HomeMy WebLinkAbout0035 MOORING DRIVE 3.5 /Y/oo.e�sc D �
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EIPT
Town of Barnstable RE.
gA 200 Main Street, Hyannis MA 02601 508-862-4038
163
Application for Building Permit
Application No: TB-17-3176 Date Recieved: 9/14/2017
Job Location: 35 MOORING DRIVE,COTIJIT
Permit For: Building-Insulation-Residential
Contractor's Name: TODD LEDUC State Lic. No: CSSL-106019
Address: East Greenwich, RI 02818 Applicant Phone: (401)965-8578
(Home)Owner's Name: CHENEY,ZACHARY A Phone: (508)944-3729
(Home)Owner's Address: 35 MORING DRIVE, COTIJIT,MA 02635 m,
Work Description: Air sealing and insulation of attic flat and basement door. { ZE
,
3.
Total Value Of Work To Be Performed: $5,000.00
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor'of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: todd leduc 9/14/2017 (401)965-8578
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost : $5,000.00 Date Paid Amount Paid Cheek#or CC# Pay Type
Total Permit Fee: $85.00 9/14/2017 $35.00 XXXX-XXXX-XXXX-, Credit Card,
8065
Total Permit Fee Paid: $85.00 9/14/2017 $50.00 �XXXX-XXXX-XXXX- Credit Card
8065
TIITTSIN, T ��
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A. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map D 2-H Parcel __ Application #a0 0 (5 6 q
Health Division Date Issued
Conservation Division Application Fee
Planning Dept. Permit Fee S'
Date Definitive Plan Approved by Planning Board O
Historic - OKH _ Preservation / Hyannis
Project Street Address 3S done p nq
Village &,f-r)4C W0
Owner An / n If \ SCI n-�' Address 3 5 '
Telephone ( '7 7� 1 r2 1B Q2;L
Permit Request
OgiLe—
Square feet: 1 st floor: existing proposed 30 2nd floor: existing proposed Total new 30
Zoning District Flood Plain _Groundwater Overlay
Project Valuation Construction Type
Lot Size . ' / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family L Two Family ❑ Multi-Family (# units)
Age of Existing Structure C) Historic House: ❑Yes M No On Old King's Highway: ❑Yes M"No
Basement Type: ud'Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing I new
Number of Bedrooms: Z4,gG existing I new
Total Room Count (not including baths): existing 5new First Floor Room Count
Heat Type and Fuel: M/Gas ❑ Oil ❑ Electric ❑ Other
/ ^J �{
Central Air: ❑Yes 2f No Fireplaces: Existing New Existing ord/coal sfo'Ye: (es �No
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Bar6;�!L I existing Ll rev size_
Attached garage: dxisting ❑ new size _Shed: 9existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ co y
Commercial ❑Yes ❑ No If yes, site plan review # 0
Q,urrent Use Proposed Use
APPLICANT INFORMATION
(BUILDER O OMEOWNER)
Name A ►O t; c4 O Telephone Number __. (71y
`Address r 1 o�) 1r License #
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
DO ri�7
SIG NATU DATE— �a
FOR OFFICIAL USE ONLY
! APPLICATION#
DATE ISSUED
MAP PARCEL NO. -
' ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
' . FRAME _
t INSULATION
4 FIREPLACE -
4
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING VMt
�i� ie 3 9 iz 1P,�
DATE CLOSED OUT
It
ASSOCIATION PLAN NO.
The Cominonweakh of Massachusetts
Department of industrial Meciiders
D,f1ce of-Imeskgations
600 Washington Street
Bostol; AM 02111
www mass gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Piumbers
Applicant Information Please Print Legibly
C Name (Business/organizationadividmD: `
k, -
Adchess: 3 �d
t City/State/Zip: • Gf�15 ��I e a s Phane#: q�3
Are you an employer? Check the appropriate box; O
Type of project(required): .
1.111 mm a employer with t 4• ❑ I am`a general contractor and I -
employees(fill and/or part-time}.* have hired the siih-contractors, ° 6 ❑N construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet 7 L odehng
ship and have no employees These sub-contractors have 8, [�Demolition
working for me in any capacity, employees and have.workers'
o workers'Comp,rasurance Comp.in�nrunce.# 9• ❑ dmg addition
req imd. 5 ❑ We are a corporation and its . 10. Electrical repairs or additions
6. I am a homeowner doing all work. officers have ekercised their 11.�Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL I2. Roof r
insurance required.]t c. 152, §1(4), and we have no
amployees.`[No workers' 13.[]Other
comp.rasurance,required.]
*Any applicant that ch=13 box#1 must also fill out the section below showing their workers'compensation poficy iufnrmadon. ,
t Homeowners who submit this must affidavit indicating they arc
xConkacttirs that check this box must at doing BE work and thm lure outside contractors must submit a new afndevit indicating such.
tanhed.an additional shoot showing the name of the sub-coatractocs and state whether or not those entities have
employees If the sub-contractors have employees,they must provide their workers'comp,policy' member, -lam an employer that isproviding workers'compensation.insurance for my employees Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Uc.#
Expiration Date:
Job Site Address: City/State/Zip
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisommei as wc;U as civil penalties in the form of a STOP WORK ORDER and a fin_e
of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be.forwmrded to the`Office of
Investigations of the DIA for insurance coverage.vm-ification
I do hereby certify under thepazns andpenalties ofperjwy that the information prmdded above is true and correct
Si Date: ) j
Phone#:
Dff dal use only. Do not write in this area, to be completed by city or_fown official ,
C' or Town:
� Permit/License#
Issmfng Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4..Electrical Inspector.S;.Plumbing Inspector
6. Other
Contact Person: Phone#:
-Town of Barnstable
OF THE rp��
P o Regulatory Services
Thomas F.Geller"Director;
* =AENSTABLE * �.
