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Home My WebLink About1111 SANTUIT-NEWTOWN ROAD 21� , 4° 0-o-O WE Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee • EMMSTnBIX - v� mass. $1639. Richard V.Scati,Director . ♦� PRESS V� Building Division Tom Perry,CBO,Building Commissioner �aC NMI 200 Main Street, Hyannis,MA 0�6�' SFp 0 7 20'� www.town.bamstable.ma.us �V tt Office: 508-862-4038 V F�ARN 'a : 8-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONL��E Map/parcel Number C)z Not Valid without Red X-Press Imprint (R Ot��, Property Address [Residential Value of Work$_j(). 7(Z8 — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Ken f l c) e y Contractor's Name nArE / //tso/( Telephone Number No I� kO C) Home Improvement Contractor License#(if applicable) 1 73_2 L/ S- Email: � I Construction Supervisor's License#(if applicable) QCj'�� 7 0 7 MWorkman's Compensation Insurance Check one: ❑ [am a sole proprietor ❑ m the Homeowner [have Worker's Compensation Insurance Insurance Company Name (pa f,06A / Ales 1.d.s [ _4, Workman's Comp. Policy# W d 6 313C26 IF I Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof); ❑ e-side 5 []Replacement Windows/doors/sliders.U-Value�3C) (maximum.32)#of windows #of dol'ors: t ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,?i.e.Historic,Conservation,etc. ***Note: Property wner must sign Property Owner Letter of Permission. A copy the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\DecolU\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOI DHR\EXPRESS.doc Revised 040215 eMen AM&maw'IDY.ndersen.i;f,%aatlism 1Nw Fmgl�wd: 9min keW!rum wiMn Neem bvlkind wp6yA&tic 11b 91 San1t 4 Neti°io rn a + M153M79j.�M n 1 F32 15; d �:$ �;,Lewd'IFirami if rlk `F +aitiit. 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WHICHEVER ICHE R DATE IS MTER.SEE,THE ATACHED NOD CE,OF CANCELLAT7ON F-0 IM FOR AN Y _ 1 Pr1�L� '�clie isL g-IILR l�Fsuair. •. � iariiriiti l`v'sintL� . • �'ia15e i'�i:►c1�:' . Southern New England Windows d.b.a Renewal by Andersen of SNE = Massachusetts Department of Public Safet j Beard of Building Regulations and Standatd.s . Licrenste::r CS-0l195707 BRIAN D DENNISON 7 LAMBS POND CIRC . CHARLTON NIA 0150 r Expiration: UommisSloner 09/08i201.8 Office of Consumer Affairs end Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement:lContractor Registration Registradw: 173245 Type: Supplemerp Card SOUTHERN NEW ENGLAND WIN66W6 LL Fviretbrr: 911B2016 DENNISON BRIAN 26 ALBION RD = _ - LINCOLN,RI 02665 Update Address and return card.Marls ream for thaw ---— ou r O swami ©7[ddrae Renewal 0 Employ0eot 10FArWa �. ID�NMIO/WA�((A�A�aot:rreeld of Osumer AILIrs h Badaea BegaAtioa License or regbtration valid for lndiridol use only *..I WIPRINrEMFJfT CGNIAACTOR before the expiration dace If found return tu: Of et of Consumer Affairs and Business Regulation on' 1J32�6 Type' 10 Fork Plan-Sake 5170 irntlon 91•I812016 SupplmneN and Boston,MA 02116 SOUTHERN NEW ENGLAN[Yif& WS LLC. RENEWAL BY ANDFR$ON is DENNISON BRIAN 26 ALBION RD - r LINCOLN.RI 02865 DaOerseeretary of Quit witbout signature I . The Commonwealth of Massachusetts r Department of Industrial Accidents a I Congress Street,Srtite 100 Boston,MA 02114-2017 ,..' wwiv inass gov/dia Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Pltimbers. TO BE FILED WITH THE PERIMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): (- ,r u 6 # Address: lr,>/l) 1z A City/State/Zip: ��i6 Phone#: Are you an employer'Check the appropriate box: Type of project(required): t Iatn a employer.with 2V temployees(full and/or.part-tune)' 7. New construction 2.❑t am a style proprietor or partnership and have no employees working for the in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.Q 1 am a homeowner doing all work myself.[No tvorket•S'comp.insurance required.]t 9. ❑Demolition 4.❑l am a homeowner and will be hiring contractors to,conduct all.work on my property. 7 will 10 n Building addition ensure that all contractors either have workers'compensation insurance or are sole I LEJ Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.n 1 am a general contractor and i have hired the subcontractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.- / 1 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.L�Other t t)i()GA d-ti &Jy0 1, 152,v 1(4),and we have no employees.[No workers'comp.insurance required.] r *Any applicant that checks box 91 must also fill out the section bclot•showing their%vorkcrs'compensation policy informs on. *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 subcontractors have employees,they must provide their workers`comp.policy number. I aru an employer that is providing workers'compensation insurancefor to1 etn toyees Below is thapolicy andlob sites {; Information. Insurance Company Name: J 4 Policy or Self-ins.Lie.#: cA 3 13(.o v Expiration Date: 7 /Z Job Site Address:_W I. 2ZAt7 /flyl'O //) lq-04 J City/State/Zip: COLI A Attach a copy of the workers'compensation policy declaration page(showing the policy numb ,Ixpiration 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. 1 do hereby cer • order tliep 'rs and penalties ofperjrny that the information provided abavve is true and correct. Si nature: Date: / Phone#: Official use only. Do trot 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#: ��. SOUTNEW.-01 UOLLINGER ACORU' CERTIFICAT onTe(M"uoonrrnE OF LIABILITY INSURANCE 61291201.E .. THIS;CERTIFICATE. IS.'ISSUED AS:,A MATTER OF:INFORMATION ONLY AND CONFERS_NO.RIGHTS UPON THE:CERTIFICATEMOLDER.THIS CERTIFICATE DOES.NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR--ALTER THE COVERAGE. AFFORDED=BY THE POLICIES BELOW. ,THIIS7 CERTIFICATE FINNSURANCE DOES NOT CONSTITUTE A. :CONTRA CT:BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE,OR PRODUCER,AND THE;CERTIFICATE HOLDER. IMPORTANT: If the: certificate holder Is in;ADDITCONAL INSURED,:the policy(ies):must be endorsed', If SWBROGATION;IS WAIVED,subject to 9 the`terms and conditions ofthe policy,certain policies may require an.endorsement A:statement on this certificate does.not confer ri hts to.the certificate holder In 11e6 of such:endoImemen s PRODUCER. CONTACT. - . NAME:: CoBz insurance,Inc.-CO PHONE._ FAx 821 1:7th.St: . AIC.Nu Ext (303)988-0446.. A► .No:..(303)98.8-0804. EaMAL., Denver,CO 80202 ADDRESS.Co,.Blzlnsuran obizinsurance.com INSURE AFFORDING COVERAGE NAIC d INSURERA:Continental Western°insurance Company 10804 INSURED WSURER'B Southem New.England Windows LLC INSUPMC: DIRIA Renewal by Andaman' 26 Albion Road. INSURER D: - Lincoln,RI 02865 INSURER B 1NSURERf: COVERAGES CERTIFICATE NUMBER:__ REVISIOWNUMBER: THIS IS.TO CERTIFY THAT THE POLICIES OF-INSURANCE LISTED..BELOW HAVE:BEEN ISSUED TOTHE INSURED NAMED=ABOVE FOR THE POLICY PERIOD INDICATED..-NOTWITHSTANDING ANY REQUIREMENt TERM OR:;:CONDIIION &:ANY CONTRACT OR-OTHER DOCUMENT WITH RESPECT TO"WHICH.THIS CERTIFICATE MAY;BE ISSUED OR;1(AAY PERTAIN THE;:°INSURANCE AFFORDED;BY THE.POLICIES':DESCRIBED:HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH:-POLICIES LIMITS'SHOWN'KAAY.HAVE BEEN REDUCED.BY PAID';CLAIMS: INSR LI EFF c POLICY LTR. .. TYPE OF INSURANCE:.. :INSD".WVD POLICY'NUMBER MMID MMID LIMITS EACH OCCURRENCE $ �. A X COMMERCIAL GENERALUAilLRY' : 1 000 OO CLAIMS MADE a OCCUR CPA3136080:. 107/01I2o.6 07l01/2017:-PREMISES'Ea occurter>ce $ 100,00, MED:EXP(Anyone person) $ 10,000 PERSONAL&ADV INJURY.: $ 1,000-00 NEN'L.AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 29000,000 POLICYPRO-JECT LOC PRODUCTS-COMP/OP AGG. $ 21000,00 OTHER. EMPLOYEE_BENEFI $ 2;000000 AUTOMOBILE LIABILITY MBI ED SINGLE LIMIT . $ 110001000 Ea acdderd A X _...,.._. _,. .„ CPA3136080....- 07/01/2016:,,07/01/2017,_`BODLYiNIORY{Per ANY AUTO,_,...:. ALL OWNED SCHEDULED BODILYINJURY(PerecddeM) $. AUTOS NO"WNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS. Per.acddent X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5000.0 . A EXCESS LIAB CLAIMS-MADE CPA313608.0 07/01/2016 -07101/2017 AGGREGATE $ DED I X. RETENTION$ 0Aggregate. s 5;0001000 WORKERS COMPENSATION STATUTE I I ERA . AND EMPLOYERS LIABLITY y/N . A ANY.PROPRIETOR/PARTNER/EXECUTIVE a Ni A CA3.136081 07/01/2016 07/0112017 E L EACH ACCIDENT $ 1,000r00 OFFICER/MEMBER EXCLUDED? ' .: (MandaLoryie.NN) E.L.DISEASE-EA EMPLOYE $ 1,000,000 Ityea,desaibe under 1,000Oo DESCRIPTION OPOPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES(ACORD 101,Addidonal Remaft Schedule,mey.be attached'IFmore:apaee_le.requirad) CERTIFICATE'HOLDER CANCELLATION' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES:BE,CANCELLED;BEFORE THE EXPIRATION.,.DATE THEREOF; NOTICE VOLL 'BE DELIVERED IN ACCORDANCE wrrH THE POLICY PROVISIONS: AUTHORCMD REPRESENTATIVE ©1.988-2014=ACORD'CORPORATION. Alf rlgtft reserved. ACORD 26(2014101) The ACORD,name and logo are registered.marks of ACORD a cam -" ,. $, -RON Considivision u fl a . Y ...... 