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HomeMy WebLinkAbout0253 GLENEAGLE DRIVE / i i i I j I I I Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-3.98-0398 Fax: 508-398-0399 10i6i2020 BUILDING D E PT. Brian Florence CBO OCT 10 2020 Town of Barnstable Building Division TOWN OF BARNSTABLE 200 Main St. Hyannis,MA 02601 RE: Insulation Permit B-20-2440 Dear Mr.Florence: This affidavit is to certify that all work completed for 253 Gleneagle Drive, Centerville has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey o/-?11q 0 6)14M 6 Y �t►�r Town ®f Barnstable *Permit# � Expires 6»ronths1roar issue date a Regulatory Services Fee t a * BARNSrABLE, + MASS.9 Richard V.Scali,Interim Director & Building Division nam Tom Perry,CB®,Building Commissioner X-rUIESS PERMIT 200 Main Street,Hyannis,MA 02601 SEP 24 2014 www.town.barnstable.ma.us Office: 508-862-4038 TOWN OFF -LOF EXPRESS PERMT APPLICATION - RESIDENT ONLY Map/parcel Number 2/ /? _Not Valid without Red X-Press Imprint Property Address 25 R Residential Value of Work$1Q t�''1a1 . Do Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 3yd Ai (tirnmina 263- Cn Dlr'iQvLA[o_ D, QRxltrwlll.2� Contractor's Name3&U hc��n �t� I lIndouxs nC1n Telephone Number t-46 I -M8=gy dip Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) 0Cj F'r7D 1. ®Workinan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner - I have Worker's Compensation Lnsurancq,,,,;,, (l Insurance Company Name Attic o ff a l iya u l;& Workman's Comp.Policy# l 9 32 3 94 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacetneni Windows/doors/sliders.U-Value .3 0 (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical c&Fire Permits required. "Where required: Issuance of this permit does not exempt compliance with other town department regulations,Le.Historic,Conservation,etc. ***Dote: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requ' SIGNATURE: TAEVIN D\Building ChangesUORESS PERMITIEXPRESS.doc Revised 061313 at LWtw1iMP VsteYQdl fy - RENEWAL Bl ! VDERScq 'MA acer.0173245 de� M CrUc8m 90MV 6 Mamr 4"WIwr -A�a vw 26 Albion Road • LinmIn,R,1 02665 Peso tfra k1E57 p5om89.563.2235•Fax 401..633AW1 1 ra,11�n4Geassiw S0 theraNeWSa9laad1rw4owt%LLCet/blix - CUSTOM WINDOW AND DOOR RI dODE1d G AOREV'. fiuferpl7J�_ . .CJ�9"irfl n ir�:tapeemcneI,.�r; rue f l 4 i=eP rei,3e�c!sss. .. _. C � a r. f•;cmeTa'ilpiicno Ne+axre.J'�•�`d+' '{ i /' VkakTck0.Gm Morba.. - • Htr+e49)kr"MbY,jcnaly road zc-111y age to purl ass alit products and/or services of Sdulhcasa New Englaat9 Vlruscfowt,L F CC d/Po✓�i Renewal icy Aralermn of Smitten)?dew C:aq d("C�3narrcao>"},in e�wticsbincG with d�.r rc�s arid axmdarons desmbcd on the fwmt and the a vein of a81nt a:yrexrncrnt what oat dte attached apeciifkauon--Owry s)(coUccdvc1v this?lgrseeae nc"t. O Historic fJ Cando Ce RiItK? `*WjobArr=nt ;, Qgr�re4 968riin 0*-- Method of Pgmenc 0 Chedic- 0 Cath j�.ftamced �nosit 6kecTr� e . li It Cft&.Car&=-aroptcd fordsPosit onl y I6:ofe9le; l',LOar1e a at Seas of job b(3]K) prolexe oest. er ree G4eeYt CaaeeJ Fblenant Form)[ir rtgryeg this F"4-cd C®mpiede Oererc Asiu emc yew u. wMedge eat dee @alerts at Sure of fcb and she 64,11ce on&t mr4WR670 , , '�I� ncc cm Si�ksantlai Canpletian d?lksb- rw be rn3�m.by crcdR Comp[etiwr of lab l�I�—�, coact mnd rraltt b±rrmde.by p�e:nal dnedt.6seda aileedi,ar•cash: Bayr=( )agrees RE under AMA that this Agreement constitaws the eaxisr a eAeestagdins between the parties,and that ebe:e are so wtrbat vedefstAnd;nss changing any of the terms of thin Agreement:84er(s)ackabwledges that Buyer(s) (1)has read'this Agreement,vA&r8hmds the terms of thlei Agreem m4 and hats received>E completed,signed,arrdi data) copy of this Agrr�mnczrt„including the two atftchedK*dccx of Canceljstlod,ad the date firkwiritten.above and(2)wez orally bxf srre ned of Buyers rivghtto cancel thb Agreement.DO NOT SIGN'l HIS 00.VfRACT EFTDRE ARE ANY WANK SPACES. (Phads t*lstrd&k.!r Only)Neitico to Buyer;(1)Do not ska thisAgreement it anp olf the spaces aterededforthe agreed terms to the emest of then available information arse left blaW (2)Yaa ore entitled to a copy of th s AgIfteateat at the time you 5:1911- it.(3)Yea,nngty as any time pay off the fall Umpsid.bnlanee dne rtoder this,Ageoomeat,natdla eo doing 7°a may:be entitled to receiwID a partial rebate of the-I.;— and ins airance�cbarge_e..M The adler has no right to unhvdully eater your premises mit or com any beesch of the peace to repossess goods purchased order this Agreemente..