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0092 OLD KINGS ROAD
9�? DIo'/`S'i�9S �/ i J f oFrT Town of Barnstable *Permit—!/d7 ti 0 Erpi'res6Lj#9 th jronr laaue date Regulatory Services Fee co --,;2 s— kA RY57lB[8. + Thomas F. Geiler, Director Building Division Tom Perry, CBO, Building Commissioner ` 200 Main Street,Hyannis, MA 02601 www.town.bamstable.ma.us Office: 508-862=403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid withotrf RedX-Press Imprint Map/parcel Number 7sidential rty AddressRe Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name Address 14, 1 w , � / 7 Contractor's Name /yl e s O0 _ . Telephone Number Home Improvement Contractor License#(if applicable)___J// S3S VW ction Supervisor's License#(if applicable)man's Compensation Insurance Check one: ❑ I am a sole proprietor0,1' ' EDam the Homeowner _ -PERMIT I have Worker's Compensation InsuranceX-PR ` Insurance Company Name I fit? CON I , 3 1 :_ Workman's Comp. Policy# �j 1 �r r.t it�l SR�lSTAS_ Copy of Insurance Compliance Certificate must accompany each permit. r�" Permit Request (check box) ❑ Re-roof(h urricane nailed) (stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ;>Replacernent ide ,Windows/doors/sliders. U-Value #of doors V (maximum .35) #of windows *Where required: Issuance or this permit does not exempt conipliancewilh other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Contractors Im rovement p License& Co nstruction Super required, p s Ltcenseis. 9 3NATURE: VP ILMFORMSIbuildingpermii formslEXPRESS.doc 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 Legibly Name (Business/Organization/I ividual) 00 SSoG NG Address: City/S to/Zip: Uftly L Phone #: 'Are on an employer?Check the appropriate box: Type of pro`ect(required): 1. I am a em to er with .4..❑ I am a general contractor and I P Y * have hired the sub-contractors 6. ❑ construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling shipand have no em to ees These,sub-contractors have g• Demolition P Y ❑ working forme in any capacity. employees and have workers' '9.. Buildin addition [No workers' comp.insurance comp, insurance.$ ❑ g required.] 5..0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work , officers have exercised their 1 L❑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. $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. f ll Insurance Company Name: , i � ✓V U I U�l Policy#or Self-ins.Lic.#: 0 S Expiration Date: jc Job Site Address: S City/State/Zip: t Q 3 Attach a copy of the workers' compensation licy declaration page(showing the policy number an' 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of . Investigations of the DIA for insurance coverage verification: -I do hereby certify under the pains,and penalties of perjury that the information provided above is true and correct. Signature: - Date: . Phone#: Official use only. Do not write in this area,to be completed by city or town official CityPermit/Licenseor Town: # Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.'Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: (;I—K 111 1VA i 1= U Edit-k011—t I T I4��'���E"`���d� yr eu w MOONA-1 1 10/05/1 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Huntidt insurance, -Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI. 02838-0001 Phone:401-769-9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE NAIC4 INSURED Moon Associates Inc. INSURER A: National Grange,Snsusance Co 14788 DBA Gutter Helmet DBA Renewal by Andersen of RI INSURERB: Beacon Mutual DBA Gutter' Helmet Roofing INSURERC: DBA Moon Works 1137 Park East Drive INSURERD: Woonsocket RI 02895 I INSURER E: COVERAGES THE,PQQQIE$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 DOCUMEv'T WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH. PQLICIE$.