11/14/14 Thomas Perry, CBO Town of Barnstable Building Division 200 Main St Hyannis, MA 02601 RE: Insulation Permits Hear Mr.Perry, This affidavit is to certify that all work completed for insulation work at 1111 Santuit-Newtown Rd (application#201402734) has been inspected by a certified Building Performance Institute(BPI) Inspector. -A All work performed meets or exceeds Federal and State requirements. C> Sincerely, -- cn Conor McInerney ConserVision Energy 376 ROUTE 130,SUITE C SANDWICH,MA 02563 508-833-8384 WWW.CONSERVTODAY.COM TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Lf Map Parcel 6,kS Application # Health Division Date Issued _54t 4 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Go Owners Address \�� SA,.s: v .-� - ��..�-e o..�►.� Telephone -S c-t- Permit Request �.r�� E.12..\ �.,..��C� \ ►.> >:v. �.� Z � To�GQ�--�X �a`T 4Gnrbt. S'R t Square feet: 1 st floor: existing proposed 2nd floor: existing proposed+ Total new`• Zoning District Flood Plain Groundwater Overlay µiv Project Valuation Z.onj�.`b Construction Type Lot Size Grandfathered; ❑Yes ❑ No If yes, attach supilorting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure \cos co 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 z new Half: existing new Number of Bedrooms: Z. existing _new Total Room Count (not including baths): existing (n new First Floor Room Count Heat Type and Fuel: was ❑ 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 c o•�c�Z yr c_�►.� _Z►.�6.�, Telephone Number s o,q - "&s% • Address ry g . 3 o License # toz a-.-k a s•.��.�.w , .� Home Improvement Contractor# _Vk \ -LS k Email Worker's Compensation c&o k\3 t (.3 ti S ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. P i ADDRESS VILLAGE OWNER" %a f DATE OF INSPECTION: FOUNDATION r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. .0�°mare, PARMIPnnxe mass save COMMMOR tra,cn cra+cr !*cy PERMIT AUTHORIZATION FORM" ,.ovuner of the property;located;et. (Owner's Name, print ) f Pro ert Street Address p: y ) (Ciry/Towr4 r hereby authorize the Mass Save Home Energy.Services Program assigned Participating Contractor listed below to aot on my behalf and obtain a,building permit to;perform insulation and/or weatherizationwork°on my,property: _ 0. neu Signature Date,/ FOR CSG.OFFICE USE ONLY ,Conservation Services.Group has;assigned the following Mass Save Home Energy Services. Participating:-Contractor to the abov.e referenced project; Participating.Contraq(pr Date Rev. 121kbll ALI— z' C dn a on4" V41 NI r s „ �-*�� Offiee of Consumer Affairs&.Rus�ness Regntatloo: �-'T �� 0 ri Val` CO ndiv�+dut u e n r fifiE IMPi20YEMEtdT CONTRACTOF2 before the expyFa' te. gistratlont 171251 fYpe: Offie$;;of, Consumer Affairs a ` lO Pairk Ctaza.r8ulte 5170 xpiratlon:: 3/1/2016` Patnership. ;; Bosron,_MA 02i1b: �;_ CON-SERVE ENERGY' CONOR .MCINERNEY 376 ROUTE 130 SUITE'G:: SANDWICH;:MA 02563: wOrsecretary, Not valid without s'ignMure 3oaiei os 13u luig Regulat« r# p.. ts �§i+tka CDMR 39 SIASCONSEtbR'P' SAGAMORE SEACH'MA 01Si52 �Lr�ts�va�� 08/19/2014. 376 ROUTE 130,SUITE C SANDWICH,MA 02563 5.08 833,8384.„ --, ._., ..-...,--: :WWW:tONSERVTODAY'COM`'s,: lhMachusetts „. o n It ial9 ns dc ' e U.Tfceof=Investigations p., . - . = L Iin' on Sheet regTi, s Boston;AL 0.21 www.mass.gov%dia Workers' Compensation Insurance Affidavit;-Builders/Contractors:,lectric>Ian=: Applicant Information._ Please Print Legibly Name (.Business/organization/Individual):_ ConwVislOn Energy Address 376 Route 130 Suite C City/State/Zip; Sandwich, MA 02563_ Phone-# 508-833 8384 Are you:an employer?Check the appropriate:box: Type of project(required) 1.0 I am a:employer with 8 4. Q I arri a general contractor and I 6 Q New construction . employees(full and/or part-trite):* have hired the sub-contractors 2. :I am a sole proprietor:or partner- itsted.on the attached sheet: ❑ Remodeling' ship.and have:no employees- These sub-contractors have:: S. 0 Denohtion workin forme iri'any capacity': workers' comp,insurance:;. 9 Q Building addition ; g {No workers'comp.insurance 5. Q We are a comoratton and its required.] officers have exercised their 10 :Electrical repairs or:additions 3.[] I am a homeowner.doing all work- right of exemptton;;per MGL 11. Plumbmg repairs or additions m self: o workers' corn c. 152, 1 4 ;and w,e have;no Y p § ( � 12. Roof repairs insurance required] f employees: [No workers' 13.F4.0thet.WeatherizatlOn.: comp. insurance required.] 'Any applicant that checks box#l:must also fill out the section below showing their workers compensation'pohcy:infoimation t Homeowners:who submit this affidavit indicating they are doing all work and!ihen hire.outside cogtractors must submit a new affidavitindicating such: tConthictots thaf>check this bok must attached an additional sheet showing,the name of ihe.sub-cost actors.:and their:`workers'.comp.policy tofoiination; I am.an employer that is provideng workers'compensateon iris.urance for my employees. Below is th.a policy and fob scte informad.0m Insurance Company.Name` CS&$7WQRKCOMPONE Policy:#or Self-ins: Lic.#: 6011316349: Expiration Date: 03/11/2015: Job Site Address ._.. _ City/State/Zips 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 th imposition of criminal penalties of:a : . fine up Ito$1.;SOO.OU and/or::one-year imprisonment,as well as civil"penalties iri. he 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:Off ce.of . Investigations of the:DIA for insurance coverage verification: !do here b : fY der th p 'os: rid penalties of perjury that the mfor»iat on provided above is true and:correct: Sr afore: . - ----------- Phone#: Official use only. Do .not write in this area,to be completed iby city.or town official. at or Town: . ,.. Perm><UIicense.;# Issuing:Authority:(cirele one): I...Board.of Health 2;:Building-ble rtmenf 3 ChyLTown'.Clerk:.4 Electrical.:Inspector 5.Plumbing Inspector - 6:Other' 376 tOUTE 130,S SA Ryr�ICH Mg1563 50 39tc.:.. erson::. ConserVigion _ Y CERTIICTE Q►F LtABtL1TYfIVSl1RAIVCE zo a µ p ng. N ND.~cnN�NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT r' LY OR NEGATIVELY AMEND,`EXTEND OR ALTER THE COVERAGE,AFFORDED-B ,('4LICIES BELOVM.THtS CEit�t(FIC. OF INSURANCE__S SNOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESE aOURANfl THL CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must W endorsed. If SUBROGA..T10NlSWAM. D,sS eci ons of the'policy,: ►tain policies may require an entlorsement. A statement onahis certHcate tloesnot confer rights to;the certificate ho .e ;u s ::. PRODUCER CONTACT` CSBS/WORKCOMPONE NAME` PHONE ,. PO BOX 946580 (A/C,No)' MAITLAND,FL 3279446580 EdA1L Phone 877 724-2669 A°oaEss` Fax=877-76375122 INSURERS)AFFORDING COVERAGE . NAIC i INSURER A: Continental Casualty Company:: 20443. INSURED INSURER B: ` CONSERVISION ENERGY 376 ROUTE 130 INSURER c - SUITE`.0 - INSURER D J Continental Casualty Company 2pg43 SANDWICH;MA 02563 INsuRERt :Continental Casualty Company .. 20aa3 -COVERAGES CERTIFICATE NUMBER:.. REVISION:NUMBER THIS IS:TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN;ISSUED TO THE INSURED-NAMED-ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER:DOCUMENT WITH RESPECT TO,WHICH'THIS CERTIFICATE MAYBE ISSUED OR MAYPERTAIN,THE INSURANCE AFFORDED BY THE;POLIC.IES DESCRIBEO.HEREIN 16 SUBJECT TO ALL THE TERMS;EXCLUSIONS AND CONDITIONS:OF SUCH POLICIES..LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS:. INSR - ADDL JSR ISLIBIR PO C E. PO LTR TYPE00INSURANCE. W1!D .:POLICY:NUMBER. NNIDD i.M9AIDD :.. UMRS GENERAL&ABILITY . EACH:OCCURRENCE $100000000MMERCIAL GENERAL LIABILITY DAMAGE TO REND $300,000 P EMISES(EaocwCLAIMS MADE OCCUR A ® N 6011316335 03/11/2014 03/11/201S IVIED`EXP(Any one person $10,000 PERSONAL:B ADV INJURY $1,000:000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 000,000 POLICY PRO• LOC PRODUCTS COMP/OP AGG' > $2r JECT - - COMBINED SINGLELIMR`.