(5)You"canoe[d"s Agreemmot> it it has mat beex sided at thr,mash,seam or a branch oIIite of the,*cHcr,provided you notify.the seBrr at hi$or peer rmain office or brarrcit office slllerwa is she Abe centtent by registered ter certified in w- eh shall beposted not loiter than rAd t of the tMrd calendar d y-afterthea`dayonwhichthe+buyers4aatheAgseeme:at,eadtidlasSandayiimdarayholidayouorldch- regalar mall deliveries are nt tmndee.Seethe of can 116tinm Air=Urge eatg]aaritiom of hayee'a rights. : meatier auaac iq e. an INt eA0r3 g19 'jj). Renewal en of Satr6cria Now En4buid Bayes(b) , Bayes(s) By. Sjuawleof PtirrtNaemt of prattnet hLvimt„er I t.m Name IPriat Name YOEN TIM 11VVER(S), MAY GANCEL T1IIS "TRANSACnON AT ANY TMIX pIOOR TO' NIGHT OF.THE TIE!" BUSINESS ttY Ar=THiE DATE OF'THIra TRANSACTION.SEE THE ATTAif:1F ED NO TIM OF CANCEL A'17ON FORMS FOR AN EXIMANATION OF THIS RIIGHM: - - - - - - - - --- - - - - NOTICE OF CA 9-H f/ 1 c UPIK 0 CAAICELdATIQN Date of Transactfon� .You may 1. 1 Date'of Transautioet Yoa rtialr cancel this transa UwN without any penalty or ebligatron,within." this:taansaetlons,WL*t rut any pmmoalty:or obligat[ony within three busfncaas days from the above date.If you car Cok any i three business days from thc.abwm data,If you cancel,any- Property traded in.any.payments made by you holder the 1 property-traded its any payments;ritmde.by you-under the Contract.or Sale,and any vegetable Instrument cioacectod .1 .Contrket or.Sale,and a"ncjatiablc instrument a mcuted by you will be returned*vA in tm business tl&P following-I .by you will.be returned within trrt business days.foifowirq receipt by the Setler.of.your-caitc+eftdan notice,and any-1 receipt.by the:Seffer'of.your canceGfadon notico,.and.any se!aerity int4rest.arWng.out -of, :3ae trar"atilon.will be security.intorost,wlsiT4 Out of the .trnina4bon wal. be erne feel Ifytru zartcl,yo�+imust irrafa<e availableto the Seller [ earaS-P -t if you e>ric"el.you rait�st maim avaibble to the Seller at your residence,in substantially.as goon!conditlort as when t at your residence,ie substantially ins,good condition as when received,a"-paed del.vorttl to you under this Contractor I recelved,aryr goads delivered to you under this Coeetraet err Sale'or you may if you wick consply v."h tM lnst mwdons cf. l Smlei or you mazy,iE yap wish,cornpty with the"initructhons of' die.Niler r eg,rding We returrg sluiprncrit the goods at the the Seger req�6ng return shipmcrtt of the goods at the Sellefs expense and rfstt.If you do maker th foods available .Sellers experetea'a it riots.If you do makes tho goads available to the Seller and the Seller does alai piek em up wftin r 1,the Seller and the Seller:dees not pick tla�up.wishin awentlr days atf eFro dada of earreeeIkftn,you mecy retain or. l: twonty d od ties date of.cancellatD*.you nu ty retain:or d1 are of the goads without sere:fi,rthw abligadom if you 1 dltpose og ttee prnods without-a_ary further adslligadom If you lbs"N gs rc�7ees the t sods xrmfahla t the Boller.t>f if you atgreer 1 fall to make the goods.auallable to the Seller.or if you agree , to return the goods to the Seller sail fail to do So,then you .i,to return ft goodk to:then Seller and fail to dose,then you: . remalmllable ter perform once Fall ab0gatfans 1nlder'the I remain liable for performance of all bbligvtiores undot-then Gaeafraet.Toorn a,eti ceal this tran9on,.ntelt.or deliver a srp a d C,ontract.To cmraoel this trwm action.mall or dellver a signed and dated'. copy of thin talncedfittion nuaeico or.'awl+ father I and dated copy of this cancellation nade a or a" outer written notice,orsenda tole gramt*R,ettewalbyArdlerserrof l wrvta3anm6ce,orsenda telegram to Renewal byArttkinetof' SouthelR-Kew End at-29Al on iG i 11 6 02865, I .&O tfiern New Env sit 2h A_Ibittnr Road;Limoln.Ri 42t6S, NOT LATER THAN MIDNF.GHT OF t (NOT-]L+Ai'ER THAN,MIDNIGHT OF HEREBY CANCELTHISTRAWMCTION. I i Ft RlERY CANCELTHISTRANSAC:`F ON. . SUP^Ift—V F"M flame x""'t swtad-. ..Mat K me - IIbJ►Coo.Whim' Buyer .Copy:.9Pdlow. Boyd CcW.Pdsik. f Southern New England Windows d.b.a Massachusetts-Department of Public Safety Board of Building Regulations and Standards j` Comstructifin Supervisor Ucet;e: CS-095707 BRIAN D DENNISON 7 LAMBS POND 61tC1. 1 Charlton MA 01507Expiration t , Commissioner 09/08/2016 Eti o ( ed?Business �' Office of Consumer Affairs Regulation 83 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9119/2016 DENNISON BRIAN 26 ALBION RD - LINCOLN, RI 02865 Update Address and return.card.mark reason for,change. scA1 •:• 20,4-05m F ;, Address ❑ Renewal J Employment -; Lost Card ��C C(,'o7lt�iraJitnctr�f�G`��jtUiUf�rr.r/�J - �_.office of Consumer Affairs&Business Revulation License or registration valid for individul use only + DME IMPROVEMENT CONTRACTOR before the expiration date- If found return to: � yRegistration: 173245 Type Office of Consumer Affairs and Business Regulation T�Jfy 10 Park Plaza-Suite 5170 Expiration: g/19/2016 Supplement and Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD � — LINCOLN,RI 02865 Undersecretary Not va' ithout signature The Commonwealth of Massachusetts Deparlment of IndushiaiAccidents Office of Investigations - _ I Congress sheet,Suite 100 Boston MA 0_1114 2�017 www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Flectricians/Plumbers A��lacant II•nforl�atlon Please Pril�t blV Name (Business/org ni?ation✓Individual): SOUTHERN NEW ENGLAND WINDOWS LLC Address: 26 ALBION ROAD City/State/ZIP: LINCOLN, RI 02865 Phone#: 401-228-9800 Are you an employer?Check the appropriate box: p 4. [] I am a general contactor and I Type of proj I. ® I am a em Toyer with 20 ect(required): 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 [No workers' comp. insurance comp. insurance.t 9. ❑Building addition required.] 