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Home My WebLink About0067 GLENEAGLE DRIVE F. ,� � _ _ . . � , , , . . ,.. :� r i n -� .. ♦� s_ � m H. ® - i 6 o �I � o � - i '�r - � ,. c 3 7 5-3 o-2 r Town of Barnstable *Permit k� D'd ly>_ Expires 6 months frons issue date X®PRESS PERMIT Regulatory Services Fee Thomas F.Geiler,Director -� SEP 11 2007 Building Division TOWN OF BARNSTABLffom Perry,CBO, Building Commissioner 2 'W Ct 200 Main Street,Hyannis,MA 02601 }f� www.town.barnstable.ma.us a Office 508-862-4038 Fax:508-790.6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �q r Not Valid without Red X-Press Imprint Map/parcel Number ! 1 I ! 7 Property Address ,Residential Value of Work G j o ` Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address DO C, 14 S Co h /a Contractor's Name /�kp � -rJc l 6 s11 ��*r.r�i r 5 Telephone Number S'O f; q(�a o 6 9 y Q Home Improvement Contractor License#(if applicable) f d 6 8 2 ? Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name l u!w Nlz M,a s P le )'h :51, Workman's Comp.Policy# 17a la o a Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value i 3 (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the me Improvement Contractors License is required. 2�� j SIGNATURE: ��,4e Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts - - ----- Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers'. Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): t? clJ £t Address: �-�l s5 :.. ee o City/State/Zip 6 Phone#: Are you an err►ployer?Check the appropriate'box Type of project(requlred)_. 1. L am a employer with_ 4. 0 I am a general contractor and I 6 Q.New construction employees(full and/or part=time)* have hired the sub-contractors listed on the attached sheet."$ : Remodeling 2.Q.I am a sole proprietor orpartner.. -. ship and have no employees These sub-contractors have 8:.❑Demolition ' working,for.me in any.capacity. workers' comp.insurance. 9. ❑Building addition [No workers'co rnp insurance 5 Q We area corporation and its. required.] officers have exercised their 10.Q Electrical repairs or additions 3.❑ I am a homeowner doing all work :right of exemption per MGL 1 LQ Plumbing repairs'or additions' m s%elf. o workers' coin c l S2, §1(4) and we have no,' 12 Roof re airs Y p Q . p insurance required.]t employees [No workers' :;:: . 1.3 Q.Other. comp..insurance required.] - *Any applicant that checks box#t must also fill out the io se'ctn below showing their workers'.compensation policy mfoimation. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .---tContractors_that check this box must attached an additional'sheet showing the name of the sub-contractors and their workers':comp policy --- I am an employer that is providing workers'compensation insurance for my employees. Below is he policy and job site information. CIOInsurance Company Name. 46W.0.S I�'� �'7"s . Policy#or.Self-ins tic.# 't -�.® Expiration Date:_ �. q. Job Site Address; _;� t �O�p rA /ram y lam' City/State&&' Attach a.copy of the* compensation policy declaration page(showing the policy number and expiration date): . Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a. -fine up.to:$1,500.00 and/or one-year.imprisonment,as well as civil penalties in the form of a STOP>WORK.ORDER and.a.fine of up.to$250.00 a day against the violator.,Be advised that a copy of this.statement may be forwarded to the Office of, Investigations of the DIA for insurance coverage verification. I do hereby certify un L pai .a enalties of perjury that the information provided above is,true and'correct Si nature: Date: 07 Phone#: r] �� [ t0 � 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 M Information ion a red Ins t ructions 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 appurienarit 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 issuance or renewal of a Ucense or permit to operate:a business'or to construct hulldings in the commoc�wealt..for any applicant who1as not produced acceptable evidence of compliance with the insurance coverage required.". Additionaliy,'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),addresses)and phone number(s)along'with their certificates)of insurance: Limited Liability.Companies.