- - $1,000,000 AUTOMOSILELIABILILX` (Ea aiddent). ANY.AUTO BODILY INJURY(Per person): ALL OWNED: SCHEDULED_ BODILY INJURY{Per acddent) A AuTos: AUTOS". .. N N 601 Ill 63"35 " 03/11/2014 03/11/201`5 ." . HIRED AUTOS NON OWNED PROPERTY DAMAGE AUTOS. " (Per:ecodent) UMBRELLA:LUU3 OCCUR EACH OCCURRENCE 1,000,000 D EzcEss uae: CLAIMS-MADE. N N 6011316352. 03/11/2014 03/11/20.15 AGGREGATE 1,000,000 :. DED RETENTION$'10,600 WORKERS COMPENSATIONSTATU: OTH AND EMPLOYERS'LIABILITY" TORY.LIMITS _ ER_' 'ANY PRO PRIETOR/PARTN"ER/EXECU_TIVE YM: E L:.EACH ACCIDENT $100,000 E OFFICERIMEMBER EXCLUDED2 N N: 601131.6349: :O3/11/2014 03111/.2015 (Mandatoryln_NH) ❑ $100,000 " tf yes;descnbe:under E L.:DISEASE=EA EMPLOYEE DESCRIPTION:OF OPERATIONS below: E.L:DISEASE-P.OLICY LIMIT $506 06 . DESCRIPTION OF OPERATIONS l LOCATIONS/VEHICLES(Atladi:ACORI)TD1;Additlonal Remarks ScheAule i<more space i5 ipulreJ). Certificate Holder is Added:as. additional insured;.as provided in the blanket additional insured:endorsemenf:. CERTIFICATE;HOLDER... .. CANCELLATION` ::Rise ng neenng SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1341 EImWOOdAVe :THE:EXPIRATION;DATE THEREOF,.NOTICE WILL,BE DELIVERED IN: Cranston,RI 0291:0 ACCORDANCE WITH THE'POLICY PRQVISIONs:. AUTHORIZEDAEPRESENTATIVE' 376 ROUTE 1.30,SUITE.0 ©1988 2019;ACORDCORPORATION. All rights reserved. The ACORD'name and'logo are registered marks of ACORD eases. 508 833 8384 WWW.CONSERVTODAY.COM �l ry;� rTown of Barnstable *Permit# Expfres 6 arerrth r haare yte Regulatory Services Fee " Richard V.Seali,Interim Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 _ -— www.town.barnstable.ma us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Prm Impnnr Mi/parcel Number O © _ Property Address /V0PnU)P /k& Residential Value of Work$ G 5 O?7 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 'p f -*`I t L/ Contractor's Name S o u-he rp �_ V�/!!U d W S NIU/ O Telephone Number l b 1?,-8"` 7 g� Home Improvement Contractor License#(if applicable) q/732`f s'C Email: Construction Supervisor's License#(if applicable) D 1S7d 7 X'Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name MAW- 10 Workman's Comp.Policy# W6- Copy of Insurance Compliance Certificate must accompany each permit. Permit Re nest(check box) Lj Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side .Z Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fite Permits required. •Where requited: Issuance of this permit does vM exempt compliance with other tmn departmm regulafi ms,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. t SIGNATURE• TAKEVIN DtBuilding Changes\EXPRESS PERMME ORESS.doc Revised 061313 Mar.26.2015 00:21, PAU1.CO' M'.RENEWAL,AMDXR 7B1 545�-1293. a.PAGE1. 1/ ;5._; tthlJdt^fn woir,?; �.ENEt��AL B1 '�s'�. 4l�Lwnmrrr�i toFR `G -a GIFWy:rrR�aram oRtLwcON,vq byAnderim A11 anR0 ►hdl-'Urviln.RI02865' Itstlnrmp�ks7 I'hr.nr EIGFi 5Ei4`t235 Yes stEi �ftrti$" i eoCatm m+Hi d .er' �v71� so.th.oNawE DOP.J l6Wov)%UCA/bAt <�rna�vat by Analeestl►-of 8o�vn-Na�'$�'�d -'46 t7!q,]0 14 WII4DOW A""DOOi IMMORWINGAGREENEM �. �`�►�.l��7y/*� fm�c.air:_:�t��.,�: . _ _,�► �a --- . Ruy29%hta:iiyjdLLdyeatilr:eVer5lh(:W-",g4"Pnrrhasr-ehnpwdud5am casevvkvinf'SnUthcruNewEuglandliYittttritt�1lxJdllrfuits+ie al try Andersen ur..Wi6,,m Nrwn�it1 E (7(kwtesu a" 'in.euirgdapiw•.with t +�m�soul he iv'sndaCvatim&actlbed'(xa dw.l'eanit Wtd t9te.Mv�jw of this RgCvM!1k and Cott the utiai$n uu I Yit)ii ivd,tIvis'Ikgrcruwxn '7 ❑'HlatoriC:`❑Caitilo CS tMeA? TosalJes6 Ama>i _ Eadmd sembnc Dtts: Eieiht of lbefnteafti sla>r Rt Ris�nccd 9 -�ra�rrdS Ooend.Rd,(3p ... C►edicCaidsareux�pdrordeosltonly=rtro Ff3oSdte 1 ;.,. psl�cccvsr(AkaieseerCadPpetkFinas}.�pigrurtt Balmm at Start of Jib{33R. EwMaked Camda:ren Due..; er a*tod�.ti�t Mir Beltnc*at IMM df job md it�a y r E6nIBnC!CII$Irb5191r1�1�pfn�ttt(Ofl C��db aim=b6 mi&bJ crnadR bad oo -G'•G PN/`7 CIA MW mum.tit mile&1 pMWW dtodt:bfnit d+ oc"cads CamFledrn d jcb .. _ Bayer(s)atgs ees mid,ModeveUM&tat ids Agreement ebmeleotos thu.zfir c'u.d tends 'biltseea the pain aml*at'•- 'there arm ao.asbadmadftsmadbnp okinglog.avy of ttu-arm'.of.ttss.;Aji4ensenv'BwjtT..�s)+aakrow ea fhat 8vyar(s) (1)1mm read thk Agmeinow,u=daoa**uds thrr loans of tbi.Agree i s"tr aaAAas recciveid,a oermPle" .tn.el dated•,•. Cppy of this AQeeerneat,laclu�ng tl.e tam awcled'Notioey of CuoceOist�,oa the"datiie Srat.rrlaee above ttad:(2)wAs orally mr d of Hay ',t t to c�aco,Ot is wg.b.®.n._DO'NOT SIGN 7AI8(MNTRAM IFTI HEREA1iM ANY:BI.NVKSWE S:. (Rhode raGmd$ales'0ftyj Nvfim t*B%&ym(1)Do tit>3 ei�o*6Agi®etia oat if:any or-me ipams�r�d�u tlbe ag.eed.lereisa to the extent of them evosM ble heFaret don are left bimik.(2).y4M r�*Wiled ao a&"Qf this Agr'/Qrnear ai t2m d umyor sign. it.W Yea mety at*"Case pay of the$tO vtt1111411 bAnuce dva u :tb.ot Agreemea't;anus to as"Yvai mmy,6r entitled io aea4we a partial rebate of tLe fid—e and iassuriince cbaeps.(4).W..e11e:has ve.F ei ee nbinsrfally eater gear premises:' -,at Ctnunk arty breach of the pea"to 1' 9bes goo&par sed under this Asreem**04(S)Yen may eaacel d®Agsetettut.- if it itss not been®!greed at the main ollke or'a brsiaa�ol&c'of;the.elleri paaysded 1 na Lily the seller it his brer.b main office or branch o erw sbo in the Agree mvnt,byr regi see:id ar ceti&rd aamiEi,.+Meti alias bi pasted notlnter tltgn agddnlphE.: of the ear tidy a t!ta'etayder w6i tbabtrywr :ytsu: : mmt,exctodiag Sunday wad.aEy holiday amw tsh the notrei of cnuce�6®Farriafor.ato eaglctrala of bsyer'6 .. BIlyrrtso aaaarn si9 Ole.Cxinvimere&VAia�it=IfI R ienwialtxl Iva tlt�Flotl Bland Ountismi x Ra wrui � (B�m�llwt++rtr�i Rezue'wwl by ` of Neav Fitgl>iaii' F RAY") �d..IP `t �i�,bttaun:F PrrutNAiitvof Pw uy7ldwr*r PrineN:eun Pr al Natavir- Y04 TM BIIYER(S),tMY CAMCKV TM&'`TRAN ALMON AT ANY-TIME PRIOR.TO'AUMMUEI T-OF IM l'HIA V BUSDIESS DAY Al?1'SR TIM DM OFT105 TRANSAMON.';=371E AT ACMW NO`I` E OF*4XC Rt TIOlN FORMS'• FOR A�ESPi.AAlt►TION OFrTIM lt1G$T' - T .NCff AtNCELLAMN Date 'of Transaction .You"rnaf iancil I Data at Trant=tCEn Yau may c anteel this traitsact9on vetthout arty ptmalty"e�obfEaatlory witltht Oils eratsaacblon,vritltout ary peatalq.or:obligation,`wkhiti three bttsd ws tt� ;from•the:ibore da*if yoti cane ty.a any;� ;three business days from dte abum it*N you ny titn al.a properly traded hi,my Payments made'by:yaou.ander dte .Rroperty tr AW ink:wry payrrsenta.maft'by"d un&r the eQMMt 00 Salo,rindr retry rtogtrdAlsk htstracrrtttrst wmwtod i Canttracs or Sale.wtd im-nagod •rBeubed by you will be rewmed within seta butinem daqs:•#mlta":,I.`bl yw-"I be retvmed within ten busFriees days yoikswptg reeelpt by the Seller of your cancellation motfe'ta,'end tug,::I reeetpt.by the-Svper:od your,cancelled" notice,ind V a y setwwraty interest araswaa out ei tt�a. trAAtiie#ion wiD ba teenarity.ii% r arsnatg-but"Of'the bansactler•wlll be canceled lfyou cancel; gust snake ava lbla to'the Segerr.. .I t ancelvid.Ef cane you mot nuVw wW ba tits Steer At pwar a�itl.nc.,he ath�bintiaitjr at good eoneiifiiorF as when'I at your rvadon in.uhatanfiA4r an good cmndWanas when receved any goads deNverezd to-you twider this.Cevrtr4cr or.,l received,ary geroils d�ivered to y►osa under.fills Contrast or_. Sak.or you nay,if port wW,;omply with the instnactlioas of`.i.,,Sale:or yotr.,mar,if Wu wi W wath,the isntrtailiorn of the.Seiberrega.dCr�ttoe return atipmestt of the gooi♦s atAlle the getter rtgar8tra�the rudtrn�of the pods at she -Sellor's and rfsX Kgow do manta the�ed� ,offando 7 'Solloet and: V piwdgs maW the goods Grill" ta.We:Seiler..and the Seller.dmes'net pick,- up wrathen, #,;.tire Stile ar+d:tilt Seller does iioT pick dietn.'up wSOhixt t woney days of B►a duo df cant.diatlory yotr.errelr t�ta9n or: � ;ewansYrdayo of thti`dome.of cantellation,.'S�au may I�tat�:00 tftro�of the goods without any'.krihaer obi igsBan.:If you I A*pose*f the goods,without any arrttupr olaftatiam Wyeu fail.te make the geode avetlabla to site Seihar,Orr ii you ogres=1 sett to,trails the goods availab9a�.tAte:Setloe; .H you agree to tatUM the`goode to thtia.SWlert aitd faii'to da tv,then yrou. l :-to re$tura+'the goods to'"SeRsr and lint to tiSo sa.then yrorr remainable..