5_ We are a corporation and its 10.®Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11_ ❑Plumbing repairs or additions myself. [No workers-, comp. right of exemption per MGL insurance required] c. 152, §1(4),and we have no 12.❑Roof repairs employees. [No workers' Other W1N°owREPLACeaet=W comp. insurance required.] zany applicantthat checks box�l must also fill out the section belonr showing their%vorkers'compensation policy information. Homeolvtiers who submitthis affidavit indicating they are doing all Rork and then hire outside contractors must submit a nety affidavit indicatine such. =Con tractors that check this box must attached an additional sheet shoning the name of the sub-contractors and state whether or not those entities have employees. If die sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation bzsurance for my employees. Below is the policy and job site it formation. Insurance Company Name: ARGONAUT INSURANCE COMPANY Polic",-or Self-ins. Lie.4: WC927938352394 08l21/2015 Expiration Date: Job Site Address:_- �� (° L.� p� nd; City/State/Zip: C 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 oneyear imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of tip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce fy under Me pains and pens of perjury thattlie infonnaiion provided above is true and correct. Date Phone : 401-228-9800 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/'fo1Vvn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SOUTNEW-01 ANCHANNA ACORO° DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/27/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Willis of New Jersey,Inc. PHONE FAX c/o 26 Century Blvd WINE E.:(877)945-7378 A/C No):(888)467-2378 P.O.Box 305191 E-MAIL ADOREss: Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Selective Insurance Company of SE 39926 INSURED INSURER B:The Beacon Mutual Insurance Company 24017 Southern New England Windows LLC INSURER C:Argonaut Insurance Company 19801 D/B/A Renewal by Andersen 26 Albion Road INSURER D: Lincoln,RI 2865 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 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. 1�TR TYPE OF INSURANCE POLICY NUMBER MM/DDY/YYYY MMIDD� LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE a OCCUR S 2029459 - 08/1012014 08/10/2015 DAMAGE TO PREMISES Ea occurrence)e $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,00 M'OTHER: L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,00 POLICY FJET a LOC PRODUCTS-COMP/OPAGG $ 3,000,00$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 Ea accident A X ANY AUTO $�2029459 08/10/2014 08/10/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED P BODILY INJURY(Per accident) $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS ' Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS-MADE S 2029459 08/10/2014 08/10/2015 AGGREGATE $ 5,000,00 DIED I RETENTION$ $ WORKERS COMPENSATION X PER OTH AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N 0000068028 - 08/21/2014 08/21/2015 E. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N❑NIA L. _ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 H yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 C Work Comp&Emp Liab WC927938352394 08/21/2014 08/21/2015 See Attached f _ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE y Southern NE LLC Road M - 1 26 Albion Road Lincoln RI02865-0000 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGE SCHEDULE COVERAGE LIMITS POLICY TYPE: Workers Compensation&Employers Liability WC: Statutory CARRIER:Argonaut Insurance Company EL Each Accident: $1,000,000 POLICY TERM: 08/21/2014-08/21/2015 EL Disease—Policy Limit: $1,000,000 POLICY NUMBER:WC927938362394 EL Disease-Each Employee:$1,000,000 .. _ t w• ��fj/x/ / may' C_ _ Town:of Barnstable *Permit# - F'pires 6,nonthr om rssi�date Regulatory, Services Fee 7.�J Thomas F.Geiler,Director774 639- MfCl .. Building Division AUG - 7: 2013 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 #. r www.town.barnstable.maus•, '- TO WRO _F BARNS TABLE . Office: 508-862-4038Fax: 508-790-6230 EXPRESS PERMIT APPLICATION' RESIDENTIAL ONLY `� / Not Valid without Red X-Press Imprint - - z Map/parcel Number _ Y `, Property.Addres5 G w� [Residential Value of Work f� _ Minimum fee of$35.00 for work under.