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0100 RUSHY MARSH ROAD
Town of Barnstable Building �' '` ' -^`u',n „f�-_,ram". .�• �` "�, ,� �� ,,, �'"s.':; � ,i.F i �, t �.+,5;e°-�. r F,s � cry... '�'��;. ' �'A�.:_ �-,.a `; �' .::�Yta'p�`* `` r s �Posf.ThisnCard So��That�t�s\/isible;From„the Street A; ,r6ued;Plans;Must be,Retamed on Job and--this,Gard�Must b,,etl;Kept • MAE& Posted Unt�1�Flnalylnsp�ecton HasBeen Made � u ��� s ,�;FTt � � �a ,� ��'.� i6�q v: ;.�'' „ . a�;" ram_ .._� x �a:.< ,. a ,.. v „ •- rt %, t ° � � ' i�=ate"'°of°Oecu anc .-s Re u�red�such`Buildmshall Not�be Oceu iedunt�l a FinalhlnsY ect�on�has�been�made � Perm1 L - �+ Where�a ertif c Permit No. B-18-1661 Applicant Name: SWEET,ANDREW Approvals Date Issued: 05/23/2018 Current Use:, Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/23/2018 Foundation: Location: 100 RUSHY MARSH ROAD,COTUIT Map/Lot: 019-131 Zoning District: RF Sheathing: X Y ,' $ Owner on Record: BOYD, F KEATS III&WENDY R Contractor:Name:` .SWEET,ANDREW Framing: 1 Contractor.License 112785 RUSHY MARSH ROAD ,� -� 2 Address. 100 US COTUIT,MA 02635 X Est Project Cost: $30,682.00 Chimney: r • Description. replacement Windows(23) Permit Fe'e: $ 156.48 Insulation: Project Review Req: r 1Fee Paid $ 156.48 Date 5/23/2018 Final: Plumbing/Gas Rough Plumbing: ., 'A.,:!. Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months aft6 ssuance. Rough Gas: 7. 1, All work authorized by this permit shall conform to the approved application and the�approved construction documents'for whi h thit permit has been granted. All construction,alterations and changes of use of any building and structuressha`II be in compliance with the local zoning bylaws and codes. Final Gas: ` .. This permit shall be displayed in a location clearly visible from access Iy street orFroad and shall be maintained open for publkc inspection for the entire duration of the f A � work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures bye a Build g and Fire officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: r <. '' F � Rough: `1.Foundation or Footing _� „ ; •• - g 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) - 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT biWE p � Application number I 1 °V " a,atuvsr�se.e, Date Issued....................:6..l.?:: .�.. .............. .... MAM16.19. ® Building Inspectors Initials................... ................ a � Map/Parcel......01.1....... ................................ TO JhARNSTABLE 15� EXPEDITE � �IT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY WFORMATION Address of Project: 16)0 W,) S 1 y NUMBER ST EET VILLAGE -/ Owner's Name: /�eQf 07 �, cN Phone Number � 3/ _ 5L D Email Address: Cell Phone Number Project cost$ 3t�� h Z — Check one Residential ✓ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize S-ee -- f+G CA.-pQ � to make application for a building permit in accordance with 780 CMR Owner Signature: - 5-e e Date: TYPE OF W®Rx ❑ Siding U Windows (no header change)# 0 Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to 04-cJe�►�,�4 �. �.�-� �,,��y„ � A CONTRACTOR'S INFORMATION Contractor's name An/io Home Improvement Contractors Registration(if applicable)# 1/2--7 8 S (attach copy) Construction.Supervisor's License# 0 70 0 7 T (attach copy) Email of Contractor y ee Si a I. c Phone number �o/- 7��- 3`?9 ALL PROPERTIES THAT HA VE TRUCTURES OVE 7.s YEARS OLD OR IF THE SUBJECT PROPERTY IS/N A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ .*For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event. Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being sewed at your event please obtain a Health Department approval between the hours of 8v 00am-9.30 am or 3.30 pm-430pm. Commercial events may require Fire Department approval *WOOD/COAL/P ELLiET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMYIR the Massachusetts State Building Code. I understand the construction inspections procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT9S SIGNATURE Signature Date S-2 All permit applicad are subject to a building official's approval prior to issuance. Home Depot Contractor License Numbers: MA:107774,112785 Salesperson Name and Registration Number: Janice Campbell:R-1-073-13-00016 Home Improvement Agreement Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: KEATS AND OR WENDY BOYD New England South 1-5X3V9HJ First Name Last Name Branch Name Lead# 00 RUSHY Marsh Cotuit MA 02635 Customer Address City State Zip r 74)313-0524 Home Phone# Work Phone# Cell Phone# wbkb3@comcast.net Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1. Shrewsbury MA 01545 Address City State Zip or Email customercancellationnortheast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT.FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN 09TICE OF YOUR RIGHT TO CANCEL. Ac o ed y: 04/19/2018 X Customer Signature Date 1 ffft't! 0,VPAf?rrirnf of PuDhc Sal r•t f�Ml f tktlr>,y Re9tstation»nd StandarriM t.#�lttsA:CS-070077 � �� SuFx•r. S�:r C#UAR c irk MA Ecpir*iQn: � � 13�i�1i8 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information y�� Please Print Legibly Name (Business/Organization/Individual): t.J f— Address: Cit /State/Zi d2>67 / Phone#: 77"Y- 766 - c2JQJ Are you an employer?Check the appropriate box: Type of project(required): 1.❑ lam a employer with . 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity, employees and have workers' comp.insurance.# 9. ❑Building addition [No workers comp.insurance p• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their r 3.❑ i am a homeowner doing all work - 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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. 1 am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: 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 for insurance coverage verification. I do hereby ce unde the pain nd penalties of perjury that the information provided above is true and correct AA . /11 Sianature: Date: 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#: The Commonwealth of Massachusetts ra: Department of Industrial Accidents �{ Office of Investigations =1 I Congress Street,Suite 100 T �y Boston,ILIA 02114-2017 , � www mass.gov/dia Workers'Compensation.Insurance affidavit: Builders/Contractors/Flee tricians/Plumbers Applicant Information Please Print'Le -blv �laMe (BLsiness/C)rganization/1ndilddualj: O Q_ O Address: * Ie 9 0 s yew l 1/RN�I City/'State/Zip: 10 OISY.'r- Phone 4: 7 / L '7,5� an employer?Cbeck the propria (b .: Type of project(required): am a employer with t. ;4• am a general contractor and I« ve hired the sub contractors 6. ❑New construction i __hployees(full and/or p -time). c ❑ I am a sole proprietor or partner- listed on the attached sheet, 7. ❑Remodeling shi and have e 1 These sub-contractors have [— ha no m o ees S. Demolition P P y Nvorlang r I 3c1 emmovees and have workers' for me in any C3D � - * 9. I Btrl g din addition [\l I-o-workers' comp.in ance comp. in�tranCe.