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HomeMy WebLinkAbout0039 ROUTE 130 �' 9 �o-�r.� iao Town of Barnstable `�©it J(D- , Expires 6 months ro issue date * Regulatory. Services Fee * BARNSfABL6, - v� MAC' Richard V.Scali,Interim Director i6;q. ♦0 RFD MA'S A 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 �^ y� �`�t Valid without Red X-Press Imprint Map/parcel Number 0 Property Address J l �C/ f ��/� U esidential Value of Work S Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �G� ��� 611-2 / 6- e /iYe1� 6�Gt l Contractor's Name Z*kI'de& ,4-1 all Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ) ❑Workman's Compensation Insurance PERMIT Check one: ❑ I am a sole proprietor JUN 3 ❑ I am the Homeowner 2014 ❑ I have Worker's Compensation Insurance Insurance Company Name TOWN OF EIARNSTABLE Workman's Comp. Policy# 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) ' ❑ 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 c y of the Ho 'e eme t C ntractors License&Construction Supervisors License is r r SIGNATURE: TAKKEVIN_D\Building Changes\EXPRESS PERMIT\EXPRESS.doc Revised 061313 The Commonwealth of Massachusetts Department oflndus&WAccidents Office of Invesfigadons 600 Washington Street Boston,MA 02111 www.mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anulicant Information Please Print Legibly % r Name(Business/Organization/Individual): L a tv l'J / � ,�!� l p !y R Address: 1�� �O tS 1 11/mil City/State/Zip: j>hone#: DD Are you an employer?Check the appropria*^ x: ' 1.❑ I am a employer with 4• of am a general contractor and I Type p (required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These subcontractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.[3 I am a homeowner doingall work officers have exercised their 11.0Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof ` insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.[3 Other.. 4v comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infommtion. t Homeowners who submit this affidavit indicating they are doing all work and then him: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'com p.policy number. I am an employer that is providing workers'co►npensation insurance for my employees. Below is the policy and job site information. / Insurance Company Name: 3 XV1441 `) Q , f'' G 6yv Policy#or Self-ins.Lic. Expiration Date: .-- Job Site Address: City/State/Zip: ' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date} Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year 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 or insurance cove v cation. I do hereby certify eP :/ury that the informadon provided abov is and correct Si afore: % Date: t� Phone#: official use only. Do not write in this area,to be completed by crty or town q,�'iciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.Chy/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#• The Commonwealth oflfMassachuseits Department of IndoWd Accidents Office of Investigations 600 Washington Street . Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit;Builders/Contractors/Electricians/Plumber A licant information s Please Print Le 'bl Name(Business/OrganizatiordIndividual): ti Address: 4 City/State/Zip: Phone#: Are you an employer?Check the appropriate box: 1 ❑ I am a employer with 4. ❑ I am a general Type of project(required): ; employees(full and/or * g conhactor and I 2 I am a sole proprietor otime). have hired the sub-contractors 6. ❑New construction partner- listed on the attached sheet.1 7. ❑Remodeling ship and have no employees "These sub-contractors have working for me in an 8. ❑Demolition I y capacity. workers'comp.insurance.[No workers'comp•insurance $. ❑ We area 9- ❑Building addition ❑ required.] pora6on and its Officers have exercised their 10•❑Electrical repairs or additions 3 I am a homeowner doing p.work right of exemption per MGL I l.❑Plumbing repairs or additions myself.(No workers' insurance required.]t c. 152,§1(4),and we have no 12.0 Roof repairs employees.[No workers' `Any aPPlicant thatch Comp•insurance required.] 13.❑Other fi ecki box affidavit must also Sn out the section below Showing a� �patty mformatton Homeowners who submit this affidavit hrdreatiag they are doing an work and then Eire tContracfors that check this box must attached an additional sheet sir ouW&contrakxors must submit a new at�davit cating such. °Ming the name aftlte mb•cw t 4om and their I am an employer that is providing workers'compensation insurance or '�'PdXY ntfotmatioa f° ati°m f eny e►►rployeaL Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lie.#: Job Site Address: Expiration Date: City/State/Zip: LAG Ci Attach$copy of the workers'compensation policy declaration page(showin the Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the oimpositionlicy ber and expiration date). fine up to$1,500.00 and/or one-year imprisonment,as well as civil of criminal penalties of a Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forof a war WORK ded to the ORDER d a fine Investigations of the DIA for insurance coverage verification. I do hereby certi under the pahu and penalties o er'u that the irtjonnation rov' f p J ry P fled above is true and correct Si store: �" / - Date: Phone#: Date:57 Gj:7 s Official use only. Do not write in this area,to be completed by city or town o rcial City or Town: Issuing Authority(circle one): Permit/License# I. Board of Health Z.Building Department 3. 