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0091 WATERFORD DRIVE
i BVIND,D' M,G, P 0 ��Z TOWN OF BARNSTABLE E(..ENERGY hoxt Jowl insulation solutions September 18, 2020 t Michael, Please consider this affidavit to confirm the wor at 90 aterford Dr. in Cotuit'has been completed and the permit is ready to be closed. The homeowner is in the process of sellingtheir home and this open permit has created.a.problem for them before closing. As,a note;Affordable.Building.and Weatherization was sold on 12/27/20`18 and'all bus`ness.was transferred over on that dateao SC Energy. Be sure to let me know if you need anything else. Sincerely, Matt: Russell C55L# 1:06162: HIC#: 195809 3 *N� TOWN OF BARNSTABLE 3 � Permit No. .........390..3..... BUILDING DEPARTMENT Ala TOWN OFFICE.BUILDING Cash t t6jq l �teur HYANNIS,MASS,02601 Bond .......`....J. CERTIFICATE OF USE AND OCCUPANCY Issued to Bays ide Building Co. Address Lot #6, 91 Waterford Drive Cotuit, Mass. 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. December 14, 89 19................. .... .. � ...... ......... Building Inspector el(cr'5//p�i1 Assessof's office (1st floor): THE Assessor's map.and lot number rnP !e.T. ........... . Board of Health,(3rd floor):. EPTICS d $�.�.�. 3 ..�?. ... � INST , .Sewage Permit number.•........ � ............ ��QQ�P�N(�`Q i Baaa9TGDLE, r Engineering Department (3rd floor): WI11'I TITi.E'S moo House•number .............�:/ ...............�.....-r........................... ENVIRONMENTAL CODE AND '°7 a�a , o gaI x Definitive Plan Approved by Planning Board r _ _ 1 . 9TOWN REGULATIONS APPLICATIONS .PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M., only' TOWN 'OF BARNSTABLE . . . BUILDIH , a�.,, � .. v f G � INSPE TOR• i APPLICATION FOR PERMIT. TO ..eQN5TRUCT" 'fi S/it/CLF (-Arh/Ly /e Sl�EyC TYPE OF CONSTRUCTION GQJ Ol�b FRl3�iE ... �. ........ � ......... .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according-to the followinginformation: L_0 7T a &//1 TFrk FOt<b DR /U9 ( 'O i v /TLocation ......... . ......... ............... ....................... ... ....................................................................................._ Proposed' Use .................................................,......................................................................... , r Zoning District 2F ..........Fire District U 6 e.............. r .. , Name of Owner....../s.A V5ID45 ../:,(—,b G .....Co.:.:...Address .....f.�..0 -`%3 d •C e EN` .� 1/ �LL-E ............ .... ............................................... Name of Builder. I.............. $ fldll Address S j..ni,E' ^ Name of Architect ......./� tNSl�t it/ :.....'.........Address .......:.e T v !T . Number of Rooms ................. ...:...................:..............r...:....Foundation w� CONCR�T ........ .......... Exterior CLAPf3Gi9 d ... / t .�... ........Roofing ....�.`ol'H✓9 L 1".............. ............... Floors, 0. /..?./L.T.,...C•/t?R PM=........�...V!.a.Y`..:.:.Interior .......//U!t .•5..+ CG•Y.°SU.iv1............................. ..... . Heating ��AS... / ¢...I�OT...u/ftT! �2.......::.....:..Plumbing .../�r/C T,CdP,°F'e.........a a /j/3T`YS..... .... Fireplace Con�CR��£ LOG,e o?� � 4 0 ............ ..... ... ...... "Approximate Cost ..... �........�..... . ............ r Area �� �... .......�.. Diagram of Lot and Building with Dimensions, Fee /Z • y '. •' ,. '-cam?" �` �•F OCCUPANCY PERMITS REQUIRED FOR NEW:DWELLINGS• I 'hereby agree to conform to all the Rules and'Regulations of the Town of Barnstable regarding the above construction. NameL! h �.... ....... _ , - Gig ••% , e Construction Supervisor's License .................................... BAYSIDE BUILDING CO. . .. .11 Story� No ...3.3003.3permit for ..................... ............. ` Single.Family Owelling - .............. ..................... . ......................... _ 1 Location �.. `Lot #6, 91 Waterford• Drive f Cotui.t.... '... .^. ......... Owner side...Building...CO.- ..... .. . J ` Type Of, Constructio'ri Frame ~.............! ........... ... .................... ........ f - r Plot .... !... .� .?.. Lot' ................................. -_ Permit Granted .....,'June ......2,..... ......1.9 89 - r. r Date of Inspection .../..... ..... ....19 Date Complet ..1.... :��......0. 7.19 ' � r co Hi Cr th v } - t•.� ^ ._fit.• � . .�f .. •. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M A / � "- IL DATA OF. BARNSTABLE, MASSACHUSETTS L N PL DATE 19 PERMIT NO. �CICANT " 1 )I'i ADDRESS �. � (NO.) (STREET) ICONiR 5 LICENSL 4MIfTO lrj.7..?...,..i i.:s. a r, �: NUMBER OF ...�....t,4.,` (.l_) STORY ...�•t•- . - _. _. ., -:�:,� DWELLING UNITS '-' (TYPE OF IMPROVEMENT) N0. (PROPOSED USE) r r (LOCATION') ZONING Ts 'i (ND•) +(STREET) FTWEEN - AND-- . . . } +' (CROSS STREET) (CROSS'SIREET) ' 9DIVISION LOT '.LOT BLOCK SIZE LDING IS TO BE FT, WIDE BY-FT BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTI TYPE USE GROUP / BASEMENT WALLS OR FOUNDATION _ (TYPE) HARKS: A OR .UME PERMIT - ESTIMATED COST - �' r FEE - (CUBIC/SQUARE FEET) — -- INER •JDRESS .. BUILMNG OFPT. BY AISM''PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, AL"_EY OR SIDEWALK:OR ANY PART THEREOF. EITHER TEMPORARI Y OR • PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST 6C AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED ,,i:..,,FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS;,., "" OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. A. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR i. AL,L CONSTRUCTION,WORK:- - CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND 4OUNC)ATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. "RIOR TO COVERING STRUCTURAL QUIREO,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL ,.INALEMB INSPECTION TI TO BEFORE FINAL INSPECTION.HAS BEEN MADE. ' INAL INSPECTION BEFORE CCUPANCY. POST THIS CARD SO 1161S VISIBLE FROM STREET ILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 27��Z= 44;' ` It HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT r. Cl 'HER ((\\• '` BOARD OF HEALTH I VY JAI-7 K SHALL PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN.SIX MONTHS OF DATE THE INSPECTIONS INDkCATED ON THIS CARD CAN I STRUCTION. ARRANGED FOA'B PERMIT i5 ISSUED AS NOTED ABOVE. Y_'TELEPHONE OR WRITT� NAITUN.` : Y BUILDING PER'�fIT N0. 3 3 �U DATEf/ )r_0 �, S F'�xr Off• ASSESSORS PARCEL NO. CONTINUATION OF ROAD BOND The undersigned owner/contractor hereby agree to maintain their road bond in 'f force ,until the following work items are completed to the satisfaction of the 'Engineering Section of the Department of Public works: C/ loam and seed shoulders as soon as weather permits: other (explain). ' LOCATIO.d: 9 / D,1Z Slur.' D (O�FdER/CONTRACTOR) (print name ) , E IG"NEE I=;G( UTHORIZATIOTT EaF0 91 Wp� �' 6 0 LOT 5 01C Z)k t/ �9 9 LOT 6 LOT 7 48, 488 t/- SF (1.11 t/- AC.) ps A LOT 8 ' # 86-559-C-6 CERTIFIED PL 0 T PLAN LOCATION : WATERFORD DR. COTUIT SCALE 1 " = 50 ' DATE : 06121189 REFERENCE : -LOT 6' LCP 23747-B PREPARED FOR: I HEREBY CERTIFY THAT THE STRUCTURE BAYSIDE BUILDING CO. SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. Of s� town cape engineering inc. JOHIN � cELWEE CIVIL ENGINEERS No. LAND SURVEYORS JUMP RTE bA - YARMOUTH, MASS. DATE F��SiI VEYOR S FRON► ELEVATION ' -CEILING ASSEhi8LY G.W.A,' TOP SUrF r. U= cQ 3 WIIIDf:WS: R O.o l ---- j !1'F12ERGLAS3 t' BOTTOM SURFACE , • - - •_,.