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR NSR TYPE OF INSURANCE POLICY NUMBER, DATE(MM/DDlYYYY) DATE(MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ I0 0 0 0 0 0 A X COMMERCIAL GENERAL LIABILITY MPS26619 09/16/10 09/16/11 PREMISES(Eaoccurenc9) $500000 CLAIMS MADE �OCCUR MED EXP(Any one person) $10 0 0 0 PERSONAL&A W INJURY $10 0 0 0 0 0 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 0 0 0 0 0 0 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $10 0 0 0 0 0 A X ANY AUTO BIS26619 0.9/16/10 09116/11 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NOWOWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONI^Y: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $10 O 0 0 Q 0 A X OCCUR CLAIMSMADE CUS26619 09116/10 09/16/11 AGGREGATE $_ $ DEDUCTIBLE X RETENTION $10 0 0 0 $ WORKERS COMPENSATIDN X TORYAIU- LIMITS ER AND EMPLOYERS'LIABILITY YIN B ANY PROPRIETORIPARTNER4DECUTIVE 28586 10/O1/10 10/O1/11 E.LEACHACCIDENT $50000Q OFFICERIMEMBEREXCLUDED? E.LDISEASE-EAEMPLOYEE $500000 (Mandatory in NH) If yes;describe under E.L.DISEASE-POLICY LIMIT $50 0 0 0 0 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS7LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCES BE CANCELLED BEFORE THE EXPIRA MOONASS DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRn NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHI NPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2099101) ©1988-2009 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD Is,tic s ofC nsw _,s .- � � , A sa ^ s 02-116 N 'Moo"N. F AAmroso 40 rfi eara.Nark xwaon ur Aat3.3o'�:a • ul Iota T 90M . F W-Mr-t r CWTAACTOR, um m4tirm f'y Timlv .x } a» °�a� �; '` E Y'i"3Ye` $.°' y*`36w''3.. �5 awe'. "a<,H 1a' suite e5'..0-0 .- � # $ olment Of Pub], sit Board of $��e,> A, A' g,�. d'. � KK wMNerNrcnrvYhN �'hwt�+•hh ,�^�f C�.Wy�.�G:.ku*e. ti<ttxw' .`��`.• �3$'�.vt.`;z.°� ``.Crlea-S +°"Aiv�?riY°UQ•¢.'�k`x^�: .'xEk"`�'x,'wk,wfw'�ek�+r'o,. "�-'�is2£ 9rA''.5'fR'kx`fix-`.9bkr:5s�:ik�4r"(3�s�S�S' C:.�,a' B:^..�k�k�§[ :1 `� fi�:�t '�sa. -`_ s . . ' �. . " pe ,seas: . Expiration: 3/23(2012 Aug G"1 i 1, 18 Jc t 408 699 3938 c i r, i?l Rene%alutatd::.31- ' 4 r r J'(I.t+' }`�rV tU`l.na s•..-r M i L......-.. IN r✓�M t i•,•t<:5 .. •yr it_r(s)Name. .ahation AdMess:9_� �l h((aSQrfny'�il-----�0 T�-i'^"'aR-i-4•L-.��f � _ !.taxing 6ddrtss: �-• �a "'- '�_�•--•. - '__. �. -_.�� 2 3�t// Cell(mrlmnl _.__..� E-mail: Home Dtume:.able� �,�,�a.!�,� r CeilfmrjmrsD - �........_Ta■esPa:din: 819 .+�zr-16 -h-r worry tmr,mrs►____ ,_, _ �.._— 1/`NC.ttu abosf✓Sata7Ws?:,s.4("Da'c'a:er si';anc the rt-r;sl gal tr:cr_U^-`tY hxrtesi at tr,c ahoy;sn,nada',ataC'r" s,'iereo. rn tty arfi se.erz:.y agree tC contra::with �r,aon.k5scc,ateS.lix d1la!r@r.ewai by I:r` Arise"tt('COntra J to 1UrrYsh,veUWf a..^.tl natd i O'at4 rrd fr-al' a.QU"C',b eC i-th15 agreerner:, Agreayrtrnt";.:ra.=;att;:cited SLxX Sh+?et(s1.Sites Agreer'.f't:iu-vna-Y aril d,ag:anstsi wnacr,�T;ecarper,.eO ne.r rc`e;e ice acd matte a pa,t here at.r,Cornptelicn Cer:iferate:.d'beexe sE='`'Oraa$uub!artti cr0 }teinstaflatcu� .�� �._, t Prgec�TyaeM1 k/ DEPOSIT/PAYMM7 OPTIONS �'�'" vc•t:ca:.co a-.Vcr f%,It aqp r:ia�1 Agmexment Amount S l 1 1.Ctteck,Cashiers Check or Money Ortter Cs c Lea;Del oditt s (Mace aaYanre to sena,.a4 b�i- .1 Adc"rIl Balance Due On Completion S /�- ._� 2.Credit Card'uark•) V Mastetiard (Ystavr-.° Arctnts2(�. 112D174ZScat,�4ie: -:tyCwaej �_ 3.tinandng i ///111 jIndicate Payment Methcd For&dance Acc,x ��Approval Code 4 C Co Due at Time of Installation: i P( t Accia �.APPr C�aiiUrh°,�•_ Litt.Star:Cate .p.—,_.J..�tst CG^tpt,4rianlTae "� _- •,,vh.rt e+ww-,>n .