Mass. .
9q, i63q YBuilding Division
ArfD �a Tom Perry,Building,Commissioner.
200 Main Street, Hyatuus,MA'02601 .
`.WWW.town bandstWe.ma.us
Office: 508-862-4038 a ' ' Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print. 1
DATE:
JOB LOCATION: S ' &I rV1 -4 b i e .: -
n/�umber Cl' street village
,e"HOMEOWNER" Af4o✓I1 0 J6l�yc,'!G' 77 3
name home phone#' , " work phone#
CURRENT MAILING ADDRESS: 3S � 061 117 j
iGr s �h 41 oar3
city/town state zip code
The current exemption for"homeowners"was extended,to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual'for;.hire who does not possess a license,provided that the owner acts as
supervisor. a.
DEFINITION OF HOMEOWNER
Person(s),who owns a parcel of land on which he/she resides or intends to'reside,-on which there is, or is intended to
be, a one or two-family dwelling;attached or detached structures accessory to such-use and/or farm structures. A
person who constructs more than one home in a two"year'period shall not be considered a homeowner. 'Such
"homeowner"shall submit to'the Building Official on a form acceptable to the Building Official,that he/she shall be j
responsible for all such work performed under the building permit: (Section 109.1.1).
i
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
4
The undersigned"homeowner"certifies that he/she understands the Town of:Barnstable Building Department
minimum inspection procedures and requirements and that he/she"will comply with said procedures and
re ements.
ignature of Homeowner
Approval of Building Official
Note: Three-family dwellings.containing 35.,000`cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control. : a
HOMEOWNER'S EXEMPTION
The Code.states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1 A-Licensing of.construction-Supervisors);provided that if the homeowner engages a'person(s)for hire to do such
work,that such Homeowner shall act as supervisor.
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results.in serious problems,particularly
when the homeowner hires unlicensed persons: In this case,our Board cannot proceed against the unlicensed person as it would,with a licensed
Supervisor. The homeowner acting as Supervisor is,ultimately responsible: ". `
To ensure that the homeowner is fully aware of his/her responsibilities,many:communities require,as part of the permit application, ,
that the homeowner certify that he/she understands the responsibilities of a Supervisor: On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for.use in,your community:
Q:forms:homeexempt
•
,
oFmE ram, Town of Barnstable ,
Regulatory Services
* EAMST"L4Thomas F.Geiler;Director
9`�prF0.19. e.`�� `Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.b arnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
.Property Owner Must,: t` ;
Complete and Sign This Section
If Us ina A Builder
I as Owner of the subject property
hereby authorize to act on my behalf,
i
in all matters relative to work authorized'bythis building permit application for
(Address of Job)
R ,
Signature of Owner Date
3
r
Print Name .,
If Property owner is applying for permit please cuomplete the
Homeowners License-Exemption Form on the_reyerse side.
Q:FORMS:O WNERPERMISSION
J A.
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Frc,"It Y7GJ r e7a.,'is/
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-- =
s Sl I OKE DETECTORS REVIE ED
h j (� RNSTABLE BUILDING DEPT. D TE
FIRE DEPARTMENT DATE
L_
307 f.31GNATURES.ARE REQUIRED FOR PERMITTING
watt G� CARBON MONOXIDE ALARMS
IMUST.BE INSTALLED PER.
IMPORTANT UPGRADE REQUIRED MAssacHusETrs BUILDING CODE
STATE BUILDING CODE REQUIRES THE UPGRADING OF �0c c. vrasV
SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN
5 C} ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED 3U 2 c,1�. T �f aor
of ��t�k ^� AC.c�e�. Cafe° NGfIoW
Come-,4c) A-o Mat}Cr de. t�vE'e NOTE`. A SEPARATE PERMIT IS REQUIRED FOR THE �.
o.� . �
INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL
PERMIT DOES NOT SATISFY THIS REQUIREMENT.
Gn iGtciC) .:JCcAt�J i flrr S
17 6_'4�oo it fiVew-- .6 K I j cw
•
16.00'
i! fi
0 5WON
Rear Deckroom
CNInIng. IR om
Kitthigh, g j }
�N 1
Vq -
ri Ali
Now.y
icy
r
-
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e
i _
y
Ft�f� T6wn of Barnstable 1l l CGSC�
�p ofyL Permit r'f.
0 Expires 6 monflts front 6-sue d
Regulatory Services. Fee
'�"' BSARVSiA.B(.E. i
Thomas F. Geiler, Director
m
Building Division
Torn Perry, CBO, Building Cornmiss.ioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable,rna.us
Offic e: 508-862-403 8
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION .- RESIDENTIAL ONLY
7 Nof Valid tpithorrt Red X-Press Gnprinl
Map/parcel Number O " Z11 .
Prop rty AddressA/4 0
1
Residential Value of Work ! 0 0 Minimum fee ofS35.00 for-work underS6000.00
Owner's Nam e Address ! vy'/�/�
Contractor's Name ' ��' Cl U j0,/V
Telephone.Number S��9(d
1-1ome Improvement Contractor License (if applicable) /��QYl? T 6
Con ruction Supervisor's License#(if applicable)_
n;Workman's Compensation Insurance a a s
Check e:
❑ I m a sole proprietor
re
am the Homeowner 0.