--'_. r'' �.: i"�' ::•<'Y�` PLYWOOD INSIDE. SURFACE os2 R= 0.63 REAR* ELEVATION.__, , .• - VIALL ASSEMBLY !GEES 1/2"sH`ETRocx TOTAL R 0.87 U— c 'S1Dc FIBERGLASS .• "'' ,1:.,:. ,. :.:;.-• ='�s.'. INSULAT I ON 0.17 SURFACE RESISTANCE DOORS:: '•_� FINISH ..:5•. • H FLOOR q t--�r� •' *r R= 0.91 �Y 1/2" PLYWOOD FLOOR ASSEMBLY -. susFLooR DD TOTAL. R - r7 ' R=A.sa RIGHT: SIrVE EL TIDE ^� ,G W:.:.+ ` 7E uu • t ' s1 "" FIBERGLASS ' . :�. a;..' , ,t ►., 'r e' INSULATION 1 ►, ac. R. FOUNDATION D;.vrAL_ .a SU?F4CE RESISTANCE V;ALL dSSEV,,^aLY MRS: i ;:,,;--'•:''Y R s 0.61 . Y BE USED • .^ .� .!..- INSTEAD OF FLOOR '.'• INSULATION •► TOTAU R= 1LE•^^.T S1D•. :E'I:E'J,"�Ti :. . •: 1il$1 E SUP ACE U • R S t3 •� . l-$�» S K c;l�tut7Y5: I" STYROFO;1i ' R' S DOORS: _.S. `R�+1•"+NENTLY . 1NSTALLEJ a -INIzULAT101`) SECTION 11NDOVIS -STO. t�1 �,.:... T� EE_:US=rJ ., WALL A. .._._w ;FOR Anc . _ • 1--'--- - i•t'tit DAT F S ,RAr:O:� ,• _ •• .r : r, r , 00 r --- O P�.YSIor—, P�UILOiNG C-.INc.' r_F NT ECV i LLE /n.o•�-"� DATE:1!4".P-o APMOVeosr: oa�wN ar. J3 DATE: in v 99 . � J-07 IYI-- ._ — was• yttin k�m .. q5 r CW-44CT j7 1111111 [Him -- .v\Vrrvn:r,�y`'.'LOGA'710.�.<<n�.Y ./HOVE.sS,<-G2vge:.izGeau"12G�4-. W-EAP- ELE\/A-rioN 10 G. v_,[J 11_r)I fj Ca Go Iijc.. eeue:U =I'ro- Annoveo er: am"By: J 3 . - ogre: /HAY H9 neMED 0 A I U SIR of 7 t _ ' i z i C�1�1iC�iiQ Foil, I _ t r _ !ml 3 E 3 .SLp", � • x 4'O �V o�in Anii2Er� :vc oo necK� 1�. � .. $os/v Sq•s/R41y� .. cc-6• 2442cc3 _ 31G: i . � r. �4�t,3rti I. �' � d I__�_— __ _-_ � _ _.— � _ N MA6780. $EDAe,oM i3'-p• t ,- - ••`^�`-.�,ft _- ri:.�7'3_awei'S� I • LI �+41i noM to asIL - r •T11. pjTcl_I v To Uo04=.4 _ tY SHE- l-, !►-�!/' Fry L 6 ND• r •';• � � � .. ..rl O ;hn,rtl I I �_� t.�1 -r_. '��.� -b 4'-- n 1:,� I �j:.b:. � � .. v "l _ wnr.k awl"I, Ilt.,n• t- '$,. a.w. WAUJACUrt 1 S 1. �{ .9 rr 41-. I�tS%� M• wC PI ES iM I J s Inu no,,. ll � _ s4 sos9�c1 e a ( 13 ` �i��y`co�VIJ1�1 uYt q�9 N 7'S.F. I r I I 20. CC3 1B/2 K1yr - oNc. �,•�••zo zccl !Eta •fit. - - : --- -._. -_ t I T � 1��.�1�+ 1 F3AY S p E i3 u i LD i t4 G Cam. .- ._ _...._ - - : —_ „ tr — ..�•. - -- _____._ '�_ 18 I W v PS _ GAF v _ .FClv�a•sr tl r,x,':9i4 y;an �p.4tra 0�10�+3.� - ' I iL F WST VV A'Ll- As Izeou1re.C.0 gY 'c.sAoe 10 ' I ,q l r S1.g„ I-I� 3• IS'•2 T I ,B-3" — y s , a v , I 90 .boo T!r - _j_ 4, Y soli, I 4 3� 41 I ra`qEEp L__"� 1 — — _ ___ -_._ _ _ _ _ .._ _ •�� ,� � � --y I -�� � • R.E r�alu @ ro" C.C,EAGu WAY I 2O91ec2 yogl cc z I • _ I �9 _o•I I » ri ' I tj L._ ° i o o j • •, _fit"'-- I s � i • �� I I ° I -_.��— •�I�il �,ALl:�-G�J//•PJ S � ��I I 1 I ..I 14•" 4" Y 14" �r�oTIN6i -,. i _ - Q � .'_��fL.G_r„c•[G�� _ „ ' I vflvn E.A u•I pj rr) C>2ia�J L'L I 9-2"nln.. =.tpec.a ALL ArMIl.,l� � '� I � -4 _ I I o o� -• .._ r I I ' \ I I' �, �, � .. � �.�'� r I I � � _�• .B Y"l i'9„C� WnLI..$' I _ 4 NE�in Qor./ep+ - I� �-•—. - _ ._ .__ '— ____L -�-__, _ h I .•ICe° lo" FaoTIIJC, K•' I I— — - . Ca tr ds 1 _ a Ir oTl9l, LLt ' E!>AYc,D E, e)uILpIwC.. Co liic ., r1T x tF�TAsm./A"ENT= I A 121176E VC—N1 T- - ..-.'L, 10 IZI oee .PICA RO •, . I2 _ '.15EAL-7AF34SPWALT 6L(INbLE q,'�•. �0 '16.,. : : '' 2.-coX. swI-A.Ti•11N6— 2;�oo FIP.J2E•GLAS -- Cv° FIF3 rl_E.G L45 IhISULA'TIADN CDX IS 1-4 eA7 i4Ih1G I- JINGLES 511JE:S sE' 2E GIZ , FIZ�I,IT ON LY . ' a; a • I 1541 [L.O OrL ✓FL'AOH1i.?V •. j:''-• Imo® FASCIA. r ALu//,, G T7F—imis ANO L.L�417E 25 E (3) 2YIG5 Op[.N• Ar IX So F'F'IT \V IT LI VENT,6 ea AfS ti` L I,IIN4 li.00/h F2i v-t'%_ Vbc 4MQ 70 Top OF.\VI 1J DOW F'rLA,^E QD oil V1 i tl FLOO F*31SH ' D/0 PLY 2L'GLAS INSULATION I ` . , �.�.--- -t— - (31 2 l0'S G11zoe1z A • Z _� 'I •1�12 � 01/ti LALLY CQLQ/AN.5 a �I 1a 1O h� %o4. ro , o = "t, upa -- .eL .� e,a r 1 r' •I��' rE A xt • 'a } a ..31t"(pwG R ETC SLAAe� Q1Q ., / �,,.. w • rLEAR'"115" .1rLA I'L6QV12 C.n 11 �PnY FINIhN 6RArJR •o �� u1 !y 1�¢ Ir �,. }/ � e 'Alto"I�^ AO _ � • . r � .. >. e'r _ .F'Ro9T�J4L.0 ��� If2JEOL112E r7 t - - s ' s : ` N�YGRAnE :1 6LSYSIDE f3.U,lldlhlGGo. . . ' C E W T E QV I L.LE. pj-pa _ • 'U'8 - 1'O• - 'r - „ 4 of l r t A Town of Barnstable 1 Building Po`stThisCardSo That it is Uis,ble From the Street "Approved;Plans Mustbe;Retamed on Job and this Gatds�Must be,, pt «: MltSitTCA8I.6, • `,•. a .' ' .,1•:k„ > ,• i 3" ,` �. .ate, ..i ,.s - 6 Posted Until F�nalylnspectton Has;Been Made "� Permit Where a Certificate;of Occupancy;is RequiredsuchyBuildmg shall Not"be Occwpieduntda„Final Inspe!ct�onNhasbeen made Permit NO. B-18-3814 Applicant.Name: todd leduc Approvals Date Issued: 11/26/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 05/26/2019 Foundation: Location: 91,WATERFORD DRIVE,COTUIT Map/Lot: 056-002 010 - Zoning District: RF Sheathing: Owner on Record: GUGLIOTTA, PATRICIA � Contractor NameTODD LEDUC Framing: 1 Address: 91 WATERFORD DRIVE i Contractor License: CS " -106019 2 COTUIT, MA 02635 .� Est Protect Cost: $5,704.00 Chimney: r Permit�Fee: $85.00 Description: Insulation;See contract Insulation: r' F � Project Review Req: Installers certificate required to close Fee Paid: $85.00 Final: Date.4 11/26/2018 l� � ( Plumbing/Gas a .. Rough Plumbing: ' sBuilding Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within si,months after issuance. •s Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents:for N4 icligthts, permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by la�ws;and codes. Final Gas: gg& i. This permit shall be displayed in a location clearly visible from access street or r6015nd shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Nil z. - �' Electrical The Certificate of Occupancy will not be issued until all applicable signature by the Bulldmg and Hkre Offi'dals are provided on permit. Service: Minimum of Five Call Inspections Required for All Construction Work-,,,, 1.Foundation or Footings Rough: 2.Sheathing Inspection 3.All fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Priorto Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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 Application number Date Issued............... .1. .)..(.1 .. ............ BAMSTABLF- y� tv1ASS. � 1 r o 163�- �� Building Inspe�ctors Initials........... ..... ................ Map/Parcel....`!v....... .. ..........� ........ t2Vs7N OF BARNSTABLE X EXPEDITED PERMIT APPLICATION: 91' §SING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION im 1 " 1- N ��S��ABI � PROPERTY INFORMATION Address of Project: 11 Qar-er-(oTc( o-Au�NUMBER. ' t� STREET VILLAGE � Owner's Name: k n L?u S i o Phone Number Email Address: Cell Phone Number Project cost$ f y Check one Residential ✓ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance w//ith 780 CMR P c-FI� Owner Signature: SLOP ca-iraL�" Date: " TYPE OF W®P 0 Siding 0 Windows (no header change)# a Insulation/Weatherization ❑✓ Doors (no header change)# I Commercial Doors require an inspector's review I1 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to - /JJQ )-/e - rI4114; 641p AJ,,4 CONTRACTOR'S INFORMATION Contractor's name ,�qa � �„' Pe� ors e ( ✓S f� Home Improvement Contractors Registration(if aP licable)# 11 Z 7$5 (attach copy) Construction Supervisor's License# 07 V 7.,L/ 7 (attach copy) Email of Contractor a3 phone number -Irfo/- 7 IV- (22 9 ALL PROPERTIES THAT AGAVE STRUCTURES OA&R 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUE®. 