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0027 ROSEWOOD LANE
�i9Li1/� -D..ST�Gi/OD P,� i I II co Xo(P ° [ Town of Barnstable *Permit Of�k7 AMIS IABLE IP,r „o, ,sfr�>ssued�e 15 Regulatory Services Fee TO 9 NSTABLE Richard V.Scali,Director 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 O 1 0 /0 3 7 Property Address 27 Rosewood Lane Cotiut Ma ❑Residential Value of Work$ 4E000. 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address JosephJr & Sandra Nicholson 5430 Moscow Place, Dullas VA 20189 Contractor's Name Northern Colony Builders LLC Telephone Number 5 0 8—4 0 0—7 0 7 5 Home Improvement Contractor License#(if applicable) 16 7 7 3 9 Email: danwbcc@comcast.net Construction Supervisor's License#(if applicable) C S—0 5 3 6 8 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Southeastern Insurance Co. Workman's Comp.Policy#WCC501 2280201 5A 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) LRe-side Replacement Windows/doors/sliders.U-Value (maximum.32)#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. A copy of the Home Improvement Contractors License&Construction Supervisors License is uire l, SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Win ws\Te ,porary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 gTFIFTp� i • b I � �;r4 i w �a�s#Y st � F; � MAS& Town of Barnstable 6TE0 MA'S � Regulatory Services Richard V.Scali, Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 wwvw.town.barnstable.ma.us 01-1 ice: i08-862-4038 Fax: 50&790-62 30 Property Owner Must Complete and Sign This Section If Using A Builder l Sandra Nicholson as Owner of the subject property h Northern Colony Builders LLC ereb� audl�.�rizc to act on m�� behalf, . r in all matters relarWe to work atbthotized by this building permit application for: 27 Rosewood Lane (Address of Job) r J. artir� of Crwncr Dare Sandra Nicholson Print Name If Property ONvner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. T:`,KEVI\ 0*'.Buildin_a Chan_ees\EXPRESS PERMMEXPRESSAOC Revised 061313 r The Commonwealth of Massachusetts Y Department of Industrial Accidents ..r Office of Investigations I 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (13usiness/organization/Individual): Northern Colony Builders LLC Address: 180 High Street, P.O. Box 278 City/State/Zip: West Barnstable MA 02668 Phone #: 508-400-7075, 508-744-3362 Are you an employer? Check the appropriate box: Type of project(required): 1. ✓ l am a employer with 1 4. I am a general contractor and 1 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. 7. K Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in an capacity. employees and have workers' S Y P ty. 9. Building addition [No workers' comp. insurance comp. insurance.: required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. 1 am a homeowner doing 411 work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.]' c. 152, §1(4), and we have no employees. [No workers' 13. Othersz� r Q 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 enrplover that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Southeastern Insurance Company Policv# or Self-ins. Lic. 4: WC50122802015A Expiration Date: 7/8/2016 Job Site Address:27. Rosewood Ave, Cotuit City/State/Zip: MA 02635 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 S 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 S250.00 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 doh ,certify wider the pain and alties of perjury that the information provided above is true and correct. Signature ` Date: 11/16/15 Phone#' 508-400-7075, 508-744-3362 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector 6. Other Contact Person: Phone#: ACC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1%. 8/20/2015 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 Bernier NAME: Southeastern Insurance Agency, Inc. PH NOR o,Eat):_ (508)997-6061 (NC,No): (508)990-2731 (Pi439 State Rd. EMAIL kbernier@southeasternins.com _ADDRESS:P.O. BOX 79398 INSURER(S)AFFORDING COVERAGE NAIL a North Dartmouth MA 02747 INSURERA:Arbella Protection Insurance 41360 INSURED INSURER B:Merchants Insurance Group Northern Colony Building Co LLC INSURER C AEIC P.O.BOX 278 INSURER D: INSURER E W. Barnstable MA 02668 INSURER F COVERAGES CERTIFICATE NUMBER:CL1582001403 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADOL POLICY EFF POLICY EXP LTR TYPE OF INSURANCE 'SUBR! POLICY NUMBER MMIDO/YYYY M 1DO/YYV LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 9520040951 7/8/2015 i 7/8/2016 MED EXP(/v)y one pmson) S 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ECX POLICY J LOC PRODUCTS-COMPIOPAGG $ 2,000,000 O1HLR $ (Eaaa accid ent) AUTOMOBILE LIABILITY COMBINED SINGLE LIMff $ 1,000,000 ccid , ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED X SCHEDULED MCA7013965 1/5/2015 1/5/2016 BODILY INJURY(Per accident). $ AUTOS AUTOS - NON-OWNED I PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ PIP-Basic $ 8,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB 1 CLAIMS-MADE. ' AGGREGATE $ . 1 DED RETENTION$ $ WORKERS COMPENSATION X IPE STATUfF. X F.H„ AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE j; EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N I A, ' C (Mandatory in NH) —J_ WCC50122802015A 7/8/2015 7/8/2016 EL DISEASE-EA EMPLOYEE $ 1,000,000 If ns,describe under P DE SCRIPTION OF OPERATIONS below El DISEASE-POLICY LIMIT $ 1,000,000 ( - • r � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02 601 AUTHORIZED REPRESENTATIVE Karen Bernier/KAB �� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I NS025(201401) f r ® Massachusetts Department of Public Safety\, i Board of Building Regulations and Standards . License: CS-053638 Construction Supervisor DANIEL J GALLAGNER,' PO BOX 278 �w WEST BARNSTABLE MA 02668 ' i 1�/�►^� l� Expiration: Commissioner 10/27/2017 nLl IOffice of Consumer Affairs and Business Regulation 10 Park.Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Crontracator Registration Registration: 167739 l Type: LLC Expiration: 10/25/2016 Tr# 264780 NORTHERN COLONY BUILDERS DANIEL GALLAGHER � ' - a _ P.O. BOX 278 WEST BARSTABLE, MA 02668 -- Ai '`e� Update Address and return card.Mark reason for change. F Address ❑ Renewal ❑ Employment ( Lost Card SCA 1 0 20M-05/11 F e op wm)wlmoeale{L C11 PIffaaaaChlaeZ 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: '�'1 Type: Office of Consumer Affairs and Business Regulation egistration: 167,739 Yp - 10 Park Plaza-Suite 5170 Expiration '10/25/2016 LLC Boston,MA 02116 NORTHERN COLONY BUI,LD:RS LfLC. DANIEL GALLAGHER C;91 180 HIGH STW. BARN, MA 02668 Undersecretary Not vavnature o�&/&hlr PEA awn of Barnstable *Permit#2— D I` 0 Regulatory Services �e issue date ute the u EUUMSTAB * UN 3 2014 v� MAW Richard V.Scali,Interim Director �i679. p1 OF BARNSTABLE 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 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 01 0/0 3 71 Property Address 27 Rosewood LaneCo.tuit MA 02635 g,Residential Value of Work$ 3 0 0 0. 0 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Sandra Nicholson Cotiut Ma 02635 Contractor's Name Northern Colony Builders LLC Telephone Number 5 0 8—4 0 0—7 0 7 5 Home Improvement Contractor License#(if applicable) 16 7 7 3 9 Emaii:danwbcc@comcast.net Construction Supervisor's License#(if applicable) CS—0 5 3 6 3 8 91Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance. Insurance Company Name Southeastern Insurance Workman's Comp.Policy# _ _ _ Copy of Insurance Compliance erti lA a must accompany eac permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to NBWS ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) 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. A copy of the Home Improvement Contractors License&Construction Supervisors License is requi ed. SIGNATURE�� TAKEVIN MBuilding Changes\EXPRESS P RMI XPRESS.doc Revised 061313 • BARN9TABLE. • - 9�, ' Town of Barnstable AlEo�a Regulatory Services Richard V.Scali, Interim Director Building Division Thomas 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, Sandra Nicholson , as Owner of the subject property hereby authorize Daniel Gallagher NCB LLC to act on my behalf, in all matters relative to work authorized by this building permit application for: 27 Rosewood Lane Cotuit (Address of Job) 6-2-14 Signature of Owner Date Sandra Nicholson Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. TIKEVIN MBuildingChanges\EXPRESS PERK REXPRESS.doc Revised 061313 The Comrattonivealth of Massachusetts Deparhnent of Indusa al Accidents Of we of Investigations 600 Washington.Street Boston,MA 02111 tvwtv.m&,mgovfdia , Workers' Compensation Insurance Affidavit: Builders/ContractorslElecti iciansJPlumbet s Applicant Information Please Print Lexibly Name(1hasomesslOsganization/ludividuau: Nortern Colony Builders LLC Address P.O.Box 278 West Barnastable MA 02668 City/State/Zip: MA 02668 Phone# 5 0 8-4 0 0-7 0 7 5 Are you an employer?Check the appropriate box.: Type of project(required): 1.R I am a with 4. ❑ I am a general contractor and I employer6. ❑New construction employees(full and/or p®at time)_* hired the sub�couctors. 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 hers` 4. ❑Budding addition [No workers'comp.insurance camp.insuranceLl required-] 5. ❑ We are a corporation and its 1�.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1I_❑Plumbing repairs or additions myself [No workers'comp. right of exemption.per MGL 12.❑Roof repairs insurance required.]Y c_ 152, j1(4�and we have no employees [No workers' 13_�Gther�. comp.insurance required.] ;Any apphcaut that checks Box#1 nmst also fill our the section below shorting their waikexe compensation policy informateoa Hameovnus who submit this affidavit indicating they are doing all was$and them hue outside contractors nmst submit anew affidavit emdicam g sneh ZCcutractots than deck this box must attached an addiaeoosH sheet showing the name of the sub-contzw-wrs and state whether or not those entities have employees. If the sub-coamsctoes have em;d gees,they rmast provide than warken'.camp.policy ouxubu. I am an employer that is providbzg worknn'cotff9waasalion insurance for my enaployam Belot®is thepolicy ea nd f ob site information. InsuranceCompatyNatne: Southeastern Insurance Co Policy#orSelf-ins.uc_#: WCC-500-5012280-2013 FxpuationI)ate:07-08-2014 7obSiteAddtess:27 Rosewood Lane CitylState/Zip: Cotuit Ma02635 Attach a Dopy of the workers'compensation policy declaration page(showing the policy member and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposifion of criminal penalties of a fine up to$1,500.00 and/or one-year impaisormenk as well as civil penalties in the forn7 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 elCr here ;&anrder the paints sn taffies afgetyarry that the information provided above is tr a and correct Si Date: l / Pb—,-#: t c5�6 -'7 `��� - 3 3 (o X Q,ei®I use only. Ike not wride in this area,to be completed by city or town off)" City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/I°own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/30/2013 PRODUCER 508.997.6061 FAX 508.990.2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 439 State Rd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 79398 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Northern Colony Building Co LLC INSURERA: Arbella Protection Insurance 41360 P.O,Box 278 INSURERB: Merchants Insurance Group W. Barnstable, MA 02668 INSURER c: AEIC INSURER D: I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD' POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YYYY DATE MMIDD/YYYY LIMITS GENERAL LIABILITY 8500059899 07/08/2013 07/08/2014 EACH G OCCURRENCE $ 1,000,000 X COMMERCIAL ENERAL LIABILITY DAMAGE N PREMISES Ea occurrence $ 300,000 CLAIMS MADE I OCCUR MED EXP(Any one person) $ 5,000 A 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 7 PRO- JECT 7 LOC AUTOMOBILE LIABILITY MCA7013965 01/05/2014 01/05/2015 COMBINED SINGLE LIMIT nANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ RX SCHEDULED AUTOS (Per person) B HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ AND EMPLOYERS' YERS'LIABILITY WCC-500-5012280-2013 07/08/2013 07/08/2014 TORY TATU LIMITS X ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OOO EACH ACCIDENT E.L. $ 1 OOO C OFFICER/MEMBER EXCLUDED? r r (Mandatory in NH) E.L.DISEASE-EA EMPLOYEEI $ 11000,000 ..yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ f,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Town of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Attn: Building Dept. