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Home My WebLink About0037 GLENEAGLE DRIVE�3� �s�� 17,2 Town of Barnstable U11Clli1 9 P,o'st:This Cartl;So That rt�s:Uisib,le Fromthe�Street Approued�Plans Must be,Reta�ned on Jab antl;this Card Must`be Ke t 1, Where a Cert�ficatenof.Oc�cu anc bis"Re uretl such:Buildm shall,Natbe Occu ied until a Final„Ins ection`has been made Permit jlilt Permit No. B-18-1240 Applicant Name: ROLAND LANGEVIN Approvals Date Issued: 05/18/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 11/18/2018 Foundation: Location: 37 GLENEAGLE DRIVE,CENTERVILLE Map/Lot: 191 134 Zoning District: RC Sheathing: Owner on Record: LOPEZ,JANE L Contractor Name INSULATE 2 SAVE, INC. Framing: 1 Address: 37 GLENEAGLE DR Contractor License 180IV 747 2 CENTERVILLE, MA 02632 Est Protect Cost: $5,956.00 Chimney: Description: Damming Attic; 10" R-37 Class 1 Fiberglass to!.(73)sq-nsulation Permit Flee: $85.00 weatherization - Insulation: fee Paid $85.00 Project Review Req:" signed installers certificate required to.close�Permit Date 5/18/2018 Final: y .... Andw - Plumbing/Gas Rough Plumbing Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authoied by this permit is commenced within six months after"issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documentsfor which Lhi's permit has been granted. 12. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning,by laws and codes. This permit shall be displayed in a location clearly visible from access street or road ird shall be maintained open for public inspec on for the entire duration of the work until the completion of the same. ilk ', ' Electrical s <'' ` _ Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Bu�ld�ng and Fire Officials are providedon this permit. Minimum of Five Call Inspections Required for All Construction Work fi- w 1.Foundation or Footing �, ,,,,; �,,� ' Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MG 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 Num �. ......�... y.. ... .. ......... * �p/ Permit Fee. MA88. er Fee........................ °ri6l APR 24 ?0� r0V vN O f9 Total Fee Paid............................................................... ...... TOWN OF BARNST�ABLE� BPermit Approval by.. on.......... l............................ ................ BUILDING PERMIT APPLICATION P Map............ ..... ................. Section 1 — Owners Information and Project Location Project Address.3-2 61ene�q/�,� �,� ,GC m q o 6�d' Vill e e �y�U�`l rr__�.r_ Owners Name �o c. Owners Legal Address, ?-') fir. g ess 7 �evte�. G n. City,_� e a<<>i G� State Zip Owners-Cell # '7911—a.S — 4 9L E-mail a e O0ife -Section 2 = Structural U e Single/Two Family Dwelling Commercial;Structure over 35,000 cubic:feet Commercial Structure under 35,000 cubic feet Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Access®ry Structure ElChange of use Demo/(entire.structure) ❑ Finish Basement ❑ Pool . Fire Alarm Rebuild ❑ Deck . ❑ So ar 1 El Sprinkler System ❑ Addition ❑ Retaining wall [��ulation Renovation j Other—Specify Section 4 Detail Cost.of Proposed Construction c,6 P5-6• Square Footage of Project Age of Structure Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms (proposed) "0 MPH Wind Zone Compliance Method .❑ MA Checklist ❑ TNFCM Checklist De sign Last 4pdated::1W31/2017. Section 5 - Work Description �9 ke-,r o-,Pe 4=0 s , lAciCci/Y1ds- or 9Co 4l90�" �z�e. K/�arP 9� LSAK6l� e� 6Cor�yl Section 6— Project Specifies . ❑ Wiring �il Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas 1 ❑ Fire Suppression ❑. Heating System ❑ Masonry Chimney ! ❑ Add/relocate bedroom ;t tf i Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility:. /' ve'cPs: d I using a crane C' Yes ❑ No Section 7—Flood Zon Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes}❑ No ❑ Section 8—Zoning Infor ation Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage T,, 4 of Dwelling Units(on site) Setbacks Front Yard Required Propo" d Rear Yard Required Proposed Side Yard Required Propo; d Has this property had relief from the Zoning.Board in the past? Yes ❑ No Last updated: 10/31/2017 Section 9-Construction Su "ervisor Name &�� e-a/xL Telephone.Nurnbe` F o 8'-S6 77 .2 0 <; Address V/D C vo v e S 9, City LCl2"�ey Stat� �� Zip da 7a--D License Number Id 3 F(b f License Type LJ E),piration Date Contractors Email 4a�gS'WI2I-IoZ Sa Oe,4f-Je- .ell# -7o a I understand my responsibilities under the rules and regulations for Licensed Co istruction Supervisor.in accordance,:with 780 CMR the Massachusetts State Building Code. I understand the construction insl ectjoh procedures,specific inspections and documentation required by 780 CMR and the Town of.Barnstable.Attach a copf of your license. Signature Date Section 10-Home.Improvemen Contractor Name ` �o�ro � e U i A Telephone Number 6-0 il—6-6 2 Address 1-6 j/e S(jL, City r 6/le P e Sta Zip ® 2 J-O Registration Number /Y'd 21,17 Expiration Date I-understand my responsibilities under the rules and regulations for Home Impro iement Contractors inaccordance4ith780 CMR the Massachusetts State Building Code. I understand the construction insl ection procedures,1specific-inspections- documentation,required by 780 CMR and the Town of Barnstable.Attach a cop .of your HIC... Signature �'G� Date Section 11 -Home.Owners Licen Exemption Home Owners Name: 42 e Telephone Number Z2c/--a7S,f- 09L69 Cell or Work NUM r 7?r—Cf79 I understand my responsibilities under the rules and regulations for Licensed- truction Supervisor accordance with 780 CMR the Massachusetts State Building Code. I understand the construction in ection procedures,specific n spechons;and documentation required by 780 CMR and the Town of Barnstable. Signature e e emu_ Date 5 l er APPLICANT SIGN kTITRE Signature Date Print Name Teleph. e Number Id --4-6 - 2� E-mail permit to:h`S a 174011' f u s a 04-. Last updates. 10134/20,17 Section 12—Department Si, n-Offs Health Department ❑ zoning poard(if required) ❑ f Historic District ❑ Site Pl Review(if required) ❑ j Fire Department ❑ Conservation ❑ For,commercial work,please take yoi ir plans directly to the fire artment for approvak Section 13-Owner's Autho ' Lion 1, e Go e-z- as Owner o the subject property hereby authorize 1�d h a%'L to act on my behalf, in all matters relative to work authoriz d by this building perm application for: (Address of job) Signature of Owner date 00 cz Print Name La t updated: 10/31/2017 I I . :.... RASE Enwneeift S EYupvat:4veaFne,SFrutb'3f9rmi�th,'►YA 4Z66S 58-3b8�tS3&:X3 FAX �118-a"(8r1$33: Page 1 PROGRAM rt m coaTl0 4`r is�o MTa sEsu Asa CVSTOAfFR.. .,. .. aFiats aaiTE .tA E L LUPEZ ( 74)25'.I-4f9 t��r r?€' O68075 .15404 SERVICE STREET 9llAFNfl:8tficET 7 Glenea I DrivE 37_CrIeni:;agle:I�riive; SSE CrFY STATC,2tiP Fisa,YJN6 CRY9TATE;ZlP Certtervitle;AAA:.62632 Centerville,M 02 `32 ,IOB%DMRWrIOR S F 3RA€rE'BAttRtEl2r Hvmeoti iter is rapons16 fair the reTtityv41 of the.'"stored Items blocking the iirctallatlon of ��_ u�atberizstitlkF�torTt.tFi;tYtc.attic.' Remoyal,itFtra�t gccia'prtbr to th¢selF�tulcd E><orlestart. � . S l [tACTE BARRI i.Homemwr FS rrsgotzstbte€or the removal of tie sic*items#slcxtc„ rife'Fussallattopt crf a ti{ enzatign work n.the basement Removal Frtug occur priior to ibe:schrduletl Work star# STOOGE,:BARRWR:HofnedVA r is responsFt�for the itki&al of the::st .items blocking the nistatiatFon'of f vvcruhenation work ts[:the gate Remoyui mtksi occ ur pnor:to thg scl%duled:'Mork start llAi�IMiPTCr;Pegviiie labor and:materials to install s:12�iay eemf R,38 unfacedfib $less liana to(73}square f for dart�musgptFose& ila$ .. _. 4TflC FE ftT PrdvW t*m and materials to Install:a l6"layer of R,7 Cta t.Geilularse:added ur(8.54 sgaaax feet of ti attic space. $F3Z6 00 A Tf!C ACCESS.l rouxle lat�tFt-an6 tiatzerials.to:install(j) easitu moved,insult carer far the attic amass f idmg stair. A small.flat �. $ spi face of so ptytiveod vt7l be crested arotr i the pp£iFatg ztl►ti;the attic; This wilt.altcnv Uie coves iri490 u�ttr�s-str+l!P!?I&co•testiiict ais:leakagts: VEAITII A fFOAI'pixwide la r;and_mateeiats�o inl sentilaisen,ebuates Fn(lair};r stal .F&zr bays to maintain air tl9w. 1kTt3�ATL()N.Pccvide lvr;3end materials w iFistall(I§mslilateii C itFaust hose with roofteil•IYapperetjt tt>exlieust.eltFstirvi 183 batltroa�n:fam(si Brnsnusodcl:#'fr34vrequt�atenc: axbaust CAI T tl 411pN.Prof ide taba€,and tnat tals to Fesw!