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HomeMy WebLinkAbout0581 MARINER CIRCLE I,I ah° Town of Barnstable *Permit bj 7° '1'� a— Expi s 6 m om's elate Regulatory Services2014 Fe 16 Richard V.Scali,Interim Director TO RNSTABLE 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 ExPREss.PERMIT APPLICATION --RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number e�21` Property Address �a2t /� �l 2 f1 rn esidential Value of Work$ f Minimum fee of$35.00 for work under$6000.00 /J o Owner's Name&Address / rGS ( aiitO�/� /l�/a 9�i�i0e�t✓/dam Contractor's Name �^ — W +, ^'�'lR>vli7td� �/ °, Telephone Number :5nop x4pd Home Improvement Contractor License/#(if applicable) Email: Construction Supervisor's License#(if applicable)(2 f/,�,' �irkman's Compensation Insurance. Check one: ❑ I am a sole proprietor ❑ I am the Homeowner �I-Dave Worker's Compensation'Insurance Insurance Company Name ,4•nl Workman's Comp.Policy# tad d I dopy of Insurance Compliance Certificate must accompany each permit. Permit Reque. check box) t4Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to IaJi ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) f✓���. ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#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. it -A copy of the Home,Improvement Contractors License&Construction Supervisors License is requir SIGNATURE: TAKEVIN MBuilding Changes\EXPRE PE T�EXPRE .doc Revised 061313 508-328-1635 SPECIALIZING IN ALL FORMS OF ROOFING & SIDING doyleandthomasconstruction.com P.O. BOX 168 BBB. ' CENTERVILLE, MA 02632 Fully Licensed & Insured Construction Supervisor Lic# 99913 Doyle and Thomas Inc.Proposes to perform the following work: Location of proposed work: Mrs. Caroline Kalogeropoulos 581 Mariner Circle Cotuit, MA 02635 Date on which construction should begin: October/November 2014 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation is not to be considered a violation of this contract. The total cost for labor and materials under this contract: $7,539.35 GAF/Elk Timberline HD Architectural shingle(Life Time Limited Warranty) Thank You For Giving Us The Opportunity To,Help You Improve Your Home In the event that while stripping the roof we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$75.00 for a carpenter and$45.00 for a carpenter's laborer, plus the cost of materials. -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier,Synthetic roof underlayment,and installed with Timberline architectural shingles.using galvanized nails. (Storm nailed) -All new 8" drip edge and pipe flanges to be installed -Cobra ridge vent to be installed'on all ridges x -Timberetex premium ridge cap to be installed -A 5 yard dump trailer will be needed on site;and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property N NOTICE REQUIRED BY LAW With the agreement,of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start;and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject.to a finance charge of 1.5%per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility fo`r the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: bate: Homeowner Contractor �� r lte nrrzir�rittaeulf�c r' 'KujjawttjeC/J Office of Consumer Affairs&Business Regulation 3_ -- ME IMPROVEMENT CONTRACTOR .�lRegistration: 145954 Type: Expiration: 3/15/2015 Private Corporation DOYLE+THOMAS CONST:.INC" TROY THOMAS 499 NOTTINGHAM DR g �a CENTERVILLE, MA 02632" Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Super-isor Specialty License.: C!kPL-099913 ?4° TROY-ATHOMA,S` 499 NOTTINGHA�VI DRIVE, :_ CENTER MUA J l Expiration Commissioner " 04/13/2016 t ,4t�oRo® CERTIFICATE OF LIABILITY INSURANCE DA,E(09l02/20142/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION,ONLY AND CONFERS`NO RIGHTS UIiTHECERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE CO ft FORDED BY—WE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TFfilr ,'INSURER(S); AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Kristine Fernandez Mark Sylvia Insurance Agency,LLC PHONE 508 957-2125 Fa No):508 957-2781 404 Main Street. Centerville,MA 02632 EADD Ress:kdsbne@marksylviainsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURERA:Fffim Family Casualty Insurance INSURED INSURER B: D&T Construction,Inc. PO