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 Main Street REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE I Karen Bernier ACORD 25(2009/01) FAX: 508.790.6230 ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I ty�> Massachusetts -Department of Public Safety Board of Building Regulations and Standards Cunsh uctiun Suiicry kor License: CS-053638 * ' DANIEL J GAL ,�' . ' �,• µ PO BOX 278 West Barnstable FUA p�2 Expiration Commissibnet t 10/27/20.15 t I v Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massacsetts 02116 Home Improvement Contra for Registration Registration: 167739 Type: LLC z Expiration: 10/25/2014 Tr# 234303 NORTHERN COLONY BUILDERS L+�C�` DANIEL GALLAGHER `� �_ >, 1694 FALMOUTH RD #135 � ~ r_ CENTERVILLE, MA 02632 Update Address and return card.Mark reason for change. Address ❑ Renewal 7 Employment Lost Card SCA 1 0 20M-05/11 Vlzs mer Afa�asae�Bu Business Regulation uaeGt License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g y ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: U'Vegistration: 467.,739 Type: Office of Consumer Affairs and.Business Regulation piration:j�--J:Q%25/201_4 LLC 10 Park Plaza-Suite 5170 Boston MA 02116 NORTHERN COLON 1 B 'U LDERS LLC DANIEL GALLAGHER��_ 180 HIGH ST W. BARN, MA 02668 Undersecretary of Val c thot t signa re 4 i �-- � Town of Barnstable *Permit# e3�007 Expires 6 inontlis front issue date Regulatory Services Fee 6 Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 1�Y 200 Main Street,Hyannis,MA.02601 VVV www.town.barnstable.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 (!�> t 6 3 , Property Address ?o �- Residential Value of Work / 0o. Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 4 H <k C .A c)/So `I a cc LG�. e C��4t � !�'i 6 C3 Contractor's Name I h e Rome 0eigaT 4+ d6Ni F .Serrlt e r 91 Telephone Number 9 q6 •(9 IV V Home Improvement Contractor License#(if applicable) f a 6 8 y 3 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Al (� Check one: X-PRESS PERMIT ❑ I am a sole proprietor 14' ❑ I am the Homeowner AUG _ 8 2007 0'I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name /Vi u-) Yg w,2s A t.-,e gh 5, C 40 Workman's Comp.Policy# `�c� li.-3 0 8 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) ❑ Re-side Replacement Windows/doors/sliders. U-Value _(maximum.44)q *Where required: Issuance of this permit does not exempt compliance with other town department regulations,Ft Hi'stw;,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of P/'rrr issiq . A copy of the Ho p ovement Contractors License is required, '1 SIGNATURE: ,^, Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts - —. Department of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 www.mass gov/dia Workers'. Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information .Please Print Legibly Name(Business/Organization/Individual): 0 j Address. LI s5aces �: o City/State/Zip +--1 b 83 Phone#: .; 6 c ?' ts/ Are you anemployer?Check the appropriate box Type'of project(required) 1. .L am a employer with 4 0 I am a general contractor and I 6 . New construction employees.(full and/or part=time).* have hired the sub-contractors 7 Remodelin 2. I am a sole proprietor orpartner- listed on the attached sheet.t : � g ship and have no employees These sub-contractors have 8.. 0 Demolition working for me in any capacity. workers' comp.insurance. 9. [] Budding addition [No workers'comp insurance 5 El We are a corporation and its required.] officers have exercised their .10.E Electrical repairs or additions 3.[] I am a homeowner doing all work right of exemption per MGL' 11-❑ Plumbing repairs or additions myself. [No workers coin c. 152, 1 4 and we have no: ' p _§ O� 12 0 Roof repairs insurance required J t employees. [No workers'. - �.ear . . . 13Other. � ��c . . . ` comp. insurance required.] 'Any applicant that cheeks box#I must also fill out the section below showing their woikers'compensauon policy information. t Homeowners who submit this affidavit indicating they.are doing all work'and.then hire outside contractors musCsub- anew affidavit indicating such. -- ,IContractors_thatcheck this box must attached an additional"sheet showing the name of the sub-conttactors and their workcW,comp;policy - I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andlob site. information. 64 Insurance Company Name:. t 1 S 1�'� '1�S' - CO . Policy#or Self-ins:Lc.# O�'-1 `���. Expiration Dater f Sob Site Address; o e Lv U.i �� .� City/State/Zip Lr�'fv, �" 6Y Attach a cogy 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 cnminal: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 under t pins and p alties of perjury that the information provided above is.true and corrects' Signature: Date: U• �:,�.. Phone M �� l OPIcial use only. Do not write in this area, to be completed by city or town official ; City or Town: Perm'm'it/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5s Plumbing Inspector 6.Other Contact Person: Phone#: I ..irilf ur xg'3' Hi. ,, - t ..:.r'r.„.i.. . #•'4in Information and .Instructions Massachusetts.General Laws chapter 152 requires all employers.to provide workers' compensation for their,employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is,def ned as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee:of an individual,.partnership;association or other legal'entity,employing employees. However;the owner of a dwelling house having not more than three•apartments and who resides therein,or the occupant of the dwelling house of another,who employs persons to dog maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because.of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or perm"t.to operate;a business.or to construct buildings in the commonwealth for any applicant whahas not produced acceptableevidence of compliance with the insurance coverage required." Additionally,MGL'chapter 152,:§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any.contract:for the performance'of public work until acceptable evidence of compliance with.the insurance requirements of this chapter have beenpresented:to the contracting authority." .Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary;supplysub contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance::Limited Liability Companies_(LLC)or Limited Liability Partnerships(LLP)with no.employees other than.the' members or partners,are.not required to carry workers.'compensation insurance. If an LLC or LLP does have employees,a policy is required:"'Be advised that this:affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insuraricd.coverage Also be,sure to sign and date the_affidavit. The affidavit should be returned to the city or:town that the application for_.the permit or license is being requested,not the Department of Industrial Accidents Should you have any questions regarding the law or if you are required to obtain a workers' com pengatidh pblicy,•'please call the Department atthe number listed below Self insured companies should enter their self insurance license number on the ji propriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affdavit for you to fill out in the event the Office of Investigations has o contact you regarding the applicant.. Please be"sure'to f 11 in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit.indicating current policy nformation(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the-city or town may be provided to the applicant as proof that,a valid affidavit is on file for future permits or licenses. A new affidavit must be f lled out each year.Where a home owner'or citizen is obtaining a license or permit not related to any:business or commercial venture (i.e. a'dog license or permit to burn leaves etc:)said person is NOT required to complete this affidavit. The Office of.Investigations would like to thank you in advance for your cooperation and should you hayWy questions, please do not hesitate to give us.a call., The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel:# 617-727-4900.ext 406 or 1-877-MASSAFE Fax#617-727-7749 . Revised 5-26-05 www.mass.gov/dia ' f.y .x,5. CERTIFIC ATE NUMBER .:A T L r F ATL-001234410-01 nzrr xmrrkr r�.�r, PRODUCER ° THIS CERTIFICATE IS IS$UEO4 k MATTER OF INFORMATION ONLY AND CONFERS' MARSH USA INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE hamedepot.ce.Itrequest@marsh.cam POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE„ FAX(212)948 0902 _. ,_.. AFFORDED BY THE POLICIES DESCRIBED HEREIN 3475 PIEDMONT ROAD,SUITE 1200 COMPANIES AFFORDING COVERAGE ATLANTA,GA 30305 COMPANY 100492-THE)-IPUSA-07-08 IPUSA A STEADFAST INSURANCE COMPANY INSURED COMPANY HOME DEPOT USA,INC. B ZURICH AMERICAN INSURANCE COMPANY - - ----2455 PACES FERRY ROAD NW BUILDING C-8 COMPANY , ATLANTA.GA 30339 C AMERICAN HOME ASSURANCE COMPANY COMPANY D NEW HAMPSHIRE INS COMPANY C�VERAGES�� � ��, '�sj�s,?�ertlfca,�,te�selllersede'�t�d-repfacg•�,�n�����nqusj�,l�su�d cectficafef��•�e,P,ulle�C )�e_�Ioci�ngt�d�belDw.,;.•tt ,;w„�� THIS IS TO CERTIFY THAT PDUCIES:DF INSURRNCE OESCRIB.ED'HEREIN HAVE BEEN`ISSUED'TO'.THE INSURED NAMED'HEREIN;rFOR.THE:`.POLIC1f'PER100 INDICATED � -4 NOTWRHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WWICH,THE CERTIFICATE MAYBE ISSUED OR MAY i PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER LIMITS DATE(MMIODIYY) DATE(MMIDDIYY) A GENERALLIABILITY IPR3757608-02 03/01107 03/01/08 GENERAL AGGREGATE $ 4,000.000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OP AGG $ 4,000,000 CLAIMS MADE OCCUR 'OF SIR:$1,000,000 PER OCC': PERSONAL RADV INJURY $ 4,000,000 OWNER'S 3 CONTRACTOR'S PROT EACH OCCURRENCE. $ 4,000,000 FIRE DAMAGE(An One fire) $ 1,000,000 MED EXP(An one ersonj $ EXCLUDED B AUTOMOBILE LIABILITY BAP•2938863-04 03/01/07 03/61/08 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BOOILYINJURY $ (Per accident) NON-OWNED AUTOS X ELF-INSURED AUTO PROPERTYDAMAGE $ .,PHYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ A EXCESS UABILJTY IPR 3757 608-02 03/01/07 03/01/08 EACH OCCURRENCE $ 5,000,000 X UMBRELLA FORM AGGREGATE $ 5,000.000 OTHER THAN UMBRELLA FORM $ C WORKERS COMPENSATION AND 2921209(CA) 03101/07 , 03/01/08 X TORY LIMITS EMPLOYERS'uaewTY 2921210(FL) 03/01/07 03101/08 EL EACH ACCIDENT . $ 1,000,000 E F' . THE PROPRIETORI X INCL 29212.11 (AZ,ID,MD,VA) 03101/O7 03/01/08 EL DISEASE-POLICY LIMIT $ 1,000,000 D PARTNERSIEXECUTIVE 2921208(AOS) 03/01/07 03/01/08.. EL DISEASE-EACH EMPLOYEE $ 1,000,000 OFFICERS ARE: EXCL C OTHER2921213(QSI) 03/01/07 03/01/08 E . WORKERS'COMPENSATION 2921212(KY,MO,NY,WI) 03/01/07 03/01/08 G TEXAS EMPLOYERS TNS-C44642086(TX) 03/01/07 . 03/01/08 EACH OCCURENCE 25,006,000 EXCESS LIABILITY SIR 2,000,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS y•i, /� j �M?a'' ...+FSF �.YaFF1, s-u1Le`.21yk1�3 �J��£;"b�W>'„ A��Y .s.,� :...r�' .z,'� t'. *•w., x ',X'. @.,.'a.:-._ .z C�FikFkCAT NQDEI x ��„ M1 ;,, =:�w�ur...rw.,-�"`5.:i�."3�'` .3.zisa`�5:7.`�'`'2.'�+*�,�,.�i`'�>,�"5'w�r��E�;w�..,:�.'�`astF�"s���'x.�..aw.-t°�".„ Z'� ".�:t•4?�;.'X.:`?�a�ieawr'"a�s"` u°&�?sr`?iH3J.°�is".^'',� +k "1;.�'r"at...:�Sa.S?. ;t...;^`w��,l.�,w,�'��w��'�` ci��'•k?;.'sF�:..�".?I':;:�?''�"a.._z:. SHOULD ANY OF THE POLICIES DESCRI13EDHEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE FOR EVIDENCE ONLY - CERTIFICATE HOLDER NAMED HEREIN.BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES.OR THE, - - ISSUER OF THIS CERTIFICATE. MARSH USA INC. - ,. • BY. Mary Radaszewski t=Y " '"r. `� M1l0,? VALI2I28/07 7ti} k�.:y�,�,;,,�'Tal:�1.�+. p: '� �"''t..'��-"�'.a,. ukrc��r�v"'�.x• '�" '�...,�,O'�*�''�: � D AS OF 0 II�_. � 3�-,•t ,p t� �a ` F• ,an . .n��-.,�'+�.L '.,,�..+. ' �--r+..r �a ,t�'�ir Y "u`�£� ,� ��+ � •?•1 .�'+{,' �`'-� "�`'���"�+,��q ...a ��`'�•�`'e'' z ?,���•.ra-"'°^x'm r�y4`''-�."�C-r��. 'M�'�a�°„�ix:s'4���"�-'-�x...�'�tE` ���.�,t�,•�'��`#us<.=�`,. '� �"s'�,:����. �.'�+�z:w;�.?I; .,.;�i�..r�. :".fi�h��«�,Y":`,�.:::�1;.�r„�U.spa,,ca�s,.a.-.rz..��...w<..,.:, �A..v..,.:1..> .. ._a,azr,�, a as rir . a i ' DA Wlu. 2/28/07, 01, W A- 3 v s 'Wo'Em. PaooucfiR ;. COMPANIES AFFORDING COVERAGE MARSH USA INC. coMPANv ` ~ homedepat certrequest(Mmarsh com` ! r ' "E +ILLINOIS NATIONAL INSURANCE COMPANY FAX(212))9484902 3475 PIEDMONT ROAD 'SUITE 1201 t ATLANTA,GA 30305 COMPANY 1` F 'NATIONAL UNION FIRE INS CO ' r 100492-THD-IPUSA-07-08 IP USA NSURfiO HOME DEPOT USA,INC. Fa G =ILLINOIS UNION INSURANCE CO 2455 PACES FERRY ROAD NW `,;. BUILDING C-8 ATLANTA,GA 30339 COMPANY H .... .,.— .,,,, � ..v a�,�-ft aq? c• ''- 's�'1�s,.-w `mac u,.;r �.'^�wx s;}` s �C •.1,t fi i`• ...zS. f-� :• „ 4"'a y .uc Y n� ti .._... x r,,.v' �`s '' 'CERTIfICATEHQLGElt-W ,wkH k� 3� ,�4� c� a r n•'� �: r c n . a�e���L�?5' �� ��m3r�R;Y4£�S FM�'C� �3a1�..:�^.ts��r&ar; r�:�.�` �``d3ts...ff'3��v..�.M•tw�Edain�i. vkka.�2r�'a`�:,basa'�•. FOR EVIDENCE ONLY MARSH U A C S IN AY __..._ ..... ?t •. . Mary Radaszewskt _ :eqr•y.`+c.Ct'• :, - ..:. , n�`" y p�.' ek�'.