6.Other City/Town Clerk 4.Electrical Inspector 5.PlumbingInspector' pector Contact Person: rtxr w"111010"p (lI P,C� ZI�JJgr�nJ(//1 of Coeaamer Affairs& asieess Regelatioe License or registration valid for individal an only ME IMPROVEMENT CON R before the expiration date. If found return to: Registration: 14WW Olfim of Consumer Affairs and Business Regolation Expiration: 10/18/Z015 Type: 10 Park Ph=-Spite 5170 SWlement~ard BOA..,MA 02116 LOWE'S HOMES CENTERS INC ROBERT ABBOTT 136 TURNPIKE RD.SUITE 100 SOUTHBOROUGH,MA 01772 Undersecmm-y Not Clout signature s , i � E i • F.4 �� ctuit:mt•r.��w//1aa�'3'�'i�iu�:urju,;c%(5 - �� Office of Coasamer Affairs&Business Regulafioe License or valid for individnl,{Se outp &- OME-IMPROVEMENTCONTRACIDR before the ezp' ate! If fomw retara to: y'188027 Type: Office of Cons irs sad Business�,�ls5aa — Iration:. 1217/2014 DBA 10 Park Plaza- .€, 170 Boston,MA 021 KEME H KENDALt, KENINIETH KENDALL.' >: '::,=:;.• :, 5 WELDEN PL — FAlRHA1/ENI,MA 02719 Undersecretary a Not out signature and Standards ' Construction SLTse!^vssar License: CS-075153 i WEEDEN PLACE s PAIItHAVEN MA Expiration' L Commissioner 01/12/2015 h� • r y - '.f ;� -, OF THE rp� * BARNSTABLE. " MASS. i639• Town of Barnstable ♦0 AjFp�,�A Regulatory Services Richard V.Scati,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, Z; , as Owner of the subject property hereby authorize to act on my behalf, . i in all matters relative to work authorized by this building permit application for: (Address of Job) �a -6 t Signa f Owner, ate Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. T:\KEVIN_D\Building Changes\EXPRESS PERMIT\EXPRESS.doc Revised 061313 Ono CsvN"4ar re,,,a� 1.) of C�.���w f� �.��� �- ���zs� 53 40 31 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �C(�J LI DATA i i r -2. I ^:. v 1 CONTRACT# i , V 000' MASSACHUSETTS SER111,01 SOLUTI— INSTALLED SALES CONTRACT LOWE'S AUTHORIZED REPRESENTATIVE INUMBER CUSTOMER &Z , STORE NO. STREET ADDRESS t STREET ADDRESS, AT /5 CfTY STATE _ ZIP CITY STATE ZIP TELEPHONE ,3�.ry + TELEPHONE -. -„ <-.� !! D V • � /�VV'i / rrJ FLOWE'S HE EN Sfi-0OM48ENTERS,LLC'S MA HIC NO.:148888 CASH � LCC CHARGE 47 q'V —� This is only a quote for the merchandise and services printed below.This becomes an agreement upon payment Upon payment,the entire agreement,Including the epepifiwly wmpleted pages of lhis'' document,the Tenns and Conditions included with this document and any other addenda and"a8aohmenta hereto,shall be raid to herein as this°Contract. PLEASE READ ALL TERMS AND CONDITIONS ON THE.REVERSE SIDE OF THIS PAGE AND FOLLOWING:PAGES BEFORE SIGNING. - INSTALLATION STREET ADDRESS CITY `. . / STATE ZIP j i NOTICE TO CUSTOMER—PRICE CALCULATIONS:In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated.bas,(fbn.the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below,Customer acknowledges receipt of this,Pod66 and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. q 7 z Contract Total , '✓' Are permits required for this installation?Xi Yes [ ]No *applicable tax included NOTICE TO CUSTOMER:Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer 4 acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. NOTE:If rotted wood is discovered during installation additional charges will:apply..You will be given a quote and a change order must be completed and signed by the customer for any additional charges..;- ->,Customer must initial. •Any work or material not specified is not included in this contract.Any changes or additions Will;be'at,an additional charge for the material and labor. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media;worldwide,in perpetuity.Customer authorizes Lowe's.to copyright,use and publish the photographs in print and/or electronically;and agrees that Lowe's may use such photographs for any lawful purpose;'including,but not limited to,marketing, advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. Work is.! commence upon reasonable availability of Contractor and/or any special order or customer.made Good(.)which is anticipated to be i ' r``y—,t [fill in date].Estimated completion date is '` / f c' [fill in date]. Said estimated substantial completion date is not of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: = (if applicable,insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: W Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: (1)Deposit$ to be paid upon signing contract.Deposit should be 113 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ ]Deposit mylour check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS_ REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M_Q L..c.14 f- By: ... Date: y Owner Signature nters,LLC B � Date THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. i BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS <' DAY OF �!