(!}insulated exhaust r ittotFtt[a;l flapper vent to Sure:: al 18 9S :: BATH:b6tJ iIST FAi�IS .]n::or or th mailttat►t hesitli�ittiloar air gtFat?:ty and remo�r sxeess rnatstFtr e curry frill tin batftr4©m should have an exhaust fan:vented tc the oatdoors.rc presade ist least 5tl cube feet per tnvotc{Cftvfj of venttltttioti::dour borate does m cusTenUy haFe eu€xg iFtf tiatltroont Trent$d:stissl:it:is our stiiag'ronFmentlatioiF YOU cans Iseer insta i'ng tltet t sn:ilFe Tteai'futitrc, 7 his is being brotFgtit to voFv"atietFEton to identify it:as a,pre=axtstm condition to;t r e wea(herFzailon�rork. plaFtned!or your haape,I'vtu:s gnatuec:is;ypne aeknc:wledgetr pt of.these co ditlons trill agteetneni to.prvice :: YEA'TtLA`t`JC1N.Provide T and�natierials to ns�lf for(l6}perated soft panets.to inctem.-ventilation,to attic areas. 60' I - A L SEt t[l*lG f'rcivide talFor aid materials to sW areas Of,your Jtcsme:anaFttst�tiasiefisl excess air leaf age I his ismrl will be peiforFtied 588ft;Qt) Fi concrct ivtth the use of spec at tools pd diagFFsistFe msta,to assure ilaat yOIff 3wrne will b left�t Ftli a tFealtlt#stl revel irf ilir exc s slid anchor ear kt3-Materials io be used to sCW.yonrhorrie caq include cauLdts,.foams:wiratnerstri mg atid;pther.proitticts Primary. areas for seatins nciaclE air tee to attics;tiasetstents at4aelt+d;�arages Mid uttbeatect�Feas;(i*tdows<are t�ge�terally addresseo} E I t)vrortttag hmrls. A reducnon m enolc,feet per miiwe.(04)of air nFfslttst an wtA ,but. 0 actual;n�tm p#gfttt.s tx>t'guai�iitead. ;:. lLrAl E S,.l:iirnisltAfid tr>statl,bRYWO in Elass t Geliiitose to.(l(l s6}square tee t of.v nyt-sided ex enor:oi tits fnvaicing wtll itcctar�poo ��:�:' ' ettaia of: irFstailatton: ... BrISEI i CFI1 SIG Frovidc l old mate€dais to.insiakl(1d4liner f _c f R l9 unfed fibs tttsulslton tti tti # riFrlrof46 Rill. #Pebasats Mcxifth'g:#iber bow. ill., RISE Kuffih anug , M- u a . I+GINI:ERtt4G' a . 5UB-5 &!9 X-�i2Q5 �:armo Fi433 Page 2 PROGR �s cACT a3 eNrmEu ursa BEN . CC.C-HES:: aKoaciecr�s; _m ..._,, ... DAM ^:apt s 7A�(la 1 6 ' t 47I. ST=09Ib 04 LOPE ter:sties - 37 G1etagle.Dri e 37 Gleneagle Drive stERVTG6 LIMY sUft-IIP BiCGlN6 tFTY 8TA7E AP CeitlerVille;MA 02632 Centenlul ;MA 02632 �Ntx'.:Pmv�de.tahor aAd na#enals,to�nstalE l 1 R e3s 3t nell;fw neeseml4�epriaucsnge#rQm,tielos Holesdnite a:kbna ltto b(el.2t6o)squareP f1eaegts oKf�e�ix teer tax $:5.90 . .... oat ave iang licaed. Wb.fdrilling or in tntui watt beahe entb rxtetror s ckte and:IrR in n tetatiei smuo.Sb condiharY:Rprsh.s andl and toitp ia�s#tmrers,r�spans�biliiy .. � : 73tit2II�IGEtTI�tE E3CPLAlt+tEFY Rt$E EngmeeFzn$wilt apply att:.appl¢c the ei�g�ble iieent�vss end yw will brtled canly Ilia net amount CurrendY fur a wbte izre$sum,tlte:Cape:Ls�}ii etiinP t mPier s 1�10 snculatian mct ntive,;wi h nts tccnrt as tf c amomtt,.Aiicl an u€centiye of't Ot!°�fc+r the:. Ali;srairng r►iessures: .. Tow'. $61—M 9 . P. rt#gram icn#Irna. : 1# 73 Cus#:om�r�trtal $1,��9't 2 WE:AG§i HERESY Td FUI%4:SERV CES-CaE KEM tN AGCORsAKE NTH ABOVE RGA710N5.FOR THE Still OP *C}ne I h sand 7vvO Hill df4d Sixty';wNiire&12floo:t ists 'UKN Pa":"? ANa MP�,tQVAI,tiY ii E014`.iNE LUSTaMER AI<it#€E6 TQ PIPE trC ana Ill lN7ERES?OP 14t C11AR6Et3 ..��JNPA7419RLA?OGE AF?SR9D�IA'�.�E: ESBR/k8POR7AN6e6ATPJl4 aaa �Aif3HT8 L7F REi`.�ION r ........_._...-.. ' -,. . ..., .. wc na Nas F�a3seatN AM"ANCEOfCON�3AtT'17fEJ�oNEVR10Es. r?ats:At{�Ca BARE. -. Fs'. szsFabfsuFtr3o' nt�Jr 'itERfBYaCER9EC YFwJEAvttCRREDTaD4: #c: Tv o� �a.i+AYtt�it�eE;,M++DE;!�au7tl.AB �oF yµe tee .. Tow.. n.of Bnrnstable . to Services. .. I7 ;gula _. s SAM,STABLE. :. ... �.lell�l'( .V.$t' 11,1}lTeetor .., •.. . rngss. $Uildilr� Division gap 1639. �� .... _ Paul Re .. _ ... Bmldmg Commissioner ZQQ Main Street,: 'ann�s,MA;Q26Q1. www.town.barnstafale.ffiaxs Otl<ice:508-862-4Q38 Fag:5Q8-79Q-6230 rope _ wner us. ....:. . .. .. .. ... :.................................................................. ... C. fete and S' This Section..... .: ; . ..... ps I, SANE L�LOPEZ , as Owner of the sub ect:property _ _ ... hereby authorize (Q, � S�v � C, to act on my behalf, ia S _ in all matters relative'to work authorized by this permit appiZctian for: .: 37 Gleneagle Drive Centerville,MA 02632 _ _-(Address of Jobs _ ... _ .. . . . . Of_.. ._ .. I -- Date _A --- Print Name . . It Property Owner is applying for permit,please complete the Homeowners License Exempt<ou Form. ap C.1Usersldecollikkl�tppDatall ocallMicps osaftlWuwslINetCachelContt0utloak\L7U69LF21XPRFSS{2?doc 01725/17 .::: .. .. ... The Commonwealth of Massachusetts a Department n,f Industrial Accidents I Congress Street,Suite 100 < Boston, !'VIA 02H4-2.0I7 ¢ www.mass.govAilia Workers,'Compensation Insurance Affidavit;Bunt€ers/Conirxctors/ lecteicians6/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print_Legibly Name(BusineWOrganizatioW[ndividual): Insulate2Saye.Inc. Address:410 Grove Street City/State/Zip: Fall River MA 02720 Phone#;508-567-6706 Are you,an employer?Check the appropriate box, Type of project(required): I I am it employer with 20 employees(full andior.pait-time).' 7. ®I,iew construction ?.�.I ants sole proprietor or partnership and have no employees working for me in 8, E]Remodeling any capacity.(No workers'comp:insurance required.] 3,[31 am a homeowner doing.all work myself,[.No workers'cntnp,insurance regoired:1.t 9. Demolition 10❑Building addition �.1.am a homeowner.and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance.or are sole 11.o.Electrical repairs or additions proprietors with no employees. 12,Q Plumbing repairs.or additions 5. l am a general contractor and[have hired the sub-contractors listed on the attached sheet. . 'These sub-contractors have.etuployees and haveworkeEs':catttp.insurance.* 13 Roof repairs 6. We are a corporation and its officers have exercised their right of exemption.per MGL c. 14,[x Other Insulation 152,§1(4),and we have no employees.[No workers:'comp.insurance mquired.] 'Any applicant that checks box#I must also fill out the section below,showing their workers'compensation policy information, t tlonleowners who submit this affidavit indicating they are,doing all work and then hire outside contractors must submit'a.new affidavit indicating:sur h. '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 enivMover that is providing workers compensation:insurance for my employees. Below is the policy watt job site information. Insurance Company Name: Liberty Mutual Insurance Policy#or Self-ins.I ic.#: XWS 56418741 Expiration'.Date 12/10/2018 '. Job 0 a lam_ t / , Attach a dre of the workers'come anon o c declaration page(showing t t e tol'ac number N U` (�n-� �a 3 rail �� le, ,� no T. copy P P' y. p g { P y anti expiration date); Failure to secure coverage as required under MGL c. 152,§25 A is a criminal violation punishable by a fine up to$.1,500.00 and/or one-year imprisorment,.as well as civil penalties in the form of a STOP WORK ORDER,and a fine of up to$250.00 a 4 day against the violator,A copy of this statement may be forwarded to the Office of investigations of the D1.A f6r insurance. coverage verification;.: .. l do hereby certify uncle fire an a tees vfRerjury that the information provided above is true and correct: r : Stgnatu . Date e Phone#: 508-567-6706 Official use only. Ian not write in this area,to be completer)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.P unibing inspector 6.Other Contact Persons Phone#: . Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Ma husetts ..02.116 Home Improvem tractor Registration Type: Corporation (74 Registration: 180747 INSULATE 2 SAVE , INC. - '' Expiration: 12128/2018 410 Grove St Fallriver, MA 02720 Update Address and return card. Mark reason for change. 