•�^ra aw(a.Lie role s-ra 4£L+t 31 i_X.:eR Id •V,_� err-.t R,£ :Pro rtnarTr.'a rao T-ya-.srn mr ahsbnat,d 9aG, it rat it n ape.0 of zta between:he :�.ra:t::.:ita the si e wdc,tMic ne,bet We 1,.T.le+amen.,aTIP trw ra are ry w-osl undt'stuy risis c•-angirg es mod't iftj any:,f the te at pus dgr ee=nant.F. a_entij IL:t i'xz!WFj.;:.J I t3:re:d the h;;nt arr3 tenon of vm Agrec"Pt a*d has rrceivtid? w rpleled,signed,ana cop,cf this t greer re",inc.vain f rite',w3 act,`Darynrg N,;ae 0 far.:el•arion rc,S.an t^r datz f es arrttter, 4-ans 11 was of all,r'armac' n`h.Sirxr light b cake)In,s 1 a-sa uI Yn.a-o Ren rat agree lj'Q:,^w_auName-t(i,z4E ng:he Laic;•;i./'r(Wcnt s'-mrn:y.Windc. ant A +ramr.•enrs;s:ne!itmi M-•ewrip of cur aTirceit., s the 1:ne'-sye Sta:emrrt cI the Wrat a:''-c:nr,I-irnu of 3--•agreeroe;t ante swe,w.--,at qreemaN;. .-r 7crs:ardir;s nr d,s:s.suan,,whtiher n?'a4 nr:.r t:,ps cnrr-.md iexc y--.�or.;c•rr.cm«rnarte�as.Y N•:rr't.-G agrerrae++t ;ia..s agre�men «av re:tit med`ied ray trna-rnd c.tppr in-ifng s:s:icc Cy,o and Ae,-- Zl. You may cancel this transaction any time prior to-nidrtignt of the third business day as indicated below in Line terms of the Notice of Canceltnion.There will be a serviCe charge eQual to 111%of chd cortract amount Y.job is cancelled by purchaser AFTER the Third business day,but before mattrfais were ordered.There will oe a service Charge eauat to 13%of the contract amount 0 the job is cancelled by Purchaser AF tER materials are ordered. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.SEE REVERSE SIDE FOR TER?AS AND CONDRIONS Of SALE, itnit rchaser(s)give the Contractor permission to contact me by telephone about future promotions and special otters. (In,t 1) rchaser(sj acknowledges having read'Notice of Possible Mechanic's Tien,on the reverse. Punch r Prrrtha r Con actor Representative ig tit? Sgnaturv, _rta•er2 wmr Narie PtIr;^Lame Pnr:%ante YOU,THE BUYER(S),MAY CANCEt THIS TRANSACTION AT ANY TIME PRIORTO MIDNIGHT OF THE THIRD BUSINESS OAYAFTEn THE DATE OF THIS TRArjsACTtON.SEE THE NOTICE OF CANCELLATION FORM BELOW FOR AN EXPLANATION OF THIS RIGHT. N,(�[10E OF CANQlLA7iraF1 NOTICE^tOF CA1VtCE1tAftON Date of Transaction �--3-- tf Date of Transaction� YOU may cancel this transaction,without any penalty of Obilip n, You may cancel this transaction,without any Pertafry Or obligation, within three business days from the above.date.if you Cancel,any within three business days from the above date.if you tancei., any proPeftt traded In,any Payments made by you under the Contract or,property traded in,arty payments made by You under the Contract or Sale,and any negotiable Instrument eaccuted by you wi`I be returned Sale,and any negotiaWe instrument executed by you will be retacrrred within 10 days following receipt by the Seller of your carceUatiort w thin 10 days folimvirt g receipt by the Seller of ytur cance0ation notice,and any security Interest arising out of the tlarsacdan wilt be notice,and any security interest arising Out of the transaction will be canceled.Ii you cancel.You most make available to the Seifer at your canceled.Lit you cancel,you must make aaaitable to the Seller at your residence,in substantially as good condition as when received,any residence, In substantially as good condition as when received, any goods deCErefed to you under this Contract or Sale;Or You may,if you Roods delivered to you under the Contra"or Sale;or you may,it you wish,comply with the instructions of the Seller regarding the return wish,comply with the instructions of the Seller regarding cite return shipment of the goods at the Sellers expense and risk.If you do make shipment of the goods at the Sellers expense and risk.If you do make the goods available to the Seller and the Seiler does