$6000.00 ' Owner's Name&Address �'" l�V " 7. oac43a� Contractor's Name 56u` srrN �� IyiN^�P�yA,C%o,o p s try Telephone Number 6 Home Improvement Contractor License#;(if applicable) 7 Construction Supervisor's License#(if applicable) a orlanan's Compensation Insurance Check one: �q ' ❑ I am a sole proprietor ❑ II am the Homeowner ❑l - µ - Jl have Worker's Compensation Insurance Insurance Company Name Q . Workman's Comp.Policy it k�(C- Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box). J = r ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. poini over existing layers of roof) . ❑ Re-side x .#of doors VReplacement Windows/doors/sliders.U-Value' F(maximum..35)#of window ❑ Smoke/Carbon Monoxide detectors 4 floor,plans marked with red S,'and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. _ A copy,of the Home Improvement Contractors License&Construction Supervisors License is required. ISIGNATURE:X�� �,- Q:1WpFILESTORMS\building permit formsTYPRESS.doc Revised 053012. The Commonwealth of Massachusetts Print ForF71 Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-201 7 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):�� e�j✓ � � ', q�q�µ� ���✓ 5 uG Address: A&6%A/ /'LO City/State/Zip: L l/ c,61N vaL86:57 Phone#: 4-10 ;�,;L,? — P&O Are you an employer?Check the appropriate box: Type of project(required): 1.Lam'I am a employer with 9 O 4.. .❑ I'am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New`construction 2.❑ I am a sole proprietor or partner- listed on the attached'sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have . 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.: 9 ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 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.❑ Ro f repairs insurance required.]t C. 152, §1(4),and'we have no employees. [No workers' 13. er comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. //►► Insurance Company Name: Policy#or Self-ins.Lic.#: 76 42 Expiration Date: 9 oP 3 Job Site Address: a 5 3 (91,wea, _ City/State/Zip. C�'C, Vl 1� 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 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 hereb certi er the sins and enalties o e 'u that the in ormation provided above is true and correct Si afar : Date 7'1.`3 Phone#: 4 l )l 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#: I ti Client#:30124 SOUTNEW 'DATE ACORDTM CERTIFICATE OF ,LIABILITY INSURANCE 5/08/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Anita Little - NAME: Willis of New Jersey, Inc. PHONE 856 914-4660 FAX 856 914-1881 HONE No,Ell: AIC,No 1015 Briggs Road E-MAIL-ADDRESS: Anita.Little@willis.com PO Box 5005 Mount Laurel,NJ 08054 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Co of the S 39926 INSURED - INSURER B:Argonaut Insurance Co. 19801 Southern New England Windows LLC INSURER CBeacon Mutual Ins.Co. 24017 D/B/A Renewal by Andersen - 26 Albion Road INSURER D INSURER E Lincoln,RI 02865 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER- THIS IS TO CERTIFY"THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.'NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY S202945900 8/10/2012 08/1012013 EACH OCCURRENCE - $1,000,000 X COMMERCIAL GENERAL LIABILITY! _ PREMISES(E.occu ante) $50 000 CLAIMS-MADE ®OCCUR MED EXP(Any one person) $5,000 - PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - - PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO LOC $ JECT A AUTOMOBILE LIABILITY S202945900 8/10/2012 08/10/2013(CEO,accident)SINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ A X UMBRELLA LIAB OCCUR S202945900 8/10/2012 08/10/2013 EACH OCCURRENCE $5 000 000 EXCESS LIAB HCLAIMS-MADE AGGREGATE s5,000,000 DED F—TRETENTION$ $ B AND EMPLOYERS'LIABILITY WORKERS COMPENSATION AIC927698352394 8/21/2012 08/21/201 WCsTLA,T oTH- _ C ANY PROPRIETOR/PARTNER/EXECUTIVEY/N 68028 8/21/2012 08/21/2013 E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? F­N] NIA - (Mandatory in NH) - - E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under ' DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY,PROVISIONS. Lincoln,RI 02865 AUTHORIZED REPRESENTATIVE - P o 6 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of,I.' The ACORD name and logo are registered marks of ACORD #S214638/M214631 AXL Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts Department of Public Safety -Board of Building Regulations and Standards Construction Super isor License: CS-095707 �111♦ BRIAN D DENNISON 7 LAMBS POND CIRCLE Chariton MA 01507 I Expiration Commissioner 09/08/2014 c�/ae �p��Uaaoorsu , ems. Office of Consumer Affairs sand Business lation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2014 DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET,RI 02895 Update Address and return card.Mark neson for change. sca t 0 mu.usm - - [j Address ❑Renewal a Employment Lost Card flke ofConsamer AR kC,&Bosioea Regslattea License or registration valid for Individul the only OME IMPROVEMENT CONTRACTOR before the expiration data If found return to: t� Office of ConsumerAffain and Bosisms Regulation �S e• Registration: 