* sur required.] 5. Rre are a corporation and its 10.❑Electrical repairs or additions 3.f I I am a homeowner doing all wozl o> cers have exercised their 11.�]Pltmmbing repairs or adci ons f I myself. tNo workers' comp. right of exemption per ivIGL i 12.❑Roof repass insurance required.] t ! C. 152,§1(4),and we have no B empiov eel. [N-o workers li.�Other w t��•9-�./ comp.instance required.] ^:\ny applicant that checks box l must also fill out the section below showing.their workers'compensation policy information. t Homcownc s who submitthis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_ :Contzetors that checkthis 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 emnloyecs,they must provide their workers'comp.policy number. I an;an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site infOrnatiom /J Insurance Companv Name: 1�F1�1 I-j C.r' �llL�ottic� 1/i�l Bnd Policy#or Self-ins.Lic.#: y� Expiration Date: Job Site Address: 0 0 'R u M City/Si?teiZip: �oT ; A / s y -ems �, � rJ . � 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. GL e. 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 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• ,ura-ace coverage verification. I do hereby certify under i ains and p alties of er'u that the information provided above is true and correct Sattae: // Date: — Phone=: � — "' iv G1 Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense 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*r: �— '�1 f`�>`� ��.tf'11(liEG'.�[��'�'!�'•�jlf, L� � �` �����e�?'-C'/Z-LfJC'�.� ' Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card Registration: 112785 HOME DEPOT USA INC Expiration: 04122.1201R 2455 PACES FERRY RD C-11 1 CSC ATLANTA,GA 30339 Update Address and return card. Mark reason for chance. � Address ❑ Renewal ❑ Employment.C Lost Card " ., ,.: :,:.•.,::... " /r"::..,::a :.,i!; • Office of Consumer Affairs S Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SUDGIe'nent Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation —_ 112765 04r22'2019 10 Park Plaza-Suite 5170 FTOME DEPOT USA INC Boston;MA021`16 ANDREW SWEET � rx� 2455 PACES FERRY RD C-11 HSC o d iili6ut signature ATLANTA,GA 30339 Undersecretary ACi� � CERTIFICATE OF LIABILITY INSURANCEDOM20vOD/YYYY) oz2uzo 18 � 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 have ADDITIONAL INSURED provisions or 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 MARSH USA,INC. NAME TWO ALLIANCE CENTER PHONE FAX 3560 LENOX ROAD,SUITE 2400 JAIQ No Fxthac No E-MAIL ATLANTA,GA 30326 ADDRESS: NAIC It CN 101642069-HaneD-GA W-18-19 INSURER(S)AFFORDING COVERAGE � INSURER A:Old Republic Insurance Co 24147 INSURED THE HOME DEPOT,INC. INSURER B:New Ham hire Ins Co 23941 HOME DEPOT U.S.A.,INC. INSURER C:HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD BUILDING C-20 INSURER D: ATLANTA.GA 30339 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353439-16 REVISION NUMBER: 3 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 17OF LTR TYPE OF INSURANCE - POLICY NUMBER fP POLICY EFF nP DICY EXP LIMBS A X COMMERCIAL GENERAL LIABILI IV W2Y312717 031012018 03101/2019 EACH OCCURRENCE $ 9,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES Eaoccurmncel S 1.00Q000 MITS OF POLICY XS EXCLUDED MED EXP(Any one person) 1 S SIR:SIM PER OCC PERSONAL 8 ADV INJURY J S 9,000,000 GEN'L AGGREGATE LIMB APPLIES PER: - X POLICY PRO- GENERAL AGGREGATE $ 9,000,QCO JECT LOC PRODUCTS-COMPIOP AGG S 9,000,000 OTHER, A AUTOMOBILE LIABILITY MWT8312718 S ANY auro 03/012018 COMBINED SINGLE LIMIT 03/012019 Ea accident S 1.000.000 X A BODILY INJURY(Per person) Is I OWNED SCHEDULED SELF INSURED AUTO PHY DMG AUTOS ONLY AUTOS - BODILY INJURY(Per accident) S HIRED AUTOSNON-OWNED Y PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident S S ;EXCESS ELLALIAB OCCUR EACHOCCURRENCE S LIAB CLAIMS-MADEAGGREGATE S RETENTION S B AND EMPSCOMPENSATIONYES'LIILIT WC 0141225Tr-(AK ,NH.NJ,VT) 03/012018 03I012019 y PER OTH- S AND EMPLOYERS'LIABILITY B ANYPROPRIETORIPARTNERIEXECUTNE YIN WC 014122578(WI) 03/0112018 03/012019 STATUTE ER OFFICERIMEMBEREXCLUDED? a NIA - E.L.EACH ACCIDENT S 5,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE S 5.000,000 DESCRIPTION OF OPERATIONS below Continued on Additional Page S,C00,000 E.L.DISEASE-POLICY LIMIT $ C ,Excess Auto 297-1=10011-00-2018 03/012018 03/012019 Limit: 4,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER. CANCELLATION HOME DEPOT USA,INC 2455 PACES FERRY ROAD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDINGC-20 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATLANTA.GA 30339 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. I Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta A'CO'R®® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY MARSH USA.II•IC. NAMED INSURED THE HOME DEPOT,INC POLICY NUMBER HOME DEPOT U.S.A.,INC. 2455 PACES FERRY ROAD BUILDING C-20 CARRIER ATLANTA.GA 30339 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier:Indemnity Insurance Company of North America Policy Number WLR C64783191(AL,AR,FL,ID,IA,KS,KY,LA,MS.MO.NE,NLi ND,OK,SC,SD.TN,WV,WY) Effective Dale:0310112018 Expiration Date:03101/2019 (EL)Limit:S1,000,000 Carrier:New Hampshire Insurance Company Policy Number.WC 014122576(DC,DE,HI,IN,MD,MN.MT,NY,RI) Effective Date:03/01/2018 Expiration Date:03101/2019 (EL)Umd:S1,000.000 Carrier ACE American Insurance Company Policy Number WCU C64783221(QSI)(AZ.CA,IL,NC.OR.VA.WA) Effective Dale:03101/2018 Expiration Date:03/012019 (EL)Limit:S1,000,000 SIR S1,000,000 SIR for the stales of AZ,CA..,IL,NC,OR,VA,WA Carrier.National Union Fire Insurance Company Policy Number.XWC 4595580(QSI)(CO,CT,GA,ME,MI,NV.OH,PA.UT) Effective Date.031012018 Expiration Date:03/012019 (EL)Linul:S1.000.000 SI.000,000 SIR for the slates of CO,ME,NV,MI,OH,PA,UT S750,000 SIR for the slate of GA S350,000 SIR for the stale of CT Carrier:National Union Fire Insurance Company Policy Number.X'NC 4595581(QSI)(,NA) Effective Date:0310112018 1 Expiration Date:03/012019 (EL)Limit:51,000,000 SIR:$500.000 TX Emdoyers XS Indemnity. Carrier-Ainios Union Insurance Company Policy Number.TNS C4916693A(TX) Effective Dale:03101018 Expiration Date:03/012019 (EL)Limit:S1Q000.000 SIR:S 1000.000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION: All rights reserved. The ACORD name and logo are registered marks of ACORD -5-��� Town of Barnstable *Permit ' "I sgs Expires 6 months from isstre date °* Regulatory Services F Fee - swartsrnt� • �, Richard V.Scali,Interim Director Building Division Tom Perry,.CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-40-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number d Q 0 3 Q _; �Oo-T - - _ AI14� �b Property Ad"iiress _ T —— 1— (Residential Value of Work$ .556? o Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address too Vo rsk d �"u"�f OA 02-435 Contractor's Name7` o7 1�11 t n Telephone Number 401-WAI a Home Improvement Contractor License#V(if applicable) l��7 5 Email: Construction Supervisor's License#(if applicable) 7 ` / / (�Workrnan's Compensation Insurance 66 `` Check one: r ` ❑ I am` a sole proprietor I am the Homeowner I have Worker's Compensation Insurance C ! Insurance Company Name /y 4T W j_ lI P/O AJ �� f�5 • Workman's Comp.Policy# S� 5 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 . z7 (maximum_335)#of windevvZ #of doo s: , ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire.Permits required. *Wheris required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: 4efo wner must sign Property Owner Letter of Permission. the Home Improvement Contractors License&Construction Supervisors License is SIGNATURE: QAWPFILESTORMS�buildin1EXPRESS.d c Revised 061313 �1 7��'�� 99 ,;- K' SPECIAL SERVICES CUSTOMER INVOICE Page 1 of 14 No. H2612-73841 Store 2612 HYANNIS Phone; (508)778-8948 �� 65 INDEPENDENCE DRIVE Salesperson:AMR5697 I HYANNIS,MA 02601 Reviewer:VXG1123 0 I BOYD . KEATS AND OR WENDY (774)313-0524 R�PRIt11'� Address 100 RUSHY MARSH RD Ph"2 canroero w� coy COTUIT. Jo00°'y" exterior door install 2018-04�3014;23 $1* MA zo 02635 emp1 r BARNSTABLE CUSTOMER PICKUP #1 MERCHANDISE AND SERVICE SUIT MARY swto���"`�'"""the 4ua""`�°'"'�''�►'� REF# W11 SKU# 000G-515-604 Customer Pickup 1 Wili Cull S.Q.MERCHANDISE TO BE PICKED UP: SIO MASONITE DORFAS E REF#SO9 ESTIMATED ARRIVAL DATE; 05f2 =18 21531 REF#! M Um D CRIPTION PI TAX PR EXTENAJON S0909 0000-479-486 1.00 EA NA 133.6 X 81.5 BELLEVILLE MAHOGANY TEXTURED/33B X A Y p 1,760,49 $1,760.49 81.SSELLEVILLE MAHOGANY TEXTURED.FIBERGLASSDOOR STYLE=314 p LITE ECTANGLEBROOKLYNPECA #1 S0910 0000-478-931 1.00 EA NA/33.5 X 81,5 BELLEVILLE MAHOGANY TEXTURED/33,5 X Y $1.811.74 $1,811.74 81.5BELLEVILLE MAHOGANY TEXTURED FIBERGLASSDOOR S -L - FULL LITE RECTANGLEB.ROOKLYNULTRA PURE WHITE#2 SCHEDULED PICKUP DATE: 1Nitl iae scheduled u n arrival of all S/O Merchandise e • 572.23 AND OF CUSTOMER PICKUP-REF#W11 6 INSTALLER DELIVERY #1 REF# 101 STOCK MERCHANDISE TO BE DELIVERED: REF# SKU QTY M DESCRIPTION PI TAX PRICE EACH EXTENSION R03 0000-264.294 4.00 EA J4-X5-1 TRIM/ A Y .12 $88A0 R04 0000-254-466 2.00 EA1/ 8•PVC BOARD/ A Y 8.16 $56.39 R05 OOM-331-286 40.0102-1/2XT PFJ WM351 CAS LEG/ A Y $6. 1 $276,41002-961-477 6X50 WINDOW&DOOR SEALING TAPE/ A Y $17.07 17.91 CONTINUED ON NEXT PAGE"• W&L-CALL a�6aCHA P FOR WILL CALL, Will-Call Items n the store for 7 days only. MERCHANDISE PICK-UP Check your current order status online at PROCEED TO WILL CALL OR , www,homedepot.co;nkwderswus SERVICE DESK AREA (Pro Customers,Proceed To The Pro Desk) Page 1 of 14 No. H2612-73841 Customer Copy I SPECIAL SERVICES CUSTOMER INVOICE-Continued Name: BOYD Page 5 of 14 No. H2612-73841 INSTALLATION #2 (Cono"pied) REF M02 BASIC INSTALLATION LABOR INCLUDES: ARRIVE AT JOBSITE ON DAY OF INSTALL AND LEAVE WITH CUSTOMER. 'ALL FEES ASSOCIATED WITH OBTAINING PERMIT(MUNICIPALITY OR INSTALLER.IF DELIVERED TO INSTALLER.THE INSTALLER WILL POSTAGE AND ADMINISTRATIVE), PICK UP FROM THAT MUNICIPALITY AND DELIVER TO EITHER JOBSITE FEES,ENGINEERING.WIND LOAD CALCULATIONS,RECORDING, DELIVER COMPLETED PERMIT PACKAGE TO PROPER MUNICIPALITY. SPECIAL NOTES: CUSTOMER IS RESPONSIBLE FOR PAYMENT OF THE PERMIT.ONCE IN FULL._NO REFUNDS ON PERMIT FEES AFTER 72 HRS.OF PAYMENT. THE PERMIT IS PAID FOR.WORK ON THE PERMIT ASSEMBLY BEGINS IMMEDIATELY.CANCELLATIONS WITHIN 72 HAS.WILL BE REFUNDED. END OF INSTALL#2 TOTAL CHARGES OF ALL MERCHANDISE & SERVICES • - • - • $5 297.89 Policy Id(PI): SALES TAX $270.87 A: 90 DAYS DEFAULT POLICY; TOTALI $5 568.76 BALANCE DUE1 $0.00 `The Home Depot reserves the right to 11mil1 deny returns. Please see the return policy sign in stores for detaits.' END OF ORDER No.H2612-73841 Page 5 of 14 No. H2612-73841 Customer Copy i. ;7 1 MASSACHUSETTS SUPPLEMENT WARNING—DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Last Name First Name Store#/ Branch Name PO(s)or Customer Order# Salesperson's Name (if any) The terms and conditions of this Supplement apply to all Home Depot(interchangeably referred to as "The Home Depot") Home Improvement Agreements in Massachusetts and are expressly made a part of all such agreements. In the event of any conflict, inconsistency or discrepancy between the terms of Your Home Improvement Agreement and this Massachusetts Supplement,the terms of this Supplement shah control. - NOTICE TO BUYER You may cancel this Agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof, provided You notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Agreement. See the attached Notice of Cancellation form for an explanation of this right. This right shall not apply to a transaction in which You initiated the transaction and the goods or services are needed to meet a bona fide immediate personal emergency and You furnish the seller with a separate dated and signed personal statement in the Your handwriting describing the situation requiring immediate remedy and expressly acknowledging and waiving the right to cancel the sale within three business days. (Customer's sig ure) TAX IDENTIFICATION NUMBER FOR HOME DEPOT: 5848533/9 NO WAIVER OF RIGHTS:Your rights under the Home improvement Contract Laws (MGL Chapter 142A)and other consumer protection laws(i.e., MGL Chapter 93A)may not be waived in any way, even by this Agreement. However,You may be excluded from certain rights if the service provider You choose is not properly registered as prescribed by law. REQUIRED PERMITS: Home Depot and/or its Service Provider is/are obligated to inform You of any and all permits necessary to complete the work contemplated by this Agreement, and it is the obligation of Home Depot and/or Service Provider to obtain said permits. If You secure their building permits, You are automatically excluded from any Guaranty Fund provisions of the Home Improvement Contractor Law. WARRANTIES:Home Depot may guarantee or provide an express warranty for workmanship or materials.Any enumeration of these matters on which You and Home Depot lawfully agree may be added to the terms of this Agreement as long as they do not restrict Your basic consumer rights. nw State SUP,CFe".01."17) Customer Care:1-877.467 2591 The tfome Depot-2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta.Georgia 30339 Page"1 2iF 1 � t ► H 2612- Customer Copy �j 3 # :` �t 6m ' � y 5f yi 9y���y[y{ T���{■u Sf � P Yy D � � 'r "r ,TO c ti•' The Commonwealth of Massachusetts Department of industrial Accidents Office o f Investigations Ed I Congress Street,Suite 100 _ Boston,MA 02114 2017 . www.mass gov/dia, Workers'- Compensation Insurance Affidavit: P �davi<t. 13n•><Iders/Contractors/Electricians/Plumbers A lica>lit Lt formafioa Please Print Legibly NaMe (Business/Or,Qmization/Individual): Address: f: i✓ c°i — City/State/Zip: Phone#: Are you an employer?Check the appropriate box: 1.