301 MAII 'n« Cr, �o�ii• f �`► /� D1(n 3 5 Contractor's Name 'nd(&,J rriA ( //rspl( Telephone Number No f 2- Horne Improvement Contractor License#(if applicable) 73 2 Z! S Email: Construction Supervisor's License#(if applicable) 7 o 7 [g Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ 1 m the Homeowner LV I have Worker's Compensation Insurance Insurance Company Name � r << e- n � Insuran aCC), Workman's Comp.Policy# r_E a 7 2—5 2—0 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roo fl ❑ e-side [1 Replacement Windows/doors/sliders.U-Value , �7y (maximttm.32)#of windows #of doors: f ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit.does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Property caner must sign Property Owner Letter of Permission. A copy the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\Decollik\AppData\Local\Mticrosoft\Windows\Temporary Internet Files\Content.0utlook\21`10I DHR\EXPRESS.doc Revised 040215 Renewal Agreement Document and Payment Terms bylll lder$en' dba:Renewal By Andersen of Southern New England Maio&Martia Guertel_lo: M.1E*1!A.!r.1Tr Legal Name:Southern New England Windows'LLC 301 Mariner Circle RI #36079,MA#173245,CT'#0634555, Lead Firm#1237 : Cotuit,MA 02635 26 Albion Rd,I Lincoln,.RI 02865 H:(508)428-4769- Phone:'866-563-2235I Fax:"401-633-66021sales®renewalsne.com Buyer(s)Name; Mario & Marcia Guareello Contract Date: 06/26/17 Buyer(s) Street Address: 301 Mariner:Circle,-.Cotuit; MA 02635 Primary Telephone Number: (508)428=4769 Secondary Telephone Number: m uarcelfhotmail.com Primary Email: . 9 • •' � :. Secondary Email: ' Buyer(s)hereby jointly and severally agrees to.purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor'-),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and anyother,document attached to this Agreement Document,the terms of which are all agreed to b the parties and incorporated herein by reference(collectively,this"Agreement"). Buyers)hereby agrees to sign a completion certificate after Contractor has completed.all work under this Agreement." Total Job Amount. $4F257: By signing this Agreement;you acknowledge that the:Balance Due,and the Amount Financed must be made by personal'check,bank check,credit card,or cash:. Deposit Received: $0 Balance Due: $4,257 Estimated Start: - • - Estimated Completion:, 6-8 weeks 6-8 weeks Amount Financed: $4,25.7 Method of Payment. Financing We schedule'installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we.are providing at this time is only an estimate.We will communicate an official date and.time at a later date..Rain and extreme weather are-the most common causes for delay. Notes: GS$2128.50 Deposit.; GS$2128:50 Balance ;Taxes Cotiut. • Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal.. understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1),has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above'and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank:You are entitled to a copy of the contract at,the time you sign. YOU,THE BUYER,MAY.CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT. OF 06/29/2017 OR THE'THIRD BUSINESS DAY AFTER THE DATE OF:THIS TRANSACTION,' WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF.CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dbaiR ewal By Andersen of S uthern New.England •:• Buyer(s). Signature of Sales Person Signature. . Signature • Dan Kolenda Mario Guarcell0 Marcia Guareello Print Name of.Sales Person. Print Name: ,.. Print;Name. - " UPDATED:,06/26/17. . Page 2••/ 9 I - ,Jassachusetts Department of Rubiic Safett] Board of Building Regulations and Standards !_icense: CS-095707 BRIAN D DENNISON 7 LAMBS POND CIRGL'E' CHARLTON MA 01507. . Ir3tTCn: Commissioner 09i0812018 oi t� Ce Or 1�OIISlliIIeL �3.�5311j�liSlIIZSS ��L_StsGII 1J ?11�i Plaza -Su'il: 5 170 V J�.1=1S - DL'StOII,lir.::SSili;nt-�SC'CIS '• -_ _ Home TImprotiement contractor RKecl; CTat1CP_ Registradon: 173245 Type: Supplement Card Expiration: 9i1912018 SOUTHERN NON ENGLAND WINDOW8 LL _ BRIAN DENNISON 26 Ai BION RD — — LINCOLN,RI 928S5 --_-- -- . - t'odnce.i-udresti and relv:v Div-yfar::rc:soa'ior Change. —.luldress —'3eae:val _EmQtavment .ast card ".=-'�7Rce of Caosumer:Vlairs•i�3usincss a galadoo;•! Regisamrion-slid for€ndividual 25e prt[^oeCore the -:v:� := esnicaliao dates U found return to: - ;1 0ME IMPROVEMENT CONTRACTOR O(fie of Baas user AtTair;and 3usinuc 2e�!alinn t. Registaadon:,J73245: T-tpe: 19 Par!t PQ-Spite S.'6 E,piratiao:-9i:1912613 Supplement Card Bostun.NLA 02116 SOUTHERN NEW ENGLAND WINDOWS I LC. RENBIIAL BY ANDERSON - 3RIAN DENNISON - L INCOLN.RI 02365 '..