�foerr Ptx6srsnaruoc.of all aEligations.u>rder.dhe• .,remain liable far.paifomtancG of alE.ob Carder tfte C*n"%CLT*saves!shts• ctiemata8 or definer`a sighed;` ConowL`d canc id this vasacdw%mall or ddttrcr a signed and,dated co" of'tha•taaraelEatipar nobie:e.arI-"W at+t�r l and',datsd�ealry of the carisx0ataen'nntiee'or`any Ether written not aa,*r and a telosram so lDontawal by,4ndersett of:I writum"iace+.orseod atofogfatrt so Rtxaewal byAndrrsen o1.1 SoudnarnNn:Eia�}>orrd'at2 A[hinnItot,d.Li:ncult d2BbSiI.`.Sdtadasti HiiFvvn andass2 A4lrianiload'Lncat .R101885', +MOT LATERT'HM MRYNICHT,OF. 4 I NOT;LATER'IH Id`M19A116HT OF (DaftIr); YGA#dCEL'fr115 TitY1Fl5�d►C77A1u:. J�_-ICY.GAPfG�ELtWE5 Y�FISA�71iON_ 1141,11J+11�` `sea str®rej . can •• tom taus ttrni.Y: Via.. dibA'Ccipy Whiee .JBuper t Yeflew BtrperfCoP):Pk�k - . I Southern New England Windows d.b.a Massachusetts-Department of Public Safety } Board of Building Regulations and Standards Construction Supervisor License: CS-09SM7 BRIAN D DENNLSON ' 7 LAMffi POND kM Charlton MA 01507 .e. N, P i;'i;' Expiration Commissioner 09/M IS � (2!2 /t2�?iYYG��?iLf,�i�ivf2 � ��!�'Cf�,(/1�� 1✓%�.i Office of Consumer Affairs 6nd Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2016 DENN'ISON BRIAN 26 ALBION RD LINCOLN, RI 02865 , Update Address and return card.Mark reason for change. SCA 1 0 2a,•o5ir, j i( Address C Renewal �—j Employment L—I Lost Card - ct/fe 7parrr7itarxret�lf�i of��li:3crc�rc,c//1 . _ (free of Consumer Affairs&Business Reeulation- License or registration valid for individul use only. before the expiration date. if found return to:. ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 173245 Type 10 Park Playa-Suite 5170 Expiration: 9/19/2016 Supplement-.'ard Boston,MA 02116 , SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD LiNCOLN,RI 02865 Undersecretary Not va" ithout signature 0 Alc RO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 08/12/2014� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis of New Jersey, Inc, NAMNE, T c/o 26 Century Blvd PHONE 1-877-945-7378C No:1-888-467-2378 P.O. Box 305191 E-MAIL Nashville, TN 372305191 USA ADDRESS:cartificatesowillis.cam INSURE S AFFORDING COVERAGE NAIC 8 INSURER A:Selective Insurance Company of BE 39926 INSUREDSouthern New England Windows LLC INSURERB:The Beacon Nutual Insurance Company 24017 D/B/A Renewal by Andersen INSURER C:Argonaut insurance Company 19801 26 Albion Road Lincoln, RI 02865 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER W529169 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER MWDDY/YEYri MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PRAEM RENTEDGE TO A SES Eaoccurrence) $ 100,000 Y MED EXP(Any one person) $ 10,000 S 2029459 D8/10/201408/10/2015 PERSONAL&ADV INJURY $ - 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY JEa a LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY CFOs MBBIINdED ent)SINGLE LIMIT $ 1,000,000 X ANYAUTO BODILY INJURY(Per person) $ A ALL OS AUTOS SCHEDULED AUTOS S 2029459 08/10/2014 08/10/2015 BODILY INJURY(Per accident) $ HIRED AUTOSIx AUTOS NON-OWNED X PROPERTY DAMAGE AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,.000 EXCESSLUIB CLAIMS-MADE S 2029459 08/10/2014 08/10/2015 AGGREGATE $ 51000;-0.00:4 '" DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED? NIA 0000068028 08/21/2014 08/21/2015(Mandatory In NH) E.LDISEASE-EAEMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 C Work Comp/EL Covg: KC927938352394 08/21/2014 08/21/201S E.L Ea. Accident - $1,000,000 Statutory Limits - WC E.L. Disease Policy Lmt - $1,000,000 - .L Disease Ea. Employee - $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) own of Nattapoisett is included as an Additional Insured as respects to General Liability when required by written contract/agreement as per policy orm. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - Town of Nattapoisett 16 main St +t�-� ttapoisett, NA 02739-0000 OL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of.ACORD SR ID:6629625 BATCB:Batch #: 79627 i L � The Commonwealth ofMassachusefts Department o,f Industrial Accidents Office o,flnva gations j 600 Washington Street Boston,MA 02111 www pass gov/dU Workers' Compensation Insurance Affidavit: Builders/Contrac#ors/Electricianss/Plumbers �licantformataon " Please Print Legibly Faille (Business/organization&&vidual): 561-04f-rv •2r.�1 �/V !�� _Address: �h i�i►1 City/5tatemp: L/"La 0,916Y Phone t yO Are you an employer?Check the appropriate bone Typa of project r 1." am a employer wishG 4. ❑I am a general contractor and I 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 sub-contractors have 8. 0 Demolition working for mein any capacity, employees and have workers' [No workers'comp.insurance comp.insurance.# 9• ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.® I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and We have no 12.❑Roof repairs employees. [No workers' IF 13 Other G�l�l do f as comp.insurance required] �ZP �� . *Any applicant that checks box#1 must also fill out the section below sh �.their wnrkers compensation policyinformatiaa. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a neov affidavit indicating such. 3Conhaetors that chest this beat must attached an additional sheet showing the name of the sub-ca&actors and state whether or not those satities have employees. If the sub-contractors have employees,they must provide their worlazs'comp.policy number. lam an employer that Isproviding workers'compensation insurance for my employees. Below it the polity and job site inforrnadom Insurance Company Name: C3 Policy#or Self-ins.Lic.#. 11�/ ' 9� f ,j 9 3 � j ` Ll Expiration Date: A-V Job Site Address: � �J t w - City/Sffite/Lip:_ CcTLtCT /V1J number AtAttacha copy of the workers'compensation policy declaration page(showing the policy 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$2.50.00 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 de . pains wad penalties of perjury that the information provided ab a is and correct c Signature: Date: Phone#: 7 / Official use only. Do not write in this area,to be completed by city or town official City or Towne PermitUcense# Issuing Authority(circle one): - I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector,5.PIumbing Inspector 6.Zther i 'R1lssessor's map and lot number ....... ....... .:. .. SEPTIC SYSTEM MUST BE %THE tO : Sewage Permit number ........::... �.-�..;.1...T"^. 'INSTALLED IN COMPLIANC - = WITH TITLE 5 r........11!/..........; 1I.J/.. = 86HB9TADLE. House numbe .......................�:..., � , ENVIRONMENTAL CODE AID� p 163q. . A P P It 0 v E s ; TOWN REGULATIONS OM d stab;®Conser"#,104 $ N O F B A R N S T A B.L E ILDING' INSPECTOR APPLICATION FOR PERMIT TO .... �!�:5 ,.� S/ �N I............................................. TYPE OF CONSTRUCTION .......fe/DD(I-71 L/,2�. ................................................ ......................... ........................................... ..........19. 1P.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 4"OIG .... ! ............................................................... 5... ... .. T..................................... �Q.u�Proposed Use .............. ............... 7 ............ .. .. ............................................................................................................... ZoningDistrict ............ ..............................................Fire District ....... ..........................I........................... Name of Owner S. �Isi I-k /5�5 AW1. &),k 11.....................................Add ..............................> /�7 /Name of Builder AAA ..............................Q...�C...Q.............................Address .../ Q � i.. Q.,............... Name of Architect ............................................Address Number of Rooms .............6o......................................................Foundation .... .��.. ...C........7.................................... Exterior ........�/ IJOQ,eQ� ................................................Roofing ....... Floors /C �1C100o� Interior .....S' C'C/ /z0( ................................................................................................................................... ...... Heating 6 QS ..................Plumbing Fireplace ......../dttSd.CQrQ�/..................................................Approximate Cost ........ POI.. .DD:................................... ..... 7/-7 Definitive Plan Approved by Planning Board ________________________________19________. Area ........a.l..�..J ........'l'r�- . Diagram of Lot and Building with Dimensions Fee ....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH n 10" OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardi g?the above construction. Name ... ... . . ��... ................................ �' I)? Construction Supervisor's License ................ .+ H. FRONGILLO & S. DISHMAN 2�448 Build One Story • No .....:........... Per t for ............................. , _I S-gi m .. Y n le F Dealing ..........: .. ,y6wha ........... Lotw#3f! 11 1 Newtown Road Location ...... ......... .................................. a Cot'-uiv t2 Owner ...,H. Vof�gill S. Dishman .,....� ........................ _ Pl ya Type of Construction2i ......, ame .tea �.............................. f ................................... ...... Plot ,......................... Lot ................................ Permit .Granted ........+June ..... ...2....................19 86 Date of Inspection ....................................19 . . ��- Date Completed ..... ...... - .........19 . �� 0 - , � L� +'"� �`► 'mow.. - Y f _ f Assessor's map and lot number .......c. M.:� .I. i Sewage Permit' number BARN LBLE, i House number-*........18.!.......... a/ ............................... M6 9 �0 'EO MAY A,. - TO N OF BARNSTABLE L , BUILDING INSPECTOR c7o,�sff s�� , APPLICATION FOR PERMIT TO ..:.. ........ ........... ........... .........................................:.. IV TYPE OF CONSTRUCTION ..................................................................................................................................... ........� ., ;%��; , Ct kt ....:)II.•..........19.4L :4�"44 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �lJ } Location ........... `...��. t fl�1.�/l..r.... if CCc......... ems;. /�� ,z�/� /rc��/fii . ProposedUse ............?.. ..: . .......7.. ......... ..... ............................................. �y Zoning District ............er .(............:......................................Fire District ........�.i?ke:•y S�dg Nameof Owner ......... �....................................................Address ............................................. .......,.................................. Name of Builder J/IQ�ttt ................Address . 11 . �G�' �� Ucf��iJ%� �,t .............. ................................ ................ ............... ................................................ Nameof Architect ...................-.............................................Address .................................................................................... Number of Rooms Foundation J ' ............... ........ ............................................................. .... ................ ,.................. ..... Exterior E�CL/ �Pc,� ...Roofing �s��✓� ............. f. .................................................................... Floor's .fl�t�lOQOOf Interior ...... �ZOCr .................................................. t Heating r Plumbing a Fireplace,.4..: ...!.'z. c f.. . I/r.. t :F. ....Approximate Cost ...d!... L�.}®:......................... ....... f E'(P 9 33 •• . Definitive Plan Approved .by"Planning Board ----------------- ,_____________19________. Area ....................................... :.: Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH r {F ,OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardin.g7 the above construction. Name ................................. �� Construction Supervisor's License ..... J/H. FRONGILLO & S. DISHMAN A=026-001 No ..2944$ Permit for ....One Story.•_.,,,,,•, ,Zingle Family dwelling, Location ,,,,Lot 9.i 1111 Newtown Road... Cotuit ............................................................................... Owner H Fronillo & S. Dishman �..... ............................... Type of Construction ,.,,Frame ................................ ................................................................................ { Plot ............................ Lot ................................ Permit Granted .........June.............•.........•...•...19 $6 Date of Inspection ....................................19 Date Completed 19 P 1 i .k r A ax IV ly G h> Z w ,p t t { PLOT PLAN OF LAND 'TO THE BEST OF MY KNOk'L.EDGE• rHE x*activo.gr-1o�/ L OCA TED IN SHOW ON THIS PLAN IS AS I T ACTUALL Y EXISTS AND a�� BA f�NS TA BL E — MASS. THAT I T CONFORMS t0 THE rDwiv OF BAR/VSTABL E ZONINY�r`s �,{ 0; �,y` �� REGIXLA TION� REGARDING YARD SETBACKS <,�,. � .;�:�� PREPARED FOR yP\r DAM: M,4�.zi a..1986 "_ r l:o• )Y OA rE. ter' zv. 19W scA i 1r , •L:F ��_� FF. ,;�✓j 3'` CAPE ter ISLANDS SURVEYING ' . FLOOD ZONE C' ?� TEA TICKE T -- MASS. i , I ...Y ...,an. .:K'• _ .. ..i• G:_. _ A�3.,... :,,-��y +s':..c� ..:-Y., +<v5_, * r.. .. -er.r'.. ,,} OF THE) TOWN OF BARNSTABLE- Permit No. ..�... .� BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash .......... ''pour HYANNIS,MASS.02601 Bond ......X....^ CERTIFICATE OF USE AND OCCUPANCY Issued to Address .u'I 1'it.t Z,-Lj USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ...... 19.....:: .:........ ................. ..... Building Inspector P ..��.ew TOWN OF BARNSTABLE BUILDING DEPARTMENT S �saaar TOWN OFFICE BUILDING 1g 1039 �er�r►� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: —? Q7 An Occupancy Permitl has been issued for the building authorized by BuildingPermit #... /,"�.., '',D,,, ».»...............................» ....»................. ............»»». issuedto ........„. 1 .. '... .: ..........r- .. ................»...»..»».»......»».».»...». r � Please release the performance bond. II THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) Im ^A CC DATA 'G BUILDING TOWN OF BARNSTABLE, MASSACHUSETTS PERMIT ' JOB WEATHER CARD c DATE 19 PERMIT.. NO APPLICANT ADDRESS f a° V „0 " t (N0.) (STREET) (CONTR'S LICENSE) ._ NUMBER OF , PERMIT TO (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) - _AT (LOCATION) ZONING DISTRICT IN0.) (STREET) K BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY, FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO:TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR VOLUME ?. ). PERMIT s ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) _ OWNER - v >_I de.+:.• �•v+ BUILDING DEPT. ADDRESS BY +•THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OF PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED .UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR .ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINEC ..PERMANENTLY. THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITION'. OF- ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE.RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING $HALL NOT BE OCCUPIED UNTIL FINALMEMB INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE . OCCUPANCY. - POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING/INSPECTION APPROVALS PLUMB NG NSPECTI APPROVALS ELECTRICAL INSPECTION APPROVALS _ - - 1*4r d_� 2 2 3 HE T!NG 'NSPECTING APPROVALS RE I I ALS I 1 Q7i;ER ;Z= V. -___----_--_-_ 2 R[f 0F' HEALTH Ali z se6 z I WORK SnA.LL NCT PROCEED UNTIL THE PERMIT W!LL BECOME NULL AND`VOID IF CONSTRUCTION iNSPECTIONS INDICATED ON THIS CAR(i.. :NSPECTCR aAS APPROVED 74E VAF!CUc WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE vSTAGES OF ODNS1'PUCTIDN• [PERMIT IS ISSUED AS NOTED ABOVE. OR�WRITTEN N TIFICATION. 1 Town. of Barnstable *Permit# 1 F.xpires6moulh ra ue a(e DAMMUBM Regulatory Services Fee ""SIL Thomas F.Geller,Director _ / Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERNUT LICA ON - RESMENTIAL O Y An r _ / Yalid without Red X-Press 1nVdnt Map/parcel Number lL L/ - Property hAddress I � Y)EUrotol-) , 61 Residential Value of Worlt a 75c;L Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address xtluk)F_Td /► QR I�j C�Ti tT AA O2_635 Contractor's Name-� 6. 44q iltNAwi3crj Telephone Number Home Improvement Contractor License#(if applicable).-. 