❑ I am a employer with a• ElI am a general contractor and I Type of project(required): , 'employees(fuli and/or part-time)." have hired the sub-contractors 6• El New construction 2.L�! 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 mein any capacity. employees and have workers' [No workers' comp. insurance comp. insurance 1 9: ❑Building.addition required_] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself_ [No workers' comp. right of exemption per MGL IZ.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [Nto workers' u.❑ Other comp.insurance required.] *Any applicant that checks box"I must also fill out the section below showing their workers'compensation policy information. fi Homeowners who submit this affidavit indicating they are doing all.work and then hire outside contractors must submit anew affidavit indicating such- tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees_ If the sub-contractors have employees,they must provide their tivork-ers'comp.policy number. I azn an employer that is providing workers'compensation insurance for my employees Below is the policy•and job site information. _ Insurance Company Name: Policy#or Self-ins.Lic.•#: Expiration Date: Y 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 ofMGL c. 152 can lead to-the imposition of criminal penalties of a fine up to$1,500-00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby Gertz under the pains and penalties of perjury that the information provided above is true and correct-v -...- Sioiiature:LLJ Date: Phone#: s• Official use only. Do not it-rite in this area,to be completed by city or town,offzciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations : l 1 Congress Street,Suite 100 91 Boston,M4 02114-2017 `y www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/'Plumbers Appficant Information Please Print Legibly Maine (Business/Orgmuzation/Tndividual): — Address: Citv'State/Zi : sX�sb M • dl tyg' Phone#: 7 _Are you an employer?Che-lr-the _propriatKIabox: Type of project(required): 'am a empiover with 4. a general comiactor and T 6. '.New construction * ve hired the sub-contractors L- %- employees(full and/or part-time). ! r, listed on the attached sheet. 7. ❑Remodeling I am a sole proprietor or partner- ship and have no employees These sub-contractors have j g. FL Demolition wo&mg for me in anv capacity. emoiovees and have workers' 9. ❑Building addition ` o workers' con mstrance comp•insurance? re p 5. ❑ We are a corporation and its I 10.❑Electrical repairs or additions required-] 3.❑ I am a homeowner doing all wort officers have exercised their 11.7 Plumbing repairs or additions myself. No workers' comp. right of exemption per;VIGL 12.❑Roof rep ' s insurance required.]t c_ 152,§i(4),and we have no 13. Oth r emp1ovee4. [No workers' j comp. insurance required.] •.env applicant that cbecl:s box 01 must also fill out the section below showing their workers'compensation policy information. Homeowners who submitthis affidavit indicating they are doing all work and then hue outside conuactors must submit a new affdavir indicating such- :Cont-actors that check this box must attached an addirional sheet showing the name of the sub-contractors and state whether or not those entities have employees. s the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job sire injunnanon � �, - - /- nsurance Companv Name:- policy#or Self-ins.Lic.#: X W Ci ! S 1 o I Expiration Date: 3 Job Site address: t`'bL�uS_y 110SF'\ , City/SyateiZip: &Qr. 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 u?to$1,500.00 and/or onnelatar. imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day ag ' s Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIk r e coverage verification. I do hereby eerdfv un a alti at the information provided abov is e and correct Si azure: Date: Phone#:rnly. Do not write in this area,to be completed by city or town official : PermitUcense# ority(circle one): . ealth 2.Building Department 3.Cityirown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Coutsct Person: Phone#: Affairs and Business Regulation - _ Office of Consumer Affa s g 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card HOME DEPOT USA INC Registration: 112785 9 2455 PACES FERRY RD C-11 HSC Expiration: 04/22/201 ATLANTA,GA 30339 Update Address and return card. Mark reason.for change. ❑ Address ❑ Renewa! ❑ Employment ❑ Lost Card _ Office of Consumer Affairs&Business Regulation - HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SUDDlement Card before the expiration date. If found return to: Renistration Expiration , Office of Consumer Affairs and Business Regulation S 12785 04/22/2019 10 Park Plaza-Suite 5170 90ME DEPOT USA INC Boston,MA 02116 ANDREW SWEET ` --- ;4 2455 PACES FERRY RD C-11 HSC r 0 Ou ATLANTA,GA 30339 Undersecretary d ith signature DATE(MWDDIYYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 0222018 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 have ADDITIONAL INSURED provisions or 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 NAME- MARSH USA,INC. PHONE FAX TWO ALLIANCE CENTER Alt No: 3560 LENOX ROAD,SUITE 2400 E-MAIL ADDRESS: ATLANTA.GA 30326 INSURER(S)AFFORDING COVERAGE NAIC 7< CN101642063HaneD-GAW-18-19 INSURER A:Old R icInsuranceCO 24147 INSURED THE HOME DEPOT,INC. INSURER B:New Ha hire Ins Co 23841 HOME DEPOT U.S.A.,INC. INSURER e:HomeRisk Captive Insurance Coiripany 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA.GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353439-16 REVISION NUMBER: 3 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. II TYPE OF INSURANCE ADOL SUB VJVn POLICY NUMBER MMIUDDI EFf MM EXP LIMITS LTR A X COMMERCIALGENERALLIABILMY MWZY312717 031012018 031012019 EACH OCCURRENCE S 9,000,000 A R ED CLAIMS-MADE �OCCUR PREMISES Ea occurrence 1.000.000 LIMITS OF POLICY XS � MED EXP(Any one person) ;5 EXCLUDED OF SIR:81 M PER OCC PERSONAL&ADV INJURY S 9.