I have Worker's Compensation Insuran e
Insurance Company Name
Workman's Comp. Policy# �G3 V L3
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)
❑ R ide
#'of doors
Replacement Windows/doors/sliders. U-Value_( , (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
requir
IGNATURE:
i WPFII.F.4IFORMSIbuitding permit formslEXPRESS.doc -
The Commonwealth of Massachusetts
Department of Industrial Accidents
jT t9 �yl
� Office of Investigations
� . a 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
Name (Business/Organization/Individual):
Address: o L15�_ PCod,e,5 ��P—�� 1 (_V+b
City/State/Zip: `3 3 Phone #:
Are you an employer? Check the appropriate b : Type of project(required):
1. '� I am a employer with _;7 4. Y I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑N construction
2.El I am a sole proprietor or partner listed on the attached sheet. . 7. emodeling `
ship and have no employees These sub-contractors have g• ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y P h'• � 9. ❑ 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.❑ Roof 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.
tContractors 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.
rInsurance Company Name: 40W $ 1-te�
Policy#or Self-ins. Lic. #: 0 t 3 6 Expiration Date: 3 l
Job Site Address: ) / � City/State/Zip: 4 4 /I/ 0 3,5
Attach a copy of the workers' compens 'on policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify un the pains and Ities of perjury that the information provided above is true and correct.
Signature:
Date: 3 3 L J
Phone#: > — 6 ! 7
Off cial use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
NOV-17-2010 11:17 P.001/001
® (MLVOD1YYYY)
A�a CERTIFICATE OF LIABILITY INSURANCE FIDATE
1/17�2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
OERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
Cer0cate holder in lieu of such endorsemen s.
PRODUCER NAME:._._A�dYth Manning _
PHONE (50$)23$-DDSs P No):,(s04)230-a367
Morse Insurance Agency, Inc. MAIL )�"
285 wgshington Street "Aop s:�ud �ngtemorsaiva.00mt _
PRODUCER D0010837
North Easton Village ShOPPea ERID.9
North Easton
MA 02356 INSURER,VAFFORDINGCOVERAOE NAICtl
INSURED rIN$URr:RA'Xa:Ln street America Assurance 29939
MCLAIIc3Y3I+IN DOORS a� WINDO>pSC:a2 );RICA AVE O:
E�GIDDLEBORO XA, 02346-1478 F•
COVERAGES CERTIFICATE NUMBER:CL10111703811 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.
1 TR POLI Y Pr POLICY EXP LIMITS
R IN-qRIVMI TYPE OF INSURANCE AbD POLICY NUMBER MWDD/YYY 1YYYnn
GENERAL LIABILITY EAcrtOCCURRENCE a 1,000,000
12EP17€ S 500,000
X COMMERCIAL GENERAL LIABILITY I Ea ecou Son
A CLAIMS MADEEZ OCCUR
F2524E 1/31/3010 1/31/a011 MEDCXP(Artyonepv—; 8 10,—
PERSONAL&AOVINJURY _ S 1,0001000
GENE—AGGREGATE 3 2,000,000
PRODUCTS-COMPIOPAGG S 21000,000
GEHL AGGREGATE LIMIT APPLIES PER $
PRO. 7LOC
]( POLICY COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY S "(Ea yyr3 nt)
ANY AUTO BODILY INJURY(Per person) S
ALL OWNED AUTOS BODILY INJURY(Per sccldoM) $
SCHEDULED AUTOS PROPERTY DAMAGE S
(Pw acg4ani)
HIRED AUTOS E
NON-OWNED AUTOB $
EACH OCCURRENCE 3
UMBRELLAUAB =0CC'URAGGREGATEEXCESS LIAB
DEDUCTIBLE
a
RETENhom WC BTATU- OTaI
B WORKERS COMPENSATION �LIMIT.S -
AND EMPLOYERWLIABILITY YIN EACH ACCIDENT S 500,0
ANY OFFICER/ME BEREEXCLUOEDCCU�VE❑ NIA 11/31/a010 1/Sl/2011 E
(Mandatory In NH) CC5007716012010 E.L.DISEASE•EA EMPLOYE 4 500,000
it yes deaaibe undw C.L DISEASE-POLICY LIMIT S 50 0
DESGIRIPTION Or OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,AddlUonal Remarks Schedule,It Moro space In required)
pater xcT,aughlin is covered by the workers, compensation Policy"
TEM sit-Roma Scrvices, InC•and The Soata AaPot are in*luded as additional insured with raspeets to General Liability
insurance.
CERTIFICATE HOLDER CANCELLATION
(50S)756-8823 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
TFID At=Yiome Services, Inc.
DZA Home Depot at Home SsrviCe8. AIJT140PJZED REPRESENTATIVE
2690 Cumberland Parkway
Suite 300
Atlanta, GA 30339 Jtidith Manning/=
ACORD 25(2009109) 01988-2009 ACORD CORPORATION, All rights reserved. -
INS025(200909) The ACORD name and logo are registered marks of ACORD
TOTAL P.001
-� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: \
Office of Consumer Affairs and Business Regulation
Registration -126t193 Type} 10 Park Plaza-Suite 5170
!' Expirat /3/2012 Supplement Card Boston,MA 02116
i
The Home Depot'�'i.."Services !