not pick them up`!the goods available to the Seller and the Wler does not pick them up within 20 days of the date of your Notice of Cancettatlon,you may withfn 70 days of the date of your Aiotace drf Can,aaticn, ,or,may retaln or dispose of the goods without any further obligation.it you, retain or dispose of the goods without any further obligation.N you tail To make the goods available to the Seller,or it YOU agree to return fait to matte the goods available to the Seller,or if you agree to return rite goods to the Seller and fat,to do so,then you remain liahk far the goods to the Seller and 13P to do so,then you rental.*Liable for Performance of all obllQalicm under the Contract. To cancel this. performance of all obligations_ under the Contract- To cancet this tramattion, mail or deliver a signed and dated copy of this Uaniattipn, mail or deliver a signed and dated copy of this cdntellatioa rlotrte ar anyothrf w itten notice,w send a telegram to caaxellation notice Or any alter written notice; or send a telegram to Renewal by Andersen,1137 Park East Or,Wtmttfaket,RI 02S95,NOT Renewal by Andersen, J137 park East Or,Woonsocket,fit 02B95,NOT LATER 114AN MIDNIGHT OF �� -/l (Barg). LATER Tlb1N MIDNIGHT OF I HEREBY CANCEL THIS TRANSACTION. I HERESY CANCEL THIS TRANSACTION}, Cwawrncr's Sr6nerura - Oair, COn3Ur77F.Y'`!Sl$nd24I8 - Date aYin;c trn� St„n..,ai,. 1.Ijr_n..t';:Dit'r.-cu a',b.'u7 £ Cad CoP3"+'n�trct.ifnsxk.n t , " oF� r�,f Town of Barnstable *Permit# ~p Expires 6 mon from issue date Regulatory Services Fee r BARNSTABLE, r _. , zc� 6 9 ,�� Thomas F. Geiler,Director r Building Division (, , Tom Perry, CBO, Building Commissioner_ 200 Main Street,Hyannis,MA 02601. / n www.town.barnstable.ma.us Office: 508-862-4038 Faz: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY /' Not Valid without Red X-Press Imprint Map/parcel Number (��Z 1 i 7Re6sidential Address Value of Work 3 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name �/Yi S. (,d,/'� ' Telephone Number ` (;)J`V Td® . Home Improvement Contractor License#(if applicable) . { as PRESSPERWIT 7Workman's ruction Supervisor's License#(if applicable)Compensation Insurance e2010 Check one: i. 't�WN . VI a sole proprietor �, BARNSTABLE theHomeowner e Worker's Compensation Insurance M 4 Insurance Company Name ee,,TC0A1 , (� Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 0 Re-roof(stripping old shingles) All construction debris will be taken to (]'Re-roof(not stripping. Going over .. .. existing layers of roof) D.r R ide #of doors Replacement Winflows/doors/sliders. U-Value (maximum .44),#,of window._ *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: Q:\WPFILES�F'ORMS\building permit forms\EXPRESS.doe no.,:..�a nnnonn i The Common wealth.of Massach usetts �ryry- z Fryry Department of Industrial Accidents. z . . `r4 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 Legibly Name (Business/Organization4ndividual): 50U V6 Address: 5 PO- /C 90-3. i-1 VC- City/State/Zip: to;L 0-,-5x SIS Phone #: q0! 7/-' 6 7 Are you an employer? Check the appropriate box: Type of project(required): 1.M I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6.' ❑N construction employees(full and/or part-time).. 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. ❑ Building addition [No workers' comp. insurance- comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ 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.anew 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 dm an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: O ~ Policy#or Self-ins.Lic.