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 9AOl.D00 POLICY PRO LOC PRODUCTS-COMPIOP AGG S 9.000.ODO X JECT S OTHER: A AUTOMOBILE LIABILITY MWTB312718 03/012018 03/012019 O aBIINEDISINGLE LIMIT S 1.000,000 X ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED I SELF INSURED AUTO PHY DMG BODILY INJURY(Per amdent) S AUTOS ONLY AUTOS 1 HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S S DED RETENTION S B WORKERS COMPENSATION WC 014122577(AK,NH,NJ VT) 03/012018 031012019 X PR STATUTE ER B AND EMPLOYERS'LIABILITY YIN WC 014122578(WI) D31012018 03I012019 E.L.EACH ACCIDENT S S,000.00C ANYPROPRIETORIPARTNERIEXECLrrNE NIA OFFICERIMEMBEREXCLUOED? a E.L.DISEASE-EA EMPLOYE S (Mandatory In NH) 5.000.00D 11 qes,describe under COntlnUed on AddtiOnal Page E.L.DISEASE-POLICY LIMIT s 5.OW.000 DESCRIPTION OF OPERATIONS below C Excess Auto 297-1-10011-00-2018 031012018 031012019 Limit: 4.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhegee �Celtitioo'� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN 101642069 LOC#: Atlanta A`��® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY MARSH USA.INC. NAMED INSUREDTHE HOME DEPOT,INC. POLICY NUMBER HOME DEPOT U.S.A.,INC. 2455 PACES FERRY ROAD BUILDING G20 'CARRIER ATLANTA.GA 30339 NAIC CODE .EFFECTIVE DATE: - ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier:Indemnity Insurance Company of North America Policy Number.WLR C64783191(AL,AR,FL,ID,IA KS,KY,LA.MS,MO.NE,NM,ND,OK,SC,SD TN,WV,WY) Effective Date:03/012018 Expiration Date:031012019 (EL)Limit:S1,000,000 Cartier.New Hampshire Insurance Company Policy Number.WC014122576(DC.DE,HI,IN,MD,MN.MT;NY,RI) Effective Date:03/012018 Expiration Date:03/01/2019 (EL)Limit:S1,000,000 Carrier ACE American Insurance Company Policy Number.WCU C64783221(QSI)(AZ,CA.IL,NC,OR.VA,WA) Effective Dale:0310112018 Expiration Date:03/012019 (EL)Limil:$1,000,000 SIR:$1.000,000 SIR for the states of AZ.CA,IL,NC,OR,VA,WA Carrier.National Union Fire Insurance Company Policy Number XWC 4595580(QSI)(CO3CT,GA,ME,MI.NV,OH,PA,UT) Effective Date:03/01/2018 Expiration Date:031012019 (EL)Limil:$1,000,000 $1.000,000 SIR for the states of CO.ME,NV,MI,OH,PA,UT S750.000 SIR for the slate of GA S350,000 SIR for the state of CT Carrier.National Union Fire Insurance Company Policy'Number XWC 4595581(QSI)'(MA) Effective Date:031012018 Expiration Date:031012019 n� (EL)Limil::$1,000,000 SIR:$500100D TX Employers XS Indemnity. Carnerlllinios Union Insurance Company Policy Number TNS C4916693A(TX) Effective Date:03/0120/8 Expiration Date::0310112019 (EL)Limit:S10.000,000 SIR:S1,000,000 ACORD 101 (2008/01) ©2008.ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ALTERNATIVE WEATHERIZATION = ME Date T Town of Barnstable _ 200 Main St. Hyannis, MA 02601 Re: Permit The insulation work at— has been completed in accordance wit ,.: :,. Agency work performed for • ds;' Timothy Cabral;' President CSL-105454 58 DICKINSON STREET I FALL RIVER,.MA:02721 1 (508) 567-4240 1 ALTERNATIVEWF. T ERIZATION@GMAIL.COM i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel l Application # Health Division Date Issued Conservation Division BUILDING DEPT. Application Fee Planning Dept. Permit Fee JAN 24 2010 Date Definitive.Plan Approved by Planning Board TOWN OF BARNSTABLE Historic - OKH _ Preservation/Hyannis Project Streq Address Village f�atjkf:�— ' `Owner W Address 0 /- �C(�6 Telephone Permit RequestAit- 3P-g,(L 13/4U)/I i e &10Se- ,b _ 07 4 t' n7 d7L b amsuts is So ��- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation f3 U� Construction Type Lot'Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number:-/)eq Address License # I- <l V ��7a I Home Improvement Contractor# 7J� Email ewa:-Al�(�,� �'' �urL. rWorker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM TXdrROJECT WILL BE TAKEN TO - � SIGNATU DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION } FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. of twe �o Town of Barnstable Regulatory Services .. BAWNSTABLE; Richard V. Scali,Director 9 MASS, cb. °a 1639 Building Division Paul Roma Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 :Property Owner Must Complete and Sign This Section 1, F KEATS BOYD , as Owner of the subject property, hereby authorize A1�_e A_3Q. � ��1 -�� ,� to act on my behalf., in.all matters relative to work authorized by this building, pennit application for: 100 Rushy Marsh Road Cotuit,MA 02635 (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form. { :',Users\caecollik\A.ppData'.l.,ocal\'vlicrosoft\Wlii(:iows'%INetCaclielC'o.iiteiit.Oul.lookl,[."?IT69LF2\EIP:RESS(2).doc. 01;25'17 The Commonwealth of Massachusetts Department of Industrial Accidents = I Congress Street,Suite 100 a Boston,MA 02114-2017 M www mass.gov/dia NYbrkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY.. Applicant Information Please Print Lezibly Name(Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC. Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 y Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 16 employees(full and�or part-time).* 7. ❑New construction 2.r7 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.a I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.�✓ Other I N S U LATIO N 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:STAR INSURANCE COMPANY Policy#or Self-ins.Lic.#:0849257 00 Expiration Date:4/4/18 -Job Site Address: filsk A/-City/State/Zip: �T Attach a copy of the workers'compe4otion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unM' , s an al 'es p rjury that the information provided above s true/ d orrect Signature: Date: �4 Phone#:508-567-42 Official use only. Do not write in this area,to be completed by city or town of 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#: �...� ALTEVVEA-01 SNERON A CERTIFICATE''OF LIABILITY INSURANCE DATEIMWOONYYYI �..•� 06/2612017 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 i BELOW. THIS CERTIFICATE OF.INSURANCE DOES'NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED 1 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)trust have ADDITIONAL INSURED provisions or be endorsed, i II If SUBROGATION is WAIVED, subject to the terms and conditlons.of the policy,certain policies may,require an endorsement A statement.on j this certificate does not confer rights to the certificate holder in lieu of such endorsenten 3 cT Christine Costa PRODUCER Mason&Mason.Insurance Agency,Inc. PHONE i FAX 458 South Ave. (AIC,No.Ext):(781)823.0i167 (A/C,NoI Whitman,MA 02382 _ .ecosta@masoninsure.com 3 INSURERtS]AFFORDING COVERAGE NAiC A jINSURER A•Evanston Insurance Co: i35378 i INSURED t INSURER B•Safety Insurance Company 139464 i Alternative Weatheerization,Inc. M:NsuRER c Star insurance Company 18023 2 Lark Street INSURER D _ Fall River,MA 02721WSI RER E. i --- INSURERR F: COVERAGES CERTIFICATE NUMBER: REVIStON'NUMBER: I 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 i CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, II i EXCLUSIONS AND CONDITIONS OF SUCH:POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR JADDL SUBRI POLICY NUMBER tM N LIMITS YYY)i tr il�YY1'!1 LTR TYPE OF INSURANCE INSD wyo I X (COIdIAfiERCIAL GENERAL LrAaillTv ; i i EACH OCCURR ENCE g 1,040,t140 ' � j 'DAMAGE r0 RErIrEO 100;000 I CLAIMS•MADE i X i OCCUR j ,3C42088 i 0610712017I 06107120181 PizEmISE 3 $ _ i 3 (MED EX P(Anyone sk one rsani s 5,000 _ 1 000 000 PERSONALS ADV INJURY i 6 GEN'L AGGREGATE LIMIT APPUES-PER: i i GENERAL AGGREGATE S 2;000,00fl POLICY PRRpp LOC i E PRODUCTS COMPQP AGG i S 2,000;404 'OTHER: INGE MIT i COMBINE -r .g . 