{}odersecretarp - nt i The Commonwealth of Massachusetts = Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 5� www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEPMTTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): e to owz Address: .2 Ce Amj2o I�J City/State/Zip: LAAIPeRl Phone#: In - 2 Q� Are you an employer?Check the appropriate box: Type of project(required): 1�I am a employer with Zo femployees(full and/or part-time).* 7. ❑New construction In 1 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition IFJ I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ]0 []Building addition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.F1 Electrical repairs or additions proprietors with no employees. 12.FJ Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14,dOther 'i�r J �d J T 152,§1(4),and we have no employees.[No workers'comp.insurance required.] (P P�k c-ei►%-e *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. //�� Insurance Company Name: Firemen$ &D Policy#or Self-ins.Lic.#: �(� 31E8*�7 2-9 — 2-0 Expiration Date: 1 Job Site Address: 3d l (1)aLei r G r. City/State/Zip: (,cju,'r, MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the ains andpenalties ofperjury that the information provided above is true and correct. 1 e Si ature: Date: 7— Z Phone# D Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I �., ESLERCO-01 SANDERSO CERTIFICATE OF LIABILITY INSURANCE DATE 0610712017' osron2o17 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CoBiz Insurance,Inc.-CO PHONE 303 988-0804 1401 Lawrence St,Ste.1200 (E c Lo,E�:(303)988-0446 (aFAXc,No):( ) Denver,CO 80202 ADDRESS:COMail@cobizinsurance.com INSURE S AFFORDING COVERAGE NA1C# INSURERA:Acadia Insurance Company 31325 INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 Southern New England Windows,LLC.dba Renewal by INSURER C:Liberty Surplus Insurance 10725 Andersen of Southern New England 26 Albion Road,Suite 1 INSURER D: Lincoln,R102865 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER M D MM/ID A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ::p CLAIMS-MADE OCCUR PA3158728 01/01/2017 01/01/2018 PAM AGE T0RENTED 300,000 PREMI E Ea occurrence $ MED EXP An one person) S ,000 I(r—I—I PERSONAL 8 ADV INJURY S ,000,000 2 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S- 000000 X POLICY❑PEe7 7 LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER. EBL AGGREGATE 5 2.000a000 A AUTOMOBILE LIABILITY EDa�d n SINGLE LIMIT 5 1;o0t1000 X ANY AUTO CPA3158728 01/01/2017 01/01/2018 BODILY INJURY Perperson) S AUTOS ONLY SCHEDULED AUTOS BODILY INJURY Per accident) S HIRED NON WNED Per.Ecu.IR,^DAMAGE 5 AUTOS ONLY AUTO ONLY S A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 5 1,000,000 EXCESS LUAB I CLAIMS-MADE CPA3158728 01/01/2017 01/01/2018 AGGREGATE S DED X RETENTIONS 0 Aggregate 5 1,000,000 B WORKE COMPENSATION AND EMPLOYERS'LIABILITY X STATUT ERA YIN CA3158729-20 01/01/2017 01/01/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE � N/A E.L EA ACCIDENT 5 O�FFICER/MEMBER EXCLUDED? 1,000,000 (Mantlatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S B Worker's Compensatio CA3158730-20 01►0112017 01/01/2018 1,000,000 C Pollution Liability EDE654299.117 0110112017 01/01/2018 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) 17-18 Workers Compesnation Includes-All states except ND,OH,WA,WV,WY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POL16'Y PROVISIONS. ' AUTHORIZED REPRESENTATIVE InformationalP ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD s 5 r' oq oFTttr r Town of Rarnstable *Permit Fxplres 6 monthsjrom issue.date Y Regulatory Services Fee ■ 13AfiNSIABLE y Muss. g Thomas F.Geiler,Director b0 165g. �0 pr6D hlAt h Building ]Division Tom ferry, CBO, Building Commissioner 200 Main'Street, Hyannis, MA 02601 www.town.barnstable.ma.us Off ice: 508-862AO38 Fax: 508-790-6230 EXPRESS,PERMIT APPLICATION - RESIDENTIAL, ONLY Not Valid without Red X-Press Imprint Map/parcel Number 3 �� Property Address_30i lve 6/. a 7 026�_� residential Value of Wort. / 00 ...... Minimum fee of$25.00 for work under$6000.00 n Owner's Name&Address MAJ-' V Contractdr's Nam �e ' � 'ec xC ow., Telephone Number `tol._V 71�G'7�®� I Ionic Improvement Contractor License#(if applicable) �/ Y,,) Con ction Supervisor's License#(if applicable} C t V PERMIT Workmen's Compensation Insurance . Check one: OCT 16 2009 ❑ I am a sole proprietor WI am the Homeowner 'T'OWN OF BARNSTABLE have Worker's Compensation Insurance Insurance Company Name efXUCJ."lz/.. !