DARREN DEMERS 5 6 j
2690 CUMBERLAND PARKWAY __._____-___
A'I'C`AN4`A,GA Undersecretary Not valid without signature
i
Ns
AU I-!� !U
,tam f• 5g :
lr�,W
a t1s ; ua a ? zt s °r:
�`,� § �:'nt�f':i��sEtt ,.I4' brYz.�''"fist t�1..43M a i3.?75 aH�xloaia's
fb�$.x.2'--..s' `."1�7''�z Dow S 'Si .. ..
a i.3;ttill,
.. �oe... R {"aan9i
Sfl' Z` 'rtA.�.�u�i
[I +' Sold,Furnished and installed by:
Branch Name: Boston Irate: U ` _ THD At-Home Services,lac.
dAVa The Home Depot At-Home Services
345A Greenwood.Street,unit 2,Worcester,MA 01607
• Branch Number:31 j Toll Free(800)657-5182, hax(508)756-8823
Federal ID#95-2698460;ME lie#C:02439;R1 C:uut.Lie#16427 (/
CT Lic#565 2;MA Ilome Improvement Cowractor Keg_A-126993
Installation Address: 5 J t VL G r ���1/ /�►JJJ C,
! City State Lip
I
Purchaser(s): I Work Phone: Ilonte Phone: Cell Phone:
d
Home Address: _ - t
(lf different from Installtttion Address) City St:ae Zip o1N
E-mail Address(to rec4ive project comnitinications and Home Depot updates).
❑I DO NOT wish to r$ceive any marketing emails front The Honte Depot
Project%formation: >ludersigned("Customer"),the owners of the property located at the above installation address,agrees io buy,
and THD At-Home Scr ices,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of
all materials described�n the below and on the.referenced Spec Sheet(s),all of which are incorporated into this Contract by this
reference,along with aly applicable State Supplement and Payment Sunmilry attached hereto and any Change Orders(collectively,
"Contract"): i
Job#: OMMUd Rd—)
I P odurts- Spec.shCct sl#. _ Project Amount
r— Roa
,,--{{,, fing ❑Siding Windows [IInsulation
5� L1 $
Guttcrs/Counts ❑Entry floors ❑ — g (�
Roofing ❑$tiling Windows Ursulatiun
Gutters/Cuvcrs ❑Furry Doors ❑
Ronfing Siding ❑Windown ❑Insulation
❑Cnitters/Covers ❑Entry fonts❑
Roofing ❑Siding ❑Windows ❑Insulation
❑Guttctx/(-'OVM ❑Envy flours ❑
Mlaimmt 25%Deposit Contract Amount due upon execution of this cootnt t Total(contract Amount $ J
Maine 11orchasers may nit deposit nwre than rite-third of the QintratxAmount. /
Customer agrees that,unnicdiately upon completion of the work for each Product,Customer Will cxceute a Conrplction Certificate
(one for cacti Product agi defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this
Contract agrees to be.jointly and severally obligated and liable hereunder.
The Home Depot reserv4s the right to issue a C h<vnge Order Or terminate this Contract or any individual Product(s)Included herein,at
its discretion,if The H.orile Depot or its authorised service provider determines that it cannot perform its obligations due to a structural.
problem with the home,i rivironmental hazards such as mold,asbestos or lead paint,other safety,concerns,pricing errors or because
work required to compl.e�e the job was not included in the Contract..
#�� included as part of this Contract, secs torch the total
Payment Summary- 1frie Payment Sununary
Contract amount and pay1ments required for the deposits and final payments by Product(as applicable).
NOTICE TO CUSTOMER
You are entitled to a coinpletely Filled-in copy of the Contract at the tine you sip. Do not sign a Completion(certificate(note:
there is one Completiod Cerlif icute for each listed Product as defined by Individual Spec Sheets)before work on that Product
is complete.
In the event ol'termina�ion of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses
and services provided y The Home Depot or Authorized Service Provider through the date of termination,plus any other
amounts set forth in th�Affccment or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS
OWED TO THE HOME DEPOT FROM THE VEPOSIT-PAYMENT OR OTHER PAYMENTS MADE, WITHOUT
LIMITING THE HOME DEPOT'S OTHER RF MF,DIES VOR RFCOVERY OF SUCH AMOUNTS,
Acceptance.and Autho#ization: Customer agrees and understands that this Agreement is the entire agruernent between Cuslumcr
and The Home Depot with regard to the Products and installation services and supersedes all prior discussions and agreements,either .
oral or written,relating to said Products and Installation,This Agreement cannot be assigned or amended except by a writing signed
by Customer and The Horne Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the
tertm of and has received a copy of this Agreement.
Su tied by:
X ultau Cs
Cusone na Tate Sal Si I
mature Date
X __ Telephone No. �v
Customer's Signature Date
Sales Consultant Liccnst;No. _
CANCELLATION: CUSTOMER MAY CANCEL THIS (its appti`shtc)
AGREEMENT WITHOUT PENALTY OR OBLIGATION
BY DELIVERING W9ITTEN NOTICE TO THE HOME;
DEPOT BY MIDNIGHT ON THE THIRD BUSINESS
DAY AFTER SIGNlk; TIIIS AGREEMENT, THE
STATE SUPPLFM>NT ATTACHED HERETO
CONTAINS A FOAM TO USE IIt' ONE IS
SPECIFi.CALLY PRESCRIBFD BY LAW IN
CUSTOMER'S STATFJ
NOTICE:ADUITIOAL TFUMS AND CONDITIONS ARE STATED ON TILE RFVFASE SIDE AND ARM:PART OF TIIIS CONTRAC.'r
11-30-09 C-SC White—Branch pile Yellow—Customer Pink—Sales Consultant
Town of Barnstable Permit# p6o-)6
o u Expires 6 months from issue date
2007 Regulatory Services Fee
MASS Thomas F.Geiler,Director.