173245 Type; 10 Park Plaza-Suite 5170 ` Expiration:9 ISM14 Supplenent:4" Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. - RENEWAL BY ANDERSON - - . BRIAN 1137 PARK - ` -1137 PARK EAST DRIVE WOONSOCKET,RI 02895 _ - Uadersecremry Not valid without signature r Jun.17.2013 21:17 PAUL CONBOY RENEWAL ANDER 781 545 1293 PAGE. 3/ 5 aaAndatm(:urapsav a i mea esnorsRenewal RENEWAI. BYANDERS✓N antµ y<TIutv_$0N3 SrbyA1derCnf 2GAbiou Road Lnxln,RI 02885 cxtnirm#123rWINDOW ■EPIA011011INr Phone 866.563.2235•lynx 401 d;33.6602 rcdcrar Tnx u?a46-056(1030 Southern New England Windows,LLC d/b/a Renewal by Andersen of Southern New England CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer fs)Name Dam cf Agreement -. ear ;►► /�'/� euyer(e)Street Address,Itity.State.and zip tbdc ,O.Box _ c9S3 G'e & del,rar, CeA rarlilif Inh 63 E.MaaAddrest NomaTNcphoneNumber Work TeiephpnaNumber e C.-I C1 y 64L C&O can • e Buycr(s)hereby j(riutly acid smerally agrees to purchase Lim products and/or services of Southern New Engfttnd Windows,LLC d/b/a Renewal Fry Andemri of Southern New England("C mlh7te lur"},in uuuitlance with the terns and conditions described on the front and the rtruerse of this agreement And on the attached specification Aieet(s)(colleudvcly,this'Agrt.emcnt')• ❑Historic ❑Condo ❑HOAT al TotaijobAmount I Estimated Starting Due: Method of Payment: U Check IU)l1h OF inanced Deposit Received(33%): Credit Cards are accepted for deposit only-•maximum I!3 of the Balance at Start of Job(33%): project cost.(ft-me see Credit Cana Payment Farm)By signing this Estimated Compleetics Date, Agreement,you acknowledge that the Balance at Start of Job and the Balance on Substantial �/S{ y'10•3ee r S Balance on Substantial Completion of Job cannot be made by credit Completion of Job(33%):_ .___! __...._.. card and must be made by personal check,bank check,or cash. Buyers)agrees and understands that this Agreement constitutes the entire understanding between the panties,and that there are no verbal understandings changing any of the terms of this Agreement.Buyer(s) acknowledges that Buyer(s) (1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rkode Island Sales Only)Notice to Bayer:(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you trip it.(3)You may at any time pay off the full unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and soy holiday on which regular mail deliveries axe not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. liu c c c Island Contractors Registration Board. — s IniridLr) Renewal by And $ England Buyer(a) Btiyer(s) r liy: utyof�rrxlt t r Sip rJ Signature -- Print Name or Product Manager Print Name. Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. — — — — NOTICE IZE..CANCELLAT ON - — - — i — - - _ — MCE"/LANCE !Ifs% N — — — —'� Data of Transaction l-17-4 You may eamai Date of Trtanehaetion 6,—Z -/3 You magi ea11ee1 this trarhttasdon,without any penalty or obligation,within I this transaction,without any penaky or obligation,within throe business days from the above date.N you cancel,any throe business days from the above dabs.N you cancel,any properly traded In,any payments made by you under the I property traded tin,arhy payments trade by you under the Contract or Sale,and any ne;otilable iacbument executed I Continue t or Sale,and any negotiable Instrument executed by you will be returned within ten business days firibwing I by you will be returned within ten business days following receipt by the Seller of your cancellation notice,and any I receipt by the Seller of your cancelladon notice,and any security interest arising out of the trans-Its will be security interest arising out of the transaction wli be -celed.if you raneel,you must make aovallsbleto the Seiler canceled.N you camel,you must make arallablato the Sailor at your residence,IN substantially as good condition as when I sit your residence,in subshantially as good condition as when received,any goods delivered to you under this Contract or I received,any goods delivered to you under this Contract or Sale;or your may,B you wlab,comply with the instructions of I SWq or you tru%If you wild4comphy with the Instructions of the Seller regarding the return shipment of the goods at the d the Seller regarding the return shipment of the goods at the Seller's expense and risk.If you do make the goods available 1i Seller's expense and risk.If you do make the goods oval "a to the Seller and the Seller does not pick them up within i to the Seiler and the Seller does not pkk them up wthin twenty days of the iota of Dance lodoN you may retain or I twenty days of the date of cancellation,you may retain or dispose of the goods without any further obligation.If you I dispose of the goods without any further obligation.IN you fall to make the goods available to the Seller,or If you agree I fail to male the goods available to the Sella;or if you agree to return the goods to