� x {;,y ,.s 9�A FR The Home Dep % kaot 6500-Series Double Hung Vinyl Window Architectural-grade,Soft Coat Low E and National Fenestration RatinRatingCou�ncil® Argon Gas-filled Insulating Glass Unit ENERGY PERFORMANCE RATINGS U-Factor(U.S./I-P) Solar Heat Gain Coefficient Visible Transmittance 0.33 0.29 0.48 Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining Whole product performance.NFRC ratings are determined for a fixed set of environmental conditions and a specific product size.NFRC does not recommend any product and does not warrant the suitability of any product for any speck use. ENERGY�.a9it"> haerkt«sta,.�ten.„e., use• ° Qualified in all 50 States Northern South/Central Mostly Heating Heating&Cooling North/Central Southern Hearing&Cooling. Mostly Cooling •o OP:25 Test Size:48 x 80 Test Number:05-30307.01 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Regrstratron 126893 • Exprratron 8l3/2008 One Ashburton Place Rm 1301 Boston,Ma.02108 ype Supplement Card THE Home Depot.,`f Horne Sery c DANIEL PELOQlJ1N s . 3200 COBB GALLERIA Y`#20 ` Atlantic,GA 30339 Administrator Not valid without signature t ' v Danya Mahot 7743230034 p.4 HOME IMPROVEMENT CONTRACT `'� Sold,Furnished and Installed by: � d Branch Name: v,,'J Date: / THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 1 � Job#: ��/��5 ) 345A Greenwood Street,Worcester,MA 01607 Branch Number: ? Toll Free(800)657-5182; Fax:508-756-2854 Federal ID#r 75-2698460 ME Lic#C 02439 RI Cont.Lic#16427 //����� J CT Lic#565522; MA Home Im�ppr�ovveement Contractor Reg.#11269 Installation Address: �-7 f*c V4 L�NLJ C v� I "f 7 City State Zip Last 4 Digits of Driver's Purchaser(s): Lic.#&F.x .MOM, Work Phone: Home Phone: SAv--n0 N01015aw Z1))JJQi Home Address: Sal (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): AV 0�19�_eo�-b` 6L3(�Q Project Information: I/We/You("Purchaser"),the owners of the property located at the above installation address,offer to contract with THD At-Home Services,Inc-("Home oe') to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet# 1n3 ,incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if, upon re-inspection of the job,Home Depot determines that it g P P J P cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to (� complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS ` (Subject to fund verification and/or credit approval.) CONTRACT AMOUNT $� ! 1. Check",Cashiers Check or US Postal Service Money Order (Made payable to The Home Depot). tLE$S DEPOSIT $ � 2. Credit Card" r payment options-Circle One Below BALANCE DUE � '} 'j� Visa Maste7Card Discover American Express ON COMPLETION $�_�_/ [J The Home Depot ome Improvement Loan The Home Depot Credit Card tMinimum 25%of Contract Amount due upon 4 New Accoua j >16isting Account (HIL&HDCC ONLY) execution of this contract. Available Credit:5 )5,1 DOD (HIL&HDCC ONLY) Indicate Payment Method For 5A,- p0 t)l@k}bIS(WExp.Date:BALANCE DUE O MPLETION: q,:ct#: ame as it appears on c A5,k I v ""By my/our signature below,I/We agree to allow Home Depot to �harge the bove referenced credit card for (thhe ep sit indicated. "When you provide a check as payment,you authorize us either to use information from your check to make a one-time electronic r tgnatS urc Date fund transfer from your account or to process the payment as a check transaction.When we use information from your check to HIL or HDCC Authorization Codes make an electronic fund transfer, funds may be withdrawn from your account as soon as the payment is received,and you will not Deposit Final Payment receive your check back. # # Purchaser agrees that,immediately upon completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement: This agreement and its attachments, including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties.. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 10% of the contract amount if job is cancelled by Purchaser AFTER the third business day,but BEFORE materials are ordered.There will be a service charge equal to 25%of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW,I/WE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND IfWE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL I,IARMITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. r ut'cnaact���: Lie,#&ExW Mo Xr: Work Phone: Home Phone: ' 5�,,.►o�tn Nl o �g4 � ?- D (St���'4y$3 (s�)S3 -4yS3 Home Address: r7 'Of different froth Installation Address) City State Zip) E-mail Address(to receive updates and promotions from The Home Depot): AV C-Apf_C^o�)5&39A vw Project Information: I/We/You("Purchasee%the owners of the property located at the above installation address,offer to contract with THD At-Home Services,Inc. o��me�7e�pot")to famish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet# 4J'S`6) (j� ,incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS } (Subject to fund verification and/or credit approval.) CONTRACT AMOUNT $ j 7T 1• Check*,Cashiers Check cr US Postal Service Money Order il fi (Made payable to The Home Ihpot). •LESS DEPOSIT $ (' !V 2. Credit Card** r payment options-Circle One Below BALANCE DUE } ']� Visa MastcfCard Discover American Express ON COMPLETION $ / 1 e1 The Home Depot omc Improvement Loan The Home Depot Credit Card tMinimum 25%of Contract Amount due upon C New Accour4,/ 'Pj�sting Account (HIL&HDCC ONLY) execution of this contract. Available Credit:$ 15'11)00 (HIL&HDCC ONLY) Indicate Payment Method For cct##: aN A• AXCA1h IWExp.Date: 3c)Loci BALANCE DUE O 1 PLETION: Name as it appears on card. _ Ase rCr� / **By my/our signature below,I/We agree to allow Horne Depot to large the•bove reference credit card for the a sit indicated. *When you provide a check as payment,you authorize us either to use information from your check to make a one-time electronic GdrdhMddrrSi6naturc Date fund transfer from your account or to process the payment as a check transaction.When we use information from your check to make an electronic fund transfer, funds may be withdrawn from HIL or HDCC Authorization Codes your account as soon as the payment is received,and you will not Deposit Final Payment receive your check back. # # Purchaser agrees that,immediately upon completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement: This agreement and its attachments, including any financing agreement, contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time. you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 10% of the contract amount if job is cancelled by Purchaser AFTER the third business day,but BEFORE materials are ordered.There will be a service charge