.l
Building Division
Tom Perry,CBO, Building Commissioner. „i
200 Main Street,Hyannis,MA 02601 0
www.town.barnstable.ma.us 1Q
Office: 508-862-403 8 Fax: 508-790-623
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
C Not Valid without Red X Press Imprint
Map/parcel Number 6 Z l
Property Address SE 1►/ I DO I-"1 Ill q �D r-1 V e Cc,+L,- I y' J\ • d a 6 3
Residential Value of Work 8�,445 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address 2en ) a-min 0, a 11yl o-n
eats; MA 0 a.9 3 S
Contractor's Name rS bl'Y)�' �1'Y1�YDV�V17(�y� +� Telephone Number Ce!1 1,9GO, 753'O4-SZ
Home Improvement Contractor License#(if applicable) U b O / , L Xe 101 ` / / a C0 7
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I.am the Homeowner
XI have Worker's Compensation Insurance
Insurance Company Name Ace A�ne f- I CCU.n __�Cn S u m✓)Ce CowpayiX
L 2 9 ,� � v l � 0
Workman s Comp.Policy# � � '7""��b d`1 C� X 04 0
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
ArRe-side
❑ Replacement Windows. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
Ho Improveme Contractors License is requi ed...
SIGNATURE: _ �' r'S / C-1 r7
Q:Forms:expmtrg
Revise071405
oF�
Town of Barnstable
• BARNSPABLE,
,�39. Regulatory Services
Thomas F.Geiler,Director
Building Division
Tom Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I Y1 a M 1 -n 'Staf M _ ,as Owner,of the subject property
L� s sic Acj
hereby authorize VVIPMV to act on my behalf,
in all matters relative to work authorized by this building permit application for:
Ooorl' nq 3 iv
(Address of Jo )
�kT/aGh�cL rolLc.
Gl 4 90L
Signature of Owner Date
1
n yy,) 'I n acc+c-m(An
Print Name
Q:Forms:expmtrg
Revise071405
�w�n�aw Sears Job No.: '�p -7
Sears Home Improvement Products.Inc. Products s:Produ Phone
Han Improvement • 7� ra?7�'/ C 2
1024 Florida Central Parkway 4 Longwood.FL 32760 rnem Stilatem-. °� //�� T•���
LlCartee Numbers:FL Sal;IFL��12538:LA 84194 L L Ux
MA 14t1807:MS 50222;NC147330'RI 27281'SC 10li89A;
TN 2319: GA
Qt70I7;CT HIG.06078� g ��70(�70l�l3us.
Name t' r Phone:Res.
St.: q,,,� ZIP:
Address: ?S/1�1��2ZJ� b��t/� CtW I1W8,the owners of the premises described below,hereinafter referred to as'Purchaser"after
of ontract with materials Sears
ssHom to immprove_
allha
ent
Products hereinafter referred to as'Contractor,to furnish,deliver,and arrange for installation
premlea located at C.� —�.r
(state) (zip)-- (Street) (city)
According to the following spec icatlone:
NOT SPECIFICATIONS
INCLUDED INCLUDED
mffiamm I, ❑x ❑ Obtain all necessary permits and insurances, rotten surface wood where necessary in work
2. ❑X ❑ inspect surfaces In Work area-Varied loose wood Baca
area excluding roof,decking or raturr%and stnxcwrd members.
3. ❑. ¢� Remove Existing sktn9: Type=
4. ❑ pL�l! Fir out wells on brick,block metal or mtttm areas:Location:
5. Caulk and seal around all windows&doors In work a
e. ❑ Instag approved non-corrosive starter strip. irmisdon.(dude one)
INSULATION:
7. ❑ mated bmkIlon on fg&vdl emu to be aided with IW4°/' Pay eDdene
CUSTOM TRIM: 8. -Klad aluminum fascle tam: W
9. a adstlng 9 S�oo�7 s ,u L�I
10. home with vinyl somt system,except tlhoee sreaa noted below.
1c� Weathotaater 0 Max 0 Plus❑Westherbei ter 0 OUW (cheek one)Color:_Patent:
11. ❑ lq Custom Vyna-IOad aluminum frieze boards:
Location: Color: Size:
12. ❑ JumpdButt window trim: Location: Color.
13. ❑ Custom Wrap windowWalss/mulWheadero with Vyna-IOad duminum:
Odor:
14. ❑ Remove and reinstall exdatlng storm wdndows/awningsloutlers.
15. ❑ Custom wrap door facings with Vyns-Klad aluminum'm'
Location: Color: _
18. ❑ Custom wrap garage door facings sirtgle/ddulxN With VYnaAW aluminum:
color
e�
17. ❑ IC► Remove and reinstall storm doors /► J
18. ® ❑ Oatuxe Comer poste: Color: lT r S
18. ❑ Gips system: Location:
D A L/�d"i—t.J2.v
: 20. ❑ Install Waatherbeater 0 Max RPlas 0 Weathertinter ❑Other Solid v �kltng.(cheek Otte)
S)la91l4
TYP Vertical - COLOR: Cis
Location; Color:
PORCH 21. ❑ Porch Color:
Sy S: 22. ❑ Porch D Color:
23, ❑ _Porch beams
CLEAN UP: 24. Clean up and removal of di j�related tit�excess matenate aril re-stock.
25. ® ❑ Each job Is over-shipped 10 avoid dafeye•
VAa cr 26, 0 ❑ Manufecbxrere warranty sent upon Completion.
Work not to be done:
At Of the above check boxes and the'work not to be done'section have n reviewed and expialned to me.
TIME FOR COMPLETION OF WORK Contractor shall commence work within approximately twenty(20)days from the date shown he in and wit be
within five 45) thereafter unless dtfe t estimated Completion date Is shown herein.
subarerhtidy completed >�Y� A ima16 compietlon date b:
xifnats startingdate Is MS AS STATED ON THE REVERBE HAVE _EXPLAINED
ADDITIONAL PROM ONS AND WARRANTIES ARE STATED EVP�E AND ARE A OFTHIS LUJNTRACr.UWE 11 �AND FTJ Y.