the Seller and fail to do sex,than I to return the goods to the Seller and fall to do Mh then you remain kable for performance of all obligadons under I you remain gable for pedfermance of all obligations under the Contract.To caned this transaction, moil or delver the Contract.To cancel this transaction, mall or deliver a signed and dated copy of this cancellation notke or any I a signed and dated on"of this cancellation notice or any other written notice,or send a telegram to Renewal by I ether written notice,or send a telegram to Renewal by Andersen of Southern New England at 1137 Park East Dr., I Anderson of Southern New England at i 137 Park East Cit, Wtwrh�oc RIA3895,�, LATERTHAN MIDNIGHT OF I WogrhsDafte5S02895`�, LATERTHAN MIDNIGHT OF I HE((RPEP BY CANCELTHISTRANSACTION. i 1 HEREBY CANCELTHISTRANSACTION. - x Buyeft ststtenw Pont Nam Deb Buyer's Signature Print Nero Date lkbA Copy:White Buyer Copy:Yellow Buyer Copy:Pink Parcel- A � Permit#Bering Dept. (3rd floor) Map �2 ;5F 02 House# o?�?J �` Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30)! �"� ee 07 Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) 1ME Definitive Plan Approved by Planning Board 19 { TOWN OF BARNSTABL AND WN Building Permit Application Project Street Address �,�"� Cr�� YV ��/ ,�� /�� i/C jckj o� Village Owner fZ?!Z Address ®26'r 3 Ca4z- Telephone 7 7,:C ^ vp o zl 3 Permit Request �IIn/'VLelAl �s ►+/ d tilt/�/�3�` ' r/y/Z/�Gs� First Floor square feet Second Floor square feet Construction Type �r® Estimated Project Cost $ l a Zoning District --T'�/ Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Z Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 2To If yes, site plan review# Current Use Proposed Use Builder Information Name ZZ r Telephone Number Address /G tf,r Al&ztl4�/"nJ f r-UP 7- License# 4�5' D3 2, Home Improvement Contractor# /,!:;O 7�'O Worker's Compensation# 139b 8A:Z NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. , ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,WA177-' SIGNATURE DATE 7 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) �.d cr - The Commonwealth of Massachusetts — � Department of Industrial Accidents -- — - exce 811VIV9 tlgatlons _ =/ 600 Washington Street Boston,Mass. 02111 " Workers' Compensation Insurance Affidavit a • cati �G city Rhone 4 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity .EIM" I am an employer providing workers' compensation for my employees working on this job. company nam .. .., address: ciri phone ft insurance co. 7t !�.00 policv# dealler3Z Z. ' I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: addre s: cin Rhone#• insurance co policv om any name: address: city phone insurance co. lice# �ttich additional sheet if aeccss_an +r."`,,,':'_..�-_�''" -';+:^_::'; '--- ,►� '' �.'`' Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to SIS00.00 and/or one years'imprisonment as-ell as civil penalties in the form of a STOP WORT:ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify pairts a penalties of perjury that the information provided above is true and correct. Sienature Date Print name _Phone ii loe official use only w do not M rite in this area to be completed by city or town official a, ciq or town: permit/license t'IBuilding Department C Licensing Board k check if immediate response is required Selectmen's Office OHealth Department rl contact person: phone a: 0t _ her fth used!"P)A 1 �� ►,I oFTMe . . ° The Town of Barnstable • sruuvsrAE= • 9� NAM �0�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date, /S=��7 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: Il//lyG �5'�i7�/✓� Est.Cost Address of Work:��,S"3 ���-�✓� � ��� �� � '�/ � Owner's Name l yillA� Date of Permit Application: Y/.4a,7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. 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 PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ea75ld Date Con ctor lame � Registration No. OR Date Owner's Name -a° l - OME . IMPROVEMENT CONTRACTORS FECTSTRATZOK l F �• :r2oard or 8uiiding Regulations and Standards .one Ashburton Place - Room 1301 l Boston, 'Hassachusetts 021.08 � I`tPROVEMENT CONTRACTOR [ �:stra�ian 100740 Expiration 06/23•/98 PRIVATE CORPORATION t Key_ I}ga3 sr- C',YTRACTOR . . E � Re^Jistrat��a l4Ci�0 k t �,7a - f3jYAi: C�ZcrPATi0.4 CAp IZZI F;OME IMPROVEMENT.. INC Ob!_ _ t L;pira�iaR 3/4: Thomas Capizzi , Sr _ . ' ., _ t •� . 16=5 Newton Rd . t t C�?� r T KOyc �racnYF.Y:`f"t, IN'- CctuLt MA 02635 t i,asas Cap: , = a t fLWNL�A.�n C:7 E'llf `Y Oi.-_ CUAr T HCNT ONE A5HUUiz QOSTUN ?UC_ =GN S'JPEVI5O� LICENSE Expires' . Qirthd�te u017012`�3a9/261is97 � -orb..< .(j•�U� `: --.-- � — ;•.' •.) . -aScCUF,ITY= . 430-5a— 4,94�:__ ;y_{ J r A _ 9- .�^-:;'?'•:,. a T; 1 1 Olt 27 Ex�sTiNG I /o7- Fo�NLti9TlOn/ ` i �y a I lo7- L.S Zo 7 wzle 1-5 s . pe,v. GLENEi96G� 17,2/✓E' �'w�o� CERTIFIED PLOT PLAN LOCATION Cd-W;r4 Viet f M�9SS. . . . . . . . SCALE . .!. .3a. . . . DATE . ,V. . .,/ 74 EDWARD E. KELLEY PLAN REFERENCE .Cat?