% 1 c I Lowe Home Centers,LLC r Lowe's nzed Representa _. Owner wner or Witness Cust er acknowledges receipt of a true copy of this contract which was compI44ely filled in prior to Customer's execution hereof.You,the buyer,m cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. FILE COPY ®20G4 by Lowe's.®Lowe's and the gable design 55102 REV. 12/13 are rag stared trademarks of LF corporation. Atrium 18005223981 .5/29/2014 12 :00:54 PM PAGE 2/003 Fax Server 1 Win.,davv Wizard- Quote 5485513 Page 1 of 2 ..-----•----••....... •-- ................••....... .................•-- ........ ............... --•••-................................................. {y� 3 ...... .i�' ..1.:.....C' t iit(�'S:..i i� -. {fir LS i�Ct.,• 54851513. -" 5.,7l.lSi�S.�.��1 C:7 S.d' \.Cl C ................... ...... ... ..... .................................. Company Name: LOWES Sales Order: Purchase Order: Contractor: CRAIG Job Name: Account: L02376 Account Name: WAREHAM MA Entered By: DLH Status: Quote" Created On: May 29,2014 fiX. t. fR8. ... ................... Repl Series 3201 Double Hung-White-Clear-Standard Low-E/Argon-518 Colonial-OHxl V-OHxOV(White)-E Half Screen-Standard Mesh-2 Locks (White)-Night Latch(Opening Size:27 3/4 W x 52 3/4 H) Glass Breakage a- DP35:Size Tested 36"x 74"-U Factor:0.31,SHGC:0.26 Meets ENERGY STAR =i in region(s):[NORTH-CENTRAL][SOUTH-CENTRAL][SOUTHERN]-Florida Approval Code: FL11826 267-2-AM-63-00-J-2-0274- 27 112" 1 s 12 524 1111 AOOO00000301100 x 52 127.78 1533.36 (1 1 021 11 000) 1/2" i-ES Repl Series 3201 Double Hung-White-Clear-Standard Low-E/Ar on-518 Colonial-OHx1V-OHxOV(White)-E Half Screen-Standard Mesh-2 Locks (White)=Night Latch(Opening Size:27 3/4 W x 44 3/4 H)-Glass Breakage a- DP35:Size Tested 36"x 74"-U Factor:0.31,SHGC:0.26 Meets ENERGY STAR .': in region(s):[NORTH-CENTRAL][SOUTH-CENTRAL][SOUTHERN]-Florida Approval Code:FL11826 t 267-2-AM-63-00-J-2-0274- ?271/2". ' 2 1 i 4441111 AOOOOO000301100 44 / 123.55 123.55 (1102111000) ES ` L�j Sub = Totals ' 1656.91 :.......................................................... ........................................................................................................ ............ ;..... Totals 1.3 ; .......:........................ 1656.91 http://,%,rw.atriumwizard-com/or /I 4811415141378503139/Order.cmd?command=displayprint&Orderld... 5/29/2014 i i Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee ®' r Beatvs°rABr 9cbMb q. ,�$ Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Preis Imprint Map/parcel Number CIO 00 Property Address (x]Residential Value of Work (o 000, YMinimum fee of$25.00 for work under$6000.00 Owner's Name&Address 3 3 �- [ �� �`4 y� ,12 Za�nQ S / Contractor's Name ,.T(S(C��-r Telephone Number _ �— .7 7// Home Improvement Contractor License#(if applicable) 106 �-S_Z Construction Supervisor's License#(if applicable) WWorkman's Compensation Insurance 20�9 Check one: N O V ❑ I am a sole proprietor ❑ I am the Homeowner TOWN OF BARNST) BBLE I have Worker's Compensation Insurance Insurance Company Name w< .X a11�nS. &-T AoJ Workman's Comp.Policy# A W"—,— n Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to �u r y'k. e_ " e4, t 'C` ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property.Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required: SIGNATURE: C:\Users\decollik\AppData\Focal icrosoft\Windows\Temporary Internet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 i , The Commonwealth of Massachusetts Department of lndusirial Accidents Office of Investigations 600 Washington.Street - Boston,MA 02111 wrtnr.►nassgov/dia Workers'Compensation Insurance Affidavit: Builders/Conk-actorsfE. tricians/Plumbers Applicant Information Please Print 'b Name(Ba> esslO,gsnization�tnaividoall: ln► ��� Address: S Li City/State/Zip: l zee ®�-r3 dome g- �V--7 -9— gq�j Are you an employer?Check the appr priate box: Type of project(required): � 1. I am a employer with :? 4. ❑ I am a general contractor and I 6. [:]New construction employees(full andloz part-time)s have hived the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and Lave no employees Thee sub-contractors have 8. ❑Demolition wonting for me in any capacity. employees and have workers g_ ❑Building addition [No wodom'comp.insurance comp.i suranml required] 5_ ❑ We are a corporation and its 10_❑Electrical repairs or additions 3.❑ I am a homeowner doing all wore officers have exercised their 11_❑Plumbing repairs or additions myself.[No workers'oomp_ right of emotion per MGL 12.Roof repairs insurance required_]i c.152,§I(4),and we have no employees.[No workers' 13_0 Other comp insurance required.] 