Please read the following bold type and initial corresponding Ikte.
ding&and
Verbal understandinge and agreements with representative shall not be binding.All underete Purchaser Initials.X r s e law
to
writing in this Contract. ble discount)Is $ Contrect Price $
The TOTAL PRICE for all Labor&Materials(including any appIkaDown Paymrent $_
Balance Payable S nn state Sales Tax(_�)$
(if applicable)
Told Contract Price $
Terms: Credit V(Sablect to the apilrovel of the Credit Department) —
Cash 0 (Ftrtd payment payable to Installer upon compietton)Funded by; Bank:
City St.
Aoct If
109E Preferred Customer Discount(PCD)awarded for any future So"Have Improvement Products purchases.Current pricing&A Mbfe for are(1)year.
hereof. he VW9 the undersigned
transaction,11undersigned areal agreement
aWkorWrig Sears Home improvtained in a ement Products to verifY and review mY/ow cree document which is incorporated herein do record wlth reference aan ind ndependentandepende a meant
pew reporting agency and release them from all iiabllky,insured from inadvertent omlgsions or end � and acknowledge receipt
IN WITNESS WHEREOF Purchasar(s)have hereunto signed then names)tux day 01 for work to b in.
of a true copy of this Contract and unless Othenwl�specdied,h is understood that the owner Is ready ) e9
ISany MESSAGE APPLIES I TO ght ��I��afterrthe date of the transsaaction sties acco accompanying cancel this notice of
cancellation foe priorrm for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE
elelcw WS ase�N31 matSPACES.
P rEi)�vae o nation arI
Date
9 D BY: oats Puny ar` •D/y
Date
BY: dad 91 um to Sags Hama ins. Dale PuMeee
D2-SO -Rev.02MG _
The Commonwealth of Massachusetts
Department of Industrial Accidents
®ice of Investigations
600 Washington Street
Boston, MA 021.11
www.rnass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Sears Home Improvement Products Inc.
Address: 1024 Florida Central Pkwy
Longwood FL. 32750 Home: 860-792-8106
,
City/State/Zip: Phone#:_ Cell: 860-753-0452
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with. - 4. ❑ i am a general contractor and I 6. ❑New construction
employees(full and/or part-time).' have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ;K We are a corporation and its
officers have exercised their l0.❑.Electrical repairs or additions
required.]
3.❑ 1 am a homeowner doing all work right of exemption per:MGL 1.LO:Plumbing repairs or additions
myself: [No workers' comp. c. 152,§1(4), and we have no 1211 R.00f repairs
insurance required.] employees.[No workers' I3.9 Other O'ny ,
nQ
comp. insurance required.]
.Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
.r Homeowners who submit this affidavit indicating they are doing afrwork and then hire outside-contractors must submit a new affidavit indicating such'
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Ace American Insurance Company
Policy#or Self-ins.Lic.#: WLRC44460798 Expiration Date: 04/01/2008
Mooring
n �A us
Job Site Address: 35 1 v `Oo r i h Jr 1 V City/State/Zip: Ad H U 43 6-
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 line
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi and tfiepains a dpena/ties ofperjauy that the information provided above is true and correct.
Si ature: { Sears Auth. Agent } Date: Y �r aoo 7
Phone#: Home: 860-792-8106 / Cell: 860-753-0452
Of
fcial 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#:
Board of Building Regulati.mis and Standards
One .Ashburton Place -• :Room 1.301
Boston.. Massachusetts 02108
1lome Improvement Contractor,R.egi.stration
Registration: 148607
Type: Supplement Card
Expiration: '10/1.1 f2007
SEARS HOME IMPROVEMENT PRODUCT
LUSOS SVEC
1024 FLORIDA CENTRAL PKWY
LONGWOOD, FL 32750 dre "
t)pdate Address and return card.(Marl:rcasorr for change.
Address i'"I Renewal I I Emphoyment Lost Card
r
F.
'j4'r t.fax ir,rtJtrr+tr/ rx 11�33rr rrl lfd
Board of Building ltcgnlations and Staudur-ds License Or registration valid for nulividul use only
tr
t HOME IMPROVEMENT CONTRACTOR before the expiration date. If found re-luro to:
i I Board of Builthrrg Regulations and Standards
Registration: 148607 One Ashburton Place Rm 1301
Expiration: 10/11/2007 Boston,Ma.02108
Type: Supplement Card
SEARS HOME IMPROVEMENT PR
LUBOS SVEC
1024 FLORIDA CENTRAL.PK1NYa4G ��� /{
LONGWOOD,FL 32750 Adminislo-Mor Not r id witho it signalurt
eco
Glair 2M Restr t3 K Enders.mm
€_i U Hg-s-ds Epa-HAZ bumd 08.26-2043
tSVEC
4BOS, "
77 TH010PSON R
THOMPSON CT 0 277
i
04/02/2007 11:20 407-767—B536 —LICENCE PERMITS SUBS PAGE 01
Y
ACORM CERTIFICATE OF LIABILITY INSURANCE. ogialn007 03/10/2006
Pk*buw.n THIS CERTIFICATE IS ISSUED AS A MATTFR OF INFORMATION
LOCKTON COMPANIES,LLC-K CHICAGO ONLY AND CONFERS NO FIGHTS UPON THE CERTIFICATE
525 W.Monroe,Suite 600 HOLDER..THIS CERTIFICATE DOE NOT AMEND, EXTEND OR
CHICAGO IL 60661 E Cd1ltACa�I�FF_O gY THE PdL�C1E_S_BEL
(3q 60MOO INSURERS AFFORDING COVERAGE
INSURED INSURER A Ace,AT11 S
1062183 Sears Holdings Corporation
dPola Seats Home Improvement Products.Inc 1} dg.7plgli y Ifls:Co,of North Amer:,.,.