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 Ilf food is being sewed at your event please obtain a Health Department approval between the hours of 80 00am-9.30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval. "WOOD/QCOAL/P EL LIET STOVES 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 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by.780 CMR and the Town of Barnstable. Signature Date /APPLICANT'S SIGNATURE Signature Date 7 All permit applicati are subject to a building official's approval prior to issuance. x • {R SPECIAL SERVICES CUSTOMER INVOICE Page vot 14 NO. H2612-77059` ,Store 2612 HYANNIS, Phone:(508),778-894.8VALIDATIONAREA « 65INDEPENDENCE DRIVE, s.Sdlesperson:E1HP.4LE HYANNIS,MA 02601 Reviewer: DAS1253 This is only a. LIUOTE for the merchandise.and services printed'below. This becomes an Agreement upon payment'and an endorsement by a;Home Depot register vaiidatiOn.. Norco Mono • GUGLIOTTA JOHN (sos)s24-2030 All*.- 91-WATERFORD DRIVE: Phw,ox . c'" COTUIT 1°bD°x" exterior door install: sM,a MA z;a 0263S o°"nti BARNSTABLE QUOTE s,valit,#or this date:06/2q/2018'; INSTALLER=DELIVERY;#1"; �E CHANDISE AND SERVICE SUMMARY' `odrtocuse httolimitthequanUh o r, 6dlse , REF# 101 STOCK-MERCHANDISE TO BE DELIVERED: . o :. QTY,`,:` Rk fti 4R(cttAbH - EXTENSION:; R03 0000=254-294 >' i3.00 EA 314"X5-1/2"X8'PVC TRIM/ 2 �. $22:12 $66:36 R64 0000-211-276 20.00 LF 1 1/16 X2-1/2 PFJ WM351 CASING% Y $0.99 " $19:80 R65 - 1002-961-477 1.00 EA 6"X50'.WINDOW&DOOR SEALING TAPE/ A R06w0000-715-4991.00 RL MULTI-PURP'16°X48°ROLL fNSUL"5:3SF/. A $548 R07 1000-239-576. 1 -1.00 EA 32"300''SS WHITE.W/`NICKEL'HDW/` A `Y' 1 $199:00. . . $199:00 S/O-MDSE MBE DELIVERED: REF# Qf ESTIMATED ARRIVAL'DATE:,07/08/2018,.. i ... . ... :. . PRICE EAGH EXTENSION S0808 0000-605-463 1.00 EA NA J 33.5X81.75 FIBERGLA DOOR UNIT L/33.5X81.75- A `Y $467.86 $467.86 FIBERGLASS:SINGLE' LEFT`INSWING#1 S0809 0000-.. -463 1.00' EA NA/ CONTiNWS,,Tl�N--44;dADEADB6LTBbREPOSITIO.tj=5,112"',b'A'H' : 1:75 FIBERGLASS SINGLE DOOR UNIT.L'EFf: A Y $0:00 '" <$0:00 " .INSWING(LOCKSIN: G P HINGEPREP,QAHINGESINCLUbED=YES,QAHINGESIZ€=4"X4 HINGE'iYPE=13ALLBEARINGVV/$AFETYSTUD,QAHINGERADIUS=518 1US/SQUARE "*CONTINUED.Qht.iltEXTPAGE'•_.. . . _ . :Checkyour iburrent order status online at www.homedepot.comiorderstatus .(6wi) .0100472616 Page. 1 of 14 NQ. H261 2-77Q59 Customer Copy. AA k Ri�geX1�tSfi.1��•.. s MASSACHUSETTS SUPPLEMENT WARNING DO NOT,SIGN THIS CONTRACT.IF THERE ARE ANY BLANK SPACES` Last Name I First Name i Store#/'Branch;Name PO(s)or Customer Order# R yc Salesperson's Name(if any) I The terms and conditions of;this Supplement apply.to aII Home Depot (interchangeably referred to as "The Home Depot") Home Improvement Agreements in Massachusetts and are ek0ressly made a.part i of all such agreements; In the event'of any,conflict, inconsistency or discrepancy between the terms of Your Home Improvement Agreement.and thJs Massachusetts`Supplement the tbirm of this Supplement shall control; l ' NOTICE TO BUYER` You May can 1 this Agreement if it�has--been signed by a party thereto at a place other`than' . an address of 1he 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, tly telegram sent or by delivery;not.later,.than`midnight of the third business day;following the signing of this: Agreement: ff s Seethe attached Notice of'.Cancellation_ form for an explanation of this right. l � � This fight.shMI not.apply to a transaction in which.You initiated he transaction and the goods or services are needed"to meet a.boriia fide immediate persona emergency and You furnish the. seller with a separate dated and signed personal statement iri the Your handwriting describing the situation re uiring immediate.remedy and expressly acknowledging and.waiving the tight to. cancel t el` in ree business days. _ -'t, x i unto efts Lsignature) i s T. IDENTIFICATION LNUMBER;FOR HOME DEPOT. 58-1853319 i NO WAIVER OF RIGHTS.�Your rights under tt a Home Improvement Contract Laws (MGL Chapter 142A)and other consumer protection laws (i.e:, MGL Chapter 93A)may not be'waived rn any way; even by this Agreement However,You may be exclutled from certain rights if,the service provider You choose is not properly'-registered as preset bed by law. REQUIRED PERMITS. Home Depot and/or its Service. Provider.is/are obligated to inform You of any and all permit`s necessary t. corriplete the work contemplatetl by this Agreement, and'it is the obligation of. Home Depot and/or,Service Proved! '' obtain said permits.'If You secure their building permits,-You are:automatically excluded'from,'-'Guaranty Fund`provisions of fhe Home Improvement Contractor' taw i 3 WARRANTIES: Home Depot may guarantee or provide an express warranty for workmanship or materials;: Anyenumeraton`of these.matters on which You Iand Home Depot lawfully agree May added to:the terms of this Agreementas ong,as they do not'restrict Your basic;consumer'rights lISASItda Sup:(F9b 01;20?7)' - - Customer Care:1.87?-+467 2581 the Home geoot:•2455 Paces Ferry Road;N W:Bldg B-3 Atlanta,Georgla'30339 Pagev1 tSf 1? �� h'�"�26�2 Customer'CoPY s . SPECIAL SERVICE$CUSTOMER.INVOICE-Continued, Name.-:GUGLIOTTA: Page"5 of:1:4 NQ..:H26122 77069. '',, , INSTALLATION #2� REF#102.' _ . .. OR INSTALLER IF DELIVERED TO INSTALLER,THE INSTALLER.WILL FEES ENGINEERING,WIND LOAD CALCULATIONS,RECORDING.. . PICK UP..P.ROM l HAT:MUNIGIPALITY.AND DELIVER TO EITHER JOBSITE 'ALL FEES:ASSOCIATED WITH OBTAINING PERMIT(MUNICIPALITY 4.DELIVER:COMPLETED PERMIT PACKAGETO PROPER..MUNICIPALITY, SPECIAL NOTES: - , ULL FNQREFUNDS ON ERM .A OAYNOAYMENTP � ...CU.STOMER S R.ESPO F THE:.PERMIT IS PAID FOR,WORK,ON_THE'PERMIT ASSEMBLY BEGINS IMMEDIATELY..CANCELLATIONS..WITHIN 72 HRS WILL BE REFUNDED It 'bF IN&TALL'#2 TOTAL.CHARGES OF ALL MERCHANDISE:&:SERVICES $1 400.48 Policy d(PI): SALES TAX $48.53 A:90 DAYS:DEFAULT POLICY; TOTAL $1449.01 BALANCE DUE $1,449.01. PAYMENT TERMS.:,: .Refer to the Home Improvement Agreemerit:for payment Terms :'The.Home Depot.reserves;the ri4ht to 60i %deny returns. Please.see the return policy U. in stores for_Oetads' D. "W f h:.sy4ft t 'Yu. :ENOF ORDER Na.H2612-77059 �,• II Page 6 of 14 NO. H2612-77469 CuStome(Copy ! �'�;l.x ta:asxg<,,s �f+F qe j�.•A,t i f,r s .� Hoard CS-074247 z - PAUL M D6WmNt 180 KESWICK.ROAD 'BROCKTON MA 0230,2. r F " ' Commissioner..-. � � ' 771e Commonwealth of Massachusetts = Department of Industrial Accidents Office of Investigations ' I Congress Street,Suite 100 Boston,M4 02114 2017 www.mass gov/dia Workers'- Compensation Insurance Affidavit: lluilders/ContractorsAElectricians/Plumbers Aoplica>at Information \ Please Print I.,egibly Name(Business/Organization/Individual): ->11,,LL_ A ll fiC> Address: City/State/Zi p= ( Phone#: Are you an employer?Check the appropriate box: . 1.