#: Expiration Date: Q % 1/0 Job Site Address: / V Q City/State/Zip: 1�" , V X I S 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 asscivil 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: fy- -- Dates I Phone#: L-' L QL to IV 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 ContacfPerson: _ Phone#:, MOON y ' JAMEM VtK Undersecretary ' '. - �,v F..ID's.:;,.e �tiimiv:="".aro, '�. ,,;,b4-'. '.saR-, 4?'J�x.^•�tt4,k.'�_2 A. ,ka"ci�^hFin.. ... .. 5£c€q"Win E i�Fi d�6�i."gmetfl=k?t-f d r ,_,,' L'i JAMS°S COIN 45 P INE ROAD , L;IAMIL.I [ Y1[1 tit[' 11[ C OPID av -MOOMR-1 0 /07/10 PRaDUci R 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. Sox 1 ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. Manville Rx 02$38-0001 ' Phane:401-769-9500 E'ax:401-769-9502 INSURERS AFFORDING COVERAGE "09 INSURED Moon..Associates Inc. DBA Gutter Helmet INSURER A: Rational, Grange Insurance Co 14788 DBA Renei'ml by Andersen Of -RI INSUP,ER B: Seacan iiatua2 insurance Ce. DBA Gutter Helmet Roofing DaA Haan Works [INSURER C' 1137 Park East Drive INSURERD:. Woonsocket RI 02895 INSURER,E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE€?TO THE INSURED NA[v1ED ABOVE FOR THE POLICY PERIOD INDICATED.NOTYJITT;ST.tNdDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 1 O h7iICH THIS CERTIFICATE MAY BE ISSUED OR We PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,E}lCLUSiONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER RATE IMPAIL?DtYYYY} DATE{faiht{GDIYYYt'} LIMBS GENERAL LIABILITY EACH OCCURRENCE $ 1€}0 0 0 0 0 A: {X COMMERCIAL GENERAL LIASILITY MPS26619 09/16/09 09116110 ' I C — / PRE M ISES(Eaoocurence} . $500000 CLAIMS MADE X�OCCUR MED E(F'(Any one person) $ 10000 PERSONAL&ADV INJURY $ 10 0 0 00 0 GENERAL AGGREGATE $2 0 0 0 0 0 0 , GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COh1P/OP AGO s2000000 , RO- POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A X ANY AU 0 B1S26619 09/16/09 09_/16/10 (Es accident) ALL OINTIED AUTOS, SCHEDULED AUTOS BODILY INJURY $ (Per persona HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per adaidant) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: — m AGO $ EXCESS!UMBRELLA LIABILRY EACH OCCURRENCE $1.0 0 0 00 0 i X OCCUR ❑CLAIMS MADE CUS26619 09/16/09 0911.6110 ' AGGREGATE $ $ DEDUCTIBLE $ 'X RETENT10N .$10000 WORKERS COMPENSATION AND EMPLOYERS'LLABILITY YIN TORY LIMITS ER 10/01/09 10/01/10 ANYPROPRIEfOPJPkFT1UEFSrEXEIX1fIVE ❑ 28586 E.L.EACH ACCIDENT $500000 OFFICERA1EMBE}EXCLUDED? - -- (t�lattdatoryittNH If yes,describe under E.L.DISEASE-EA EMPLOYEE $500000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RENEWAL DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Renewal By Andex'5Qn IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENT'S OR . 1137 Park East Drive REPRESENTkTIVEs. Woonsocket RI 02895 AUTHORIZED REPRESENTATIVE ACORD 25{2009/D9} 0 Ig88.2009 ACORD CORPORATION. All rights reserved, The ACORD name and loclo are reaMered marks of ACOR D ��III Ge� East �--/ ��� Customer Naroc:Rd( O N hk lit A-)*X h��'141 BUilc: }� Y Renewal by Andersen of Rhode Wand Sales Agreement Mdtesa y t)}C l L o, Cwwmer 1Ddx: cape cod rxkmm Dlive City,Stm ZIP. Order Number. I�,00n � RI 02895 Mnataow alwlcersrT .eAr,da.eaCoup.oT LP'"7` T Ph.Horae �k Sl l� — Phone-Work: Page:-I—of—2 Due: / license N RI-30839 RI-12259 MA- - Eatad: 7i9� 0� �AfGbS�I9f�'f.-iL 119535 CI'-562725 UNITStt GIt41ES ROM D a 1I 1k,HJk,.4 X.1 I I IF cQ L6aG 3 L 1 ► t � 3 2 3 2 � r 1 2 3 'n icy `t 419 1J DD 3 5- Er =— 2- ?-w w 1 t CU 5 3 4rOpOtY1.AU of -- —A &alfnr vMd M NJ&Xas rn be p 1,kel Na the nnat aren—nmwl in drc y-.