1,fl0Ofl B sAUTOMOBILE uAsury �ti 0410812018 s;6237702 {041fl612017 ANY AurD > o OWNED X SCHEDULED ��— i AUTOS ONLY AUTOS BODILY INJURY(Pet accident)I S i ii ��pp N�y�� f402 O' S X AURTOS ONLY X AUOTOS ONLY i i J i i.s j A ? UMBRELLA LiA8 i X OCCUR EACH OCCURRENCE i 5 .3 i0fl4,004 j i1471201 s 9,Z00,o44OB66966 'OW0712017'X EXC£SSLIAB CLAIMS-MADE AGGREGATE 3 DED RETENTIONS {( i {X 7-PER OTH C ENSATION STATUTE 1OE M�EARP j LIABILITY 3 Y i N , WC fl8d9257 flfl j 0410412017•,'W041201$i E.L.EACH ACCIDENT S 609,000 ANY PROPRIETORIPARTNER;rAtcUTIvE t—j NIA A�Analraa torynIj EXCLUDED? ; I�l ; i i 504,400 E.L.D#SEASE-EA EMPLOYE cI S H y85,dES.'7ib8 ur4er i ' I i DESCRIPTION OF OPERATIONS below i i El,DISEASE-POLICY LIMIT'S �4'�4 I ' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE$ ACORD 101,Adds tied Reemriis Schadute,may be atuchsd;If more sPM is required) ,Action Inc.and National Grid USA,its direct and indirect parents,subsidiaries.alr I affiliates shall be named as additional insureds on Commercial General Liability policy per terms and conditions of forms CG2010 and CG2037 and Commercial Auto Liability policy per terms and conditions of formSCA 006(02 j16).Forms Available Upon Request I i • I CERTIFICATE HOLDER CANCELLATION I , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREO IN National Grid i ACCORDANCE WITH THE POLICY PROVISIONS,. 40 Sylvan Road i! Waltham,MA 6201 I i UTHORMEO REPRESENTATIVE i ACORD 26(2016103) O 1488-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD d Y yt 4 v f t 41 v 4'3 f4 9 M� �\ (]�r�'\ /fJ/J/J,(./✓�' `1�)r� /�f���//)�•��] /4����E'.1�/t%����t'l� / {�`.��������rL,f/a/��J�1��%�/TL�Gf/a%�4:./C/L/..J' Office of Consumer Affairs and Business Regulation W 10 Park Plaza- Suite 5170 Boston, M usetts 02116 Home ImprovemeniLdntractor Registration Type; Corporation `5X Re piratn: ALTERNATIVE WEATHERIZATION,INC Expiration: 0 5/28/20 19 2 LARK S FALL RIVER,MA 02721 � y Update Address and return card. dark reason for change, 8 C A Co 20W.-05';: _ ...._....,_.__.___..._._.._._........._. D-11,ddr"s FP.S38itsTal 1=�+rf>il`! nt Lem aril `� '!:%1/f:��•:f)JY1:K:.1YdfiL':(l,Lfi1�r�' `Lfl,1�.-.iI,LC,'TLII,I.G'�l»- . Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTORRegistration valid for individual use orgy TYPE:Corooratim . before the expiration elate. If found return to: a on i3 P Office of Consumer Affairs and Business Regulation 4 z i7 3_ 05/2812019 10 Park Plaza-Suite 6170 ' ALTERNATIVE WtAWW ION,INC. n,MA 02116 TIMOTHY CABRAL 2 LARK ST FALL RIVER,MA 02721 Undersecretary flt 1i< fl S� 118 i ` FEE TOWN OF BARNSTABLE, MASS. bow 19 •� THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO o� OO v o .-� V ....................................................................................................................................................___..................... .................................................................................._.........._....._.._. 0 .0- (PROPERTY OWNER) (ADDRESS) tic w !A bw 3 TO ..........................................................................................__.........._............_..._____.__....................................................................................................... (BUILD) (ALTER) (REPAIR) yQNt�q (TYPE OF BUILDING) (APPROXIMATE SIZE) oaLOCATION ......_.._...._......._......_..............._..._.............--.............................__._ ..._......................................................................_......_... __..... V d (STREET AND NUMBER) (VILLAGE) be c NAME OF BUILDER OR CONTRACTOR �.____ _ .._..._�......._ _ __....._..._...._�... _ ...___.__....._....., .___.. aAPPROXIMATE COST ...._............_...._...._.._..............._._..............._......_........._._ _....._.__.... .__ _ .._..__._._......� _.... omca I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN '0 OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. a� 0 a ° Cd _._......__.._.._....__...._.._........................................................................ _....._.............._................................................................_.._.........................................._.......... rw N Ca h (OWNER) (CONTRACTOR) co o U »' _.. __.».........CD ...__..... �_..__.._...._.._........._.__............._....._............................................................... r� BUILDING INSPECTOR Subject to Approval of Board of Health. �=�� ��? Y SE1vIOR CENTER TOURS A11D TRIPS FLOWER SHOW -- Thursday, March 18. Cost: $10.50 (includes bus and admission . Bus leaves West End Municipal Parking Lot, corner of North Street and Bassett Lane, promptly at 9:00 A.M. Standby reser- vations only. WASHINGTON D. C . CHERRY BLOSSOM SPECIAL -- April 1 - 4. Cost $189.00 double occupancy, includes 6 meals and sightseeing. Standby reserva- tions only. BOSTON BUS TRIP -- Tuesday, April 20., 1982. Cost: $7.25. Bus leaves West End Municipal Parking Lot promptly at :0� 0 A.M. Leaves Boston at 4:00 P.M. (Please note change in time due to Bridge repair) . Call Center for reservations. Tickets must be paid one week in advance. MAP U IP JAFFREY NEW HAMPSHIR.E -- Th�i� r( RN 4H osgIxd '9— 0 ins u es us, guided tour o historic visit try nXiphnson s Sugar House and luncheon at !'Im9 sZIONl100 Woodbound nn -- choice of Yankee Pot Roast or Bak ' 5HA(ad*f&L ) All taxes and gratuities included. Call Center for reservations. TEN-DAY CRUISE -- S .S .ROTTERDAM -- May 4, 1982 to Charlotte Amalie, . St, Thomas, Philipsburg, St. Maarten and Bermuda. Cost: $1425 .00 per person. Brochure available at the Center. STURBRIDGE VILLAGE -- Thursday, May .20. Cost. $24.50 (includes full course buffet, admission and bus) . Call-Center for reservations. WORLD'S FAIR. KNOXVILLE TEIU1 ESSEE -- June 7. Cost, $499.00 double occupancy�49..00 -triple; and 29.00 single. At this time., standby reservations only.. . . NEWPORT, RHODE ISLAAD -- Tuesday, June 22. Details next bulletin. NOVA SCOTIA AND PRINCE EDWARD ISLA11D -- June 27..;,' Six days.. Cost: . 