(LLC)or Limited Liability Partnerships(LL]')with no employees other than the'. . members or partners,are not required to carry.workers'compensation insurance. If an or LLP does have employees,a policy is required."Be advised that this:affidavit maybe submitted to the Department.of Industrial Accidents:.for con frmation of insurance.covera a Also be,sure to signand date the affidavit. The affidavit should be returned to the city or own that the application for-.the permit or license is being requested,not the Department of Industcial Accidents Should you have any questions regarding the law or if you are regwred to obtain a workers' compgn #'*dh' bli6 please call the Department atthe number listed below:Self insured companies should enter their self insurance license number on the appropriate line. ;., ........, .. ....: r. :. uw.,gs.:Nrpww+.a.4-tLLar,yav:r«.•-A.. - .. City or Town Ofricials Pleasg be"sure that the affidavit is complete and printed legibly. The Department as provided a space at the bottom of the affidavit for you to fill out in the.event the Office of Investigationsas;to contact you regarding the applicant.. Please be'sure. to f ll~in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 officiallystainped or marked by the or town may be provided to the applicantAs proof that a valid affidavit is on file for future permits or licenses. Anew 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 (Le'.a-dog license or permit to bum 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 togivcus a call The Department's address,telephone and fax number: The Commonwealth of Massachusetts :Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617'727-4900.ext 406 or 1-877-MASSAFE Fax# 617-727-7749 . Revised 5-26-05 www.mass.gov/dia f f - MBER WigR - ' THIS GERTIFICAT6 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE FAX(212)948(2TeQUeSI@IT1afSh:COR1 POLICY,THIS CERTIFICATE DOES NOT AMEND,.EXTEND OR ALTER THE,COVERAGE FAX(PIEDMONT R I AFFORDED BY THE POLICIES DESCRIBED HEREIN . , 3475 PIEDMONT ROAD,SUITE 1200 ATLANTA,GA 30305 COMPANIES AFFORDING COVERAGE COMPANY . 00492-THD-IPUSA-07-08 IPUSA A STEADFAST INSURANCE COMPANY . INSURED COMPANY HOME DEPOT USA,INC.2455 PACES FERRY ROAD NW B.. ZURICH AMERICAN INSURANCE COMPANY BUILDING C-8 CCMPANY ATLANTA,GA 30339 r C AMERICAN HOME ASSURANCE COMPANY COMPANY " ,� D NEW HAMPSHIRE INS COMPANY THIS.IS-70 CERTIFY THAT POUCIES.OF INSURANCE DESCRIBED HEREIN HAVE'BEEN T$$UEO TO THE INSURED NAMED HEREIN FOR THE POLICY pER1,00'INOICATEO. - �� NOPNITHSTANDINGAIVY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WRH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL.THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. CO. TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER - DATE(MMIODIYY) DATE(MMIDDIYY) LIMITS A : GENERAL LIABILITY IPR 3757 608-02 03/01/07 .. 03/01/08 GENERAL AGGREGATE $ 4000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OP AGG $ 4,000,000 CLAIMS MADE X]OCCUR 'OF SIR:$1.000,000 PER OCC' PERSONAL&ADV INJURY $ 4,000.000 OWNER'S 3 CONTRACTOR'S PROT EACH OCCURRENCE ' $ 4,000,000 FIRE DAMAGE(Any one Bra) $ 1,000,000 B AUTOMOBILE LIABILITY MED EXP(An ona arson) $ EXCLUDED BAP 2938863-04 03/01/07 03/01/08 X ANY AUTO COMBINED SINGLE LIMIT' $ 11000,000 ALL OWNED AUTOS SCHEDULED AUTOS ` r: BODILY rrpersINIJ)URY $ HIRED AUTOS. BODILY INJURY NON-OWNED AUTOS i (Per accident) $ X ELF-INSURED AUTO HYSICAL DAMAGE PROPERTY DAMAGE $ GARAGE UABIUTY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY EACH