❑ I tun a employer with 4- ❑ I am a general contractor and I Type of project(required): employees(fuli and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.M I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ' ship and have no employees These sub-contractors have. g. ❑Demolition Working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance# 9- El 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.❑ 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. Wo workers' 13-❑ Other �- comp.insurance required.] *Any applicant that glad—box 11 must also rill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. (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 ain an employer that is providing workers'compensation insurance for nzy employees Below is the policy'and job site information. Insurance Company Name: Policy#or Self-ins.Lic.-#: Expiration Date: Job Site Address: City/SthtelZip: 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 certa under the pains and penalties of perjury that the inforination provided above is true and correct ___ t 'L 1 — - -- - — -.— Sl�llature: � `�, — Date: Phone#: s� Official rise only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): L 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 IndustrialAccidents Office of Investigations 1 Congress Street,Suite 100 91 s ry Boston,AL4 02114-2017 `y wwm massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information `� Please Print Le 'blv Name (BusinesstOrgu=i:iowlndividual): Pi 1/ - - -ess: _r',_xv'State/Zip: s� sb /� dis'Y.V- Phone#: 7 r `on an employer?Check_the ^4opria 1: Type of project(required): I am a general co=actor and I I ]! I am a empiover witity r-- 6. ❑New construction f jemployees(full and/or part-time).` have hired the sub contractors listed on the attached sheet. 7. ❑Remodeling I am a sole proprietor or partner- I ship and have no employees These sub-contractors have i g• FL— Demolition worldnQ for me in anv capa employees and have workers' city i 9. j Building addition o workers' coin insurance comp.leer"a"ce:` I p 5. We are a corporation and its re E 10. Electrical repass or additions ] officers have exercised their ;.[ I am a homeowner doing all work 11.❑Plumbing repaia•s or additions myself. 2�Io workers` comp. right of exemption per;VIGL 12.❑Roof repzks insurance required.]t C. 152, §1(4),and we have no 1 Other CEO ar empiovevi. [-io workers• i comp.insurance required] I , r e (ac-e^e�-r •v v appccant rhat che cls box d l must also fill out the section below showing their workers'compensation policy information. r Homeowners who submitthis affidavit indicating'they are doing all work and then hire outside contractors must submit anew affidavit indicating such. :Contactors thal check this box must attached an additional sheet showing the name of the sub-contwtors and state whether or not those entities have --tmpioyem. :the Sub-contractors have employees,they must provide their workers'comp policy number. I am an employer rhat is providing workers'compensation insurance for my employees. Below is the policy and job sire infunnation. //1�� � �/ - /- L-2sn.•�•ance Company dame: I.GJ�"/'/{•r lLT tplt�/ V N�ei✓ �//'C� �it/SPolicy#or Self-ins.Lic.#: X W � 7 � l ��� Expiration Date: 3 ` Job Site Address: � h/A-I'er- Ofrf �f City/Siatelzip: �7 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 on4- c imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day stlator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA r e coverage verification. I do hereby certify un e i at the information provided above is true and correct Si attn-e: Date: Phone#: — Official use only. Do not write in this area,to be completed by city or town offtciaL Cite or Town: Permit'License Issuing Authority(circle one): l 1.Board of Health 2.Building Department 3.CityiTown Clerk 9.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone : Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card HOME DEPOT USA INC Registration: 112785 2455 PACES FERRY RD C-11 HSC Expiration: 04/22/2010„ ATLANTA,GA 30339 Update Address and return card. Mark reason for change. ❑ Address ❑ Renevra! ❑ Employment ❑ Lost Card - - Office of Consumer Affairs&Business Regulation --- HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE Suonlemeni Card before the expiration date. If found return to: Registration Expiration , Office of Consumer Affairs and Business Regulation 112785 04/22/2019 10 Park Plaza-Suite 5170 DOME DEPOT USA INC Boston,MA 02116 ANDREW SWEET -- 2455 PACES FERRY RD G11 HSC ATLANTA,GA 30339 Undersecretary d iihou signature DATE(MWDDf"YY)ACC CERTIFICATE OF LIABILITY INSURANCE o2rz212o,a 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)- PRODUCERMA CANT RSH USA,INC. PHONE FAX TWO ALLIANCE CENTER Arc Not, 3560 LENOX ROAD.SUITE 2400 E-MAIL ATLANTA.GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC ti CN101642069-HomeD-GAW-16-19 INSURER A:Old RepuNic Insurance CO J2047 INSURED THE HOME DEPOT,INC. INSURER B:New Ha tore Ins CO 23841 HOME DEPOT U.S.A.,INC. INSURER C:HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD INSURER D BUILDING C-20 ATLANTA.GA 30339 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: ATL-OD4353439-16 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 ADDL SR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER fMMFDDNYYYI 1Mw1IDDrYYYYI A I X coDAMAGE TO RENTED MMERCWLGENERALLIABILITY MWZY312717 0310112018 031011YD79 EACH OCCURRENCE S 9,000.000 CLAIMS-MADE IT OCCUR PREMISES fEa occurrence 15 1.000.000 LIMITS OF POLICY XS EXCLUDED MED EXP IAny one person) ;S OF SIR:S1 M PER OCC PERSONAL&ADV INJURY s 9'000,COO GEML AGGREGATE LIMB APPLIES PER: GENERAL AGGREGATE s 9,000.300 PRD- X POLICY 7 JEC7 [7 LOC PRODUCTS-COMPIOP AGG S 9,000,000 EC OTHER: I 5 AUTOMOBILE LIABILITY MWTB312718 03MI12018 0310112019 COMBINED SINGLE LIMIT S 1.000,000 Ea amdent X ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED SELF INSURED AUTO PHY DING BODILY INJURY(Per accident) 5 AUTOS ONLY AUTOS HIRED NON-OWNED i PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAR HOCCUR EACH OCCURRENCE S EXCESS Lin CLAIMS-MADE AGGREGATE s DIED I I RETENTIONS s B WORKERS COMPENSATION WC014122577(AK,NH,NJ,VT) 03101f1018 03/0111019 X STATPER UTE O ER TH- B AND EMPLOYERS'LIABILITY Y 1 N WC 014122578(WI) 0310112018 0310112019 5,00D,000 ANYPROPRIETORIPARTNER/EXECUrNE E.L.EACH ACCIDENT S OFFICERIMEMBEREXCLUDED' N N I A 5,000.000 (Mandatory in NH) E.L.DISEASE-EA EMPLOY S 0 yes,describe under Continued on Additional Page EL DISEASE-POLICY LIMIT s 5,000.0DD DESCRIPTION OF OPERATIONS below C Excess Auto 297-1-10011-00-2018 03f0112016 03101/2019 Lirrut 4,OOD.000 DESCRIPTION OF OPERATIONS/LOCATIONS[VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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. ManashiMukhegee _l�'tatitiQo',= ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta A16-� "® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY MARSH USA,INC. NAMED INSURED THE HOME DEPOT,INC. POLICY NUMBER HOME DEPOT U.&A.,INC. 2455 PACES FERRY ROAD BUILDING C•20 CARRIER NAIL CODE A7LANTA.GA 30339 .