Attn:NO Management 854770
3333 Beverly Rd
Hf=Fftes,11.60179
COVERAWS SEAkjd 7FI6ATE OF INird,AMMO EU N n PRODUCER AND HE DING
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWRHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT DR"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,EXCLUSION$ AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CpLpA�I�MS.
INSR POD EXPIRATION
-LTRTYPE OF INSURANCE UCY UTABER r IdMRS
GENERALUAHRITY M RIE
A X COMMERCIAL GENERAL UASILrrY HDO G2.I729383 04/01/2007. 08/01/2001 FIB Q&.AA w� g Excluded
CLAIMSMADE E OCCUR ►.+ ,neE,c _n) s Excludcd
PERSONAL a ADv na3IJ ,F 5.000 000
s 5.000 000
EN'L AGGREGATE LLIpII�MpIIT..APPLIES PER! PRODUCTS-C ! AGG $ 5.000 000
POLICY dfCCT
AUTOMOBILE LIABILITY
�BI E0 SINGLE LIMIT g 5,000,000
A X ANY AVW ISAH08219953 04/01/2007 08/01/2007 dEa dr derrt!
ALL OWNED AUTOS
B LYiNJURY I aC�{xxnx
SCNEDULEDAUTOS (ParPaR±ari)
HIRED AUTOS BODILY INJURY
l NOR-OWNED AUTOS (Per amident) s XXXXXJ{�{
1
PROPERTY DAMAGE S xxxxxXX
(Par accldentl
GARAGE LIABILITY AUTO ONLY'EA A OID
A ANY AUTO S.I.R.$5.0001000 04/0)/2007 O8/41/2007 ggR rnAN ;;ACC, S XXXXX.XX
AO ONLY:
MWESS LIAMUTY EACM OCCURRENCE a 10,000,000
A X OCCUR ❑CLAIMS MADE XOO G23573930 04/01%2007 O8/01 2(M AGGREGATE s 10 000,0m
UMMUILLA xxx_ 'xx
DEDUCTIBLE FMW XX2Q3CXX
RETENTION 4 S XXXXXXX
A w0weRBcoMPEm xnmAND W1.RC.44460737(CA)(IDED.) 0VOM007 04/01/2008 X sTA o
A EMPLOYERS UAMLWf SCFC44460749(WI)METRO) 04/01/2007 04/011200$ E. .EAcm Acmom-r $ 1,000.600
B WLRC:44460798 04/01/2007 04MI120M r.,L,,DtS&AN.EAEMPLOYE s 00
13 ALL OTHER STATE EL DISEASE-POLICY LOW s 1 OOO
A OTHER S.T.R.$50M.000 04/01/2007 (W6112007 S.I.R.KONA(*
(1-BelreMn Liability
DESCRIPTION OF ADOEO BY ENDOR,SEMEffrM CIAL PROMSIONS
Alfred W.Nyman,Jr..Liemstl0400012s3A located®1024 Florida Calttrltl Pwkwoy,Ltsngatwdpd,Iqn,32750 and Alfred W.Nymam Jr.,Limm NCMC124951.0
tooatcd®1024 Florida Central Parkway,T.ongmd,FL 3275.0
HOLDER-. A UR>Q
2260002 SHOULD ANY OF THE AgM DESGRr90 POLI01159 BE CANCELLED l MOR THE EXPIRAMN
Sears Horne ImprovementProductS DATE THEREOF,THE ISSUING IN$uRERV4LLENDEAVOR TOMAR 30 DAYS WRrffCN
1024 Florida Central Parkway
Longwood FL 32750 NOTICE TO THE CERTIEICAT>z_HOLDER NAMED TO THE LEFT.bUT FAILURE TO DO 90 SHALL
IMP'Oft NO OBLIGATION OR UABD.iTY OF ANY MNO UFQN THE INSURER. ITS AUENTg OR
REPRESENTATMl
AUTHORIZED REPRESEWATKIE
ACORD2&S(7197) Nergn�eeomaaremetlr�e.Atller,.eauna�rmmecru ,dfnnuroraeuvar.,often.nw»nnio�pytnocnontaoeeeeerro6r: 6DAC0R6C0RpdRATION196B
Received on. 4/2/2007 9:22:`20, AM.
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: w 1.48607
xPiI dtion: 10/11/2007
Type: Public Corporation
SEARS HOME IMPROVEMENT PRODUCTS INC.
ALFRED NYMAN JR. - -
- --- 4-D24 E)R 6'D -c -T AL—P-K T r a f
LONGU' OOD, FL 32750 Administrator
40 7- 5 S- i S-40 a
gasw. d. ,t -r "A,. v+ 'r";Lcr" g' e•,y, `'? l:fi',) L ,.
1 .r ' , ` .•.. - c x., F " i�`..c. `n 4 :`My.p Y "�•1. c'" 4
33
ft �'s' 'Rf ' P� ! ra�'°' r�� tik ') drvs i•x a'F,,.i� ...
.t>d• a�..� ri ''mo�d.yr_ , , .�• ' " :S'}y�.� 'i^t �,., s.- t SAPle,
1`+ woo 38 + ^
45.aY,
e
Zoo (o!) sF
I2'5,00
PLAN SHOWING
FOUNDATION LOCATION
G O T UI T, MASSACHUSE T T S
OWNED BY: CEVAiz Ae-e—a j Z�40^6.mq -re.-a s r I" or
SCALE: Om 30` GATE " '� ` /so t0R,,!jAN �.