ACCIDENT $ . l AGGREGATE $ A. ExcEss uAB►uTY IPR 3757 608-02 03/01/07 03/01/08. EACH OCCURRENCE $ U00,000 X UMBRELLA FORM AGGREGATE $ 5,000,000 OTHER THAN UMBRELLA FORM C WORKERS COMPENSATION AND $ EMPLOYERS'LIABILITY 2921209(CA) 03/01/07 03/01/08 XTWC TORY LIMITS ER L� E 2921210(FL) 03/01/07 03/01/08 EL EACH ACCIDENT $ 1,000,000 F THE PROPRIETOR/ X INCL 2921211(AZ,ID,MD,VA) 03/01/07 03/01/08 D PARTNERS/EXECUTTVE EL DISEASE-POLICY LIMB $ 1,000,000 OFFICERS ARE- EXCL 2921208(ADS) 03/01/071 03/01/06 EL DISEASE-EACH EMPLOYEE $ 1,000,000 C oTHER 2921213(QSI) 03/01/07 03/01/08 E WORKERS'COMPENSATION 2921212(KY,MO,NY,WI) 03/01/07, 03/01/08 G TEXAS EMPLOYERS. TNS-C44642086(TX) 03/01/07 03/01/08 EACH OCCURENCE 25,000,000 EXCESS LIABILITY SIR DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS 2,000,000 CritTFFFCAZE NQFDER� r � , t F.ANCEFATf(JfI < skt� � SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL_X DAYS WRITTEN NOTICE TO THE FOR EVIDENCE ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAQ:SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR - LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES.OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. By. Mary Radaszewski LO-10 �, � ' - �. ..�•- ��, 3 r, -=:$.ate,-» , -1 ,.h E �1 ;s� MNL (3tQ2 d x _VALID AS OF02%28/07,. .. g ux 11 a �� DATE(MMIDDIYY) e Rw .,.:,..:, zz-�..:�.�,�z.� .::",� - �• 3< . = COMPANIES AFFORDING COVERAGE. . PRODUCER MARSH USA INC.: ,OMPANv homedepot.certrequest@marsh com E ILLINOIS NATIONAL INSURANCE COMPANY $ FAX(212)948-0902 3475 PIEDMONT ROAD,SUITE 1200 ATLANTA,GA 30305 COMPANY F NATIONAL UNION FIRE INS CO. 1 C 0492-THD-IPUSA-07-08 IPUSA INSURED COMPANY + HOME'DEPOT USA';INC. G ILLINOIS UNION INSURANCE CO 2455 PACES FERRY ROAD NW BUILDING C-8 . ATLANTA,GA 30339 COMPANY H F. fix.N+ AN } �s- a..k -re '3+ ,'f"''C s> a�s�"5 y CERTIFICATE FfOLQERM �r,f �� 9 v"va.,exi ,•t�.:s.....�Y '� 'zea� :^a::A n'z{`` .u�� :m z.+..'e4.na �:.. x. zK.,...6s"'^ zrx ..s°.,M FOR EVIDENCE ONLY MARSH USA INC.BY May Radaszewskl � f 3e �z''� 9 x 063-A-033 40-45 DH CM r;100 Renovations xtncc Double 'rIunq - Vinyl Argon/LOW i E SC SS N r on No Grids ♦�CouncA 1-C300-741,;-.6686 NFRC 2001 ENERGY PERFORMANCE RATINGS U-Factor(U.SJI-P) Solar Heat Gain Coefficient 0 . 4 0 . 29 - A ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 . 49 Manu(acturerstlpWetesthattheae ralings conform to applicable NFRC procedures for determining whole NFRCratingsaredetarminedforafbmdsetofenvironmeawconditionsanda product performance. specifleproduct sin.Consult manufactimn's literature for other product performance Information. www.nft.org A III ENEf6"1i St`Aft Unit qualifies for Energy Star Region(s) : Northern, North Central, South Central, southern Im �D IND: REIN 001GLASS SSIH-R30 L)P a `—'. mesh Sire: 44 x 60 Order ##:3830873030001 40318 HS 71. �narnmzoouuea`l/ o�✓ aaaaclu�ae 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 Registration: _126893 One Ashburton Place Rm 1301 Exprratron 8/3/2008 Boston,Ma.02108 Type:` Supplement Card THE Home Depot FAt_Home S,ervic MNIEL PELOQUIN� _ 3200 COBB GALLERIA PKWY"#20 -- Atlantic,GA 30339 Administrator Not valid without signature SEP-01-200T 03:56PM FROM-HOME DEPOT T-779 P.001/004 F-817 nvlvLLiivirKvve.ivimni A-VtNIxAt,.t Y Sold,Furnished and Installed by: Brancli Name: n Date: j 0 THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 1 345A Greenwood Street,Worcester,MA OT 607 Branch Number: 3 1 Job#: Toll Free(800)657-5182; Fax:508-756 2859 Federal 1D#75-2698460 ME Lie ft C 02439 Rl Cant.Licit 16427 r CT Lie 0 565522; MA Hom provomcrrt CCo�nt�t'aCwr Res.9126893 Installation Address: l0'r-ty I f;i� �!'°�4 �>� k�t�V hTG t�yl j �� 07473 City State Zip Last 4 Digits of Driver's Pn;�hnscr(s): Lie.