�nenx 71a �t1 Itt r �TOM�ti O� ftpw t Me*od yaa.l arm remabt vdid fm JU a. .ueprw,re by b,rh Cwna„er.uA&ncwd bq Ar.Wxn M1Ln�µcr u w 1. Sub TOW WKhoW niyvi tdrai G 2 Lkncelprion/Note;C o,'&7 j `A t) Sub Totd whw Di-vI r71 Cn®t Cad QUtamm Vw we bavbf audnariud to Rarni.h a0 aidcxt aad.k.wa rc pirod m namrkre ��rf„_,�•19� '{rJ S Mire.Gadtts or Expr w p glreuna,e kn waidr mlRr,al ap es to Pay fhv.MY t.rarrd a,Mia nbrav„enr wW xcordi,�a ehe prat hcrta,f. See Reverse Side for Tera w and Conditions of Sale.You,ehe b�uyyeett,m cancel L � A v T T0W t�,�s transaction at sty time to mi t of the buatni ss 02 ifter Sam e�11a I e !bati°o of tra aft gibed notice of caaceiladou for an �I V�e/faS 3 act me '• Total M{scd6ncaw Credltsor Expenses ov 1,. Mara roawftvaz' , , _ �—3,/ Y O (wry over top!w mLs ardit I owes"edurnn ar right) WOO Parrett Cog �I. C omdemb a MRwo ArceluW rh 3�uC � ftd*D" st.raoos Ihp ianwu+Appm,va Sipruure Special Order Nola Total Amaelt of AynalerK AttclnnlLjLaey t>¢aewr raoT Oor Feypy�y� Dntr Rrt—albyyAndvn MarglerS*.wM �f �. �y D�lma�ytyyd 9pW11trMARw ' °D+ drtga �� ypya�a�wr.M d.dedowidaM o flwtY4 orrwnmt�lemlNar�lYYq 2- .�- `r !'! ailrme Doe as Compkdon Brat UdaOen..eapr edeMderepr�yd b d.*VMar.wcaargoLrewmpap. P&ebtdxda labor,ntaur7ds.inatullarion.- ���a�se��.eeqn caalearatetnrwrafa Nl oeoprl'wrc � tw�prMp4tlosNr.d6�ir D d�C dtarageaea.ea.a se6mr9rd adwnalreaopa ale�W«Yh`Maom dilrb wa4 w---d..na&posalol'pod..wo*ced- CANN .� Cuswnrw u.aepealnn it s.Was1'avn.wrAnOagaoA µRjp,_plypy -AnplNtion i'i�dt•xolotoMM Rtltla� �Jty� tata.b: ^•i:. cop , =.~ TOWN OF BARNSTABLE BUILDING N N �� N ���� INSPECTOR ���0���m���� �� �� �� � ���� � ���0 0 �����~ ���� � �� �� APPLICATION FOR PERMIT TO -- ..... TYPE OF CONSTRUCTION ----..�!��/���%%.^-� ..........................-....--_.----.-- ' � ��' / ^+ --..- -..:��_----.-l9.��- TO THE INSPECTOR OF BUILDINGS: followingThe undersigned hereby applies or ypermit according to the momn of Owner -�^^/ -.�~^:�°����,�`-';=�'===--'"""'�" ''---'`--''^-^---=''�"'°--"—'°--~'`' ----- � ^ ' Nome of Builder ----------------------'A66rms -.--------..-.-.---.---.------~ Nome of Architect ................................ ----..A66ress ---------.��-----.-----------.. Number of Rooms ..............7...............................................Foundohon --' ......................................... E*eho, ---- ------'Rno�ng ----- ............................... «~` ^���+�� F|uo,, ----.. --.{~����7�����-------Interior -----.c�e-4�.�,�,�-..x'z----..L-----.. Meohn ^ .-�'�'����"�L..........................................................-.F1um6ing ---'..-. - ----..�_-___. �� �� Fireplace +� Approximate Cost ------..��..�.^'-.{�.�!�� ---_. / ^~ �'`� ( Definitive Plan Approved 6v Planning Boar 6 --------------------------------lA----. Anyo --����!�..------' Lot ` Diagram of � and Building with Dimensions' Fee .......... ______ SUBJECT TO APPROVAL OF BOARD Of HEALTH � ` ---------------------- / \ - + . A07 . OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ' | hereby agree to conform to all the Rules and Regulations of the Town o{ Barnstable regarding the above construction. . ' ' Name .............. - ...... ../��.*���-, � � /~� � Construction Supervisor's License -' /^ ../ . � � �� MCSHANE, CONSTRUCTION A=22-96 J -0�& No .2-7.156..... Permit for .............. I ........ ingle. FamilX Dwelling...................... Location .Lot„100�.;92 O1d.Kng';s„Rc ,•, ................Cotu ................................................. Owner McShane Construction .................................................................. Type of Construction Frame ..................................................................... .......... 1 Plot ............................ Lot ................................ 2 7 Permit Granted ...... ctober 29, 19 84 Date of Inspection ....................................19 Date Completed ......................................19 2 2 Z� bb Assessor's ma and lot number ....... �'....^....9� �4 G dam- �— /� f� -p ............ 