equal to 25%of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW,I/WE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS_ BY MY/OUR SIGNATURE E W, I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE RECEI O A C F THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATIO SUBMITTED BY ' 47 Datc: Sal onsul�y _ ACCEPTED BY: (� Date*. i Picliaser Date: Purchaser NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 6-1-07 rev 4-2-07 C-SC White—Branch File Yellow—Customer Pink—Sales Consultant S 'd 11PE00E0EFLL gotleW eBuea I OASTAL NGINEERING OMPANY, INC. 260 Cranberry Highway Orleans,MA 02653 Orleans 508.255.6511 Provincetown 508.487.9600 Hyannis 508.778.9600 Fax 508.255.6700 www.ceccapecod.com April 4, 2006 Project No. C15630.01 Mr. Thomas Perry Barnstable Building Department 200 Main Street Hyannis,MA 02601.. Re: Dennis McCarthy Residence 27 Rosewood Drive,Cotuit,MA Map 10 Parcel 37 Dear Mr.Perry: On Wednesday,March 29,2006 at 12:15 PM, staff from Coastal Engineering Company made an on-site inspection at the above referenced property. It is our understanding that this house has been relocated from another location. The concrete foundation wall at the front of the two-story section should have been made slightly wider to match the framing line of the building. The weight of the front wall and roof has caused the wood sill to tip.The contractor has installed a continuous pressure treated 2x6 ledger with 5/8"x6" long stainless steel expansion bolts, as indicated on the attached sketch detail. This will stabilize the sill plate and help transfer'build rig'loads back to the foundation. If you have any questions,please feel free to contact me. Very truly yours, Coastal Engineering Company,Inc. Robert Brookhart RB/dlb Enclosure: Sketch Cc: Dennis McCarthy -John A.-Bologna;P.E. ■Providing solutions for the benefit of our clients and community■ OASTAL NGINEERING `� .r OMPANY, INC. Pp 260 Cranberry Highway Orleans,MA 02653 Orleans 508.255.6511 ■ Provincetown 508.487.9600 ■ Hyannis 508.778.9600 ■ Fax Sp$7255,-6700 www.ceccapecod.com April 4,2006 Project No.C15630.01 Mr. Thomas Perry Barnstable Building Department 200 Main Street Hyannis,MA 02601 Re: Dennis McCarthy Residence 27 Rosewood Drive,Cotuit,MA•+ Map 10 Parcel 37 Dear Mr.Perry: On Wednesday,March 29,2006 at 12:15 PM Staff from Coastal Engineering Company made an on-site inspection at the above referenced property.It is our understanding that this house has been relocated from another location. The concrete foundation wall at the front of the:two=story sectiori.should-have been made slightly wider to match the framing line of the building. The weight of the front wall and roof has caused the wood sill to tip.The contractor has installed a continuous pressure treated 2x6 ledger with 5/8"x6" long stainless steel expansion bolts, as indicated on the attached sketch detail. This should stabilize the sill plate and help transfer building loads back to the,foundation. If+you have'any questions;please feel free to contact me. Very truly yours, Coastal En in ring Co any In Robert Brookhart a RB/dlb Enclosure: Sketch Cc: Dennis McCarthy John A.Bologna,,P.E. t .. .. ;,. .j .11:tj 1 D'00005600,15630115630"01I'Repor wfisp ekon.,04=04z'06.doc ■Providing solutions for the benef t of our clients-and community■ COASTAL ENGINEERING CO,,. INC. Joe 27 �Ey�1o09 . Colo IT � mC CAa`ft�'1 260 Cranberry Highway SHEETMD. S_ � y OF— ..._1 ORLEANS, MASSACHUSETTS 02653 Rp, 3�nn�/(� O (508) 255-6511 CALCULATED er ".`-� DATE ...._.i- l FAX (508) 255-6700 www.ceccapecod.com CHECKED B'( DATE SCALE ' ....... /✓mow :1 °Y • .. .�;. Gar . 0 ye 'e Bo �i T i0 :�/vZ✓... 0✓ . . . . . . . wv 7 To Spa t 0A. Tp� Town of Barnstable *Permit# 'Y0 Expires 6 months from issue date HAMsMBU. = Regulatory Services Fee Ir a0l s t� 9 1619. �e� Thomas F.Geiler,Director Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601 w a � N Off ce: 508-862-4038 Fax: 508-790-6230 -Nov % 0 ?004 EXPRESS PERMIT APPLICATION ? Not Valid witbout Red X-Press Imprint 10VVN OF BARNSTADL_il'I Map/parcel Number j C.)C ..Property Address csidential OR ❑ Commercial J Value of Work t:"' Owner's Name&Address l Contractor's Name � j 7—� � [�/ _ Sa ,n 1� Telephone Nurnbcr.�—U—U Home Improvement Contractor License #(if applicable) ice_ '7/ `� Construction Supervisor's License#(if applicable) Q,z4 gWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Q-fhave Worker's Compensation Insurance Insurance Company Name T� yo.^-����p 1 Workman's Comp. Policy# �//(•� /9� y1�3 r�,fs� Permit Request(check box) Re-roof(stripping old shingles) ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature expmtrg of zt+e r Town of Barnstable ' *Permit it 'Expires 6 months from issue date DAMt,�� = Regulatory Services Fee . r i619. ► Thomas F. Geiler,Director Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w Xf-PP R E = ; Office: 508-862-4038 Fax: 508-790-6230 it 0 V `! o ?0 0 EXPRESS PERMIT APPLICATION 7 Not Valid witbout Red X-Press Imprint IOW ! OF BARNS IA8L_-�/ Map/parcel Number f C'C Property Address csidential OR Conuncrcial Valuc of Work Owner's Name&Address ZZ �. Contractor's Name � / �" z � j "2_-1 S Telephone Number, J j•J� Home Improvement Contractor License#(if applicable) ice_ Construction Supervisor's License#(if applicable)__ ).0 DWorkman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner Q-fhave Worker's Compensation Insurance Insurance Company Name�2,��wtDn�^- ���o.7 � Workman's Comp. Policy Permit Request(check box) [`rR-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows. U-Value (maximum.44) Other(specify)_ *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Consern•ation,etc. Signature expmtrg Assessor's map and lot',number ......M:�.�.��..:.�'...V 0_7� oSEPTIC SYSTEM MUST 6E 7,Y7 INSTALLED IN COMPLIANCE Sewage Permit.number .................................................... I IANCE r< :-""' WI T H ARTICLE II STATE SANITARY C D D WN TOWN. O F B A RN-S- YA JE' wti Q ♦ ; BARISTSDL i F•; �� "AM BUILDING IN 0M s »; O. cs APPLICATION: FOR, PERMIT TO ..... ,.........4w...�? 1.:� !:��.� . .................... ...... ........... -. "1 TYPE OF, CONSTRUCTION ................. :.......... 1���... ....✓'Fc!n I�`.� r 2.. C{.;w....��. �............. ...........................G: a .....19..�.7 w w TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ .....���................ Ae. t�C:? ��......N� ....:...............