173 3 t;Z �(S� Construction Supervisor's License#(if applicable) U / 0 dWorkman's Compensation Insurance X-PRESS PERMIT Check one: ❑ I am a sole proprietor ❑ I am the Homeowner D E C 19 2013 �I have Worker's Compensation Insurance Insurance Company Name 0 �j O` BARNSTABLE' Workman's Comp.Policy# 97 3 J �W Copy of Insurance Compliance Certificate must accompany each permit. Permit Reatiest(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)- El Re-side #of doors Replacement Windows/doors/sliders.U-Value - .30 (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. - c SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 Eec.06.2013 19:25 PAUL CC-NBOY RENEWAL A-ND2R 7131, 345 1.233 PAGE. 3/ 10 4 y n al R�vEG1f:�1L l��'.c�N]3L';<�S�'V a � ersen. - xsavos ntreaeelttMr a: N+Lill! .r 26°4fbicasRri:.el • .Unfo[ip,J.:1028U5 e.w1 ,R112 thane 1166.3S4.Fl3,1•Rix 4111.03.61364 Soudseres New England Vffssdows,LLC d/bl a flanasyslbyAndersenof SauthernNewrEngland CUSTOM WUNDOW AND DOOR REMODELING AGREEMENT Csrnrll:Ysrne __. / `L�/� G. .jam ------_—�j lave nve•�i __. r 90 � .�..��..------ „ 0+trsr'dj Srsa,kd v::.�ry w mi p Case f P.0-aaa:• f':wnkTLYpsno Wmirhi':. a�, L WatUTOUP.-irw W..'ba llaper(s)hr1r0 4A T.y itrd 5rsrra0y nlFecg:r.,pun Mate d1C pIrAuro,and.•'t:r srivkcs of Soud-tern Nets England yh'fnOnwr 111k;dAVit Ibcae.scral )r}+.1 rxlr:;rn a,P yUpihCrn NmY h rya u:rl("Oyrdsyldnr",+,in:uwrsT iln+:+ +`ah(hs lean;;tM J rnnrlitinnx eirrnih;xl ran the.fignq 11cid tisti:IVvl=ru of 1.1 ;•rr,::nes:rn a,ul n.s the wlcrhad dfiraiiue•lstrl(a}(wRrrlinay,tali,"Agnnnn ens'')• 13 Historic 0 Comfe 0 HOA7 Total Job An%vjrr_-..)!•!o!�.' E+rngyud SClrti+g Dun: Method of Payment: Q Cheek sh Q:innitced Depot Reteivetl al: !` r Cree i Cxres are zaepted for deposit only-mvisnum V1 of&,,e Balance rat Start of Jeb(33%): project cost(Mae tee:redo Cadhlrsaat kta)By signing ols ErtisnredlCraZahthba Diew Ap aenoM Yew ark+o�egge that tktNtn.,:v acSwrt Jeb n+d thq Bats lCC ols Sub#rt Q�['(� �%Cytr/� Bttaaea on 5ss�uanclal Cempfstion afjeb cannel.ba,naa'a 6y csedir COn7Fisxop cf JCb ><,:/S. s` ! ardand snust be rnr de byp=r-.anal checic'bank neck,or cash Noyer(s)agrees and understands that this Agreement constitutes the entire understanding betaccn the parties,and that there are on verbal understandings changing any of the terms of this Agreement.Buyer(is)achnovAedges that Buyer(s) (1)has read this Agreement,understands the terms or this Agreamony and has received a completed,xignad,and dated copy of thity Agreements including the two aneebed Notices of Cancellation,on the date first written above and(Z)was orally an£rjrn,gd of II..y¢ras right to cooed ilda Ag eamoet_DO NQT SIGN THIS CONTRACT IF THERE ARE A:\lf BLANK SPACES. (Rhode Island Sales Only)Notice to Brayer:(1)Doaotsigd sLia Asreamentif any of the epnew intended for the aged to.ems to the extent of then available information areleAblank.(2)You are entitled to p copy of tbia Agnvimtrmt at the tithe yow alg.s It. (3)You may at any time payoff'the tUil unpaid balance due under this Agreement,wqd fix se dofA you.stay be untitled w meelve a partial rebate of the finance and insurance charges.14)The seller hilt:ne right to tlnlawfieny enter your promisee• or Im"I Rrlt Any bae".1%of thv pes<ce to"Possess goods purcb8 5;4 Ungler t6ig Agreement.(3)You may panel-this Agreement if it has not been signed at the main offlre or a bxstnch office of the seller,provided you notify the seller at his at her main office or branch ofifice shown in the Agmemunt by registered tar certified mail-which*hail be pasted not later than:midnight of the third calendar day alter the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.Seethe a--------A- notice of cancef kdsm form foram ex hrnation of buyet`5 right". B ,. itcrand the co_>Rnnicr adum ion matetiIR pnwirled by ilia Ith.wle Island C mttncto,s Rrmtriricn l mil r iff_sTes'a h itsr'.} Renewal by not ewEr4and Bu.' s euyer(s) 5- a<rl'}4a out h`1 tper % mousse SisEn:drn:: h ini N:unl:Of Nrtldvca A•ianaye:r Pr rat +mute: ['c�u t tsinur YOU,THE RUYER(S), MAY CANCEL THM TRANSACTION AT ANY TI41B PRIOR TO MEDIINIGIiT OF.THE THIRD OUSOMSS]DAY AFPER TM DATE OF THIS TR NSACTIO\.SEE THE ATTACHED NOTICE,OF CANCIELIATION FORBIS ]FOR AN ExpLAMM'N,OF THIS R[GIM, . %�— — — — — _ _ _ _ _ —._ _��'_ __— — — _ — 4•4-- — — — — — — — - — — — — —=e NOTICE F CF L TIO NOTICE OF CANCELLATION Onto of Transaction 3 .You may cancel I Date of Transaction .You may cancel this transaction,witheaft&ty penalty or obligation,within this transaction,without any penalty or obligation,wkhln three business days(MM the above date' you cancel,any I three business days from the above,date.It you cancel,any property traded on,any payment:made 6y you under the I property traded in,any payments made by you under the Contractor Sale,and any negtttlable Instrument coedited I Contract or Safe,and any negodable instrument emcuted by you will be returned within ten business days following I by you will be returned within tent business days following receipt 6 the Seller of your emeellatlon notice,and any I receipt by the Seller of your cancellation notice.and any socurlty by arising out of the tran:action will be security 'interest arising out of the transaction will be canceled.rf you cancel,y�ou must matte available to the Seller I canceled.if you cancel,you must make available too the Seller at your residence,in substantially as goad condition as when I atyour resldenco,In substantially at good condition as when received,any goods delivered to you under this Contract or I received,any goods delivered to you under this Contract or Sa16W you ft W I(you wlsh,cemplywith tine Instructions of I' Sala or you may,ifyoui wish,comply with the Instructions of the Seller regarding the return shipment of the goods at the4, that Seller regarding the return shipment ofthe goads at the Seller`s expense and risk.If you do make the goods available A Seller's GlItrppense and risk.if you do snake the goods available to the Seller and the Seller does not pick diem up within I to the Seller and the Seller does"rapt pick sheen up within twenty days of the date of cancellation,you may retain or I twenty days of the date of cancelladom you may retain or dispose of the goods without any further obligation,if you I dispose of the geed*without any further obligation.If you fall)to make the goads;vai lable to the Seller,or if you agree I fail to Make the goods avallalble to the Seller,or If you agree to rewrlt the goods to the Seller and fall to do so,then your I to retort)the goads to the Seller and fair to do so,then you rumain liable far p+erformancei of all pbliga#ioni under the remairt liable for performance of all obligations under the Contract.Ya cancel this transaction,mall ot deliver a.signed 1 Contract.To cancel this transaction,mall or deliver a signed and dated copy of this cancellation notice or any other I and dated copy of this cancellation notice or any otter written rtotice.or send a ticleggrram to Renewal 6yArndei^aen of I written notlte,or send a telegram to Renewal byAndersen of Southern New England at 26 Albion Road,Llncola#Rl 02065, 1 Southern New England at 26 Albion Rvad,Lincoln,RI 0266S, (NpOT)LATER THAN MIDNIGHT OF lr�-rd r0 1 NOT LATER THAN MIDNIGHT OF I HEWEBY CANCEL THIS TRANSACTION. i I HEREBY CANCEL TH IS TRANSACTI ON. 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KCMCwxI ersen o rt:rn New i:nglanll •crf5) tittycr(») ltw: qu:• r ri I•x ii I ACir.,Ce:r Slim EeWe of icl Maluk a• Mill Mir _._ r,lnr Y:aula Dec.0„.2013 19 r3 PAUI k^C Ov- REVEW L 791 —04. 1233 n E 1! 10 4 Y, Renewa byAndersen. ,dab# � Q� Daft Home Ame Ad;drrsa TLJts,J, Csi t' 1Ab Ono IF- .Scat Daft , TOW Of' #02f.Bmsow& 4 ofDoon wmow Cbkr ii%e v si��, +tce w TnaiAc 4 Ci oxide ot EE Eev, I ;t, _. NO ft& JLoofim e ern OdcrIIM C7atOT ell- ' !c 'ar i - I 1 i • e c Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Comtruction Supe.nfSer License: CS-095707 11I♦ BRUN D DENNLSON r f 7 LAMBS POND CIRL1< T< s Chariton MA 01507 a Expiration Cormnissioner 09/0812014 - Office of Consumer Affairs Business a atton 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration RegisLation: I-M45 Type: Supptemed Card SOUTHERN NEW ENGLAND WINDOWS LL Ecka M: 9119=14 DENNISON BRIAN - —`-- 1137 PARK EAST DRIVE --------------- -- WOONSOCKET,RI 02895 ._-_ _...