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: Carver:Indemnity Insurance Company of North America Policy Number.WLR C64763191(AL,AR,FL,ID,IA KS.KY,LA,MS.MO,NE,NM,ND,OK,SC,SD TN.WV,WY) Effective Date:03/01/2018 Expiration Date:03ID112019 (EL)Limit:51,000,000 Cartier New Hampshire Insurance Company Policy Number.WC 014122576 (DC.DE,HI;IN,MD,MN.MT.NY,RI) Effective Date:031012018 Expiration Date:0310112019 (EL)Limit:51,000,000 Carrier:ACE American Insurance Company Policy Number.WCU C64783221(QSI)(Q.CA,IL,NC,OR,VA,WA) Effective Date:031012018 Expiration Date:0302019 (EL)Limit 81,OD0,000 SIR.51,0O0,000 SIR for the stales of AZ.CA,IL.NC.OR,VA,WA Cameo National Union Fire Irisurance'Company Policy Number.XWC459558D(QSI)(CO.CT,GA,ME,MI.NV,OH,PA,UT) Effective Date:031012016 Expiration Dale:031012019 (EL)Urrit:$1,000,OOD V.D00,000 SIR for the states of CO.ME;NV,MI,OH.PA.UT 5750;000 SIR for the stale of GA 5350,000 SIR for the state of CT Cartier.National Union Fire Insurance Company Pdicy Number.XWC 4595581(QSI){MA) Effective Date:031012018 Expiration Date:_03101/2019 (EL)Limn:51,OD0,0DD SIR:SSD0;000 TX Empoyers XS Indemnity. Carnerlllinios Union Insurance Company Policy Number TNS C4916693A ITX) Effective Date:0012018 Expiration Date::03/012019 (EL)Limit:S10.0D0:000 SIR:S1,000,000 1CORD 101 (2008/01) ©2008.ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD (( Of Town:of Barnstable *Permit# Expires 6 mondts fro issu date Regulatory Services Fee + lAaF6 mu, Mnss'i639' Thomas F.Geiler,Director �f0 MAC► �_ Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY l Not Valid without Red X=Press Imprint Map/parcel Number 0�(P�/ (.)U-471 t) Property Address �� (k)01M W27 19-4 0 a 6TO 11 Residential Value of Work �� QDU. Cro .Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address M69LI, /NJ Contractor's Name NOS I L G 1�E 5'IG/J Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) C`j�5 /�a-�•��' :MP R E S S PERMIT 5/Workman's Compensation Insurance A«G 1 Check one: ❑ I am a sole proprietor TOWN OF BARNSTABLE ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# W C, 6Q Copy of Insurance Compliance Certificate must accompany each permit. Pernut Request(check box) Re-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to t,p I'S ❑Re-roof(hurricane nailed) (not stripping. Going over existing layers.of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,.Conservation,etc. ***Not .. Property 0 ust sign Property Owner Letter of Permission. A cop of.t Ho a Improvement Contractors License&Construction Supervisors License is requi ed. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\DDV87AAZ\EXPRESS.doe Revised 072110 E 711e Commonwealth of f Massachusetts ccideia.ts I�epartttaent o�f'IaFrrltastrial A I w Office of Investigations +600 Washington Street a• } Boston,M4 02111 , 1191G!IV Mass.govldi a . Workers' Compensation Insurance Mfadavit: Builders/C+ontractui•.slElectizciau&Tltamabers Applicant Infor][nation Please Print Legibly Mane(.Biisi❑essiGrgauiza oivin& idual): ,/��U1771 YI�S �U i � T�e����t l 1:4 t' Address: City/state-,Zip: C"'OTV l l I VW M 6Uo5 Phone n: - 2 - c O 1 Are your air employer?Check the appropriate box: Type of project(r equiued): 1. 1 arm a employer with 4. ❑ I am a general contractor and I 6. ❑Nets'construction employees(full an&m part-time).* have hired the sub-contractors 2.❑ I aim a sole proprietor or partner- listed on the attached sheet_ r• ❑Remodeling ship and have no employees These sub-contractors ha.ve g. ❑Demolition _ .vorking for me inanycapaciry. employee..and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. El We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I wn a ho meommer doing all work officers have exercised their 11.❑Plumbing repairs or additions r myself.[No workers'comp. right of exemption per INIGI, 12.Q Roof repair insurance required.]- c.152,§1(4);and we have no employees.[No workers' 13.0 Other comp.insurance required.] °Anv applicant that checks box#1 must aho fill-our:the section below shon-ing theirrtoikers'compensationpolicy info,-=tioa Homeowners who submit this affidm it indicating they are doing all wcak and then loin outside contractors must submit a nett'affidavit indicating such. :Contractors that check this bat must attached an;3dditionaC sheet showing the name of the sub-contta.ctors and state whether or aotthose entities]rare .- employees. If the sub-contractors have einployees,they must provide their workers'comp.policy number. R1Ja aJr ePltplo4eY Vaal is pYOi idIFJyo 1A�Orl�PY•S'COaJJpeJr3afi0JJ IFtSFJYaadCB for dJit'BNJpIo�'ees. Belott'is the polio'and job site ilrforwallon. InsuranceCompanylacne: Policy 4 or Self--ins_Lic. 0 eo Li,— 31J Expiration Date: Job Site Address. Cit,:+Statelzip: COTUIT Attach a copy-of the workers'compensation policy-declaration page(shooing the policy number and expiration date). Failure to secure coverage as.required Wunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and+or one-year imprisonment,as well as cital penalties in-the.ford of a STOP WbRK ORDER and a fine of up to$250.00 a day against the violator. Be advised thatt a copy of this statement may be fornvarded to the Office of Inv.esfigations of thi D.LA.for in ura ice coverage verification. I do here 'c .rtrfl'ilia 4? th.. p ns and ps atties of peljn v that the in form ation pomided abo�lr'e is true and correct Si tune: Date: Phone#: 0f f`iCI[dI use onP . Do not it rite in this area,to be completed by city,or toom o ciat Cite-or Town: Permit)11cerise A " Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTourn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6-0ther Contact Person: Phone 4. 6 . ATE(MMrbDIYYYY) ACORQ. CERTIFICATE OF LIABILITY INSURANCE D01/17/2011 PRODUCER S08.428.6921 FAX S08.420.S406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Leonard Insurance,Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 7 Wianno Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 Sax 494 Osterville, MA 026S5 INSURERS AFFORDING COVERAGE NAIC# INSURED Lagadinos Building & Design, Inc. INSURERA: National Grange Mutual Ins Co. 14788 13 Thankful Lane INSURERB: Chartis Cotuit, MA 02635 INSURERC: INSURER D. INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR SR TYPE OF INSURANCE POLICY NUMBER R ADD DATTE1(MMIDFDANW TME POLICY ATE( MID ON LIMITS GENERALLIABILfTY MSB87460 01/01/2011 01/01/2012 EACH OCCURRENCE $ 11000,000 DAMAX ETO COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence ' $ S0,000 CLAIMS MADE FX]OCCUR MED EXP(Any one person) $ 10,0001 A PERSONAL&ADV INJURY $ 1,000,006 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,060 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT' ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ 'I SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS {Peraocident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- O H• AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVEYIN WC 004-30-3313 01/02/2011.. 