50A 1 0 20M-001 ....__ ..._ .__._........ _.._... . _. _..-..., __ :...C1..Ads ICI feval ©Employ#nent ©Lost Card Office of ConWrmer Affairs&Busteess,Regulation? HOME:lMPROVEMENT CONTRACTOR Registration valid for wividuai use only. TYPE:Corporation bef*the expiration data. "found return to: . €)WIVatI611 office;af Cortsurner Affairs and.8usin6u.Reauiation r 1212812018 10 Park Plaza=Suite 5170 Boston;MA 02110 INSULATE 2 f Roland.t angev t, {�,; 410 Grove St " `r� Faiiriver,MA 027� " $�;✓£ Undersecretary Not valid lnrltttout signature Corvur"weam"of Massa ttsefts Division.of Professional Licers"e soard o ds, Cons m.�. isrst RO AND FALUL RfItER' y �13'4f7Ssioner � e �� o CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDMMIDDIYYYY) 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). PRODUCER NAME: Anthony F.Cordeiro Insurance FAX AICNr o Lxt: 508-677-0407 AIC,No): 508-677-0409 Fall Pleasant Street Fall River,MA 02721 ADDRESS: hsouza@cordeiroinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual Insurance INSURED INSURER B: Insulate 2 Save,Inc. INSURER C: 410 Grove St. INSURER D: Fall River,MA 02720 INSURER E: 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N R VOL 51JUK P L Y EFF POUCYEXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE Fx_1 OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 5,000 A Y Y BKS 56418741 12110/17 12/10/18 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 7 ECT LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED S NGLE L M T Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED gpq 56418741 12/10/17 12/10/18 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS Y Y X HIRED X NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 * EXCESS LIAB CLAIMS-MADE Y Y USO 56418741 12110/17 12/10/18 AGGREGATE $ 10,000 DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ORµ AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A XWS 56418741 12110/17 12/10/18 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESEN r.^ ©19 -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r Town of Barnstable *Permit kR— Erpires fifi � U 6 montHs from issue date Regulatory Services Fee nn ? RARNsTAB><& = o U fMAE& Richard V.Scali,Director 9. i Building Division ,-" a_` Tom Perry,CBO,Building Commissioner r p 200 Main Street,Hyannis,MA 0260 DEC 2 1 2016 www.town.bamstable.ma.us OF 8 HAf Faxjj508-790-6230 Office: 508-862-4038 d d EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1 .3q Property Address .37 G an ea g le JY �'�'1�'�✓t �/� residential Value of Work$ tp, / s 0 — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address --rane- Z e 7 (Sterl ect r, l `��. 4ewv; !Ie. 2- Contractor's Name W T Vol r N F, Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) 07 2-:7 7 Z.. YVorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name fffA'RTiFD1 'f'11Z,i: 11US[l%2i�X-�C In "IC� Workman's Comp.Policy# 22 W�-C-t--T Z6 3� 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) ❑ side [Replacement Windows/doors/sliders.U-Value - 2-9 (maximum.32)#of windows (y #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE. C:\Users\Deco)1 jtajc1a;1;\�Mierosmdowffemporary Internet Files\Cbntent.0utlook\2Pl0i WEXPRESS.doc Revised 040215 Window World of Boston,LLC :MA HIN Registration Offices&Showrooms Number. (YLL(�i ❑15A Cummings Patio L7 295 Otd Oak Street 166025 Woburn,MA 01801 Pembroke,MA 02359, Federal ID# (781)932-4805 (781)826.6281 27-1461665 ,simply fire Best for less" www.WindowWof1dof8oston.com h Phone G Customer. () tnstall Addr 1ZPhone(w) City: Ile- State:MA Zip -mail WINDOW WORLD GLASS OPTIONS 1000 Series Sin le-hun Alf-Weld $189 SolarZone Elite $993� 9 9 2000 Series DH Mech/Welded Sash $195 _____Triple Glazed T02* $175 134000 Series DH All-Weld $205 ('Series 6000 only) _6000 Series OH AIFWeld $240 WINDOW OPTIONS 2 Lite Slider $334 _Glass Breakage Warranty $151NCLUDED 31-)te8lider nu,lta,lui nr4.mim $525 _112Screens $91 CN LURED Picture/Fixed Lite $334 _Foam Insulation on iambs and Head $11 INCLUDED _Awning $260 ~Double Strength Glass _ $15 INCLUDED _Casement $2g0 _Double Locks(>26") $5 INCLUDED _2 Lite Casement $575 _Full Screens $22 _3LiteCasement waru,lnf m+.imm $860 —Colonial Grids(Conioured/Flat) $45 _Basement Hopper $334 Prairie Grids $51 Diamond Grids $69 _Bay Window-Soffit Mount/INS Seat$2660 _Simulated Divided Lite $182 _Bow Window-Soffit Mount I INS Seat$2785 _Tempered DH Sesh(BSO)(TSO) $65 _Garden Window $188( _Obscure Glass(BSO)(TSO) $35 _Specialty Window $ _Oriel Style(40180 or 60/40) $30 —Beige/Almond $40 _Foam Enhanced Frame $35 _Wood Grain Interior(Series 400016000 only)$1 CO PRE 1978 BUILT HOMES(Federal Lead Contain f Law) (LoQak)Dark Oak)Cherry I Fox Wood Lead Safe PracticesRectudred $2 AchAfaple) MY HOME WAS BUILT IN THE YEAR Initial Brown Exterior(Arch.Bronze I American Tenn)$100 Designer Color Exterior 55 t MISCELLANEOUS Custom Exterior Aluminum Cladding ❑Textured ❑ mpoth G-8$75 $_ Window ColorA �/ Facing 'ob�G�IJ lam. Inside Ou side Metal Window Removal $50 . NON CUSTOM DOORS �Now Construction Vinyl Removal $175 Vinyl Rolling Patio Door 50.or OR, $995 _Speciafty Window Exterior Trim $ _Vinyl Boling Patio Ooor SR. $t095 Mull to Form Multi Unit $30 _Add to base price for Custom lolling Patio Door$1150 _Install Interior/Exterior Stops $50 _French Rail Sliding Patio Door sit.or eft. $1225 _Install Interior Casing Starts At $95 _French Rail Sliding Patio Door BR $1395 ^—Insulate Weight Boxes $20 _French Rail Sliding Patio Door sit. $1495 Roof for Bay/Bow Windows $500 _Custom Exterior Cladding $150 ~_Existing New Const.Ext.Retro Fit $160 ' _SolarZone Elite or ETC Glass $178 _Removal of Existing Bay/Bow $250 _Grids Patio Door $12E Repair Sill,Jamb or replace sill nosing $50 Wdodgrafn Interiors $E95Full Sub-Sill(Single)replacement $150 _Exterior Designer Colors $ Mullion Removal $30 _Interior Casing 212 V2 $175 _Bay/Bow Conversion Ext.Retro Ft $350 _Handlaset Options $ (New Siding Will Not Match) $— _Building Permit $16LS(= Door Color / �ROUND UP FOR WINDOW WORLD BARES, Inside Outside X:f t lei tl� iob=})fir Agp Customer declines exterior wrap and understands aiming and/or repair may be required Initial Customer declines grids on windows/doors Initial DISCLAINIEB:Customer is responsible for the following In connecdon with this contact Panting,Staining,Alarm System diseonnerNmunnect Building Permhfees is excess of$25.00,Homeownerand or Condo Association Approval,Hlstork 0lstdcl Approval City of Boston p4hrg&sidewalk Permit fees in connection with Installation NO EXTRA WORK IF NOT IN WRITINGI Customer agrees to the terms of payment as follows: Extra Labor&Materials $ Site Set Up,Disposal&Delivery Fee $ $195.00 Total Amount $ Q _ Custom Order Deposit 50% $ Ck# Balance Paid to Installer upon Completion $ ll/1 Amount Fi anced $ Window World of Boston anticipates starling this vrodc on t V and being substantially completed in�Isys.Security Interest Yes Any deposit required in advance of the start of the work SHALL DT exceed 331/3%of the total contract price or the actual cost of any matedai or a Ipme of a special orderar custom made nature,which must be ordered In advance of the start of the warxto assure thatthe project will proceed on schedule,Nognal payment shall be demanded until the contract is completed m the satisfaction of both parties. All home Improvement contractors and subcontractors shall be registered and that any Inqyuires shouts contract ar subcanbactor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,Tan Park Plana,Suite 6170 Boston,13A 02116.Phone:(517)973-3700 No work shall begin prior to the signing of 149 contract and transmittal to the owner of a copy of such contract. Window Wadd of Boston under provision of Chapter 142A of the general laws is required to apply for and obtain all construction-related permits.Window World of Boston shag not be deemed responsible for delays in the work described In this agreement caused by regulatory,permit granting agencies,authorities or individuals. Nonce:If the