(...C?.�[..!. .:...... . ................ . ........ Proposed Use 9`J.!!PN ...rXI E'l/<. 'L ................................................................... . ..................................................... n� 1 Zoning District .............. K .. .................Fire District ................��`-.:.1..�..<..�...................................... Name of Owner�el� rt..T Pr^r{{F......A5 rcac:......� ..... d ........3..7. ..................... P �; /P.... J. / ..��.z..Address .J. �j Name of Builder .........77 e,llf,', ...................................Address ...............................rr�E�Gti1.. ...................................... V Name of Architect ..........f....P.l(.E' '`I.............................Address .............................C' ..P.................................... Number of Rooms .................. .............................................Foundation .... a? ......�0.4K e(.....(� I ,r / / / Exterior ....T�l(.......A! .,�../0.��....S.�Pwa1h�c�..Raafing .. ....,. ..2c//..................... Floors .......... .s !. <.........h......�....:.... . .............Interior f�: ?!;��� �rC�C.!`.... .. /........ Heating ........... l L...................................Plumbing (` ............................ Fireplace .........Q_5, 5!�,d...... ...........................Approximate Cost ......!22.,..GU.G.............. r Definitive Plan Approved by Planning Board -------------------_-----------19_______:- Area .... .7 ../ Diagram of Lot and Building with Dimensions Fee ` SUBJECT TO APPROVAL OF BOARD OF HEALTH /t54 a? a P�pOse� Lvelf I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. -- Tellegen & Perrone �t t S I i No .19785.... Permit for ........Z...sUr-y..DweIling, .............. ..... h... ............................. L 27IosetoodLocation Dr....... . Cotuit............. ...:........... Owner Tellegen & Perrone s ........................................ .... ......... Type of Construction ..Wgad Frame,,, ....•... - - t' `� ..... ......... . ...........................=H .. - .......... e -Plot ............................ Lot ........28.......:........... : ti` -_ Permit Granted :....... . 'November.__28i 9 77 - • .a Date of Inspection ............................ .......19 = i ;' Date„Completed'' � /. f,�......:.......19 PERMIT REFUSED .......................'' :....... .. 19 w . ..... ................................ r. , .•r .........................._.......... _ ...... ` .............. ................................................ Approved ............................................ 19 ............................................................................ 0 Assessor's map and lot number ........�........ :::�........ im. 'rHE tp�� Sewage Permit number BAUSTADLE, i House number ................ .. :,?,.�.......................................... 9� M & 39 'F0 AIAY a�e TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO � r a�' .. In/ '�.............. ......................................... TYPE OF CONSTRUCTION �� /�? !.1 T '� -r `./ fc� a 19.F�• TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according � to the following information: Location ....;•'�..z....... ). ............:?:? ......' .! ..... ....C, r.� ..'�........................................:........:....... ............................ ProposedUse f� rr�a� ......4 ................................................................................................................... Zoning District ...��'.s��e".a��. ...................................Fire District .............................................................................. Name of Owner (.�`�46 ?......Address .�7.t�.....l fi'�� .4:• , �.�..... . ....... Name of Builder . /ff`,''��so�„Cc;?zYi"„ A, i/J :....Address ..... ." �'c ....•..� ��'` 3r;<ar?I..a...r�' .... arl��r Name of Architect :r 141I r?a6 , 61r.Ag n......................Address ?...4ie CoX ,,!- Number of Rooms .....{..................................................:.......Foundation � r?!"R:: .... e,.a�,-r✓�ir' r.✓ftC -�a ac+cC ExteriorX ,'a.0.?g...................................................................Roofing ..... ........................................ Floors ilJ1 ............/4.mO = ...........Interior ..... ...... Heating ........./....................................Plumbing ...... .: . . . . ................................................................. Fireplace ., ........................................Approximate Cost� :r .. ......................................Definitive Plan Approved by Planning Board __________________________ c7 19 ---• Area ...................... Diagram of Lot and Building with Dimensions Fee �S SUBJECT TO APPROVAL OF BOARD OF HEALTH y Ae, , nfl ,, �e �, ,� �:... ., tip._.---•-- _� V; Q f ta'` �1` 'it I hereby agree to conform to,all the Rules and Regulations of the Town of Barnstable regarding the above construction. f� Namere..;a....f�.: �`' -..........!.�....... '� 7;5p 4/e/ate �c,�rs3►iut,« C, ,ter, Cannon, Edmund M. & Susan g. A=10-37 22376 to dwelling No ................. Permit for .............................. ............................................................................... 27 Rosewood 4.ane Dr-, Location ................................................................. Cotuit ............................................................................... Edmund M. & Susan Cannon Owner .................................................................. Type of Construction \............frame................. .......... .........................................;...................................... I I Plot ............................ Lot ................................ Permit'Granted .........July 29 ..........19 80 Date of Inspection ...............................19 Date Completed ,RhklT REFUSED .!.. .... ..?... 19 ............ ...... .. . ....... .. .. ...... ................ ............ . ....... ............1................................... ...............................I..........11.................................... Approved'... ......... ................................... ........................................... ............................................................................... Assessor's map and lot number 1 1 I n ` Sewage Permit number .......................................................... QyOFTNErO�♦ TOWN OF BARNSTABLE i BARNSTABLE i 9° M6 9 BUILDING INSPECTOR Op�O APPLICATION FOR.PERMIT TO ..................... ��s? .. :. .. ....................................................................... TYPE OF CONSTRUCTION Gt r e)el +"� � 16t ,� ► ,� „� .l ..