3i>L < THET Q Sewage Permit number ...........v. ..ef�.�...................... House number .......................... 9.Z............................... SEPTIC IC SYSTEM t��,t � anLB, D do a INSTALLED IN CO611E, '° �N". TITLE 5 TOWN OF BARNST� BjtJ&-' C E D TOWhi REGULATIONS f f . BUILDING ' INSPECTOR s 4 APPLICATIONFOR PERMIT TO ............(! ...�..... ......... ........................................... .............................. .... TYPE OF CONSTRUCTION ..............Xi ...:. ..... .. ................................................................................ q.. ........................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... .o�-- .1 ...... .G../...F.G]L..... .� ..` .. ....... . ......... ........,t................. Proposed Use ........ ....... ....... ........................... ................................................................. R� ZoningDistrict ........................................................................Fire District .............................................................................. G7 G Nameof Owner ... .0 . ...... ...Address J0.:..................... . ................ .......................... .... Name of Builder ................Address ..:..........: .................................................... ...................................................................... Name of Architect .......... Numberof Rooms ............. ...............................................Foundation .......: .................................................................... Ezierior ................ ........................Roofing ............... . . .�r4,e.-J�........................... A, , " VY Floors ..........................Interior U-� /� ............... .. .... .................. .. ....... .. Heating ' .... D.`. ........................Plumbing ................ -...i ................ ..:............................... Fireplace .......... ............. .......................Approximate Cost .................... .. . ....v ................ Definitive Plan Approved by Planning Board ________________________________19________. Area .......(�/ :................... Diagram of Lot and Building with Dimensions Fee b�%.®!� SUBJECT TO APPROVAL OF BOARD OF HEALTH l NA, OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......... ... . ...... ....... ......... .... .................. i Construction Supervisor's License ......C�. ...1 1 tA`IMCSHANIE, CONSTRUCTION No ..... Permit for One...Story.............. ...... ........... Single Family Dwelling . ............................................................................... 92 Old King's Road Location ...ZeGAt..1DQ cotuit ............................................... er............................................................................... Owner AcSharka....Conatruction................ f, Type of Construction Eras.............................. ....................................................................... tiPlot ... ....................... Lot ................................ r 7 October 29,,,, fir84 Permit Granted .......................................f19 Date of Inspection ................49 'Date Co pletecl .....................................19 0- r,q ell tt l( `T„�•;� O.� TOWN OF BARNSTABLE Permit No. __----------------- Building Inspector Cash ------—------ - � �Yl 9 ego• v �0y"' OCCUPANCY PERMIT Bond ---- ------------ -------- Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ................................................... 19............ .................................................................................................................. Building Inspector a x J ��.,�� o•�'. TOWN OF BARNSTABLE f: BUILDING DEPARTMENT. TOWN OFFICE BUILDING rua 59- HYANNIS, MASS. 02601 f� MEMO TO: Town Clerk FROM: Building Department DATE: June 3, 1985 t An Occupancy Permit has been issued for the building authorized by BuildingPermit ,27176 #............... ............ ...._.... ._ _......_. _............_............... �.. _. issued t' McShane Construction Please release the performance bond. F • 2g8 2 / L WSJ i i p z s'j- .1-C7 7- �L OT 4C>L.S7N OF v� O'/c- .O.pE.�ARE© FOre A-7 CO, C>/-,z7A/ /S .475 /7-E"X/STS .47i AD T.�iS7T /T p,Q�.E T2p/ sc.`.�tE• "= yrQ .CO/VFORMS TO ZoN/iV� REGUG�T'/O^IS• " �:�- -,..-•� "•-- C.q.�E �" /SL.9N0 S �g`l/.P✓E Y/�/G ^ O,� Expires 6 meths froze issue car Regulatory Services Fee .25 "� i6s� Thomas F.Geiler,Director 9 `e� Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w Office: 508-862-4038 Fax: 508-790-6230 X-PRESS PERMIT EXPRESS PERMIT APPLICATION A p R 25 2001 lam'"' Not Valid without Red X-Press Imprint MapiparcelNumber 022 � TOWN OF BARNSTABLE Property Address -of ts I ti _S o c, CEO Residential OR ❑Commercial Value of Work 000 Owner's Name&Address i°a M y ( I e- N • a v S � � e s � � A , Contractor's Name �INSLk6,(C_,� o W e— Telephone Number 0 Home Improvement Contractor License#(if applicable) 1 126 7 Construction Supervisor's License#(if applicable) 7 Workmen's Compensation Insurance : Che one: I�am a sole proprietor I am the Homeowner ' I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy#_ Permit Request(check box) Re-roof(stripping old shingles) 17 Re-roof(not stripping. Going over existing layers of roof) 2-'Re-side Replacement Windows. U-Value (maximum.44) Other(specify) *Where requited: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic.Conservation.etc. Sienature expmtrg C'tRTIFICATE OF LIABILITY INSURANCF�OPID K DATE(MMIDD/YY) - CRI1 04/13/01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Northwood Eshbaugh Ins. Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 805 West Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-771=1632 Fax:508-778-1789 INSURERS AFFORDING COVERAGE INSURED INSURER A: MASSWEST INSURANCE INSURERB: MASS WORKERS COMP Rick Lyynch Home Improvement - -- Richar3 C. Lxnch, Tr. INSURER C: P. 0. BOX 65/ INSURER D: Hyannis MA 02601 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 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 TI4E TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR TYPE OF INSURANCE POLICY NUMBER PO CY EFFECTIVE POLICY EXPIRA 10 LIMITS LTR DATE MMIDD/YY DATE MMIDD/YY GENERAL LIABILITY . EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY TBD 04/13/01 04/13/02 FIRE DAMAGE(Any one fire) $ 50000 CLAIMS MADEEl OCCUR MED EXP(Any one person) $ 5000 PERSONAL BADVINJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS_COMPIOPAGG $ 2000000 POLICY PROECT. LOC CSL 1000000 J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO - _ (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Par accident) - GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE _ $ -- $ DEDUCTIBLE __------_ __-_-_---_- $ _—_-_----- RETENTION $ $ WORKERS COMPENSATION AND X tTORY LIMITS ER EMPLOYERS'LIABILITY - ------- - -'----------- --- B APPLIED FOR 04/17/01 04/17/02 E.L.EACH ACCIDENT $_ _ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSAIEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER N ADDITIONAL INSURED;INSURER LETTER: CANCELLATION BORNSTI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL a—DAYS WRITTEN BORNSTIEN COMPANY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL? FAX#(50 8)77 5-8 7 8 9 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 297 NORTH ST HYANNIS MA 02601 REPRESENTATI AUTHORIZ PRES TIVE ACORD 25-S(7/97) ©ACORD CORPORATION 1988