NORMAN GROSSMAN------REGISTERED LAND SURVEYOR
�ti0 5l+ft'E'���4
I HEREBY CERTIFY THAT THIS FOUNDATION- 1S LOCATED
ON T/HE LOT AS SHOWN AND CONFORMS TO THE TOWN
OF BARNSTABLE ZONING REGULATIONS REGARDINGHI PLOT PLAN WAS NOT 14AOEoM
SETBACKS FROM STREET' LINES AND LOT LINES . A►dtTN"UMtfldtSURVEY AND IS FOR THE USE
OF THE /3AAIJe-ONLY, UNDER NO CJRCUM.
�1 STANCES ARE OFF'SW-Ts To BE UGM FOR
reftras, w*!AA kriorses m
NORMAN 6ROS61WAN R.L.S. DATE
TOWN OF BARNSTABLE ____________
Permit No. _________________
Building Inspector
{ )m7TAX Cash
OCCUPANCY PERMIT Bond ----____ U
yn'
"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
Asses map and lot nunn);k_,�....................................Z.. HE
Tod
SEPTIC SYSTEM MU
Sewage Permit number ,,�................................................. INSTALLED IN COMP
-# WITH TITLE 5 = 33ARNSTABL-,
4P
Housenumber ...........................3.�.................... ..............
ENVIRONM. FNTALC D 11110
T,,-,'�' j"! A ION
TOWN OF BARNSTABLE —
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ...................
.................................. ........... ...........................................
TYPE OF CONSTRUCTION .....it! .... .. .................. ...... ............ .......... ....................................
........ . . . .. .l.. ..................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit cording to the following information:
Location ...... ..................... 4!!� ..�7-4,0000*.*.........................................................
ProposedUse ......z. ............... .. . ...........................................................................................................................................
Zoning District ................................/P/............. ................Fire District ......e ..... ...................................................
..........
Name of Owner AAd!�10..&A40.. ... ...
........ ..... , ,.---Address ........................
-J. ..........
Name of Builder ....................................................................................
.0,101"". ......................................I.........Address
777-
.Name of Architect .............................................................77a-dTiss ....................................................................................
Number of Rooms ....................... .............................
...........................................Foundation
Exterior ....a)"....66.&. .. Roofing .......... ...44e�... ....... . ............................................... ....... ........ ..... .... ..............
...........
Floors .......... or ....... . ... ......... ...... .............................. ......... ......
.............. ....... ..................................................Interior
vo
Heating .... ...... .............. ..... .11:!14................................Plumbing ........................ . .... ..............................................
Fireplace ............. ....................................................Approximate Cost .....d.4
Definitive Plan Approved by Planning Board J-3----------igP-D---. Area .. . ....
Dimensions Diagram of Lot and Building with Fee .............. .(.2. ............
SUBJECT TO APPROVAL OF BOARD OF HEALTH
14,15
ol
Ufa
-----------------
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable egarding the above
construction.
.........................
......... .........
Name .. ... ...................... ...............................
�
'
. .
o
`
,
- .
^ ^ .
. '
. '
- .
^ � -
, . .
. ,
'
'
'
. .
. . '
. `
.
'
dEDAR ACRES REALTY TRUST
One St r
Cotuit
PERMIT REFUSED
\ .
.. '
. .
J
'Assessor's map and lot number
/U"� �"l �P�pi Tpi`
Sewage Permit number
Z EAR39TULE, i
House number
G t639.
ViV
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ................... ?.! �: ..............,..................................................................
_
rfi
TYPE OF CONSTRUCTION .......:......:::{:.?%� �.- -;�'?�.-.,.:.....::!..:/.�;�a.�,` ?�i....................................
.:.....................
�;�A ..................19.
7....... , ....
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies fora permit accordingto the following information:
Location`' . � ... /aC' `2!t, 'a /;:�r�t1 ......i" '.7 ! •�• r ......................Proposed Use �f� ....... ................................ ......... .........................................................................
Zoning District ....................................... ...........................Fire District ......�'f�. r�tf.: ................................................
r; '
Name of Owner . .�?�r •..f �'�r :J , ...... .:....Address ......................... t!.......��. ................'
w '
Name of Builder` s � .r ... ` ....Address
Nameof Architect ..................................................................Address ....................................................................................
�,
Number of Rooms .......................v Foundation "
..................... .................................
Exterior ... �, It✓�i `... ��r, G t°:�....1, �'( r...........Roofing ......L-G /f....:^......: �-' (_c,
}, r
Floors �' !L% /.rf ......................................Interior
_r� ✓rl ...Plumbin y. l..Fieating -.................................. g .......................... ...... ..................................
Fireplace ............f... .'�:........................................................Approximate Cost ......:�� �......................................
Definitive Plan Approved by Planning Boards --- .-?-_________19/1 __. Area
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
i
._
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .�.l r`.L. .... rz-e'er/
.. ..... .. .. ....................
f CEDAR ACRES REALTY TRUST
22540, :s
No ...-..:.::::.:.... Permit for ....One StorX ...
Sin le Famil Dwellin f
..... .....................�'.....................�:..................
Location Lot...l,11 35 Mooring. Dr
Cotuit
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Owner ..Cedar Acres Realty,. Trust
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Type of Construction FrZW.e.............................
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Plot ............................ Lot ..................
Permit Granted ....SeA "'ember 2 6, 19 80
Date of Inspection J............................19
Date Completed ..........................19
PERM REFUSED
.............................. ........... ............. 19
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Approved ................................................ 19
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