#&Exp.MOW; Work Phone: Home Phone: 4 ) ( ) ( ) Home Address: ASOV97 (ff different from installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): Project Information: I/We/You("Purchaser"),the owners of the property located at the above installation address,offer to contract with THT)At-Home Services,Inc.("Home De t")to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet# Z3. ,incorporated herein by refertxtce and made a part hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS r approval.) CONTRACT AMOUNT '$ t• 'Checkr,Cashiers Check or U::�crrdit Money Order [' .7 talc a ' • LESS DEPOSIT $ 2. Credit Carder and/or other payment options-Circle One Below BALANCE DUE Vim MasterCard Discover American Express ON COMPLETION $ ~Q The Home Depot Home Tmpmvement Loun The Home Depot Credit Card tMinimum 25%of Contract Amount due upon ❑New Account 0 Existing Account (HIL ac EDCC.ONLY) execution of this contract. Available Credit:S (ffih 8c IMCC ONLY) Indicate Payment Method For Accdtp Exp.Dsm! BALANCE DUE ON COMPLETION: Name as it appears on card: Lls - 1 �� r By my/our signature below,I/We agree to allow Home Depot to charge the above referenced credit card for the deposit indicated. -When you provide a check as payment,you authorize us either to use information from your check to make a one-time electronic Cardholder's Signature Date fund transfer from your account or to process the payment as a check transaction.When we use information from your check to make an electronic fundtransfcr,funds may be withdrawn from HLL or HDCC Authorization Codes your accouar as soon as the puyeaeut is received,and you will not. Deposit Final Payment receive your check back # # . Purchaser agrees that,immediately upon completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated- and liable hereunder. Entire Agreement:This agreement and its attachments,including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do nit sign this contract before you read it You are entitled to a completely Mled4n copy of the contract at the time yow?lgn. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law protibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction any time prior to midnight of the third business day after the date of this contract See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 10% of the contract amount if job is cancelled by Purchaser AFTER the third business day,but BEFORE materials are ordered.There will be a service charge equal to 25%of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW,UWE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREf)1T HISTORY'AND UWE AUTHORIZE HOW DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT REPRECErPT NDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INADVERTE OMISSIONS OR ERRORS. BY MY/OURLOW, VWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. 1/WE ACKNOWLEA CO Y THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELSUBMITTED Date: 7 ultan Acce, f6D 8y.V Date: D Purchase Date: baser NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATIED ON THE REVERSE SIDE AN 0 ARE PART OF THIS CONTRACT 4-2-07 C-SC White-Branch File Yellow-Customer Pink-Sales Consultant q .� ..... p II !II. s Issue late: 5/29198 ------------------------------------------------------------------------------------------------------------------------------------ ProJu<er: { Ihis certilicale is issue/ as a aaIIeI of ialoraation only and confers { no rithts a►oa the certilicale holler. Ihis certilicale lots not alien/, SOUTHEASTERN INS AGCY extent or alter the coverage aIfolle4 1y the policies deloa. PO BOX 2618 --------------------------------------------------- 641 MAIN ST tONPANiEf AFF0861116 (OYEM E HYANNIS MA 12611 — --------------------------------------------------------- tede: sul-toll: i to tit A: ARBELLA PROTECTION --------------------------------------------------------------------------------------------------------- Insured: { to tir t: ------------------------------------------------------------------------- HOLCOMB PLMB 6 HTNG { to ttr l: to tit D: GREAT AMERICAN P 0 BOX 178 OSTERVILLE MA 12-8171 ----------------------- -------------- ------------------------- -------- � Co tlr E: --------------------------------------------------------------------------------- ---------- ------------------------- COVERAGES Ihis is to certify I h a I /01ities of insurance lisle/ ieloa have teen issue/ to the insure/ rtasie/ adore for the policy period iaIticaIe4 a IIfiIhsIanliat any relnifeaent, Ierr or cenlition oI any contract er other /o<urenl IrilA resperl to which Ihis cerIifitalt nay ie issued er a a y pertain, the insurance aIf0rled iy the policies lescridel herein is sudjecI to all the terns, exr10$i0as, and conliiions 01 such policies. I.ialIs shorn a a y have leer je4ucel I pail clai as. -------------------------------------------- ------------------------------------------------- to I { Polity { Policy { tit{ Irtsuran<t Y Poli nuater ' elIecIIvt Jate lextiIatton la le{ AIi tiails is IhousanJs type of , c , I -------------i-------------------------------------------------------------------------- -A1 6EIIEFAL tlAtlaliY ----- ORDERED 12/18�97 { 12118/98 { 6eiteIaI aIIretaIe: A i looser<itl general liaiifity { ProAucls-cony/ops allret: 1 {t II I Claiar rate 1X1 Occur { I I iPersona!/a/verlising inj: if OMner's d <ontratIor's Prot I { I Eath occurrence:I 51181{ { Fire lama te: ,I 'MeIita1 expense: 5 { ------A-U---i0Y0t---I-t-E l ----A-t-l-t-!-/-Y------------------{--------- --------{----------------{----------------I------n-e-l---------------------------1---- tloaii , Any auto { i { ifingle IiaiI: { f All osrnel autos { { { Itodily injury { I Schedule! autos I I { (Per person): { Nired aulor , tolify injury Non-oanel Autor { { i (Per a titlenl t ): 1 1 6arale liadilily I � , , I iProperly laaate: ' l I I - ------------------------------------------I------ ------------------------------------------------ -------------- - EKIEfS t1A►ItllY ' { { Each Occurrence AIgr*Iate � t I( Other than usirella lore ---------------------------------------------------------------------------------------- D I NORKER'S lOYPENSA►iON WC916143881 { 12/18/91 { 12J18/98 { statutory {______---------______________ ' ' 111 (Each acritleni) { AND i I fdPtOYERS' tiA8ltliY 588 (Disease-policy liail)' , I ' i , , � 111 (Di�seare-each em/loyet) I ------------------------------------------------------------------ ------------------------------------------------ 1 01NER I { I I II I { { 1 I { I I I _______________________________ Description of operalions/lotatiorts%vehi<les/reslricliens/special items: ANY AND ALL PLUMBING AND HEATING OPERATIONS ---------- -------------------------------------------------------------------------------------------------------------------------- CERTIFICATE HOLDER CANCELLATION { Shouli aey of the alove 4escriiel policies It ta0celle/ lelore the I expiration /ale thereof, the issuing company mill tndeav0r Io RON MONTAQUILA mail 11 days #title# notice to the ceftilicatt helJer named If the 1 R N PROPERTIES i IeII, tut failure to mail suck notice shall impose no oililation or 192 SANDY VALLEY ROAD { lialiliIy of any find upon the tenpany, its alenis or representatives. MARSTONS MILLS MA 12648 -------------- { Authorized representative: SCOTT i9 LOME JA ----------------- --4/89 .... .. DATE(MM/DD ) aCORD PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HERBERT GOLDMAN &ASSOC INS HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR _13 FALMOUNT RD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. J I(ANNIS.MA 02601 COMPANIES AFFORDING COVERAGE COMPANY A Hartford Fire Insurance Company INSURED COMPANY B Hartford Underwriters Insurance Company WENZEL FRAMING INC COMPANY 45 WHIDAH WAY C Twin City Fire Insurance Company CENTERVILLE,MA 02632 COMPANY D Hartford Accident and Indemnity Company TH.. POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS UED TO THE INSURED NA MED ABOVE FOR E 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE MM/DDIYY DATE MM/DDIYY GENERAL LIABILITY GENERAL AGGREGATE COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ CLAIMS MADE OCCUR PERSONAL 8 ADV INJURY $ OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED EXP(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ............................ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ Iq AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ B WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY 77WZ VM4967 04/16/97 04/16/98 TORY LIMITS ER THE PROPRIETOR/ EL EACH ACCIDENT 100.000 PARTNERS/EXECUTIVE R INCL EL DISEASE-POLICY LIMIT $500,000 OFFICERS ARE: EXCL EL DISEASE-FA EMPLOYEE $100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS ....:......:.........:...::.:..:................::::::::::.::::::::.;:.;:.;:.;:.;;:;.;:.;:.:<.;;;:.;:.;:.;:.;:.;;:.;:.;:.;;;:.;;;;:<.;;:.;:.;:.;:.;:.;:.:<.:<.;:.; ;.:;.;;s:;.;:;.;;.:;.;>;: WE. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL R M PROPERTIES INC 16 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 192 SANDY VALLEY RD BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY -AARSTONS MILLS,MA 02648 OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED R SENTATIVE DC .. ; � t � AT :. � �� 0::: 6 .. ....A R 4 r 8 Map Parcel Permit# House# A. Date Issued i Board of Health 3rd floor 8:15�-'9:30 0:00-4-" 4P_;?t)7 ee. 0 0 Geus"ua4on Office(4th floor)(8:30- 9:30/1:00 2:00) � � - Plarraing-Dept. (1st floor/School Admin. Bldg.) ��HE rp 3Projetreet an Approved by Planning Board 19 SEPTIC SY T BE INS TALLED ANCE TOWN OF BARNSTABI IR. WIT ONIVlE NTAL CODE AND BuildingPermit Application TOWN REGULATioNs Address10 Village Owner tM Address t��' &�Ull n.o ?Air ``l Telephone Permit Request lab J k-T60 { r First Floor square feet Second Floor square feet ,Construction Type Estimated Project Cost $ �'(] Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 2(/ Two Family ❑ Multi-Family #units) Age of Existing Structure Historic House ❑Yes EI No On Old King's Highway ❑Yes �1 0 Basement Type: W(Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing l y New Half: Existing New No.of Bedrooms: Existing New S 1' Total Room Count(not including ba hs): Existing New First Floor Room Count Heat Type and Fuel: ❑G s Oil ❑Electric ❑Other Central Air ❑Yes 7o Fireplaces:Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Dtached(size) Other Detached Structures: ❑Pool(size) Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal.# Recorded❑ Commercial ❑Yes dNo If yes, site plan review# Current Use Proposed Use 1 Builder Information Name D-1 M-0 D1.A,�h-tQ�;�`A- Telephone Number Address kO D License# 044 61 SAS ti �r w� Home Improvement Contractor# 1 Worker's Compensation# � NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONST ION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO , Fy SIGNATUR DATE BUILDI ING RE ON(S) ` A6 FOR OFFICIAL USE ONLY PERMIT NO. ; ti l `' - • ,� y ' _ s`�'xe , DATE ISSUED , MAP/PARCEL NO. ADDRESS , J VILLAGE' -OWNER DATE OF-INSPECTION: 4 FOUNDATION z FRAME , INSULATION t s FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING:} ROUGH FINAL r — GAS: t RQ GH C FINAL _ } . co c FINAL BUILDING >- DATE CLOSED OUT r - , y ,.. i! ASSOCIATION PLANN'0—% s The Commonwealth of Massachusetts - �€= Department of Industrial Accidents #IfC.0 o1l11F8SZ galioos 600 Washington Street ;. Boston,Mass. 02111 Workers Com ensation Insurance Affidavit riff i��iaia�iaiiaiii iiiiiii��%��%%�/ : � -� "��%%%%%��/��%��%��%��. •�. name: 1 location- city phone# T� 50 ❑ I am a homeowner performing All work myself. ❑ I am a sole ro inctor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. coat nnv nnme:G .....::....... address: city phone#- insurance co, nolicv# ///////////%/////////////%/////%//%/////////////%/%/%/%///////%///%%////%%/////////////////// /////////////air;;;•. I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who ve , the following workers' compensation polices: eoinynnv name address city \ ,'��' `.» phone#r . r olicv!! insurnnce co. :..