01/02/2012 E.L.EACH ACCIDENT $ 500,000 B OFFICERIMEMBER EXCLUDED? F-J (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ S00,000 IFyes describe under SPECIALPROVISIONSbefow E.L DISEASE-POLICY LIMIT $ SOO 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 'Builder in Massachusetts CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF,.THE ISSUING INSURERIMLLENDEAVORTOMAIL 10• DAYSWRIiTEN NOTICE TO.THE CERTIFTCATY HOLDER NAMED TO THE LEFT;BUT FAILURE TO DD SO SHALL Town of Barnstable IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,TTS AGENTS OR 200 Main Street REPRESENTATIVES. - Hyannls, MA 02601 AUTHORIZEDREPRESENTATIVElot Tina Correia/LEOTC1. (/ .. ACORD 25(20091.01'} 01998 2009 ACORD CORPORATION. All rights'reservbd. -- Massachusetts- Department of Public SafetN- ' Board of Buildin Re- ulutions and Standard. Construction Supervisor License License: CS 12653 a NICHOLAS A LAGADINOS � 13 THANKFUL LANE -' COTU IT, MA 02635 Expiration: 7/16/2013 ('uuroissiiucr Tr#: 19980 , GfIte�o-vio�ui�lea/� ���/ a ' License or registration valid for individul use only Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Type: Office of Consumer Affairs and Business Regulation Registration:r>4104804 10 Park Plaza-Suite 5170 (:C. `D Expiration: 7i1.1:5I2012 • Private Corporation Boston,MA 02116 'LAWOS BUI�T?C11;:G&D�S1: ,fsINC •NT , lY -='x:: Nicholas Lagadino. 13 Thankful Lane �Y _ ej � � — Cotuit,MA 02635 Undersecretary Not valid without A nat e l . oF11HE r BARNSrABLE, x'� MM& Town of Barnstable FoA Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, &&2LI 6Ae S S )ykd (/ , as Owner,of the subject property hereby authorize !S((U, Cal&ba-'-'d{ to act on my behalf, in all matters relative to work authorized by this building permit application for: 9� U�11Jz 27 J iN iT (Address of Job) ignature of Owner Date f�/3�,��T_ l�ltdSs�t�lliln Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87'AAZ\EXPRESS.doc Revised 072110 mot , Town of Barnstable *Permit#` 6L153 I Expires 6 months from issue date Regulator Services Fee ►sz��. Y Mass. $ Thomas F. Geiler, Director i639• ♦0 ��` Building Division. Tom Perry, CBO, Building Corrunissioner 200 Main Street Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL. ONLY Not Valid without Red X-Press Imprint Map/Parcel Number 056/002/010 Property Address 91 Waterford Drive. ®Residential Value of Work $ 2,000.00 Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address Herbert Grossimon 91 Waterford Dr. Cotuit,MA 02635 Contractor's Name NICK LAGADINOS Telephone Number 508-428-4097 Home Improvement Contractor License#(if applicable) 104804 Construction Supervisor's License#(if applicable) .12653 ®Workman's Compensation Insurance Check one: I am a sole Proprietor am the Homeowner X PRESS PERMIT ® have Worker's Compensation insurance AUG 2 2 2008 Insurance Company Name AIG TOWN OF SARNSTABLE Workman's Comp. Policy.# WC6983341 Copy of Insurance Compliance Certificate must be on fide. Permit Request(check box) ® Re-roof(stripping old shingles)All construction debris will be taken to Casella Q Re-roof(not stripping. Going over existing layers of roof) Q Re-side Replacement Windows. U-Value (maximum.44) *Where required:Issuance of this permit does notexempt compliance with other town department regulatyo�s,i.e.Historic,Conservation,etc. * * * 0 Pro erty er ust sign Property Owner Letter of Permission. om mprovement License is required ;fir SIGNATURE: The Commonwealth of Massachusetts D e artme nt o Industrial Ac c P idents . f Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation I.nsuranee Affdavit:.Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): • / 71 00 S '?V C bJ V1 t, l Address: /,12? e5 City/State/Zip: �lS t"r Ili rd,a 3.i Phone #:— (:gV - Of 7 Are you an employer?Check the appropriate box:. Type of project(required): 1.C� I am a employer with 12- 4, ❑ I am a general contractor and I 6. Q New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ ram a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' camp. insurance. 9 ❑Building addition [No.workers' comp:insurance 5. ❑..We area corporatioa and.its required.] officers have exercised their. 10.❑Electrical repairs or additions 3..❑.I am a homeowner doing all work right of:exemption per MGL I I..❑Plumbing repairs or additions myself. [No workers' comp. - c.152,§1(4);and we have no. 12 of repairs insurance required.] t . employees.[No workers' 13 ther comp tnsurance required:], 'Any.applicant that checks box#1 mustaiso rlii out:the section below showing therrworkers compensation pohc rnfomration. ,r; t Homeowners who submrt3hts;affidav�tmdreatingththey are`dourgall work and then hu-mnutside contractors most submit a new affidavit indreaung,sucti s:%Contractors that check ttus bozmusrattached an addrtrnnal sheetshownrg fhe name,of•the sub=codtractors amid themworkets''com : oli P P cy information. . KzL _.- ' -"s f I am an employer that is providing workers'compensation insurance for my employees Below is the polccy and job site r,r informario►r ., . .. Insurance Company Name:- (7 Policy-#or Self:ins. Lic.#: (,�C (a��)�, / '7 Facptration Date: 1 Job Site Address: rr IA1l�i Z �2i�. k City/State/Zip: C'(�U 1 I LM( �(, 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 tine 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.fne of up to$25i1.00 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 tit)li y certify un the ai s and penalties of perjury that the information provided above is true and correci Signature Date: Z Phone#: Z�3 Official use only. Do not write in this area,to be completed by city or town offciaL 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 C(')ntact Person: Phone#: - S,�'i� p� T1, �\ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Reglstrat!,on,,104804 Exp1rat*on,:7%:15/2010 Tr# 270833 One Ashburton Place Rm 1301 Boston,Ma.02108 }Type Private Corporation LAGADINOS BUILDING~&.DES1G'N,INC Nicholas Lagadinos 13 Thankful Lane Cotuit,MA 02635 Administrator Not valid witho signature o' ' r �FIME row Town of Barnstable Regulatory Services saiuvsrns�, ra 1Mass. ,�g, Thomas F.Geiler,Director �pTEDµp'�p Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, M- P,t-2Z 1 Use, 4 , as Owner of the subject property hereby authorize ' to act on ray behalf, in all matters relative to work authorized by this building permit application for: U° (Address of Job) z ture of Owner Date T 6i2ossi WeJAI Print Name Q:FORM&OWNERPERML4SION 02/U812UU8 FRI 14:46 FAX 5U8 42U 54U6 Leonara Insurance Agency IA0021002 ACORD CERTIFICATE OF LIABILITY INSURANCE oiios%io 0 PRODUCER (508)428-6921 FAX (508)420-5406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Leonard Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 7 Wi anno Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 Box 494 Ostervil le, MA 02655 INSURERS AFFORDING COVERAGE NAIC# INsum Lagadinos Building & Design, Inc. INS.3RERA-. National Grange Mutual Ins Co. 14788 13 Thankful Lane INSURERB: AIG XSB009 Cotuit, MA 02635 INSURER I INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 INSR D-1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY MSB87460 01/01/2008 01/01/2009 EAcHoccuRRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 5,00 000 CLAIMS MADE Q OCCUR MED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 1,000,000 !!!I GENERALAGGREGATE $ 21000,000 1 GEML AGGREGATE LIMIT APPLIES PER PRO- PRODUCTS-COMPlOP AGO $ 21000,000 POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Perperson) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTO$ (Per accident) PROPERTY DAMAGE $ c' (Per accident) 4I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC6983341 01/02/2008 01/02/2009 wcsTATu- oTH- EMPLOYERS'LIABILITY B �CER/MEMBER PROPRIETORIPARTNERIEXECUTIVEE E.L EACH ACCIDENT $ If yes,describe under E.L.DISEASE-EA EMPLOYE S SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main St. OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE � ��- Nancy Henderson LEONHI ACORD 25(2001108) FAX: (508)428-7709 ©ACORD CORPORATION 1988 • Town of Barnstable •Pertsut# �v2 XV&411 d monthtftom Inue date Regulatory Services Feed MAN' a�� Thomas F.Geller,Director r° Building Division Tom Perry, Building Commissioner �a 200 Main Street, Hyannis,MA 02601 ®� e�� PER Office; 508-862-4038 _ IT Fax: 508-790-6230 APR 2 2 2003 EXPRESS PER GT APPLICATION - RE S ONLY j Not ValtdwkhoutRedX-Freujrmprint RNSTABLE Map/parcel Number I `� Property Addzcss(q( +e oauit- Value of Work 00C) Owner's Name 8e Address Contractor's Name_ oo &Ze00 In Telephone Number L5C7,:0 �A \- T-] Home improvement Contractor License#(if applicable) to -J-7 f Construction Supervisor's License#(if applicable) c 5workman's Compensation Innuance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance C9Wpany Name Trcxy e`-e r-5 Tbd.e-1'Yl V- 1 t(i .00, Cf _-I:a,;r)c!�1S workmen's comp.Policy# -7PJ U 13-p(aa X Q 53 - 502 Permit Request(check box) ( " - c-roof(Stripping old shingles) All construction debris will be taken to YO,r lam ❑Re-roof(not stripping. Goiug over existing layers of root) Re-side [] Replacement Windows. U-Value (m,xim=,qq) ❑ Other(specify) •Where required: Issuance of ribs pa rvit does not txempt cotiipliancc with other town dtyattntent regulations,i.e.Historic,Conservation,cte. Signature Q:Fomts:expmtrg . Ravisedl21901 I R O O F I N G 1031 Main Street Osterville,.MA 02655 www.cazeault.com P.C. Box 2781 Orleans, MA 02653 Mr Herbert Grossimon Mg) 420-3372 DATE March 28 2003 STREET 91 Waterford Drive CRY/TOWN Cotuit, MA 02635 Strip off Flat Roof system. Re-nail any loose boarding. Pull sidewall and roof shingles and put back. Install 1/2" polyiso insulation(R-value 6.25) Install Carlisle Sure-Seal .060 rubber membrane roof, fully adhered. Flash all curbs, pipes, chimneys, skylights, and other roof penetrations in accordance with manufactures specifications. Install .032 aluminum flashing on perimeter edges. Workmanship to be warranted for a period of five years. Remove all roofing related rubbish from premise. COST: $3,000.00 Three Thousand Dollars 3,000.00 Payment to be made as follows: 1/3 due with signed contract, 1/3 due when job is half done, 1/3 due upon completion Credit Cards Accepted Mastercard Visa Discover All matter is guaranteed to be as specified. All work to be completed in a skillful manner according to standard practices. Estimated by: Mika /Aden All agreements contingent upon strikes, accidents, or delays beyond our control. Owner is to carry fire,tomado, and other Note:This proposal may be withdrawn necessary insurance. by us if not accepted within 30 days Qeceptatwz of J na paad Customer Signature The above prices,specifications,and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment to Date of Acceptance oS be made as outlined above. Please Sign and return one copy to contract job Toll-free in MA:(8001 698-5569 Osterville: (508) 428-1177 Orleans: (508) 255-5569 Falmouth: (508) 457-1141 Nantucket: (508) 228-5911 Fax: (508) 420-4555 ,M CERTIFICATE OF LIABILITY INSURANCE - DATE(MM°D/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION� - MCShea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Osterville, Ma. 02655 -- 508 420-9011 INSURERS AFFORDING COVERAGE INSURED ------------ _____ __ Paul J Cazeault & Sons Roofing Inc. INSURER A_RQ�al &_Sunal_llanc�_ - -----Roofing, Inc. INsuRER B: J rae_h r_sI ndem t _ o1031 Main Coof__Illin. StreetINSURER C: Osterville, Ma 02655 INSURERD: - - COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION "----"—-- -POLICY NUMBER DATE MMrDDIYY DATE MM/DD/YV LIMITS GENERAL LIABILITY EACH OCCURRENCE __ s 1,_0-0.0,1_0 0 0_. COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Mry one lire) S X --- --I CLAIMS MADE I X I OCCUR MI_D EXP(Any one person) A PAC5912908 04/30/02 04/30/03 ---"------ - — PI_RSONAL&ADV INJURY GENERAL AGGREGATE g 2 J'O.0 0-1_O O 0- " GEN-L AGGREGATE LIMIT APPLIES PER: —"---- — POLICY PELT F— LOC PRODUCTS-COMP/OP qGG PO $ -- 1�_ -��Q CIL- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accideni) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO ___-- OTHER THAN EA ACC $ AUTO ONLY: qGG $ EXCESS LIABILITY rI EACH OCCURRENCE S OCCUR u CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION S — -- $ WORKERS COMPENSATION AND WC STATU- OTFI- EMPLOYERS'LIABILITY }[ TORY LIMITS ER 7PJUB-922X653-502 08/10/02 08/10/03 E.L.EACH ACCIDENT E.L.DISEASE-EA EMPLOYEE-$1 OTHER - E.L.DISEASE-POLICY LIMIT $ 00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 () DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENT 'TIE ACORD 25-S(7/97) 1.;!�-�L-..� �X {_... .,-._- O ACORD CORPORATION 1988 One Ashburton1 ; 01 011, Ma102100 r STI--;UC-rlory uh�h✓I ;oi; i_icr-WSi-: n/,1::n1 i1. l N �I I; n• : ':t ili -"I, li,li li.r,rr,.:ll,l .unl ,.i..ni•� ul ,ulrlur-.r,, in.lrlir..,{I,u,. U0ARD,;01*= UU1LUINl3 W-GuI_!1'I'IUN;; LiconLu: C ';'FkUC�I'IOIJ ;;111'L:I VI:;C,I i Lxpiru,,;:10/20/;_OG:, Restrictud::00 MAUL J CAZLAUur 1535 MAIN OSTERVILLL, iv1A 02G55 (.(�_ "_`��i!✓Y'i1^ ' A,jj lislialor Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration . Reqistration: 103714 Type: Private Corporation Expiration: 7/9/2004 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault P.O. Box 2781 Orleans, MA 02653 - Update Address and return card. Mark reason for change. Address I- I Renewal I L'mployment -; I..ost Card ✓�( Vb9Jl.IJLl17GIOC2LCIL 0�����iasal,/uufe(.(a ` Board of Building Regulations and Standards License or registration valid for individul use only , HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 103714 Board of Building Regulations and Standards Expiration: 7/9/2004 One Ashburton Place Rin 1301 F Boston,Ma.02108 Type: Private Corporation CAZEAULT&SONS, INC. zeault 3h Rd. i MA 02653 --- ....— _ _.. ._. .__ Administrator Not valid without signature ,Assessor's office(1st:Floor): / / SEPric �a u Assessor's map and lot number �C� ""�!D /� u� �N � � i�41 .6 o�T"E to Board of Health(3rd floor): r S-rAL �N CO Sewage Permit number L �1�i" Engineering Department(3rd floor): ENV/R Oro ON�EA� Das19Tenic . qi.I rAea House number '° 6 �N N� vrr ww Definitive Plan Approved by Planning Board 19 LA 10 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only A P P R 0 V TOWN - OF BARNSTABLE arnstablu cc, arvat on Coin na.sBUILDING INSPECTOR 1✓ OR �c��_ —Signed Date I , TYPE OF CONSTRUCTION TA �Z —A C/ 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 7Z ��' �� ZG/ Proposed Use �r9N )0 Zoning District Y" Fire District H nT2os S(/AQ A Address Name of Owner v,ri✓� l Name of Builder k/ • A►y 1J or-'s'OYO Address 1 GtJ//1IPJ� /fit Name of Architect yo_e� Address Number of Rooms Foundation Pk Ac31Ze_k Exterior 6006?U r-e4P Roofing �i�©,QP/L. M Floors e%, =eni Interior Heating Plumbing Fireplace �4 Zm:-a O j Approximate Cosh �— Area 49 Diagram of Lot and Building with Dimensions Fee L CR Se-e, f A VJ A ry M 1 kxts��N � (J2clP615 e� s OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Bar regardin the above construction. Name Construction Supervisor's License �� I ROSSIMON, HERB �• No 34642 Permit For ENCLOSE DECK. i. Single Family Dwelling i Lot #6, 91 wat�rford Drive \ L Location - Owner- Herb Gros<sCotuit -mon` Type of Construction Frame Plot Lot - • Permit Granted October 16 , 19 91 Date of Inspection 42, 19 Date Completed 19co An ICE a �r 't too.ro. , 3 � \ DEPARTMENT OF PUBLIC SAFETY COMMONWEALTH OF 1010.COMMONWEALTH.AVE.. MASSACHUSETTS BOSTON,MASS.02215. r._.,.. LICENSE 10%31/1993 CCNS.TR., SUF'ERV ISI�t ` EXPIRATION DATE R€STRICTIONS. EFFECTIVE DATE- LIC-NO. 00 11/01/1988 041,7405 DAV I D O ANDERSON _ 34 WINCHESTER/�L1RL/ PHOTO(BUSTING OPR ONLY) FEE: 'a" .