PURCHASERS)chiefns his own construction related permits for We work described under this agreement or deals with unregistered contractors, the PURCHASERS)is hereby advised that in the event of a dispute,judgement and nonpayment,the PURCHASER($)will not he unfitted to make a claim or collection from the guaranty fund established by chapter 142A,M.B.L You the buyer may cancel this bransacillFin at any time prior to midnight of The third business day after the date of this transaction. Notice of cancellation must be in writing postmarked no later Than midnight of the following third business day. ORDERTHIS IS A CUSTOM Indo "FranchisersIndependent owned and operated b window Woddat 86soin,LLC,undenccensefromWindowWand,Ire. Owner.D n sign if thelfe are any t nl paces, Date - I �) L — sane an:Do no n if there are any blank spacea. Date Owner:Do not sign If there are any btank spaces. Date 1 ennan 07.16 White copy-Original 'Yellow Copy-file Plnk Capy-Customer esyeevenunaeeeae�111s i iassachusetts Department or pubiic Sa`ery Board of Buildino Regulations and Standards _icense.CS-072772 JEFF CSTEELE 24 SHERWOOD AVE DANVERS MA 01923 Commissioner 04107/2018 O_ITce of Consumer Affairs&Business Regulation . HOME IMPROVEMENT CONTRACTOR. Registration: 166025 Type: Expiration: 4/1212018 LLC WINDOW WORLD OF BOSTON,LLC. JEFF STEELE 24 CUMMINGS PARK SUITE 15-A WOBURN,MA 01801 Undersecretary I i - a . i I , } I I License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 riot valid without signature I I M . i i The Commo wealth-®j 11`€ssachuseus Department ofindusvialAccidengs Office of In-ve adon-T Ld I Congress stpee4 Snake-7 00 17 Workers' Co=-pewaflon Insurance da d Buflde,slCOM-L-ri.ct®rsl-ViLetV cians/pl ers Plo w Matt Lejdbw ;v^=r-, e �*=siness/Qrgnizaiionfindividual): WINDOW WORLD OF BOS x a� ��C. �:_e&,es,:24 CU MMINGS PAR S:Jf t:L 15-r", L - / 1AfCSttRN. VI 0180 i �:!$ 932-�8C5 C.-_v tGl eil71--P._ Are yap ai;F a i®yes? Check the a props ate hex: Tie ae ect +;gea ea?: . 1.ICI 1 ama employer with 20T 4- 1 am a general contractor and 6, Gi New construction. ? have hirede sab-co�iacto�s employees i andlor part-time).* _ T '7. Remodeling � i 1 am_a sole prop-e€or.or Gartner- listed one s_�ached shee� - i These sub-contractors ha�re 8_ Demolition ' i ship and have no employees - I employees and hale'workers- IQ. g,addition wo�cug for mein any capacity_ r � �uildina i _ comp_�su:ance.= Electrical os additions 'GIs worlce=s' com _ass ance 10_�: CtCtcal2pat=s I {� F' ? � !^.le are a COS pOi'aIIOII aL�1�S ? 1 required,.1 -� �,o— Pl t, g, or additions `' ; ► i atn a hcaeo�'ner doing all wort: o ucers hove exe=cised� �__ l I_�j �-bin� t� i �.t of exemption per inn �., i _ coofrepai-s myse'l_ ! o workers comp. _ ? insa-zceWe l 3_Li ther O - emplovees. _�To woti>e_s t ; (a COMP. insurance required !'c�10 err applicant that cbee s box=l must also fill out the section below showing$sets workers'compensation poiic}�i�ortnation. fiomeoa hers who submit this a-cdavit indicating they are doing all work and then hire outside contractors must submit a new af`ndavit ind'c nF-such. tConmactors that check this box-must a achee an additional sheet shonmg the pyre o`the snb�onn~�c[ots and StSte whether or not those entities have ernpioyees- Tf the sub-contractors have employees,they must provide their workers'comp.polio.-number_ Ctrac err e jr%2fled `u`ECc?S 3r FiVirtet`ca i�?PfCPt"S�CO?c?�7e!'S O�� SeFr�F2C?s'r'F rF j�S9�i �GvBG'�. eY�i�«s?�Le �f� dZ3�t ©b S ee T�ctrrartCe Cernpany�12s71e: nR !=C3RD F RF SURf=,M COMPANY -- 22`VECL?2E35 ;;,piation Date:01/27/2017 `:olicy=or Self, ins. �2c_ . / col; Site Q�eress: J l I'. Ci�r`Staie, ip: ( pnfoi'd��e d�— Ete co?, offtie ®riae�s' c�npe�sa�® ® c� deelarade-,page(s a a e ®liar �e�a�er �es •aata®� xze?. ailu�e to sect-ccveraQe as required under Section 25 -ef-IIvL c. 152 can lead to the imposition or c;munal penalties ei a h a En e i.�to I 500_0ti aZdiar one-year imprisonmeiZ% as well as cT penalties in the ford of a S i Op I�iTC J i an c fine e violator. Be advised mat a copy of his S=ement may be forwarded to the Office of clap to 525,:r:.00 z eaJV asainst,� _ 1Lvestiggat=ons ofthe.DlA forE rar--ce cove3Lgojefificattoa. ar o el t� �u' s�rzii a :eS qf, eekr- :�iQe above is Sze and co d^. isiiltre: a , Sate: � ------------ V e3i. -ITYa-nor'W!-ftE cFt this Lei 8G7 to be Co➢?pL. ed by c;'v or f0wit 007cw i t i EET�"_99U+yCe se Y T ssz g�Lclaoriqr(_iz=ele one;: Depa ent 3.City/`z:r 6.Other Phone#` � .. t Ce�atact ray soaL: • 9 I - WINDO-2 oP ID:" h �1 ACO�t©" DATE CERTIFICATE OF LIABILITY INSURANCE �n� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY EXTEND D coNFM NO OR ALTER'niE oU�► ON THE AFFORDEDCWMCATE THE HOLDER-q� CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, S HE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( 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 tthe the terms and conditions of the policy,certain policies may require an endorsement. A statement on this ceriificate does not confer rig certificate holder in lieu of such endorseme"s). wNr F C.Timothy Ward,CPCU,CIC PRODUCER NAME Senn Dunn-GSO �° 336-272 7161 18&FAX Igor -1397 3625 N.Elm St &OREss tvA� nndunn.com Greensboro,NC 27455 wuc C.Timothy Ward,CPCU,CIC INSURER(S)AFFORDING COVERAGE INSURER A'Crftans Ins Co of Am�iea 31534 INSURED Window World of Boston,LLC INSURH2B-4u+4-Flrw�Benm 1�82 118 Shaver Street INSU[�C:ffart[ord Fire Insaranee Co. North Wilkesboro,NC 286S9 [MR�ta' iNSURER E INSURHtF: COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSU ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD WITH RESPECT To D. INDICCER7A ICATENOT NOTWITHSTANDING OR MAYPUIREM THE INSURANCE AFFORDED BY THE p CiES DESCRIBED HEREI OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT SUBJECT TO ALL THE ICTHERRMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. M099999— i P°UCYEFF POLICYEXP I LIMITS INSR TYPE OF INSURANCE I i i POLICY NUMBER 5 1,000, A LTR X co>rIeERCwt GENERAL LUIBILRY I I EACH OCCURRENCE DAMAr OB6790252707 0410112016I 041Q1120'17 j PREMIses = ' CLAIMS-MADE X,OCCUR I 1 i t {MEp DCP(Anyare pin) - j S S'O Business Owners I i I 1,000,OO 2 Dj i I I PERSONAL&ADV INJURY 1 I f TE ,s 2,000,00 I GENERAL AGGREGA GW APPESPER: + 2.00 +00 PRODUCTS-COMP/OPAGG POLICY 0 JPRO- ECT LOCP, ( ( f S OTHER: ; i { I COM SINGLE LIMIT I S 'i,000,00 AUTOMOBILE LIABILITY B X ANY AUTO '• �W687576`15 106116f2045 106M 612016 BODILY INJURY(Per person) I- i ` i BODILY INJURY(Peracddem) `` ALL OWNED i—1 SCHEDULED i ' PROPERTY DAMAGE Is I AUTOS i I AUTOS ; NON-OWNED i f eracadentl HIRED AUTOS �_j AUTOS 1,000,00 I x I UMBRELLA LIAR �-X--OCCUR i ' { i EACH occuRRENCE I S A I Exctxs Luse t CwMs nrAOEi i IOB6790252707 1 04101(20161 04101]2017 I AGGREGATE S ! i5 pm RETENTIONS I i { X i STATUTE I ail I I { ` 500,WORKIM COMPENSATION ! AND EMPLOYERS'LIAB111n iN ; I22WECW2635 0112712016I0I 12017 j EL.EACHACGDENT --- S C ANY PROPRIETORIPARTNERIEXECUTIVE I NIA ' I SOO,OO OFFICERIMEMBER EXCLUDED? �{ I EL DISEASE-EA EMPLOYEE S (Mandatory in NH) j I I EL DISEASE-POLICY LIMIT{S SOQ,OO It yyeess desenbe under DESCRIPTION OF OPERATIONS beh" { I PjD)EmMPjPnoN OF OPERATIONS►LOCATIONS r vEll)CLES(ACORD 90'i,Addffional Remm16 Schgdute,may be aAhehed it more spare Is CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE rwtar,,,cr,,,LED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE wrrr..THE POLICY PROVISIONS AVMROM REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved- ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD EAb `Own of Barnstable �. bl� �t�mic# M�3 ervices Fee a Richard V.Sca% Ix 1,pL�,j B� - aa .�� F aw Tom Perry,C20,i3u �� V 0 2016 - -- ZflQ Main Street,�[1� ►��tu1°A.ag?6!W www-fown bamstaable-mkus °'� TAB�,E Office: SO$-862-4038 Fax:508 790-6230 UAL ONLY lVa.pipareel Number N Not ValJB"ftautRax-Press'Tmprint Property Address 17 O/,ned-ho Df + "` -- W Vol of Wow Mhdmum fee of 535.00 for work under$6000.00 Owner'sName&Address L 2— Contractor'sName "- i?ona Telep[�oneNimiber�b1-7/� �. Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 1010 2 7 ' ( *011 nan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Corapensation,Insurmmce Inswwce CotiipanyName Worlman's Comp.Polio,,VV G C)/37s'/ Cop3*of laeurance Compliance Cerhiieafe must accompany each peeimE PcnnkRe (checkbox) / Re-roof OnnTieane nailed)(stripping old sbingles) All construction debris will be taken to(�Lg e,liana c i1d i ❑Re-roof(hurricane wed)(not stripping_ Going over ods&g layers Of roof) ❑ Re-ide ❑ Replacement Windowsldoors/sliders,.I7 Value (m•�m�nm 35)#ofwindows #of doors.- -0 Smoke/Carbon Monoxide detectors 4 floor plans marked with reel Sand moons required, Separate Etectaiad&Fire Permits required, ' °� 7�ceafibsspeanitdoesuutegempLcflmPliancewitho�toi¢n only ie.1�s,Cattsetvatioa,etc. *"Note: Property er "gnPmPer#y'Owner LettwofPerntissim. A copy of H ipnpr wement Contiractors License&Construction Supervisors License is required. _ SIGNATYJM T:IREVIld D�BmTdiaF,ChaageslE� RBSS dcc Revised 061313 HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: PLEASE READ THIS CONTRACT THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 908 Boston Turnpike Unit 1,Shrewsbury,MA 1545 Branch Name: Boston North Date:10/20/2016 Toll Free 8779033768;Fax 8009863610 ME Lic#C 02439 RI Cont.Lic#16427. Branch No: 33 CT Lic#HIC.0565522 MA Home.Improvement Contractor Reg.# 126893 Federal ID# 75-2698460 Installation Address: 37 GLENEAGLE DRIVE CENTER CENTERVILLE MA 02632 City State . Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: M/M JANE L HURLEY LOPEZ (774)251-0916 Home Address: 37 GLENEAGLE DRIVE CENTER CENTERVILLE MA 02632 (If different from Installation Address) City State Zip E-mail Address (to receive project communications and Home Depot updates):janelouisehurley(r�gmail.com Marketing emails will not be sent from The Home Depot. Project Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy,and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installati on")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary(where applicable)attached hereto and any Change Orders(collectively,"Contract"): Job#:(internal Reference) Products: Spec Sheet(s): Project Amount 9633313 Roofing 9633313 $14 318.00 Minimum 25% Deposit of Contract Amount Total Contract Amount $14,318.00 due upon execution of this contract Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As.applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# 9633313 ,included as part of this Contract,sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). 06117/14SA Page t of 7 r HOME IMPROVEMENT CONTRACT PLEASE READ THIS CONTRACT NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time of sign.Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor, expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law.THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVER OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Contract is the entire agreement between Customer and The Home Depot with regard to the products and installation services and supersedes all prior discussions and agreements, either oral or written,relating to said products and installation.This Contract cannot be assigned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. You are entitled to a paper copy of this Agreement if you choose. If you consent to an entailed copy,your consent applies only to this Agreement.By contacting sales office(R77)_gol-376R ,you may update your email address,with your consent,or obtain a paper copy of the Agreement at no charge. By signing below,you confirm the following: • You consent to receive only an entailed copy of this Agreement • You have access to a computer that can receive and open emails and PDF(Adobe Reader Version 10.1.4 or later)formatted documents. • Your email address is correctly listed on the Home Improvement Contract Submitted by: Accepted by: NUM JANE L HURLEY LOPEZ (Oct 20.2016, 6:43 PM) Christopher G.Read Customer Sales Consultant Signature• License Name. (877)903-3768 Customer Telephone No. Signature: Accepted by:CR10(Oct 20,2016,6:43 PPA) Sales Consultant License No. (as applicable) CANCELLATION:CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BI DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT.THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE 06/17/14SA Page 7 of 7 I f Massachusetts Department of Public Soetll Board of Building eegufatons.and Standards Dfcense: CSSL-101027: Cstr&--tion Super-visor Specialt-V NU ori F� Rt3hJALOO SOLANO 763 WAVERL`!STREET FRAMINGHAM MA 01702 '`;' -- - ------- -., - ------ Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA-02114--2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant.Information Please Print Le ibl Name (Business/Organization/Individual): Ej -ROOF//UG Address: 7103 W auer iv City/State/Zip: AIA A 6174'2. Phone#: TOR-316 •-!1 3 ya Are you an employer?CbeeV the appropriate box: Type of project(required): 1.❑ I am a employer with 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 me in any capacity. employees and have workers' insurance.$ 9. ❑Building addition comp.[No workers' comp.insurance p' 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its 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.E]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers®compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insuranc erage verification. I do hereby Eff nu e t#e pains a4 4naldes o er'ury that the in ormation provided above is true and correct Signature: z gen - _.._...._- ---._.._-- _._-_--A Date:__._.__...___..,._�____-.._. 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#: Information and Instructions - Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the.issuanee or renewal of a license.or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A.copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said'person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE. Revised 7-2010 Fax#617-727-7749 www.mass.gov/dia 0;!/ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home ImprovernentEon tractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2018 THD AT HOME SERVICES, INC ----- ------- ANDREW SWEET :h _.... _.-_. --- - --_ -. 2455 PACES FERRY ROAD, HSC C41 ATLANTA, GA 30339 ___ Update Address and return card.Mark reason for change. Address [-] Renewal ;_ ] Employment j_ Last Card "!/, Y,'r:.nutntla••rw�/ti rr''`7/rr.;Jrtrlvi.ir%l; �fficc of Consumer Affairs&Business Regulation License or registration valid for individual use only i� before the expiration date. If found return to: ];HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: _126893 Type: 10 Park Plaza-Suite 5170 Supplement Card Boston,NIA 02116 Expiration; 8/g/2018 THD AT HOME SERVICES,INC: THE HOME DEPOT AT HOME SERVICES ANDREW SWEET - 2455 PACES FERRY ROAD,HSC ATI'ANTA,GA 30339 Undersecretary Not v with ut signature i The Commonwealth of Massachusetts DI Department of Industrial Accidents ' - Office of Investigations ^ai I Congress Street, Suite 100 Boston,4 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers ppticant Information Please Print_Legibly Nan1e (Business/Organization/Individual): The Home Depot At-Home Services Address:908 Boston Tpk 'hrewsbury,MA 01545 phone'.508-962-6942 City/State/Zip: Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with p 200+ 4. I am a general contractor and 1 6. ❑New construction employees(full and/or part-time)." " have hired the sub-contractors listed on the attached sheet. 7. Remodeling 2.❑ I am a sole proprietor or partner-ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.- required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.�Plumbing repairs or additions myself [No workers' comp. right of exemption per aIGL 12. Roof repairs insurance required.] ' c. 152, §1(4),and we have no 13 Other employees. [No workers' comp. insurance required.] Any applicant that checks box 41 must also till 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 n:y employees. Belmi,is the policy and job site information. Insurance Company Name: New Hampshire insurance Company WC 015519215 Expiration Date:3/112017 Policy#or Self-ins. Lie.