� Workman's Comp. Policy#. IS Copy of Insurance Compliance Certificate must be on fine. Permit Request (check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ZRe- Replacement Windows/doors/sliders:U-Value . _5,� (maximum.44) ( . 'kvAere required: Issuance of this permit does not exempt compliance with other town department regulations;i_6.Historic,Conservation;etc. . ***Note: Property Owner must sign Property Owner setter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: � 1� ik-T? 1i_L•.1;'%F RMS\building permit i'omzslEXPRESS.doe Revised 100608 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600-Washington-Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibly Name (Business/Organization/Individual): oord 5 70 JV, L , Address: w 3 % t t ✓� ' fir ��' f City/So/Zip:y�l(10N-1'30JCl— 1<:L (q?. .Phone #: Cr1 l 6 71. 6 G/50. Are u an employer?Check the appropriate box: Type of project(required): 1. I am a employer with v 4. E] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6.- 0 construction 2.❑ I am a sole or partner- listed on the attached sheet. 7. Remodeling proprietor ship and have no employees These sub-contractors have g 0 Demolition working for me in any.capacity. employees and have workers' comp. insurance.$ 9.,0 Building addition [No workers comp. insurance p• - required.] 5. 0 We are a corporation and its 10.❑Electrical repairsor additions ] 3.❑ I am a homeowner doing all work " officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t' c.-1.52, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether )r not those entities have —em to ees.-rf the subconrrac ors have employee,thie must-gravid their warkem mm . ofrc number — -— '-- — — — -- -- - - - - - - P Y � � P P P Y -,r I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: �G0'JU Ct� `' , Policy#or Self-ins.Lic.#: Expiration Date: /U Job Site Address: ©/ /i/1/T/ ./�/C� ��/ City/State/Zip:coh/ 0 35' Attach a copy of the workers' compensation,policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL.c. .152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form.of aSTOP WORK ORDER and a fine of up to$250.06 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage`verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: -' -> Dater Phone#: 0/ ��^ 7 00 Official use only. Do not write in this area,to be completed by city or town official City or.Town: Permit/License# Issuing'Authority. (circle one): 1.Board of Health 2.,Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other:. i Contact Person: Phone#: r y L a us! 'xesseg �attn D �tc ;s ? 4f2fii. ?r# =:285438 �cprt�x +' ± �y #gip 4 S MOON AS4.00 IN oi jv out WOONO p ^ '�: +✓i i'}w°i•"'t(S'gi}Aai : ry a"or p�Fi Gs``• x'yni. ,s . ��. IA m.jij�Ws- ��# - 1° If ' � fid II t4}}f a Nrt =Is PIN N a RO From:Shaunna Robinson, Hunter Insurance At:Hunter Insurance,Inc. FaxID To:Denise Glode Date:9/23109 09:45 AM Page:2 of &W-RA ,,CERTIFICATE' O,F LIABILITY INSURANCE OP ID SP DATE(MM/DD/YYYY) MOONA-1 09/23/09 PRODUCER k! THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 389, Old River Road, P.O. .Box .1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 " Phone: 401-769-9500 Fax:401-769,-9502 INSURERS AFFORDING COVERAGE NAIL# INSURED Moon Associates Inc. 1' INSURER A: - AIC 9 DBA Gutter Helmet National Grange Insurance Co DBA Renewal by Andersen Of RI INSURER B: DBA Gutter Hel seacan mutual Insurance Co. - DBA Moon Works !, INSURER C 1137 Park East Drive I'y 4WO011socket RI 02895 it 1 wsuRERO: I + INSURER E: COVERAGES 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 OROTHER 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE I POLICY NUMBER - DATE(MM/DD/YY DATE(MM/DD/YY) - LIMITS GENERAL LIABILITY I - e EACH OCCURRENCE $ 10 0 0 0 Q 0 A X COMMERCIAL GENERAL LIABILITY MPS26619 i 09/16/09, 0.9/16/10 1 PREMISES(Ea occurence) $500000 CLAIMS MADE X OCCUR ' , "I i # ,_ r:. ' MED EXP(Any one person) $ 10000 n `'•�� ( �' 4 PERSONAL&ADVINJURY $ 1000000 r 1 + I t c) GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 20000 0 O POLICY PE0. LOC. '>.l: ! '{ - I . - +" r ,. $ AUTOMOBILE LIABILITY, COMBINED SINGLE LIMIT ANY AUTO B1S20O.LV, ? 09/16/09 09/16/10 (Ea accident) $10000Q0 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS - _ `. 1 " ' l - (Per person) $ - - HIREDAUTOS � r q J BODILY INJURY $ NON-OWNED AUTOS 6 tt• ! r y k r, (Per accident) is + 1 t PROPERTY DAMAGE 1 r .