BOX 168 - INSURERC: Centerville,MA 02632-0168 INSURER D: INSURER E- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE-TEf MS, .EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP. LIMITS TYPE OF INSURANCE POLICY NUMBER MIDD MMIDD A COMIMERCIAL WNERAL LIABILITY 20OI X0485 7/21/ 0 4 7/21/2 15 X EACH OCCURRENCE $ 1,000,000 DAMAGE TO CWMS-MADE❑X OCCUR PREMISES EaENTED occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY a JECT El LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - Ea accident ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR _ EACH OCCURRENCE_ $ EXCESS LUIB CLAIMSMADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 2001 W7501 7/25/2014 7/25/2015 AND EMPLOYERS'LIABILITY STAME ER YIN ANY PROPRIETORIPARTNERIEXECUTIVE - E.L EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.LDISEASE-EAEMPLOYE' $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE D&T Construction Inc THE .EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 168 ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name.apd<logo are registered marks of ACORD r Y 77a-e.CornnionivetaM of Massa diusetts — �--. ,Oepcirtttagit�flfrd!irst'iral.�cc�tletiss . Office of Iravesiigadolm 600 Washiragtora street = Bostop t,MA 02111 - 1 a nn v.rl 1 d_S&go vld co Workers' Compensation Insukaat.ce Affida,%zt:Builders/Coutimactors/Elec.tnciansfPlumbers Appficam Information Please Print Lexib4� 1= Name(Busions/Or fit pl x Address_ OAA none M o Are You 1�er:+C#�eck the 'psop to boa. 'Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and 1 haze hired the sub-contractors b. New construction employees(fult ardor part.t�e). . . . , listed on the attached sleet: 7. Remodeling 2.❑ I am a sole proprietor or paamer- ,. � ship and have no employees These subcontractors hate g, []Demolition working- for in . capaci employees and.hive workers' � � �S`r co yosu�ea�ee.I p. llti6dirrg addition NTo wotieers'comp.iusumme '` required-1 5. El We are a corporation and its 10.0 Elechical repairs or additions 1❑ I am a homeolAmer doing all work. officers have exercised their , 11.0 plumbing repairs or additiom myself No woes'co right of exemption per 01. . Y �- - �, l?_ of ears insurance regrived.I.J. c_153;§1(4).and we.have no to Fo vvos3cets' 13_ Other yam'-U comps inwum a required.) 'Any applicant dm checks baz A mug also€tll oui the secdon belm showing&&r woQkes°eompenra on policy iafa�stiaa FPozoewnvnus who submit dus sfdaa7t i3barting dm,ere doing all work anal dot bire outside contactors must submit a new affidavit indicafag such =Goatractors that check this has test attsczed as additiama8_sheet sbosriog the amne of We sot•cootmcton and state whedwr or out those entities hale erup!ey me If Yl:e wb-cantrecrom h ve employees,eb"nmi proidde dnir weAers'mmp,policy number, ----- lain an einplot er that is pi m iditrg trrorkers'eonWensafian insrrtranee for my en rlq eex Helosw is the polieb'and Job site 1r�fornrQfi©a�, /� Insurance Company Name revs a✓vvr� �i/G l ,ni'J L A Policy#or Sic f-ins_Lei Expiration Date_ 02 l� Job Site Address_ _, �!t�^K'�5 �i � CitylStatePZp: Attach a copy of the work-ers°compensation policy declaration page(show€iug the policy number and expiration date), Failure io secure.coverage as required under Section 25A of MGL c, 152,can lead to the imp tion ofCriminal pMalties of a fine up to S 1,500.00 andfor one-year imprisonment,as well as ci na penalties in the farm of a STOP W-ORP ORDER and a fine of up to S250M a day against the% olator. Be advised that a coPy of this statement maybe fzma-arded to the Office of Ittte-sugations of the,DI for insurance covevip yerif tion. I do hereby certify rnrder the ins and penalties ofpeTtry that time information prmided abmw is mace and cow Phone Official,use only. Do not,vrfte in Arc`s area,to be completed hj eit or town ofcfaL - City or Town: Pe.rmitUcense Issuing Authority(circle ore); 1.Board of Health ?.Building Department 3.Cit€1 rows Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other , Contact Person: Phone!