'Any applicant d mt checks boa#1 m¢st also fill cue the.section below showing their workers'cou peosation policy informatiM ?Homeowm as who submit this affidavit indicating they are doing aU was$and rhea hire cutside contractors must submit a new affidavit indicating such. ZContractors that check this boa mats[attached an additional sheet showing the none of @ie sub-cemnartars and state whether air notthose entities have employees. If the sob-contractors have employees,they must provide hair workers'comp.policy number. I am an employer tliat is pms iding workers'compensation insurance for my ougdoyam Below is the policy and job.site' information. n Insurance Company Name: fyG0.1/1P� l r "C L)a Policy#or Self-ins-Lie_#:—Z w C D I4,r, 6_S Expiration Date:tie Ad ' I ttZp:Job s cS tLk14 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 andlor 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 kDIA for insurance coverage verification. I do hereby certi.&u er theprrins an o perJury that the information pro dird above is true and correct Date: Phone#: ! t 7 J 071e j Official use only. Do Trot write an tins area,to be completed by city or town of cia[ City or Town: PermitlLicense Issuing Authority(circle one): 1.Board of Health•2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Date: 11/5/2009 Time: 3:34-PM To: 0 9,15087598699 Page: 002 Client#: 13888 2BAYBU ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1DATE(MM1DDNYYY) 10520 9 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 973 lyannough Rd., PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: National Grange Mutual Insuranc Dennis Mascetta DIBIA Bay Builders INsuRER6: Guard Insurance Group 19 Washington Avenue INSURER C: Buzzards Bay, MA 02532 INSURER D: 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. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NS DATE MMIDD DATE(MMIDDIM LIMITS A GENERAL LIABILITY MPP2868L 01/01/09 01/01/10 EACH OCCURRENCE $1 QQQ QQQ X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDenool $500 O00 CLAIMS MADE FX-1 OCCUR MED EXP y one person $1 O QQQ PERSONAL&ADV INJURY $1 QQQ QQQ GENERAL AGGREGATE $2 OOO QQQ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000 POLICY LOC • 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 $ (Per accident) GARAGE LIABILITY -AUTO ONLY-EA ACCIDENT $ AUTO ANY OTHER THAN FA ACC $ • AUTO ONLY: AGG $ EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ [RETENTION $ $ B WORKERS COMPENSATION AND DEWC012565 01111109' 01/11/10 X WCSTATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERlE(ECUTNE E.L.EACH ACCIDENT $500 OOO OFFICERIMEMBER EXCLUDED? YES E.L.DISEASE-EA EMPLOYEE $500 OOO If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Dennis Masetta is excluded from the workers compensation policy. Job: 39 Route 130,Cotuit, MA Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Robert Frazier DATE THEREOF,THE ISSUING INSURER VALL ENDEAVOR TO MAIL IQ_. DAYS wRITTEN 33 Lincoln Avenue NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Bourne, MA 02532 IMPOSE NO OBLIGATION OR LIABILTrY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES- AUTHORIZED IYPRESENTATIVE ACORD 25(2001108)1 of 3 #S62975IM62974 LS1 ® ACORD CORPORATION 1988 oF� • IARPI3fABI.E. « 3 9. Town of Barnstable Regulatory Services Thomas F.Geiler,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, V��— R^C'2k e ,as Owner of the subject property here'oy authorize At&% zatL ( ,> rM act on my behalf, in all matters relative to work authorized by this building permit application for: -4--3 0 � 13 D (Address of Job) X le a e of Owner Date rr-� 7 ZI CJ✓\- Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\User3\decollikWppData\Local\Microsoft\Windows\Temporaiy Internet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 Massachusetts- Department of Public Saret Board of Buildim- Re.-ulations and Standards ✓lae [�oor�rzoozulea/da a���oaaac�zuaelta Construction Supervisor License Board of Building Regulations and Standards License: CS 42999 HOME IMPROVEMENT CONTRACTOR Restricted to:, 00 " Registratrori: 106232 i ExprraUon 7j22/2 DENNIS A MASC010 Tr�F 271019 ETTA t :_ } 19 WASHINOTON AVE '" Type DBA' BUZZARDS BAY,M..A 02532 ,t BAY BUILDERS L Dennis Mascetta 19 Washington Avenue' Expiration: 3/9/2011 Tr#' 11990 Buzzards Bay,MA 02532 Administrator ('nmmis.iunar t Barnstable Assessing Search Results http://www.town.barnstable.ma.us/assessingt2009/displayparce109map... BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WOK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) A e . F 3 . 2 of 2 11/5/2009 2:04 PM f v 06 09 10:05a Dennis Mascetta 508-759-8699 p.1 License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 Not valid without signature- { Assessor's -map.and lot number ...... .............. ... . ... Er Sewage Permit number ................. .................................. 13AU STABLE, : House number ........................................................................ V NASIL 639- Ar, TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO(;�;. a.. ..... ........... 9"r............................................................ TYPE OF CONSTRUCTION ....... ........................................................................ S...............19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according.to the, following information: Location ...... ........(R .....laal-­11­01��L ................................ ................................................... ProposedUse ........................... ........................................... ZoningDistrict ...... ...................................................Fire District ... ................................................................ Name of Owner . ...... .........X4 t. . ..........Address ........ Name of Builder .... ....................Address 41n1nV141,41... ........ P m/7. ............... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ................................................................. Foundation ............................................................................... Exierior ................................................ ...................................Roofing ..............:.:.................................................................... Floors ......................................................................................Interior ....................I.....................?........................................... Heating ...................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -------------------------------19-------- - Area Diagram of Lot and Building with Dimensions Fee �44.....400 W. .g9;.�77. ... SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 . .......... . ... .. ... ........... .......... Construction Supervisor's License ......... FRAZIER, ROBERT No ..... Permit for ..RAZE GARAGE ....................... ....Dwelling............ ................................................. Location ..3.9.AQqt9...!.aQ................................... .................Q.Qmit............................ .................. Robert Frazier Owner .................................................................. Type of Construction Frame...........:............................ ................................................................................ Plot .... ....................... Lot ................................ Augu9t 8, 85 Permit Granted ... ....................................19 Date of Inspection .....................................19 Date Completed .... ... ........ ......19 t 1 � �...�- Assessor's map and lot number ...!..: .................... ......... I E Q Sewage Permit number ........................................................ Z BARNSTABLE. i Ff,buse number ............ !� MU& :.................................. 1639 00 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..` (1. �..... .�{... .. ........................... .......................................... TYPE OF CONSTRUCTION .......Z�. rivZ...... ..d...............................:....................................... ............. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....% ............ -. ':: >� r.....:............:.................. ProposedUse .................................___. ..................................................................... :.....................:....:. .. ..... J..... .... l ZoningDistrict ..................................................................Fire District ...1,... A.................................................................. Name of Owner .? .....�.-...... . 5 ..........Address Nameo .0.Fr. ............. � .........Y. . ............. Nameof Architect ..................................................................Address ........................................... c Numberof Rooms ............ .......................Foundation............................... ......,....................................................................... Exierior ....................................................................................Roofing .................................................................,.................. Floors ......................................................................................Interior Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate. Cost .....................................!.'' Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ....... .,................................ Diagrari-'of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH it i 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 .� 'T � ...Xv/ ' /: Gs'�./ ......b� ................. Construction Supervisor's License 1 !.%..t �P......... 28303 RAZE GARAGE Dwelling 39 Route 130 Loca�on ----------�----------- ' Cotuit ----.---------------------.. ' Robert Frazier Owner .................................................................. , . . . Frame Type ofConstruction ........................................... , ---------------.----------.. -- ^ Plot ............................ Lot ^------'--- ~ ^` ` . - - / Permit Granted `—..J�A����.�8"----..lA 8� Dote of Inspection -----.,------lA ' Dote Completed ............... ---..—lV ' ` ~~~-_ ' . . . . ' ^ - ` ' - ^ ' - ' ' | � ^