#-. nn Job Site Address: 3 7 I PnPa ti�!? �!• City/State/Zip:6p.7fenil tie A: 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 TMGL 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 r nsurance coverage verification. I do hereby certify u er pains andpenalties ofperjury that the information provided above is true and correct Simature. Date- Z' Phone#: 401-714-6 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.Othee n . Contact Person: Phone#• f I! ) ® DATE(MMIDDIYYYY) A !ev CERTIFICATE OF LIABILITY INSURANCE 02/18/2016 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). CONTACT PRODUCER NAME: MARSH USA,INC. PHONE FAX TWO ALLIANCE CENTER A/C No 3560 LENOX ROAD,SUITE 2400 E-M RE ADDRESS: ATLANTA,GA 30326 INSURERS AFFORDING COVERAGE NAIC# 100492-HomeD-GAW'-16-17 INSURER A:Steadfast Insurance Company 26387 INSURED INSURER B:Zurich American Insurance Co 16535 THD AT-HOME SERVICES,INC. DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshire Ins Co 23841 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003746646-14 REVISION NUMBER:8 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 POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY GLO4887714-06 03/01/2016 03/01/2017 EACH OCCURRENCE S 9,000,000 DAMAGE TO RENTED CLAIMS-MADE FTI OCCUR PREMISES Ea occurrence $ 1,000,000 LIMITS OF POLICY XS MED EXP(Any one person) $ EXCLUDED OF SIR:$1M PER OCC PERSONAL&ADV INJURY $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 9,000,000 X PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 9,000,000 POLICY❑ JECT OTHER: B AUTOMOBILE LIABILITY BAP 2938863-13 03/01/2016 03/01/2017 (CEO, D SINGLE LIMIT $ L000,000 Ea accident X ANY AUTO BODILY INJURY(Per person). S ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ — ._.:..HIRED�AUTOS-_...,...:.:ACITOS'_"_._..:-..+....._.........__.._....._,_.._�:_..._.M,._._.._..�.__-..,..:...._,..._ UMBRELLA-LIAB OCCUR EACH OCCURRENCE- $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTION$ $ C WORKERS COMPENSATION WC015519215(AOS) 03/01/2016 03/01/2017 X PER OTH- AND EMPLOYERS*LIABILITY STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC015519217(AK,KY,NH,NJ,VT) 03/01/2016 03/01/2017 E.L.EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? El N/A WC015519216(FL) 03/01/2016 03/01/2017 E.L.DISEASE-EA EMPLOYE $ 1,000,000 (Mandatory in NH) If yes,describe under Conitnued on Additional Page E.L.DISEASE-POLICY LIMIT. $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE,HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF,, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee Ma�wJDv . 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD � 1L40 ( � pFIMErp�Y Town ®f Barnstable *Permit# pExpires 6 monthsftom issue 1 de Regulatory Services Fee ■ARNSTABLE, �cb 639. �� Richard V.Scali,Interim Director prEO NIA A / Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 N Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIA ONLY Q .r Not Valid without Red X-Press Imprint Map/parcel Number I i f•�• • Property Address��G benp�- �r�\/� _ Residential Value of Work$ G,17.39Loce-z ' Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Irl81 G lenea le -D r i v e Ce n+-e r v I e-'s M 0. 0 ZC33Z 44.J.6oS Z4SVeC - eCtrS en 860 .753 . 0452. Contractor's Name I Telephone Number Home Improvement Contractor License#(if applicable))448 ^p07 EmaiI:�ECM I@ Gma.i I, C0m -! / ET Construction Supervisor's License#(if applicable) i :ti c; 11 XWorkman's Compensation Insurance Check one: El am a sole proprietor JUL 4 cu+�• r ❑ I am the Homeowner 1 have Worker's Compensation insurance Insurance Company Name Ac e Aymeri C Q ► 1 1. • Workman's Comp.Policy# WL RC -4 13 Z Z J 34 Copy of Insurance Compliance Certificate must accompany each permit. Permit R,ewiPct loheok box): '• NA ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to NA — ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) NA -- ❑ Re-side Replacement Windows/doors/sliders. U-Value Q.3O (maximum .35)#of windows of doors: NA —n Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&""Fire Permits required. *Where required: Issuarice: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-Flome Improvement Contractors License.&Construction Supervisors License is e ired. SIGNATURE: Aftb T:\KEVIN D1Building hanges\EXPRESS PERMIT\EXPRESS.doc Revised 061313 f Tlie Commonwealth,ofMassachuseas Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 0211.1 www rnass.govfdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/individual): Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL 32750 Phone #: 860-753-0452 Are you an employer?Check the appropriate box:: Type of,project(required): 1.❑ I am a employer with_ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full ard/or.part time).* have hired:the sub-contractors 2.❑ I am a sole proprietor or partner listed on.the attached sheet. t T ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein:any capacity. workers' comp. insurance.. 9. ❑Building addition [No workers' comp. insurance 5. We area corporation and its required.] officers have exercised their 10:❑Electrical repairs or additions 3.❑ I am a hom eownerdoing,all work right of exemption per MGL 1,1.❑ Plumbing repairs or additions myself. [No workers' comp: c. 152, §t(4),and we have no 12.❑ Roof rc�airs insurance required.] t employees,[Na workers' f comp. insurance 13.M Other required.] r *Any applicant that,checks liox.#t must also fill_out.the;section below 5howing their workers'comp ensation,pol icy inform ah.on. �� t t Homeowners who submit this affidavit indicating they are doing all work•and then hire outside contractors must submit a new a id avit: _tict�l v K/ lContractors that checkthis.boz must attached an additional"sheet showing the name.ofthe sub-contractors,and their workers"comp.policy information. I am an employer that is.provi.di.ng workers'.compensation insurance for.my,employees:.Below is the policy..and job site information. Insurance Company Name: Ace American Insurance Company / Phone: 866-283-7122 Policy #or Self4ris. Lie. #: WLRC47322534 Expiration Date.. 08/01/2014 Job Site Address: DH City/State/ZipCen+e ry i l le .* "a' Attach a copy of the workers",compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Seuion 25A of 40L c. 152 can.lead to the impositio of crw' nihal eralt&' of a fine up to`$1,560.00 an&or one-year imprisonment,as well:'as civilpenalties in the form of a STOP WORK ORDER and a fine of up to$256.00`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 cer ' un fhe.painsand nalties ofperjury that the:information providedabove is=true and:correct. Si na (Sears Auth.Agent) Date. 1�'!'— o Phone.#: Home—Fax : 860-935-0346 / Cell: 860-753-0452 Official use only. Do:not write in,this area, to be completed by. city or torten official: City or Town: Permit/License# Issuing Authority(circle one): L.Board of Health 2.Building Department 3.;City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other C.o.ntact.Person: Phone#: ACO DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE D7/19/2D,3 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 0 0 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED m REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 0 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 O) NAME: Aon Risk Services Central, Inc. PH ON ff (866) 283-7122 FAX (800) 363-010S y Chicago IL office (A/C.No.E:t): AIC.No.: .