#: �tKWE r Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee 3'�7 XPRESS9� MASS. Thomas F.Geller,Director PERMIT Building Division JUL 19 2p12 �✓ Tom Perry,CBO, Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.bamstable.ma.us TOWN OF"A Office: 508-862-4038 Fax: S 8- TABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY L p� Not Valid without Red X-Press Imprint Map/parcel Number G A 1f Prope Address ss 1 M'�Y1/�/eN Cl�%le C 07 V/ esidential value of Work o� �o C9 U Minimum fee of$35.00 for work under$6000.00 4 AV A 11{64 to 6e 0 p o-u l 0,5 ��il �TrO i� Owner's Name&Address_ C 20"E, ��/f � Yo 6 e,//t AIA91 s14. Jo'�x�wi%fie AN O 2 ?,V- IS-1i Con actor's NameTrt //'` yUVQe�7 'Telephone Number o�3e�� !!` �avf Home Improvement ract tcense# t applicable) Construction Supervisor's License#(if applicable) . C j O l 3 dF Exorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner WI have Worker's`Compensation Insurance Insurance Company Name /t s f 0(i4 fi0d j!l p y��S!:� f VW 4l Vl& Workman's Comp.Policy# t^' CIIG �d 10 5{7Q / 2d// . 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 (V/N// OWAP-0-0-Y �dttJ � #of doors Replacement Windows/doo slider -Value 0,3l (maximum.35)#of windows *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: .r C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\DDV87AAZ CPRESS.doc Revised 072110 i V J2e a�nir�io�ecueaCG�o�C��ccdJacncGJe�l _. -.,x- _. ftice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before'Tthe expiration date. If found return to: egistration:,,:900740;.. T Office of Consumer Affairs and Business Regulation Type- 10 Park Plaza-Suite 5.170 xpirat E ion 6/23%2014: Supplement Card pp Boston,MA 02116 CAPIZZI HOME IMPROVEMENT INC.. ROBERT ELLS WORTH 1645 Newton Rd. Cotuit,MA 02635 Undersecretary Not valid without signature 1t Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License:CS-061438 ��SFTI'.S Ujn I ROBERT T ELL ORTH i 69 PALMERjRD i MASHPEE I jA 022 r Commissi'ot41�` Expiration ner10/15/2013 I i 1' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ��zz I k we)oft, Address: i G '/S' NeaYOWII R0 City/State/Zip: C`o � 144 OZ6 35- Phone A u an employer?Check the appropriate boar. Type of project(required): 1.Vam a employer with 7 0 -e 4. I am a general contractor and I F employees(full and/or part-time).* . have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have _ g, Demolition working for me in any capacity. employees`and have workers' ' - 9. 0 Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I.am a homeowner doing all work. officers have.exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 oof repairs insurance required.] t c. 152,§1(4),and we have no employees. [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 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: /7 SfOCl� fl� ����r���d �✓dj',Owe`� C� Policy#or Self-ins.Lic.#:, Wc L,7®ye-< V 701 ;Le Expiration Date:_ /A`/2 5-1 2 Q-a— J'r�f 1114",/Iv . .� C City/State/Zip: / Job Site Address: 6��` o �`� � Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition,of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine j of up to$250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under a pains and enalties qfperjury that the information provided above is true and correct Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town:. Termit/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#: Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/08/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO.RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ` PRODUCER - CONTACT Karen Walther NAME: Rogers Sr Gray Ins.-So.Dennis PHONE FAX 877-816-2156 A/C,No,Ext: A/C,No 434 Route 134 E-MAIL South Dennis,MA 02660-1601 -ADDRESS: 5O8 398-7980 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Grange Insurance CO. INSURED INSURER B:Associated Employers Insurance Capizzi Home Improvement,Inc. -Capizzi Enterprises, Inc. INSURER C 1645 Newtown Road INSURER o Cotuit, MA 02635 INSURER E: INSURER F:. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR - - - - POLICY EFF POLICY EXP LIMITS -LTR INSR WVD POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY MPB1075H 06/08/2012 06/08/201 ,EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence $500,000 CLAIMS-MADE I Al OCCUR MED EXP(Anyone person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $2,000,000 POLICY PROJECT LOC $ A AUTOMOBILE LIABILITY M1 M28044 6/08/2012 06/08/201 COMBINED SINGLE LIMIT Ea accident 500;000 ANY AUTO „�•, BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X Drive Oth Car $ A X UMBRELLA LIAB OCCUR CUB1076H 6/08/2012 06/08/2013 EACH OCCURRENCE $5 OOO 000 EXCESS LIAR CLAIMS-MADE AGGREGATE s5,000,000 DED I X RETENTION$10000 $ B WORKERS COMPENSATION WCC5010547612011 12/25/2011 12/25/201 X WOC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N - E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED?- EN N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 - DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 E THORIZED REPRESENTATIVE AZA ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD' #S82889/M82857 TLH Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER:OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT / � r .I, Av+a C a (,o A10 dV kj OWN THE PROPERTY LOCATED AT IN �au:r �' MASSACHUSETTS: I HAVE AUTHORIZED : `CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE.' - I GIVE MY PERMISSION TO LESSEE TO APPLY FORA BUILDING PERMIT KACCORDANCE WITH 780 CMR,THE.. MASSACHUSETTS STATE BUILDING CODE. _ SIGNATURE OF OWNER OWNER'S ADDRESS: OWNER'S:TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S:ADDRESS: LESSEE'S TELEPHONE: - APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd:,.Cotuit,MA 02635 APPLICANT'S TELEPHONE: 508=428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: . RESPON81BLE.OFFICER'TELEPHONE: MATTHEW J.MARCUS,ESQUIRE 04-.�14—2 011 & 0 ' a 3 8 P COLUCGI,COLUCCI,MARCUS&R AVIN,P.C. 424 ADAMS STREET MILTCN,MA M186 TRUSTEE'S CERTIFICATE PURSUANT TO GENERAL LAWS CHAPTER 184, SECTION .35, AS AMENDED AND CHAPTER- 203 SECTION 2 AS AMENDED We, Caroline K. .Kalageropoulos of 40 Belknap Street, Somerville, Massachusetts, and Joanna Demopoulos,` of 37 Earl .Street, Malden, Massachusett in accordance with the provisions of MA Gen. Laws, Chapter 184, Section 3.5., as ,amended, .and Chapter, 203, Section 2, as amended, do hereby certify as' follows: 1... We "are the Trustees of The Maria. Kalogeropoulos Irrevocable Trust (the "Trust") . 2. The Trust -is . the owner of the: real estate 'at 581 Mariner ' Circle, Cotuit, Massachusetts (the "581 Mariner Circle Property") , having acquired title by deed of ..even date to be recorded herewith at the Barnstable County Registry'of Deeds.` 3: Pursuant to the terms of the Trust (with .respect, to- the 581 Mariner Circle property AND .ANY. OTHER PROPERTY OR INTEREST THEREIN HEREINAFTER ACQUIRED.BY THE TRUST) , the Trustees- have` power and authority:` (a) to acquire, buy, deal- in and manage, real estate, whether the. same be improved or .unimproved; . (b) to sell, assign, convey; mortgage or otherwise encumber and dispose of real estate; (c) to enter into, execute and deliver .-=eases, . subleases-'and options to lease'=or subledse;. (d) to grant or acquire rights, easements and licenses and enter into agreements or arrangements with. respect to any real estate; (e) to borrow -money and execute and deliver notes -or other evidences of such borrowing; (f.) to guarantee obligations of. third parties`; 1 _ i Bk 25382 Pg 293 #19229 r periods. of. extending over e f (g) to create obligationsg p time beyond the date of any possible termination of, the., Trust;. (h) -, to take such other action as shall in the Trustee 's sole discretion be necessary or desirable in connection with the acquisition, transfer, management, 'financing, construction, development, marketing, maintenance,. repair, renovation and preservation of any real estate or interest- therein (which shall include easement, rights and also.,fixtures comprising a part. thereof) . The powers and authority expressly set forth above or otherwise granted by terms of` the Trust shall be construed in,the manner which would authorize "self-dealing" by any Trustee7in the exercise of. any such power of authority. 4.. The Trust contains no conditions precedent to any such acts by a Trustee, or which are in any other manner relative to or' germane to the affairs of the Trust, with the exception that no trustee shall be required, or ,obligated to take any action which will, in the opinion o_f the Trustee, subject the Trustee to personal liability unless first..indemnified to the satisfaction of the Trustee. 