— Update Addrm and retard card.Marc reason for change t a amiyt Address ,—Renewal Employment Loci Card WE.* tCaomReadaiov License or regiatrati-valid for is HOM me oat yIMPRONT tP7Nif1ACTOR before the sapiration date.If lbnod retard to: Office of C um,r Aldus ad B®fuss Regulation • 17W45 TYII- 10 Pant Ph=-Suite 5179 r�forc 9)1972014 SuPPlerrlenl::ald Roston,.MA 02116 SOUTHERN NEW ENGLAND WINDOWS I.I.C. RENEWAL BY ANDERSON DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKEC.RI 02895 .__-._._...—..— _...-- Uadersrcemry Not valid without sigrfelure The Commonwealth of Massachusetts Depaa tiarent of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance AMdavit: Builders/Contractors/Electricians/Plumbers A Rylicant Information Please Print Legibly Name(Business/Organization/Individual): rX AL 0-- Address: 2 & Amok) �b City/State/Zip: bPO-01Pi 142ZS_Phone#: Are u an employer?Check the appropria*^box: 'Type of project(required): 1.[lI am a employer with 20 4. ,E] I am a general contractor and 1 employees(full and/or part-time)part-time).* have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. - 7, 0 Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' Building addition [No workers' comp,insurance comp.insurance.t required.] 5. We are a corporation and its ]0.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.n Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13. j employees. [No workers' Other comp.insurance required.]` �- *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy nformation. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers`comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#:�!c.�9Z 70�t�i�:� �� Expiration Date: Job Site Address://// - 1 � 1�� • 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 er the pains and penalties of peajury that the information provided above ' true a d correct Si ature: Date:- 7 / Phone#: —ZZ 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#: C110110: 90124 SOUTNEW ACOW, CERTIFICATE OF LIABILITY INSURANCE D8/06/220 3YYY) 'THIS CERTIFICATh 13 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 COMlflcato holder In An ADDITIONAL INSURED,the oHc les must be endorsed.If SUBROGATION IS WAIVED,subject to tho 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 ondorsonlont(s). P►ODUCCR Anita Little Willis of Now Jersey,Inc. NAME, Ho 856 914-4660 1 FaIN1 1015 Briggs Road,PO BOX 5005 E-MAIL anita.little@wiliis.com' PO SOX SODS INSURER(S)AFFORDING COVERAGEL M Mount Laurel,NJ 06054 INSURER A:,Selective Insurance Co of the SINSURED --�801 Southern New England Windows LLC INSURER a{Argonaut Insurance Co.DIB/A Renewal by AndersonINSURERC:Beacon Mutual Ins.Co. INSURER D 26 Albion Road IN E i Lincoln,RI 02865 INSURER F t COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER: THIS IS TO CERTIFY THAT' THE POLICIES OF INSURANCE LISPED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 1NDICAT'ED, 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 Oil SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.- - .�.. ..-.,_�-—__ TYPE OF INSURANCES AD Y POLICY EFf POLICY NUMBER POLICY EXP MMIOD MMIDD LIMITS A GeNaRAL LIABILITY S202945900 8/10/2013 08/10/2014 EACH OCCURRENCE $1 OOO 000 X COMMERCIAL GENERAL LIABILITY R RENTED �� tiFEsT Ea occurrence S 100 000 CLAIMS•MAOE D OCCUR ( MED EXP(Any one pew) $10,000 PERSONAL S ADV INJURY $1 000 000 •-. ��w GENERAL AGGREGATE s3,000,000 GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP/OP AGG S 3,000,000 PRICY PR LOC S A AVTOMOSIL LtWUTY S202945900 8/10/2013 08110/2014,cOMB(Ea�INo DSINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Pet person) $ ALL OWNED SCHEDULED f AUTOS BODILY INJURY(Pot aotldent) S AUTOSNON•O>VNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) S 5 q X UMBRELLA LMB OCCUR S202945900 8/10/2013 0811012014 EACH OCCURRENCE S5 OOO 000 11I(CESS LMe CLAIMS-MADE r AGGREGATE S5 OOO 000- OEO NTWN S C At NO empLOYOI �eRS w191urNr 0000068028-RI 8/21/2013 08/21/201 X WC STATu OTrt- YIN 13 OY J2 56rjtM E L R0c9 ECU'E❑ N I AAIC927818352394 81?1/2013 08/21/201 E.L.EACH ACCIDENT S1 OOO OOO (MsndeMy In NH) E.L.DISEASE-EA EMPLOYEE $1 OOO 000 p s, IP N OF hotaw 1 E.L.DISEASE•POLICY LIMIT $1 000,000 I # t OZSC"'ftOIi OF OPQRAMF=I LOCATWNS I VEHICLES(Attah ACORD 101,Additional Remarks Schodule.M more spsa is required) T 1 � + C FtC TE HOLDER CANCELLATION SHOULq ANY OF THE AeovE DESCRIBED POLICIES BE CANCELLED BEFORE 1 Southern NE LLC TINE EVIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN t 26 Albion Road ACCCR�ANCE WITH THE POLICY PROVISIONS. ) Lincoln,RI,02888 AVFKORIZITRErESENTATnn 1et18•Y010 ACORO CORPORATION.All riphl B reserved. ACORD 15{2010105) 4 Of 1 The ACORD name srid lope ana replawmd marks of ACORD , #8218109/M215088 AXL Town of Barnstable *Permit •�,C Expires 6,not:t from is e me Regulatory Services Fee BARNSrABI E MASS' Thomas F.Geller,Director 16 q. �0 . ��D MA't(i Q{•G � �Zi II�3 Building Division I / V 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 O Not Valid without Red X-Press Imprint Map/parcel Number c� Property Address ! I AN7ut �tu1To�J b t Residential Value of Work , Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /iMu `U�tuToN J�c ui7 14A O L6.3 Contractor's Name B04i ha N o14Dtbj&V W/Ntt'd -Telephone Number YO/-Z Z.19'—Q Home Improvement Contractor License#(i applicable) 4WIVOW 12 �Z Construction Supervisor's License#(if applicable) 0 V PRESS P MIT Workman's Compensation Insurance g 2Q13 Check one: NOV ❑ 1 am a sole proprietor ❑ I am the Homeowner I have Worker's Com ensation Insurance C `TOWN OF BARN STARLE Insurance Company Name 0 —/`'if l �'! Workman's Comp.Policy#�/ . QZ/ D 3 z. / 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 t #of doors Replacement Windows/doors/sliders.U-Value 130 (maximum.35)#of windows ❑ 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 Prop Owner Letter of Permission. A copy of the Home Ii e e t Contrac icense&Construction Supervisors,License is , required. SIGNATURE: ` C:\Users\decollikWppData\Local\Microsoft\Windows\Tempora Int F'es\Content.0utlooklQRE6ZUBN\EXPRESS.doc Revised 053012 i T/te Comn:onwealtlt of Massaclr.usetis << z; Department of Industrial Accidents Office of Investigations T 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/Organization/Individual): �/V A&AC&6LLB Address: cit (0 loll/ 9-0 pp City/State/Zip: LIA/CO& o;;84,5 Phone Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with A Q 4. I am a general contractor and I 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 sub-contractors have g. Demolition working for mein any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.[]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.employees.[No workers' 13XOther comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 5_yrale/ C a-+✓ -ins.Lic. � � 3 Policy#or Self /Zly Job Site Address:j AVriUT �QQi=N-f City/State/Zip: G(/ 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi v under the pains and penalties of perjury that the information provided above is true and correct Si nature: Date: t0 _ Phone# 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#: Client#:30124 SOUTNEW ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY) 8/06/6/202013 THIS-CERTIFICA1S]S=ISSUED AS A MATTER OF INFORMATION-ONLY AND CONFERS-NO-RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES-MOT-AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE-COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Anita Little Willis of New Jersey,Inc. PHONE g56 914-4660 ac No): 856-914-1881 AIC No Ext 1015 Briggs Road,PO Box 5005 E-MAIL ADDREss: anita.little@willis.com PO Box 5005 INSURER(S)AFFORDING COVERAGE NAIC# Mount Laurel,NJ 08054 INSURER A:Selective Insurance Co of the S 39926 INSURED INSURERB:Argonaut Insurance Co. 19801 Southern New England Windows LLC INSURER c:Beacon Mutual Ins.Co. 24017 D/B/A Renewal by Andersen INSURER D 26 Albion Road INSURER E Lincoln,RI 02865 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: " THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 LTRR TYPE OF INSURANCE ADDLSUBR NSR WVD POLICY NUMBER M �DY EFF POLICY EXP LIMITS - A GENERAL LIABILITY S202945900 8/10/2013 08/10/201 DEACMH�OECCCURRENCE $1 OOO 000 X COMMERCIAI GENERAL LIABILITY t PREMISES EaErrence $100000 CLAIMS-MADE F OCCUR i MED EXP.