� 200 East Randolph EMAIL p Chicago IL 60601 USA ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED ' INSURER A: ACE. American Insurance Company 22667 Sears Holdings Corporation INSURERB: Indemnity insurance CO Of North America 43575 dba Sears Home Improvement Products, Inc Attn: Risk Management E3-219A INSURER C: 3333 Beverly Road INSURER D: Hoffman Estates IL 60179 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570050796993 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY MDOG 08/01/20130 EACH OCCURRENCE $5,000,000 X I DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $5,000,000 CLAIMS-MADE X❑OCCUR MED EXP(Any one person) EXcl uded PERSONAL&ADV INJURY $5,000,000 GENERAL AGGREGATE $5,000,000 m GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $5,000,000 N X POLICY PRO LOC o r A AUTOMOBILE LIABILITY ISAH08719780 08/01 2013 08/01/2014 COMBINED SINGLE LIMIT `O A ISAH08719792 08/01/2013 08/01/2014 Ea accident $5,000,000 A ANY AUTO ISAH08719809 08/01/2013 08/01/2014 BODILY INJURY(Per person) Z X ALL OWNED SCHEDULED BODILY INJURY(Per accident) - (D AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE to AUTOS Per accident N UMBRELLA UAB OCCUR EACH OCCURRENCE L) XCESS LIABCLAIMS-MADE AGGREGATE J�E ED RETENTION A WORKERS COMPENSATION AND WLRc47322S34 08/01/2013 08/01/2014 X WC STl S ERH EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN - CA MA AZ E.L.EACH ACCIDENT $2,000,000 B OFFICER/MEMBEREXCLUDED? NIA WLRc47319122 08/Ol/2013 08/01/2014 (Mandatory in NH) All Other States E.L.DISEASE-EA EMPLOYEE $2,000,000 It yes,describe under .DESCRIPTION OF OPERATIONS below. - E.L.DISEASE-POLICY LIMIT $2,000,000_ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Y s CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE HALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1540 American Way Longwood FL 327SO USA t�O�d i �G�r�sLP/�d �� eJ�ZCI ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I � / {/'(fed? '�' (i2`l Cf�t („ '^� f . . ert;�Il(IC' ,. '' �- Office of Consumer Affairs and Business.Regulation 10 P'ark,Plaza - Suite 517 0 .Boston, Massachusetts 02116 Home Iinproveme,nt Contractor'Registration Registration: 148607 Type: Supplement Card 'Expiration: 10f111201-5 SEARS HOME IMPROVEMENT PRODUCT ' a 1024 FLORIDA CENTRAL PKWY __r -.m ��___ _. LONGWOOD, FL 32750 _- ` r~ Uttt3ate.address anal return card.Mark reason for change. L. x scr iF.t, ;;,s Address �Ren�wal ? Einpldymetit Lost '.:✓�,. - [}Rice of Gonsunter,lffairs A Business Regulation License or:registration valid for indilidul'usc:only �, 1<, OME IMPROVEMENT CONTRACTOR before the expiration'date. If found.return'tbc �f.Registration 148607,-,, Type; Oftiee of Consumer Affairs and Business Regulation IO Park.Plaza -.Suite' Expiration 10/11l'2015:; Supplement Card. Boston,MA.O2116 SEARS HOME IMPROVEMENT PRODUCTS INC. LUBOS SVEC h y : 1024 FLORIDA CENTRAL P.t<WY LO.NGWOOD,FL U750 Undersecrct:uq va a ivrt tout signatur� S ' 9 `iLsf � r�.` ? tee �arPt�1 S'tfet� . . ter 1<66S'SVt C 821 Thor Cf31 #'S Q�RQAQ�� p 7 � 0811120.14. 4 L Y II II I II I I III III Office Location:BOSTON Proposal Date 06/30/2014 Job Number 17391312 Sears Home Improvement Products,Inc. Customer Name jSW �rrs ^ P.O.Box 522290 JANE LOPEZ 1024 Florida Central Parkway Customers Home Phone Customer's Work Phone Longwood,FL 32750-7579 (508) 957-2293 Home Improvement Products Phone(800)469-4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 37 GLENEAGLE DR MA(148607) City State Zip code Windows plumbing and electrical services performed by CENTERVILLE MA 02632 Is installation within city limits? licensed subcontractors - Installation Address County BARNSTABLE (Yes/No): YES FEIN 25-1698591 Billing Address(if different from above) City State Zip Code Project Consultant Name&License No.(if applicable) SUE ENG SUE ANNE ENG Description of the Project and Description of the Si nificant Materials to be Used and Equipment to be installed 1. Remove existing units to be replaced.(PLEASE NOTE:The removed units are likely to be damaged.) 2. Prepare openings as necessary to receive replacement units.(No finish work other than normal installation is to be done unless otherwise noted below.) 3. Installation includes the clean-up of all job-related debris upon completion of the job. 4. (If applicable)After the.completion of the,project,the customer will be responsible for the application and removal(storage)of shutter panels. In the event that the project requires the installation of storm shutters or egress windows, Sears Home Improvement Products, Inc. ("Sears") will not re-install any affected security bars. 5. (If applicable)In the event Sears is unable for whatever reason to obtain the proper permits prior to the commencement of any work,Sears will refund any previous payment and this contract will be automatically cancelled. Summary of Window Order Addendum(see detailed Window Order Addendum for more information): Type: WB PLUS (WINCORE) Quantity: 2 Type: Quantity: Type: Quantity: Type: Quantity: Type: Quantity: The Window Order Addendum.is made a part of and incorporated into this contract by Customer(s)initials reference. Additional work to be done:KITCHEN WINDOW CONVERTING TO GARDEN WINDOW Work NOT to be done: N/A SPECIAL INSTRUCTIONS:N/A All of the above check boxes, "Work NOT to be done," "Additional work to be done," and Customers initials "Special Instructions"sections have been reviewed and explained to me. SW1-MA (Dig.) Rev 08/13/12 Page l.of 3 IIII'I III I I III III Job Number: 17391312 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 2-3 WEEKS (Approximate Start Date) It will be substantially completed by approximately 2-3 WEEKS (Approximate Completion Date) These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products, Inc. ("Sears")or at any other time by mutual written agreement. Customer understands that the Approximate Start Date is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. ASBESTOS ABATEMENT: This Estimate and Proposal assumes that there are no asbestos containing materials ("ACMs")that would be disturbed in the performance of the installation work. If upon further inspection by the contractor or others it is learned that ACMs have to be disturbed to perform work,then Customer must arrange and pay for abatement of asbestos by a qualified person prior to the start or continuation of work. If Customer fails to arrange for necessary asbestos abatement within thirty (30) days, Sears may cancel this contract upon Customers)initials �_ written notice to Customer. I F The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 6,739.65 Contract Price $6,739.65 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 2,021.90 State Sales Tax( 0.00 %) $ 0.00 Final Payment(balance payable upon completion of job)$ 4,717.75 Local Sales Tax( 0.00 %) $0.00 The Initial Payment is due prior to Sears ordering products. Total Amount Due $6,739.65 The form and method by which the Customer(s)will pay is described in a separate Cash/Credit C stomer(s)initials Card Payment Addendum made a part of and incorporated into this contract by reference. c"L-%_ NOTICE TO BUYER: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER)AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ADDITIONAL PROVISIONS Proposal and Approval.Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown.This offer must be approved by the Installation Department. If this is a credit sale or a payment on completion sale,it must be approved by the Credit Sales Department. If this proposal is not approved or the installation cannot be made in accordance with the law,this offer will be withdrawn and any payments you have made will be refunded to you.Any materials left over after the installation has been completed are Sears property and will be removed by Sears. Installation. I understand that Sears will not install the materials but will arrange for the installation. Sears is not responsible for materials or installation NOT furnished or arranged by Sears. Sears'installation contractor(s)will obtain all building permits required by local law. For homes located in historic or landmark zoning districts,Customer will be responsible for obtaining required approvals and related permits prior to the commencement of work on this contract. Authorization. I authorize Sears to: (1)arrange for a contractor(licensed where required by law)to make the installation of materials; (2)issue a work order for this installation to a contractor; (3)inspect the installation;and(4)pay the contractor when the installation is complete if I have signed a certificate that the installation has been