<.:;.: cam any name. :. addresr 1 y rV�C �r l cityC\11 b nhooe#r Insurance co. %% ilk to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Me up to S 1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this sta meat may be forwarded to the Oince of Investigations of the DIA for coverage verification. I do hereh c ify under t ains d penalties ojperjury that the information provided above is tru,,and correct Signature Date 1 A _ Print name 00 NV-D ��' V Phone "1 / official use only do not write in this area to be completed by city or town official city or town: permit/license it _ QBuiiding Department ❑Licensing Board ❑check if Immediate response is required ❑Selectmen's OtIIce ❑Health Department contact person: phone tt; ❑Other�� (m'uea W95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", 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 section 25 also states that every state or local licensing agency shall withhold the issuance 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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 pi number which will be used as a reference'number. The affidavits may be return Ed to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 �'r-' Office of Imtesduadoas 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 M CUR Appends J rV� Table ALlb(continued) Prescriptive Packages for One and Two-Family Residential Buildings Heated with Fossil Fuels MAXIMUM MINIMUM (hazing (3laang Ceiling Wall Floor Basement Slab Hesting/Cooling Am'('/.) U-value= lt value' 1t value' R value Wall perimeter Egwpm m Efficiency' page R value° R value' 5"1 to 6500 Hndue Degree Days' Q I25's 0.40 38 13 19 10 6 Notmal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 83 AFUE T 15% 0.36 38 13 25 N/A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25. WA WA 85 AFUE W 15% 0.52 30 19 19 10 6 M AFUE X 19% 0.32 38 13 25 N/A N/A Normal Y 19% 0.42 38 19 25 WA WA Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA Ir/. 0.50 30 19 19 10 6 90AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: 9 -forms-080303a 780 CMR Appendix J Footnotes to Table J5.2.1b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ftZ of decorative glass may be excluded from a building design with 300 ftZ of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. •Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass( masonry,concrete to wall constructions,but do not apply to metal-frame construction. g) s The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements,are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). _r 43 r IQ The Town of Barnstable 9 9. �' Department of Health Safety and Environmental Services � •`° BuiIding Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 BuiIding Commission! For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization. conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: ' Bn' IR001A wws I VIM, Est. Cost ` Address of Work: la� 'J �� k� �� '��t1c,o 1 Owner's Name A � Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGZAM OR GUARANTY FUND UNDER MGL C. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply r permit as t e gent of the owner: M D to Contractor N me Registration No. OR Date Owner's Name ' y ✓`ee Vo-m�no�eoea� a��,czaaac�iuve� ! DEPARTNENT OF PUBLIC SAFETY CONSTRUCTION;\SUPERVISOR LICENSE Nu®her EX ires: Birthdate: II P CS — 2 00171 l'/@2(1999 11(62(1943 - -� Restricted Ta @@ RONALD'R`-11DNTAQUILA ,•� � �,,,� 192 SANDY-VALLEY RD oft*# NARSTONS HILLS, NA 11648 g�- 7 , r'~h'HOME IMPROVEMENT.CONTRACTOR :Registration 114073 f ktType PRIVATE CORPORATION t "'Ex piration Q8/02/99 �v y�. sk��• .x f:". �. t..o�y3.3 tint.s 4 -� -. � s R.N. PROPERTIES, 1ONALD R. MONTAOUILA mo` 'iL SANDY VALLEY RD 3 '"' "TOR MARSTONS MILLS MA 02648 " •� � •� � � .,�. ,t�vJkp �'„�� t�.