2 Bk 25382 Pg 294 #19229 Signe/d�under .the pains and penalties of perjury this Zf `rday ' of 2011. Caroline R. a opoulos . arena Demopoulos COMMONWEALTH OF MASSACHUSETTS �l�. ipfr S S• ���i� .": �, 2011 On .this ?1 day .of , 2011, before ,me, the undersigned. notary public, personally appeared Caroline K. Kalogeropoulos"proved to me through satisfactory evidence which was' a ['Massachusetts driver"s license or to be the person whose name is signed on the preceding attached documents, and acknowledged to me that she signed it voluntarily for its stated purpose.. MatthewIMarcus Notary Public Commonwealth m Massacfnisefts My Comm?ssion Expires: My Commission Expires `October24,2014 COMMONWEALTH OF MASSACHUSETTS S S. s 2 2011 -0n this z +day of 2011, before me, the undersigned notary public, personally appeared Joanna Deinopoulos proved. to me through satisfactory evidence which was a Massachusetts driver' s license or to be the person whose name is signed on the preceding attached documents, and acknowledged to me that she signed it voluntarily fir its stated purpose. Matthew J.Marcus Notary Public My Commission Expires.:. Commonwealth of Massachusetts My Commission Expires October24,2014 3 BAR�STAKE"STRY OF DUDS issess 's map and lot number .. : ......... � .:.` .....r� t ' THE T Sewage Permit number `'/..9........................*....... ' SEPTIC SYSTEM MUST O 6_� �. ' - INSTALLED IN C PUANCE B; 5"LE, House number ......................�.O../...................:..... i63 , e� 9 6 ff `, WITH TITHE 5 °0 9• \ 'ENVIRONME ,TA1,1 �YPYp'' TOWN OF BARN-S- BE ,�.#- BUILDING I.NSIPECTOR APPLICATION FOR PERMIT TO TYPE OF' CONSTRUCTION ...�,� .. � ... .. . .. ..... ... ................//.../....................19.0 TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies for a permit according to the following 'information: . Location ... .�VL... L.0 ' .. fit. �.... �. ...................... •. ............................................... ... Proposed Use .�.9............. ................................. .................................................... .... .. ..... ZoningDistrict ........... ... .............................................Fire, District ...... .................................................. Name of Owner ..i! ........ .. ... ...2'.. ..........Address .............Name of Builder .. ` .../...! .......... ..........Address ................................................... Name.of Architect ..................................................................Address .................................................................................... Number of Rooms ............:.....46..........................................Foundation .�� ..L �................................. Exlerior .�� .. .5,...... ..................................Roofing ... ?....................................... Floors ...... ................................................Interior ....475 ,xv....."......................................................... wraurirg _ :!k: .Plumbing �.................................................................. Fireplace ................./.............................................................Approximate Cost ...... ..P Q Definitive Plan Approved by Planning Board L�-_ ------19.-�---. Area .. ..... ... ...................... Diagram of Lot and Building with Dimensions Fee ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. • Name .U,! .. .. .. .: .. �.r CEDAR ACRES REALTY TRUST r,. or 22755 One Story - !No,.? Permit for ......................... ......... t. Singl.e...Family..Dwelling.............. , � « r - Location „Lot #25 581 Mariner..Circle` -; ..... ...... .............. ........ F Cotuit ' n r Owner ...Cedar Acres...Realty...T.r. at r Type of Construction ...Fr: Me.......................... ............ ................................................................. Plot ........................ Lot ............................... Permit^Granted .....Decemb:er..•12•,••-•19 80 ' � r r Date of Inspection ............................ ...:..19 i Date mplet ..`19 5'l N .161 r / PERMIT REFUSED ........................................r]9 .: ... .......... ................................ .... ±'.j ......... . ... .............................................................. F ` j ........ ......................................................... . • �1 `/"� .r ' •..........�•................................................... .......Y. + ' + „/• 7 - r �' F _' Approved ................................................ 19 i ............................................................................... 1 Assessor's map and lot number y �i1:.Y.:..... +� ..:•.....................� .... THE ua� / P .` Sewage. Permit number 1 ..::......`:..�................................ Z EASHSTAXLE, i House number ......................::r.Y. !................................... 90 rasa p 039. \�0 �FQ YPY h• TOWN OF 'BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ...!j!�.�'�1: ... �fr"z Y .... // .......... ............................................:........ c� . ................ ....................19.�f 1. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:/ Location .... fi.f.......... . .:..........:...J :Lim .....in V,r� 1.' c.'?�!�rl ... ( �.......... ................................... ProposedUse .................................. ............. .............................,........................... ZoningDistrict .............................Fire District l.:...... ................ ...................................................................... . Name of Owner .. •": ...�tOJ .. �`�.. .� ..........Address ............. ......�.�. !........................... .. .: Name of Builder tea ! .. ?f: �f�' ��. �� .. Address.....:... ......... ............ .................................................................................... Nameof Architect .............."... ..........................Address.................. .................................................................................... Number of Rooms ...........................................Foundation �� .✓ . j................fA ,......../................ /...... f ................................. Exterior � f '. '...r..`' rC:(- /�:��`{ �:...................... .Roofing ... �'.1�1r!,C ...' l+1✓`:'��f'f .................................. Floors ...... ............ .. .................................Interior ..... ..;.............................................................................. .......... .. . Heating ......... -' �y "�Tr`J...................................Plumbing ...... ... .... .. Fireplace .................../...... .....................................................Approximate Cost . . C ........................................ Definitive Plan Approved by Planning Board ____y���_f_: `_�_ 5_________19_� '_. Area ........................................` I . . Diagram of Lot and Building with Dimensions Fee .......................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH t J �j I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. I /� Name ..... *�....L !! • ` ....../:........ ./') ............ CEDAR ACRES REALTY TRUS No ..3.3755.. Permit for --- --.. g.. ..DvKellil:Lg............. Location ...58l.. le ^~°�uit Frame Plot ................./........ 19 - CompletedDate ` � PERMIT REFUSED / .......................... 19 . '~~ —'—''T'--------'' K—...---.--....-----.—.--~---'' ' ^'—''----'-^--^----~^^--^^~'---~' , - � Approved .—'�=~ ... 19 ----------- ... ..*«--..�----. . � v -------'.--.-.--'..—.---.......—~—, | ` | st°{ aZUo QtiUw a o►� W Ncrm(j M PLAN' SHOWING GG Z>i � a D� Jew 13 FOUNDATION 'LOCATION O�° o_ !- N ILIT a� COTUIT MASSAC SETTS d owaFo aY r �^ z}Q_ . "-:-- )k � DATE: NORIIIAN.-GROSSMAN'-7---- REGISTERED LAND SURVEYOR , l HEREBY GERTIF'Y.THAT THIS FOUNDATION IS LOCATED ���A OF r4�s�9 ON filE LOT`AS. Sk-OWN AND'C0IVFORIttS TO THE TOWNo�y OF.OARNS.TABLE IONING REGULATIONS RE6AtRDING �a NOR;AAN' ` GROSS,17AN SETBACKS "FROW STREET LINES 'AIYD -LOT �LlIVtS . 12n5 p s w , !aid: S'oll 0 SUM � NORMAN GROSSMAN R.'L'.S. DATE „*1 a TOWN OF BARNSTABLE Permit No. 22755� l Building Inspector ...� Cash — OCCUPANCY PERMIT Bond _ X 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 Cedar Acres Realty Trus}Address South Yarmouth Lot f25 581 Mariner Circle Cotuit Wiring Inspector f J r�� Inspection date Plumbing Inspector ^ Inspection date Gas Inspector `y � N 4 Inspection date I)- /j i(t j4-f 111 VEngineering 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. _, / Building/Inspector _ . �