(Any one person) $1 O OOO - PERSONAL&ADV INJURY $1,000,000 GENERALAGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I' PRODUCTS-COMP/OP AGG $3,000,000 "POLICY jRC7 LOC - $ A AUTOMOBILE LIABILITY S202945900 8/ 0/2013 08/10/201 Ea accident)SINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS - Per accident A X UMBRELLA LIAR HOCCUR S202945900 8/,"10/2013 08/10/2014 EACH OCCURRENCE s5,000,000 EXCESS LU\B CLAIMS-MADE AGGREGATE" s5,000,000 - DED RETENTION$ $ - C WORKERS COMPENSATION 0000068028-RI 8/21/2013 08/21/201 X'WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE AIC927818352394 8/?1/2013 08/21/201 E.0 EACH ACCIDENT. $1 000000 OFFICERIMEMBER EXCLUDED? � NIA _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 00O 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 I j i I. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) , i CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. Lincoln,RI 02865. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S215109/M215088 AXL Southern New England Windows d.b.a -. Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of BuildingRegulations and Standards . Construction SupenNor Licens.':'CS-095707 ; BRIAN D DENMS_ON 7 LAMBS POND CIRCLE 1 Charlton MA 01507 'I lit 1, Expiration Commissioner 09/08/2014 / " - �� ptznz�rz.�a,�,vea,�Gf >� - Office of Consumer Affairs n Business egu anon: 10 Park Plaza-Suite 5170 Boston,Massachusetts 021.16 - Home Improvement Contractor Registration Registration: 173245 " Type: Supplement Card - SOUTHERN NEW ENGLAND WINDOWS LC Expiration: 9/19/2014 DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET,R102895_ - Update Address and return card.Mark reason for change. - ees t oylt _ Address ❑Renewal. 0 Employment Lost Card rryb.•`Fig.H.i..,,,...a/</../n//.,�,../..,v/4 . ", . mce ofCoosamerARatre B:Badom Neaaladoa Lkease or registration valid for iodividul use only before Id retina date.If found return mi e expiration " . OME IMPROVEMENT CONTRACTOR . •-" p ' RoglaVaOon: s7 q5 Oflic,orZasumer Affairs and.Business Regulation T t t " ., 10 Park Plaza-Suite 5170 . Expiration:13/i9f10ta ". SuppletnenU':erd Boston,MA 02116 SOUTHERN NEW ENGIAND WINDOWS LLC. .. RENEWAL BY ANDERSON -' DENNISON BRIAN " 1137 PARK EAST DRIVE - - mod— • - ,, WOONSOCKET•RI 02895 Undersecretary Not valid without signature t.;J4TU1tT WiNDQ3tili AND]VORREMODIELYNG1 i1 GREE,.Mr—,'\'T +s?Si,eceAadis�o..Cr�ear�,�:�Zp• o F P !� i/ I'I `"'J' �"e:�` y._ Irrder:. Mtn;TaW.r- n yy n JJti•tv!;1"Id�uT..ri1 Stl��SsrtStl:4�'JyCLr!9ChY�a.�� If�r�LLS R!J�71��,ID�9R'.I iJI �'J�Y�",�l.Ni�i 1iS::�,FWC��:rUlt 'a ll�•.LiG111L�CI11�L�;{.�;'�:1�1.9rlril,��}fil'df�ll�?'`� i6.iL.'�-�.i'�'l��.y.{�k L�J9ki5'.:1� . . u&titl a Ui eLrxzrd,ttnt :s+ [h t13e.tR7tld•�71:i4�SS^i'# fll13t157CdetnclaL� eln.91hr.orr��mt1a,^,x.+ r��^ cfa;t?{�t�G1'.�:tl,t�tYBi�i,°.rl 4�� x.ce.'�2�15pts:il`tc,r,��,tn,uh��c�.4,>;culhJ.;�Giist�3�r�RhiM:�+�,r�•e:t�ctvu'i. l I'bt dV,`0 COMO is H:OA TaW!J'aaAmourit Z0%' Evx- nyLad15wfinp;patm: Mao.odl of Pallner ' DcFcrte�ecetxeii�� !•��„"�'�r�-�' _ _ trail QP45 ere aeCepted'.br dcpvrk onli?-r=jinum 11,q cf dM @alsnae at Stirs of J;a6 Fro e.t tt see .a: J,ay'31p ire"Ar: Esaf+ared.omvl ,,k9a c Agre"IM4 ou,=knorwAc that the ps4 r ac.5c3 6xlame*A Sul r��aall d 1 Jai l tic; !, / a-+.c @a.anw oms4boura !Ci�,7p10con efJo'bcs vrit L=n.ad*by crvdit, eRtgletian of f pts�33�c✓ m7d and m^a;�o a de by Persorm ¢hum"<'.bank ch eik or cash. SUye+rM agtvov and,undermnds that this:Agreemant const fusee Ebb estt3je timtlerata�di�rg lirl<+teen the 4ratrtt;e ,a that: there sre id his A ll eem. t P c6ag0- any of dzg Wnw o ir>'�s eeme.nt. Huyer(s) acknowledges.t'lkat ICI >�as this ®emene and'crsYands;the te-rcum of se,i A,veenaent, and has received a con%ple� dlr a shed' and e_izt con of this-lam9om4Q,hecludiae g*r, . tad Notices erf 9>$nceTli clan;an c data fi et.+ralstt n abov?t and waxi artilfty fff$a3M-ed:AG'$uyrec"l;"C:t;a Ml++wcl.chisApeeftent.DO NOT SIGN THIS CONT- PAC1 i+`F''PHERE ARE;ti1yY IlEt?ItYK ilF,1GES., cEtrndSB1reaOwWNotEgetoySuyexa lt) OnoseSignthis gweesnentif'tenyrof the spacessinc'ndgdfor the Agreed tetce_tes to t'hc M,cat of then 4►vIAXWe;:nrarma-don,art Ilafc.blank.(2)You dre couched to gas c of'tlds Agreement ut the dine}tiy+a 5 �!YOU ratty a t Any tans haX Off,tba fmU:unpaid balance,due under tlu?� ��eRrecnt,ac�ltl%tr�.a clavag}tis�d xna�j�`k�e entltlad to "ems eI a Part➢sl rebate of the tfinAnce and insurange db te. ice-- X�p �d 'I?h0 glee b l® t' t to u%tl'tuaK iiT 'Qatar rems°srx *r comtmit asu7ph breach of the.�Isact tg.+�raaseee :s purchased,under tijs;+'tgreeanetnt.(5)YAu:z nag camel tw-a A�►F"e�ruC if it b�not been sige_eeal ttt the rmtnj offike or a,branch lofAce o1 tke selfleir prdAdo d aotl�rLc' tl At bid 0r, her n tie owes or breach office the in tw Agreement b regiatered!cw certfiiedmail!,ah1oh.t ltaat111 be posted!toot iat�'t A- R:t#etr`dteigbr of the third calendar dad*after&c day on which,else•bust+_ a tthe&-reetttkmtts etclttdfi�at�iJmdsy and�'7h'6otida�r oa,v�6i:cb xvguarnu ffdediv erl";am not rnaede.See the accocrnpanyi eice of can.c4Ilotiaft farm€o r&*wep3'an:etlan of >d<> e Haw.. r- %givcd ! -'C -♦,°.43!'It:�'tl4' tli� t, .+ rp15n1t l' W ML .. - F ii &-newal,by en of outhr NMI Engbd. B1a}irlej 1 `L2Lti1 of l'aratlU -Print Namc nF PrMixtt hilt cagy. YO1l6, TME.]BUM(S)I!,.14hyY QWCEL THIS TFUNSACTION AT A0W TIME; P91OR T I �L�NIGhII" or TIM THMD RtCr81 ESS;DAY AFUR THE,DATR O F'itil a.S iRRYNUCT,ION::SE.Il;TM A` kCHILD NOrTICE;OF CXNCE MALTIONVOILMS FOR.AN EULAMAT110N OF,THIS RIGjff,. E Q4n� NC-FLIL T +CiELLATIJONDate oMatnsaction �'3 YW may cancel' ; Date of Ti u.action .You mayl" cante11 this araltesaceion� withou .apon�Iq� or obIjVt]onJ W[Alnr 612 trantata.6 m. without any penalty or obilgetdl�,wkhin there Ihuslne eIa>, Irtrnn the abase dabs,if y►mu:cs�trdk,arrlr 1, thKco lawn d'a ftrotr,n .n above date,.If you esrictq any ptroplertyr traded) tln.+ pa ttta entails byr knlu und'sr the I: prwp?ertkyr rraduct rn;,ark' paymants wrade� by you under,the Contract or Wo,and'amyr ne8!gtisl�lb Itt�UM-eeat et M,-toil: f Cca Bract olr Stop Ard any n _ _able imtirulnent executed! by you will be: r twrned within tern bu�lne" days fioRawEn � I . y S i by >!go'wip'be u�atur-ned wltlhin� cen,business days to1119w1hg If eC i0f hx the Seller of your cancellation, t:► dies, and! a reoA pt by,the. Ull'or of}►oar sancelle,t an tnodee,L and any secutrity i•Ittbet'elt at wmg out of the transac-dan, will br securky rnk rr,* arisng gut of the transactions wiviN be caiieel' d!.,IF yont eanclel,,yrrrrt must,aka aVaffahi'n to th.e se1k r- , cmceled.lf =nCel,yeM MUM MAO asv0abla to.the S'slletr at your resldence.leu 4ubACitvtiAlyP as.good cunditi'atn as;where I at your r*esICnWcey pn;:tutrstaltdtiaA as gQQ4j candid*"a$when: received',any goody d!eItVeft d to you,under th s Contratt or I received,a;myr ga ds de9ivered to Iwu under this,Contract t►tr Sale;ar You,chair.id with.comply with,the Instructions etc' I S~t►�t or you nrtatyti If wt'sl,comply with the d nt�uctiQtts of the$81[ar regarding the Iraturma t'hipmem t l the;goods at the the Sel:letr regarding the return sfi imant of the;goads at the Seller's expe�e and rlek.If you dui make tlho goadi awailablm � �I�srht e�tpensa and resit.If you do make the goods Vftgabl'er to r.Frc:Sallow and the:SelUe?r' t�s net, pick them, ecp Witham t` to that SOW and deer Soifer doa:c not pick t hemp up wkhln tfr you retul` w f dlipa�s o thtd ni anylf fort Q ob may retain or fill!to snake the i0ods avillablo to t6 Selllet tar'If you agree 1 I the d �n► �_• I$you tv�reep_ s a.' ae e act cbncega tlgn. n r dispose of filtrth r ) than tads•vrltl+toettt Qbla attars I a,tion xa a8 1 fai �trrrake ��gee_s�-- el�bk e�►the;gel�r ©r�i agree to return the ids to the Sedlar, and fail to do,soy then you. I to return the Vrods to the Ss Ear and fall)to do so.there you iren"laiin liable Tar perforttnaanoe of ali obligations under the; re naln Babble for pertienkrtance of At abligntions under the Cantract;Tm cerise)thEs trail ,attteon.mall!or dal xar a s[gn Comr.a."Ta cued;this trt es;rit,rJ mAlt t►r deliver a$ignt;ti and! dattad�capyr of�thisy ra;ncellaoion notice,or oaryr other !' and. dated!_copy of, this cancellation notice or 4w other