349.00 double occupancy; 319.00 triple; $449.00 single. Deposit of $25 .00 per person due March 12. Standby reservations only. Due to the tremendous response, there is the possibility of a second bus. rUTURE TRIPS are being planned to the ISLAND OF HAWAII and to, IRELAND provided enough interest is shown. 1 ' I /4 03 arlista " er�r+arA4iePLZ, D b e °'PCY 59• r a � ,ct a „QrLJ:1�o nthI� ' �L �a — L rbon180 ai, X-vicc Director o+4n trsua,farr Bui.ic i.,Ug DiT,,ision Tom Perry, 13ti1�ng Commissioner Office: 508-862-4038 2001v1ain Srxcct, L; Fax: 508-790-6230 Yarinis,MA 02f,01 ���EId,M T APPS,YC�TION NO V 2 O 2003 Nor f/al M A R Q Map/parcel N / thou[Rr�/YYrevjrMprfnr r umber 31 ` aLC Property Address `00 Rcsideatial Owncr's Nam=&Address �� AT �- value of Work Contractor's Nance ?Ck.o 1 �` fl , r^aTU --`-- -_ Home Improvement Contractor Lic nS '� Dc,c ,,, - . ,Telcphon M oember cn�c k(d — __3 epplicablc) Construction Supervisor's Lic -_ _- erase#(if applicable) "- - - 303 'Wor]Qaan's Corz�ponsation 0 Inswancc Cbock ono: --- ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker'9 Compensation Inau;ancc Lasu"Ir-c Company Narao I l� Ci,.V e.Workmaz's C ,t11�.�.-�- �� 1 �• Y o CC mP Policy# �� J u(3- c�,�, tt, ,, J �)o�7 _ '--- Peru it Requost(chock box) Rc-roof(stri ---_._—. PP� ❑Re-roof(not stn g old zhinglea) All cons�cdon deb be taken to PPrng. Going over ex-isting Iayers of root, ❑ Re-side ❑ Replacement Windows. U-Value ❑ Other(specify) r"--(MAcimum,44) "X%oro required: vsuance of this parrml don nut exempt GQrnipliaacc rt}i oma town ucaNtnent rcgulapor,a,I.c.Illstonc,(:onacrvaciaq r.rr.. ' ;nature , ornU:expmvg iscdl21901 _i 3Jt7d 4 Board of Building Re�'Lda ions and Standal-ds ' 60 One Ashburt011 Place - Room 1.301 Boston. Massachusetts 02108 Home IillprovemeLlt Contractor Registrat.iol1 Registration: 103714 Type: Private.Corp)ralioi Expiration: 7/9/2004 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault P.O. Box 2781 Orleans, MA 02653 Update Address and return card. Marc reason for change. / L- Address I ReueNN A Employment Los r t Cad .Nl, '1�1041111,'""U'v"'(.61� n//,.il%r<1dCLC�uLJP,/,�d 11 Board of Building Regulations and Standards License or registration valid for iudividal use only . t - +,_ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found rcturu to: Registration: 103714 Board of Building Regulations and St:uulards 9 Expiration: 7/9/2004 One Ashburton I'lace Rm 1301 Bos'lon, Nla.02108 Type: Private Corporation PAUL J.CAZEAULT&SONS, INC. Paul Cazeault. 22 Giddiah Rd. �� u� I ✓�u iJarn�rzoruuea o`�Gluovrxc/uatalGi Orleans, MA 02653 I Administrator 1`I�?; � BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR ' Nu,mber. CSk 026325 B i rthdate: 10/20/1959 Expires: 10/20/2005 Tr.no: 8603.0 Restricted: 00` PAUL J CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 Administrator �% L,/ Board of Buildin a ulations One Ashburton Ace, Rm 1301 Boston, Mca :02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE _ Birthdate: 10/20/1 959 Number: CS 026325 Expires: 10/20/2005 Restricted To: 00 . t PAULJ CAZEAULT 1031 MAIN ST : OSTERVILLE, MA 02655 ' Tr.no: 8603.0 Keep top for receipt and change of address notification. DATE IMWDBIYY) �ry CERTIFICATE OF LIABILITY INSURANCE :1-8/1 5/200 3 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION - ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McShea InsuranCe AQenCy, InC. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 749 Main street, suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Osterville, MA. 02655 INSURERS AFFORDING COVERAGE. �NsuRED Paul J Caz®atilt & gong Roofing Inc. INsuHtR a, Wester"erif'-R-3__Xn L, CO, _ INSunER R: TT&V®lera Indj=njj y_ COOS_1.1 1031 Drain Street INSURERC i 00terville, Ka 02655 `lNwAER D 19DQ-698-5564 INSUHERF COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOT WITIISTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY OE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY T'HE 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'TR - POO—LAY EfFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER TE MW E MlWDUlY LIMO IS I GENERAL LIABILITY EACH OCCURRENCE lOO. 1000 —. x COMMERCIAL Ut:NFRAL LIABILITY TIRE DAMAGE(a'Y ona lira) is CLAIMS MADE I OCCUR MED EXP(Ar-y one poison) S A _... SCP0467325 04/30/03 04/30/04 PLHS(INALA.ADVINJURY � OOQ00 GENEI IAL A(!CAFGIITE—I S2.00Q 0(1 GEN'LAGGREUAIE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG Sl.,QOO.OOO POLICY DPRO' JECT AUTOM081LE LIABILITY - GOMB,NCO'iINOIE OMIT ANY AUTO - IFe accldonl) I$ ALL OWNED AUTOS EIOOILV INJURY SCHEDULED AUTO$ Ivet parson) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Pat xxidam) S P„OPERTY DAMAGE I$ (Per udder) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AU 10 OTHER THAN EA ACC I .._. .. AUTO ON LV. AG6 S EXCESS LIABILITY - - LACH OCCURRENCE S OCCUR I 'CLAIMS MADE AGGFIEGATE -S -- S OFOUCTIDLE $ Ht rFNTION $ _ ..—. $ WORKERS COMPENSATION AND t.L.EACHAGCIDENT P Y LIMI TS EPI EMPLOYERS'U �( 1'ABILITV 7PJUB-922X653-502 _ 108/10/03 08/10/04 ., .. _ S100,000 8 F.L.DISEASE•EA EMPLOYE.[ 3 O E.L.DISEASE•POI ICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLFUF.XCLUSIONS ADDED BY ENDORSEMEnT/SPECIAL PROVISIONS ' CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION -- - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE,)BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOII TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT-'AILURE TO DO SO SHALL i I IMPOSE NO OBLIGATION OR LIABIOTY,OF ANY KIND ON THE I11BURER,ITS AGENT$GR REPRESENTA 1)FS, r AUTHORIZED R RE T ACORD 25-5(7/97) o ACORO CORPORATION 1988 J PROPERTY OWNER MUST COMPLETE AND SIGN THIS SECTION IF USING A BUILDER / ROOFER (Please relurn this form to Cazeauit Roofers with yozir signed proposal/contract) I/ as Owner of the subject property Hereby authorize Paul J. Cazea_ult & Sons Roofing To act on my behalf, in all matters relative to work authorized by this building Permit application For (address of Job) h kd __ Signature of O ner Date Print Name, r j Assessor's map and lot number ......(... .. ... / Sewage Permit number ..... _CevG . y�F7NEr0�� TOWN OF BARNSTABLE • BARNSTABLE. i M6 9 BUILDING INSPECTOR o Gm . APPLICATION FOR PERMIT TO ............f?U.{W.......1P.i M L!11........ 0 a1.................................................. .......&QM N.V.y1....A.Md...:U..t�. ........................................... TYPE OF CONSTRUCTION �!............................ A)o q....8...........19..73 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fpr-a/p,7mit according to the following information: Location ...........�r.0.. t1.LT....r....... l....... a' ........................ ................................... s ProposedUse !...... a L ................................................�u j11.r... ....... ..e.............................. ZoningDistrict ........................................................................Fire District ..................../.M........................................................ Name-of Owner ....�P.U�...... �.....W1� ./.!V. ....................Address ....a196I x.....!:.a.?Rr.5.4.......... �?...�...... Q v1 Name of Builder ....P.R ..... }!(ski.L'....611 ........Address ...../. -17....6 ........!T.�.. ....!Y.�...1.!v. ../.5.. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation !............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors .......................................................................................Interior ..............................................:..................................... Heating ...........................Plumbing .................................................................................. d0�DO Fireplace ........................................,.........................................Approximate Cost ............s�rl. ................................................ Definitive Plan Approved by Planning Board -------------------_-----------19________. Area /6...X 3a 00 Diagram of Lot and Building with Dimensions Fee .................. .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 73 X ode Le �QD C5 pools O� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....q6$...S&Mkie..6..ZAA. ....... ............ Wiggins, Paul H. + No ...16714.. Permit for �i SW1.M 74g =.Pool ........................... ............................................................................ .. Rushy Marsh Road Location ................................ ........ t Owner .............Fa.lbl..IL—Wi lu.................... > 1 Type of Construction ................................................................................ Plot ............................ Lot ................................ ^1 r Permit Granted ...........40yp&er..9....... 19 73JON Date of Inspection .... ..... w4. .. Date Completed ......................................19 PERMIT REFUSED = ! + f .........................................................�...., 9 e) .........................................................:..................... i .......................................................................... Approved ................................................ 19 V ......................................................... ;, .r C� / /(z / 3 /d 7 Assessor's map and lot number , SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE ARTICLE WITH C T^ Sewage Permit numbe .. �A .. .................. .. I I ET�`�r SANITARY CODE AND TOWN Py�f7HEr0�o TOWN OF BARNWTXBLE BARNSTADLE, i "6 9 BUILDING INSPECTOR e APPLICATIONFOR PERMIT TO ....................:........................................................................................................ TYPE OF CONSTRUCTION .......wQR.j.......l�.Y d I?'l.C`'........................................................................................ �D.......19.I3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies s for a permit according ngg to the following information: Location ...... ?I! `l.y......1....1.............� .... �..........�.�.Q. c!� .a.....1�..... ......................... ................................... ProposedUse ..... ...°/G/.... �J ............................................................................................................I......................... Zoning District ...............................................................I........Fire District ......... .. .. ............ Name of Owner .1�1�/ �� ��i7�d/ �' t�����!�S..Address 11VS.�7 � `a.rsl7 Il .�rf ......... Name of Builder ..1..�!.v�.....1?..:..YY!1`-�.���riS...................Address ...... l!? ..................... .......................... .............. Nameof Architect ... Oa!l4�..............................................Address ..........................................................,......................... Numberof Rooms ........©.P'l.e.............................................Foundation .....\ .1. .. ........................................................ , � y� C� (ter 'h,��/ems ,.A ��.1-t Exterior .�. .................�............ ......................................Roofing .... . ........ .............. ................................... Floors .P..??.�Y' - e .Interior .......Ljd f. !.h..!.S.�l ...................................................... ..................................................... Heating .....)..".d .. ...........................Plumbing �°�d�'JC'' ... ... . ............................. ....... .... .................................................................... Fireplace .....!.'!. ��.........................................................Approximate C st .......l... ......'..0...........................:.;........... Definitive Plan Approved by Planning Board -----------_-------------------19__ ____. Area 8. .. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH c N s✓ �YJ c,rr I hereby agree to conform to all the Rules and Regulations of the Town-of Barnstable re arding he above construction. Name. .... G ...........f-....... i Wiggins, Paul H. & Edith 14. No .167g3.... Permit for .........ool /s�he Location�. ,Rushy Marsh .a........ Cotuit ? .....................................:.................................♦....... Owner ........... aul H. & Edith H. Wiggins ......................................... Type of Construction f.rame i .. .......................... ! ................................................................................ Plot ............................. Lot .................I............... Permit Granted .,, December 10 73 .....................................19 Date of Inspection ..� 1...�.Y.. . .. 9 a „ Date Completed ...... .... ... ........... r PERMIT REFUSED ................................... ............... 19 , ............. ...o. .............:........... ............................................................................... ............................................................................... ............................................................................... Approved ................................................. 19 ...............................................................................