(Per accident) $ F GARAGE LIABILITY- AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ 6 , 4 r I AUTO ONLY: AGG _$ EXCESS/UMBRELLA LIABILITY i • <. t ; P j: EACH OCCURRENCE $ 10 0 0 0 0 O A X OCCUR ❑ cLA,IMSMADE. CUS26619` 1 09/16/09 ,09/16/•10 AGGREGATE: $ - $ DEDUCTIBLE X RETENTION, $10000 ,+p ( 's i 'I ` ! $ $ WORKERS COMPENSATION AND ' ' 5 _ _ EMPLOYERS'LIABILITY - X.TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE - . 28586I'44 '! 1 ` - 10/01/09 (10/01/10 E L'EACH ACCIDENT $500000 OFFICER(MEMBER EXCLUDED? If yes,describe under ! } 3 E.L.DISEASE-EA EMPLOYEE $5 0 0 0 0 0 SPECIAL PROVISIONS below E _ E.L.DISEASE-POLICY LIMIT $500000 OTHER Ye DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION • +�+ ' j BUILD IN SHOULD;ANFHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION. tl '. DATE THHE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN + , .Building Corn. Reg. Board l T NOTICE TRTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALLDept. ofAdministration one Capitol Hill IMPOSE ATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR tProvidence RI 02908 REPRESES. AUT ESENTATIVE of _ ACORD 25(2001l08) ©ACORD CORPORATION 1988, 5:cQ Z6- 3' �5 . .. i:sw.ncr Na.rrc:Ado.,�m!A- IB U CT�o7aar Ruhr _.I�,1" Rene..il by Aad,,,c.l,,(Ith�,ue I.Ixnd!C i Rddtta: . —� (. C.od . Re 11� WI r,..,:s Al reement ,,.� .� _��_�,. (hr�umhcr: _.--- 137 Pak Fiat 28 m. 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Sewage Permit number ..... ..................� '76. SEPTIC SYSTEM MU �a fNSTAl1ED IN COMP 3TsnLE, House number ................................................................. Aes 2 39- WITH TITLE 5 ��0 MAI TOWN OF BARNS�;&=L °®NS BUILDING INSPECTOR DAMISTAB�E C0r*S0,V,*,.-;, APPLICATION FOR PERMIT TO _ .......... . .................. ...... c®r�lrlssl®r�........... TYPE OF CONSTRUCTION .........l�f� .... : /�Gx! .......sC;/.GLt .� �, ....... ! . l .......19........ TO rHE IN C Ok OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: s� Location ... ...../.� LZ!.aL!r...e`'Ls...� ���Z ..�............ �E i"'v!f,.....�� .�. ��?'. � ...................... ProposedUse .........L................. .................................................................................... .............................................. Zoning District ..Fire District J� "' .... :..... �............ frl Ric`rs!.................................................. Z4 Nameof Owner .. .// ... ......................... .• :......Address ...... ..... 9 .....y .............. . ....................... Name of Builder ...(................. I ........................... ...../..'�,.Address .................................................................................... .Name of Architect ..................................................................Address ...:.....................................................................0.......... Number of Rooms .............` .....................;.........................Foundation ..... ...ez . . ....:...... . . ........................... .............. ....................:......Roofing .... ..... .. (.,.,.... ..471, .. ..... Floors �!"..... ........... Interior ......... .............................................. kip- Heating ... ' Plumbing / c .... �� .. (N.'... . ........ ............................... .................... ......................... .. ...... . . ...............A Approximate Cost .'... ..lP �� A Fireplace ............���....................................... pp y... ...........................................�.... Definitive Plan Approved by Planning Board J-41- __!5 Area ................. Diagram of Lot and Building with Dimensions Fee .....�; �e .. SUBJ CT TO APPROVAL OF BOARD OF HEALTH r 3 ( I 3-3 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. .4 Name .. .. . .... .. ....... .............. fir . —SPERO THEOHARIDIS Permit for .......One S �9K........: . y .. Frame Dwelling ......................................................................... ..... Lot #59 301 Mariner irclm Location ....................................................... ........ .a Mariner........... Cotuit ................................................... ............ ............ . L Is Owner .-Spe.�t..:Fheohari is ..................... ...... ................ Type of Construction ........Frame .................................. ........................................................ ....................... Plot ............................ Lot ................................ Permit Granted .......Mc-jY...29.x.............. 8 0 Date of Inspection .............................a.......19 Date Completed ....................................419 PERMIT REFUSED ........ ..%....... ..................................... 19 .......... ............................................... ...........V.- ................................. ........... ...... ...................................................... .... J, ............. . .. ............................................. . L Approv6d ........................................... 19 ............................................................................... ............................................................................... -46- Assessor's map and lot number ,"", ......... � �G � __.. CFTHEtO / ,� y-.Z 4rQv O Sewage Permit number ......lr� d w Z 33AWSTADLE, House number ....................... ......................................... ao rnsa O i ,39• 9� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO — f� TYPE OF CONSTRUCTION ......... �t1 ,..... ° ........* ' ;`.'.4 c�.......2 ..........TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ...../.: � ......'a�:.!.... / f'�" � `...c:.::. .... !l%....:... � .................................. '�_ Proposed Use .......... i`...,;.�p :r -- ....... ..... ......................... Zoning District .......... .......................................... .... ...............Fire District ........�.c�1f..<t .............................................. .. . Name of Owner -�`f �° .... � "fir ``� Address 0 .., . ........ , .................................................................... . CtC�I./�." P .ta Name of Builder .. -C ............ fi ......... ... ..Address ....................................................................................... .�. .__ v Nameof Architect ..................................................................Address .........................................................,.......................... Number of Rooms ............../...............................................Foundation rr (�. //-�!./�!,O 7 ... ....................... r Exterior ...::........... ...............................................................Roofing ....:.... , ................. _ N e Floors .......... ............ :t? r'...'................,.,.........................Interior ..........! ��:c.� l.C/ft' .C.............................................. � A Heating ,r g ...... ......./ .....4?� Fireplace ............ ......................................................Approximate Cost ................... r 'C-?' t�....................................... JJ, ' Definitive Plan Approved by Planning Board ____�/�",_X _19 Area ...... .....r, rj ............................ Diagram of Lot and Building with Dimensions Fee J r SUBJECT TO APPROVAL OF BOARD OF HEALTH I 171 l I ! S I ► � I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name :............... ,. �„ SPERO THP,0HA'R1DIS A=39-11 a No ..22.225.. Permit fo,"...rJne Story ............... Single Family Dwelling ............................................................................... Location „Lot..#5. ... 9 301. . ...M.ariner. . ...Circle. ... .. .. .. .. .. .... ....... .. .. .... . Cotuit ............................................................................... Owner ,Spero Theoharidis ................................................... Type of Construction ...Frame Plot .................................Lot i....................0........ a Ma/29, 80 Permit Granted ........................................19 Date of Inspection ....J /...........................19 Date Completed -..19 ' PERMIT REFUSED ................................................................. 19 X , ......................... . .. .. .......... ..... ..... ........... ... I'I .........�. ....:.............. Approved ................................................ 19 ........................................................................ ............................................................................... /2G.G '7 0 L 4 PLAN SHOWING FOUNDATION LOCATION GOT UI T, MASSACHUSE T T S OWNED BY: Cew'- C drl'n_s TY --off SCALE : P 4d DATE: 511 { NORMAN GROSSMAN------ REGISTERED LAND SURVEYOR I HEREBY CERTIFY THAT THIS FOUNDATION 1S LOCATED ON 77HE LOT AS SHOWN AND CONFORMS TO THE TOWN OF BARNSTABLE ZONING REGULATIONS REGARDING , noRMa, ; SETBACKS FROM STREET LINES AND LOT LINES . cRoSsM > 127vwt Jrj �r�' .r5�-`,,r��'f„y ,.,re �.,is• G1./s"c? F +�� ��6-^�Q ` /r3i�-f NORMAN GROSSMAN R. L. S. DATE-4� 7:— 7. r