completed to my satisfaction. Delays in Installation.I agree that Sears is not responsible for delays in delivery or installation due to weather,fire,strikes;war,government regulations or any causes beyond Sears'control. Oral Agreements and Changes in Contract.I understand that there are no oral agreements between Sears and me.Everything I expect Sears to do has been included in writing in this contract.Nothing can be changed in this contract unless it is in writing on a separate form accepted by me and Sears. Res onsibility of Bum. I agree that any information or measurements that I give to Sears are correct and complete. I am responsible for any special work described in this contract. Electrical&Plumbing Service. I will provide adequate electrical and/or plumbing service(s)to run any newly installed appliances or other furnishings. If the electrical and/or plumbing service(s)do not meet the standards of the utility company or electrical and/or plumbing codes, I will make the necessary changes at my expense unless Sears has agreed in this contract to make the changes. Payment.I will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warranty Information.Appropriate product warranty documents will be given to me by Sears.Sears'Warranty on Installation is: SEARS'LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s)used(which warranty becomes effective the date the merchandise is installed),if the workmanship(or application)of any Sears"arranged installation proves faulty within(i)one year for Weatherbeater Value Line,(ii)two years for Weatherbeater Plus,or(iii)three years for Weatherbeater Maio,and Weatherbeater Stormbeater,then upon notice from you Sears will cause such faults to be corrected by repair at no additional cost to you.If Sears determines that repair is not commercially practicable or cannot be timely made,then,at Sears'sole discretion,Sears may elect to provide replacement or refund.Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1-800-222-5030, Option 4.This warranty gives you specific legal rights,and you may also have other rights that vary from State to State. SW1-MA (Dig.) Rev 08/13/12 Page 2 of 3 IIIII II II 1111 III Job Number: 17391312 NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IFANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT.KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME,AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY[FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER]AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH,YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING"I HEREBY RESCIND"AND ADDING YOUR NAME AND ADDRESS.A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR.PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY In addition to the Notice to Buyer shown above, Massachusetts law requires that contracts for home improvement work state that all home improvement . contractors and subcontractors shall be registered and that any inquiries about'a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration - P.O.Box 871 Taunton,MA 02780-0871 Telephone:.(508)821-9375 Please note that owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Notwithstanding any other language in the contract or.associated documents, Sears will not remove, replace, or install any heating or air conditioning system, or any portion thereof, if asbestos or asbestos-containing material is known or likely to be present in that heating or air conditioning system,or any portion thereof. If it is determined or reasonably suspected that asbestos is present,either before commencement or during performance of the work, it shall be the customer's responsibility to select, retain and pay all costs of a Division of Occupational Safety ("DOS") licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determination or reasonable suspicion of the presence of asbestos arises after Sears has started the work,Sears will immediately cease performing the work until a DOS licensed Asbestos Contractor, hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R. TOO and 453 C.M.R. 6,00 or verifies that none is present. By signing the contract the customer agrees that it understands the above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 06/30/2014 06/30/2014 Customer's signature Date Customer's signature Date Accepted by Sears Home Improvement Products, Inc.("Sears")on -06/30/2014,: by: Date . Management Representative SW1-MA (Dig.) Rev 08/13/12 F Page 3 of 3 JOB NUMBER: 17391312-0005 PROPOSAL DATE: 6/30/2014 WINDOW ORDER ADDENDUM 1 WP-GARDEN WINDOW 1 34 W X 38 H WHITE BIRCH TWO SHELVES WALL THICKNESS=[WALL=] LOWE/ARGO N/C LEAR 2 WP-PATIO DOOR 1 r70 W X 80 H i WHITE 3 RIGHT OPENING i LOWE/ARGON/CLEAR TOTALS: 2 COMMENT: �(�U 06/30/2014 06/30/2014 Customer Signature Date Customer Signature Date , r 1 of 1 . I ............. ............ I 19/1.8/2012 12:5E. 81 ,71,2575 BCSTON SALES P,a:.aE 011b1 wcw 54005'Serree V0 Double Nung Wledbw" "V!N'ft F7AME rCdprF�kpbeNt6LEAfl (% ,. RON.G wwo ' VGitltd SliderWieda:r y a , CP.D WCJI N{=:4?-00029-DbQ07 � �_ . ENERGY PERFORMANCE RATINGS ti-Factor 441°,S.fi-R� Bw Kest 6810 Coett.ient�_ 0.30 I 0e24 AOOiTIONAL.PERFORMANGE RATINGS 0.481, Cv !Jisi6leTraismillaece - A.flngracjuiarBllpUlattlt!'m he5eradApag4Alermi4a?G-ge'.ttsPe7racedmeAYs gCa'4lNglpt�seta - prodUtLD174tR'7Ace h!NC'la4leCt I6e ODtertnlCod .I'idC is Ye�rlraamrplAl ttmdNtenaa 4.a'. aDetiCie 6rObJ'dra.Nfg7:;d-tt Ael tet4t ma"t@}Pe4Fgd end Ata!at@ wrram Ida.4,tfI4 zi JOY Ip'Ab:a I4t atY a94tI}I9'Jet:dAADuN mAOelu',rn Y.i;ir7!are laf O'aai P16ggbr dE I'fiance 196rmsilon . `�, design Presstiiea357—38 Maxinlam Size:46`%'88 FSC;None Tasting Slastdard:AAMAfdlDMAICSA 1a1116VA640-05 Test lab:ARCHITRTURAi.TESTIMINC.. f , _, i TNEr��y TOWN OF BAR.NSTABLE Z BAflH MLE, i ti b 9{► k BUILDING INSPECTOR 11 MAX O'E -t APPLICATION FOR PERMIT TO ..... ...... TYPE OF' CONSTRUCTION ......�ct0�..a..!?.......:.._.....::��.` 5�r.......................................... ................................................19.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following^information: i Location .....J� ! .K... G.:4: :.:........... c-1�^ ,........G. ! ...N..�c�. ...... . DPI. .s -` �::. L- "G Proposed Use } Zonind District Fire District 1..... ............................... Name of Owner ... �- d /�/z. en/.!#�?!�. ... .N.?'ll.........3.�...................Address .....�.'�f.5..:. Name of Builder . .....5.49.. .. .......�...............................Address .... �:?D.Pq ................... Nameof Architect .....'5�2.fi.q�....................................:..........Address .......... �......_.................................................... Number of Rooms .. J......... .................._.............:........,Foundation ...... .:a:: :. P( :3' ..................................... t. Exlerior .� P..'L.:ltih�a:D..V :K. 7J/ ,��.... 5..:.: .. .CrF..... ..Roofing ............. . 1�N..15! .�..,f....................................... Floors ... d'...P.:..,Y . . .,.. ?r .s7.......lnterior ....... ......'` .fff�. .T..... .o..S .�............. ........R..... ..Wo:�l.Lh. o Heating Q`.t-� E✓o." .? :2 ! a....�:............Plurnbing ........a..'. rS ?T/�! ........... . • , .................. .}. . -. 1.............. Fireplace .......:. I ..Approximate Cost: . : Definitive Plan Approved by Planning Board _______-___ 1 q, Diagram of Lot and Buildingwith Dimensions ` SUBJECT TO APPROVAL OF- BOARD OF .HEALTH s 1� M'U ST SE , CODS A� s, r i I hereby agree to conform to all the, Rules and Regulations�of tthe�.Towrr'of'Barnstable regarding•the above construction. -_ ----- -- -_ `Name .. i> ..__.....V .. 16097 1 1/2 story single family dwelling Gle ----'— —'' '' —` Centerville de e 1414 -PERMIT REFUSED .................... 19 --------------.----'�^------' ee ...................................... . ' EL —'-------r---^-----^^—'----- . . ' --------------_-----.—.--~— ^ Approved ................................................ l9 | ' / ~ -------'------------------- -------------------------.— ko U � ] �