`SO 'DENN I S- MA 02660 . 150 v0 iy t � N _ VALID UNTIL'SIGNED BY UCENSE�•;AND HEIGHT. $ wia�i+`Eat SIGNATURE Of THE•, THIS DO& ENT MUST"i �* SIG URE Fy'UC CARRIED ON THE PERSON OF t THE HOLDER WHEN ENGAG- ED, ,OTHERS RIGHT THUMB PRINT , IN THIS OCCUPATION ° �'4 r 1 ZooMzez�1429 i • ��ei ��'y�•`�., TOWN OF BARNSTABLE ' BUILDING DEPARTMENT = rARIOT a TOWN OFFICE BUILDING ru t6J9. �� HYANNIS, MASS. 02601 i MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized.by BuildingPermit �02..... ......................................................................................._....................................... issuedto .. .. �1.._ I................................................................ . ....»......................_........ /.. 1.. Please release the performance bond. i Ur t - - t f r - I, 1 �1 1 L 'L Y . S f I I I If I ! � x 1 - } rus 4 + - - J ....... . _ v - r �f _ i - , .. . PT-- w tat"- q---Stfu�n \ w�c.lo�un�-_. ._ nl cu . 4 .....__ y,yX b_PT os+ G roe. 1 . u -77 - --- - -. ............... I _..�- - I � -- : ( - - - I i I I l 11 . I --- New I' 1 1�4 I I l 1 � i•j i r I 4 (� : r l `II t { I L—I_ —�_- T Ll 6"o C : PT Sc�t'SC g 5_t�v+� ��u sh M,S� ---- - O ape• D C. -- 1 YEy ...__ I J _... - I : _I I : x ash I --- -------- I {- ----- - - k u IJC.A. t R� PC peck INc oS'URF (�2 �R- 7ti1�.'�.:... ��tiz,o��moLv �_t�t...)p•��i�"�a�,d p�� Coto 1�:F mp .. aal�S " J oS L) �_ � T'• ^ 1 fiat �RAQ y z n . z LL . ,,. .. Coto I a - ' g Y F � v C I �1 CGOe , ' r` x n � e d _ , l Q nr1(� 1 f r 'T F la , �r F s Assessor's office;(lst floor):`". /1 Assessor's ma and lot number !....!...p sf° L/� oFTHEto P {�.; �' Board of Health (3rd floor): Q�ccyyl2f ! `O�Q ♦� y ..........Sewa a Permit number ........ BA"STLDLE, i Engineering Department (3rd floor): co 1639• \e� House number ..............`1./................................................:..... o war a' Definitive Plan Approved by Planning Board _____`':I— --------19________ . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... ..................................AJ Te U r /9 _5//tJ� L F �-7 In/L`/ �� 51p,!5 riCA= ........................................................................................ OO TYPE OF CONSTRUCTION .................. ..........l)........................................................................................................ ......... y 1------19.. .9 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �,OT IJ.4r,-4r-'o� D 19RIv, Co7u r Location ....................................................................................................................................................................................... Proposed Use Zoning District .................................... .............Fire District .............0 Cl T 0 I ..................... ................................................... Name of Owner 4 A Y.J./06: /3 4.6.G.......� :.....Address 1,2 d . /3 6 X 9� e �/tjre,� V 11/ o 5 Name of Builder — ........................Address fl I Name of Architect . 0......1 13A15DA-:-AJ C 07 v f r' ..............................................Address .................................................................................... Number of Rooms ....................�............................................:.Foundation .f. .E[......C. .....T`.:......................... Exterior C.i !gP/3U /E'Q.....I....-)/II/ 6C ,,.......................Roofing .....o��/�ff✓�L C ........................................................................ ©/�:K 9.7 Rr.T.....?`"...V<N Y�- �11UA � ('Y/'s 0 Floors .........Interior ... ................................................................................ Heating �211:5 14:/RtFi) .../'/O.T...1,Vr�T/". '..................Plumbing ...!) /C•.T.C'.�p,,,5=�C' a s 64 r/Y-. w, Fireplace CON,,k'1 . Gam... ?LGC�.... .... . ................Approximate Cost ;?a �4.00�...... .. .. Area 4i Diagram of Lot and Building with Dimensions Fee i I �I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... ..................................................-? 'Y �-� / /........................ —G Construction Supervisor's License BAYSIDE BUILDING CO. A=56-002—TOO of 0 No ..,33003 Permit for ......1 z StorX Single„Family Dwelling Location 91 Waterford Drive ..............I............. Cotuit ............................................................................... Owner .Bayside Building„Co Type of Construction ....Frame ......................... ............................................................................... Plot ............................ Lot ................................ Permit Granted June 22 , Date of Inspection ....................................19 Date Completed ......................................19 r.r."�'4'•-•'++fN.t �r `:�I'r*' r-•�,.sYNi..r'=+roa.x�+i�` rMT+f'vn." -w^'S'y',�'''{•n:�e-,..,.ra+::s"..v'^rr.✓17`-+vs,++'k�*�':`�*, ` .. �.���,s, .. �•n�'r• .^mT ; `'.• .. r'+tir.r � y/'4 'Mid.. - ,� -�"''-M"'�•" eht7"+'nr+K� .r'1r-::>-^r-.--,/"'^' Assessor's office(1st Floor): ,c #/ Assessor's map and lot number � J/� d Z ^0; Xo 6 poi TWE to` Board of Health(3rd.floor): `�Q��� ♦w Sewage Permit number? Engineering Department(3rd floor):R _ = t+Aassrsnt t �j/ � rus House number i639' Definitive Plan Approved by Planning Board 19 �a M1, 6' APPLICATIONS PROCESSED 8:36-9:30 A.M.,and 1:00-2:00 P;M'.only a u TOWN OF BARNSTABLE w BUILDING INSPECTOR 1"CV-1\O OR PERMIT TYPE OF CONSTRUCTION. �// /6 Kl< �GC. li 19 TO THE INSPECTOR OF BUILDINGS: { k The undersigned hereby applies for a permit according to the following information: ��G Location / .� � � /biz � �� i - oC�G 313 i Proposed Use Zoning District Fire District Name of Owner S/rVLD X7 Address Name of Builder A J • H ►j 1J YJ Address Name of Architect �� Vl � Address Number.of Rooms .� Foundation_�c',c�lh Exterior '-feJ�,J 41.4�7'� Ci l�li7� �24etJ2 <<`Cloofing ,lxlc�d�C33e2. //!1 y� _A � Floors ///Ni/�/ /4 �,c n� � 6ig4 14V/ Interior Af2,'" Heating h n Plumbing ,` --�--Q/ Fireplace Approximate Cost Area ~ Fee Diagram of Lot and Building with Dimensions - -"--� I G4.a . f R8 8 S e c ; i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barn table.regardin the above construction. Name r i Construction Supervisor's License �� �� GROSSIMON, HERB A=56-002-01.0 No 34642 Permit For Enclose Deck Single Family Dwelling Location Lot #6 , 91 Waterford Drive Cotuit Owner- Herb Grossimon -� Type of Construction Frame Plot Lot Permit Granted October 16, 19 93. f Date of Inspection 19 Date Completed 19 i r goo