+J�" �L. �/"`a`:t+`aa..,:..;;21�..;;•�'i-iy,n,��`... '. ^+'•r„':n-' ' Assessor's map and lot number Sevvage Permit number . y�%THE Z'® N ®F •BARNSTABLE P c 0 F � ��BdBB9TADLS, � •z •� � - I r • ;MA86; aj •s ..�. O� i639, '00 a. UU.ILIG . INSPECTOR 0 MFY [z , APPLICATION-FOR PERMIT'-T0 .......�...�..1.'.o.......- .......`..........................................................:.......... TYPE OF CONSTRUCTION ................ t ./.................19 „ TO THE INSPECTOR OF BUILDINGS: 1 ' The undersigned hereby applies for.a,permit according to the'�following information: Location j,/r ......'-`� '� t�CT � A-w-. .+f�/ •1, �„ !! C�::....................... -.................... ........n................... ......................................................... ,. .,.. f ••Proposed Use �1 ' 1 '' '%..................................' .� Zoning District ..............................r�.......................Fire District ................, ............................... J � �� /.� � ,may Name of Owner . --fl>C1-t �� .. ...:..........Address � "'� �-��fl- N!1 "�(%� �t,��i ....... Name of Builder ...::;.'. . . Lc. ..:..............................Address ......... < ...... ,...................................... Nameof Architect...................................................................Address .................................................................................... Number of Rooms ............ ..........................I.........................Foundation L.... 1/L.. ........ Exterior ..... ,+ .�� ! lf,, 1 i4•'(,..� ;�'Gli?',',dl Roofing .........�6i1�;s!l,k ,fir,� Floors .!t../ ��. � `Interior �!!1!...�;��Z ............................ ....... .r F , Heating ,-� ......................Plumbing ... . Fireplace ............................................Approximate Cost ...................I............................................... Definitive Plan Approved by Planning Board ________________________________19________ . Area i Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 z 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....................................................... ...?/f.,............... Ginn, Russell E. A=191-147 19104 one story No ................. Permit for, ..................... ......... .... single family dwelling ............................................................... .............. Gleneagle Drive Location ..............................................i......... Centerville ............................................................................... Russell E. Ginn 11 Owner ...........................................Y........:............ fram Type of Construction ................. ........................ . ...................................................... ......................... #16 Plot ............................ Lot ..... ... ...................... Permit Granted .........Ab\il... ........19 77 Date of Inspection ...... .... J. ...............19 - Date Completed ........ .............................19 PERMIT REFUSED IT REFUSED .............. . ............ ... ............ ....... .. 19 ...... .. ............ ........................... ................................................ ............................. ............................................................................... ................................................. . ....... ... ............. Approved ..................... . ......................... 19 ............................................................................... ...............................................................................