•........................................................•........ .. ..... ............. ........... ...................................... .....19. .. ' r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... .......;Ik............... .; I?., 1�,..�f...... �...................�.�,................................................... . ProposedUse �,Ti' ram/ra�� /e G► .......................................................................................................................... r Q Zoning District .................. .............................................Fire District ................ ? :+ ,' ............................................... 1[� / Name of OwnerT... t-P�rA�� � T ..Address -�` 7 7 3 ( c�'�r��'r^�f .. - ... ... ............................... ,r Name of Builder ..........� /�P ,oar....................................Address ................................,rya fM P Name of Architect ....... / .......Par.....................................Pt Address ............................re:? ?.!.+r�.................................... . ........ Number of� Rooms rr � i 1 �? . 7r .... ..� P /aQ nP % dExlerior ��....... ................................ f ,Sd� n .....................� Floors .........�!.a... !.�.A..........1. !'......�.... .., !.c 'A.Q.............Interior .......... <l� 6( n....................................... ............................. Heating ....... /!/lt)..............!'.:.. ..../...........................Plumbing .......1" .......................... ........................................ Fireplace a Fireplace ........Jicrcl................................... '..........................Approximate Cost ...................`............................................... Definitive Plan Approved by Planning Board ---------------_-__-----------19--------. Area ........ -7� 1.............. ............... Diagram of Lot and Building with Dimensions Fee ... •���........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH CM p r _ 1 k�j 1 roPosed wel f 45e Wcod I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ��f•, '�//vvd AllT�I`I ............ ....... ... ............................................. Tellegen & Ferrmoa «' , No .19M.5-- Permit.for _ --------..,..---...----...--.--,' ` Location Lo.t..28—..27..&Qauwp.Qd..Dx^--.-- � ................................�atodLt-----------. a) 0 � t � Owner ...]P-l1 .&.Yerr.Qne.---.---. . � . � Type of Construction ........Woad.-Fzrauma---- E ^ u —.~--.—.--....~----....--'---.---.. � - � Plot ............................ Lot 2a--------- . � Permit Granted --- ..28--lg77 o c Date of Inspection ------------lV 2 Dote Completed ...................................... . ,0 � PERMIT REFUSED � .--.--,.--,—.-...-.,,.--.----- lR � � c � -- -0 ` � . . ..~' .......... .. --.�=«'�,�. ---.- � � � ........................... � � Approved c � � ................................................ 19 m � � .---~--.-------...--.—.....~...._ 0 � m � � ----'---.----------~.—....--... � | ` ' ` Assessor's map and lot number 4v• �OF T H E'TQ� Sewage Permit number ...�..� "/'• � . . SEPTIC SYSTEM INSTALLED MUST A"STAILE, House numberX .. ✓ � MI COMPLIA ........................c�":..;�............::...,..................... rasa WITH TITLE 5 1639. 0� ENVIRONMENT ' ODE AND TOWN OF BARNSTAB IONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....!CJ.C�/.//:::7... ?.m!.1�...'��`!�?/ ..�G1 (/.�.:° �.....�. ....:.. TYPE OF CONSTRUCTION .......4142...D. ::��.�e . ........................:........................................................................ ........... �'..........19......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according' to the following information: Location �..... f�{�5 ec�.C? ......'�'� .......... .... ......... :I..... .. .................................................... ProposedUse �4i...... ..................................... ...................................................................... ..... Zoning District ... ............... ......Fire District......... Name of Owner C„diaaw{ �!!l (iSo) 0..� �� ........: Address .?Z j...co.AY.IT.......... Name of Builder /..1!�. ��7.. !!sfi- �, i/IC Address zSS , ✓`I�D � �1�� ark �'� u�i� Name of Architect /4K'?4.3...... .�✓e�s!,t......................Address Zv�s..<S!9/�0... l�Qp...bT.....�oy`lii� ............ .... Number of Rooms ..... ..........::..............................................Foundation .. I1r44�...1;e.?.4i-�.j1� G✓`C� 6/0c cC ........ ........Roofin .. .. /L Exterior .�O.O...O...............:........ ............................ g .....'���7,c.%1..!.......................................................: . Floors A?Wlp....../ m.�'.." .. /!'.{ .Cc1N..t ...........Interior .........L 4�� �' ................................... Heating ......................:.........................Plumbing 0�/7,:n Fireplace ... a ..- ...........:...........2 , .............. Definitive Plan Approved by Planning Board --------------------------------19-------- AreaZU 6 Diagram of Lot and Building with Dimensions `... Fee . ./ as SUBJECT TO APPROVAL OF BOARD OF HEALTH C t�, N W - toO y �� 7 ; R — (A �a . G 1 � I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ii ....a. ..... ... ........... ... Cannon, Edmund M. & Susan No .... Permit for .....add-.to...dwelling ........ .... ...... . . .... ............................................................................... 27 Rosewood -bafteD-- Location ................................................................ cotuit ........................................... .............................. Edmund M. & Susan Cannon Owner .................................................................. I frame Type of Construction .......................................... ................................................................................. Plot ............................ Lot ................................ Permit'.Granted ...........July.29..... 19 80 Date of,Inspection ......... 19 Date' Completed .... ..... ...XX4 r ......19 4ERMIT REFUSED M 19 lo ............................... .................... ......................................... 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