�G. . La T.' Z.¢. CUMMAQUID, MASS. 02637 EDWARD �, !N T�AA-' daaE!,7.�G. �f1G'4� 74 . a KF�E 0 2310( I CERTI FY THAT THE . . n�7�, v cC�STER� SHOWN ON THIS PLAN IS LOCATED ON THE GROUND �av suIRV�yA AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF SPieoS Co���uCT/off . . . . . . . . . WHEN CONSTRUCTED. ��G .:3t l9 78 • 3s 04,eG�' e64 o DATE y PETITIONER: ��77 REGISTERED LAND SURVF,xvR SI, a Y- 7Asiessbkift map and lot nu ber .. "'..I.QRL.19 - 101", ` SEPTIC SYSTEM MUST BE *TNET�� Sewage Permit number '.........�...\� INSTALLED IN COMPLIANC WQy ♦� """""""""""""""""' WITH ARTICLE 11 STATE Y SANITARY CODE AND TO BAWSTADLE, House number �'.�:.?�......... + rasa ` REGULATIONS. oo t639. �o war a• TOWN Of 'BARNSTABLE BUILDING 'INSPECTOR APPLICATION FOR .PERMIT TO ...... 11WO.......aev g... ° ..f.�..0 d�''�............................:............. TYPE OF CONSTRUCTION ......................................................................................... ........................... �./.......19.... t TO THE-'INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....!?T'.#.-......64.PN. . A 1..... !�� �6/L ................:..................................................... tProposed Use ........................................................................................................... ......................................................:...... /Q _ Zoning District ......! .. .......................................................Fire District ........C ... ............................................................ Name of Owner �PfRo.. 3S ���LA ?9 f� / . � 1 ........... ..................... ................................................Address ......... .... ..... ... ........r............ .. Nameof Builder ....................................................................Address ..............................................................:..................... Name of Architect ..............1( ...............................................Address 0 .................................................................................... Number of Rooms Foundation �./t/C,?.47. ............................................. ................................................................. ...... ........ ......... Exterior l�" � ` C 9 � ...Roofing .........� � ..... ......`......�....®........................... .. . ............................................ Floors .............I�!t14D.��.a...0...........................................Interior .....7.�'.� /QLIG� ...... ... .............................................. Heating .........................................................Plumbing .......... ........................................................... vo d Fireplace .........®.v .....................................I.....................Approximate Cost ....... ..................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area 1 7o�.Y......................... Diagram of Lot and Building with Dimensions Fee [/ f.. . ^.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH —wd/va I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �. Name .... ... ............ . ................... S, Balodimas, Spiro6 .,, 204.. one story No ............. .. Permit for ...... _.._........ = singld' family dwelling .............................................. —........................... _ . 253 Gleneagle Drive Location ................................................................ Centerville. ' ............................................................................ Spiros Balodimas Owner .................................................................. fi Type of Construction ..........frame..................... ..` ............................................................ ......... ..24 Plot .......................... Lot ................................ Permit Grantedll ;uS ..14....I.......19 7$ ------� -- Date of Inspection Date Completed ..... �i........:....... 19 PERMIT REFUSED :"�` -' ,• t ..................................f .................... ... ....................................4 .... ......................... .... .................... ? ` ................`........................................ +`.,.. Approved ................................................ 19 ............ ....................................................... ...... . i ' Assessor's map and lot number '� �'� *THE TOE ............................................ Sewage Permit number ..........5. `2..:........................�..... --2 :' Z BAU ABLE, i House number ....'%....:..`Jar.: ............................................. '00 639 0� YPy a TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......L j;..? �/ �°��y Q U.S.. ..................................................... .................................................. TYPE OF CONSTRUCTION F 1?,A"1 ............................................ ......... .................................................... ............................. f..... .y....19..... � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit+according to the following information: Location ............................. .......�.........`..: �~..f...1........C. !L;P....✓t�L�IG....'-�............................... ........................... ProposedUse ........................................................................................................ ............................................................... ZoningDistrict .....!!...�:........................................................Fire District .............U............................................................ Name of Owner .......... /' ?.��..... �a !�r Address C?f L/. . ....... ?,o.t........................................... Nameof Builder ................ ..................................................Address ...................f ........................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms..............................................Foundation ..r �' .................... .............................................................................. Exierior r . ^ .................................................. t. ..f............... ......}........� ..................Roofing ......... S1,2,1v,g6 Floors r1' tuft/J je Interior Sf7rF_,iTR� .... . .. . ./.................................................................Plumbin .................................................................................. Heating ....! g I - r Fireplace G�y�= ..................................Approximate Cost............ .......... ........................................... Definitive Plan Approved by Planning Board ________________________________19________. Area l�r 7°? ....:..................................... Diagram of Lot and Building with Dimensions Fee ......... ................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH '�,Vt o' r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. -�� �c.r,C`6� r.�!0 Name . .. ....... .. ........... Baldimas, Spiros A=192-142 J - { No ...20479... Permit.for ........one stor ......... single family dwelling .................................... ... ................ Location 253 4eneagle Centerville ..................................................................... Spiros Balodimas Owner .................................................................. Type of Construction frame . .......................................... ....................................... ........................................ #24 Plot ......................... . t ................................ ' Permit Granted ...........Augus t 14.........19 78 Date of Inspection ....................... ............19 Date Completed .. ..............19 PERMIT REFUSED ...... ........ 19 . + ...... . ............................ I , .. ............................................. ............................. ' .....................0....................... ............................ Approved ................................................ 19 w .................... ......................................................... i i TOWN OF B'ARNSTA f BLE •:" Permit No. -204 9 Building. Inspector. Cash - - - °` OCCUPANCY''1P..ERMIT•. ' Bond X i' --- — "No building nor structure shall be`•ereeted;and,no land, building or structure shall be uacd fora new, different, changed, or enlarged use;•without a Building Permit therefor first having been obtained from the Building Inspector:No building shall'be occupied,until a certificate of'occupancy has been••issned by the Building Inspector."` Issued toF Soiros Balodimas ,* , Address 35 ^Carla. Road$. Hyannis: lot #2.4 253 Gleneagle.,;I)n ve, Centerville, Wiring Inspector �� 1'�//.-.G',f�llt-400! Inspection date �� Plumbingedtor ` v `1 Inspection date'Insp Gas Inspector l✓'„ ll h'y Inspection date WEngineering Department Inspection`date-,-' THIS PERMIT WILL NOT BE VALID, AND-THE BUILDING SMALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR; UPON ;SATISFACTORY COMPLIANCE WITH, TOWN. REQUIREMENTS. a. 19 — C.�,� Lam•.�............................._......._._ Building Inspector , •f ! 1 I Ole 0 27i --- 00 � � Ex sri/vG I -oTa►non/ M 1 Fz/v. GLEN�i9GL� DRI✓E . -5zo`wlot CERTIFIED PLOT PLAN LOCATION .CE?�!Tt�V/CL c� �ll9SS. . � . SCALE . �. t. ,3.q. . . . DATE EDWARD E. KELLEY PLAN REFERENCE .a4?4 q. 4 7. Z-.Se CUlVIMAQUID, MASS. 92437 5,416 kph/oN A Pe4.,V `N OFs`I9 L....�O.�N.•�o. ew reA-w eaae.?�o. P�c��- 7./. . . EDWARD %. E. a KIjk E 0 231 Ei7/ST/n/G �o�� Dn rr u w I CERTIFY THAT THE .. . C�ST6R� SHOWN ON THIS PLAN IS LOCATED ON THE.GROUND �aa Sup-4�y� AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF 13f1!?"/5??4Q4�. . . . . . . . . WHEN CONSTRUCTED. sP�e�s Co�isreucT/o�/ ��P��v y DATE ;!w PETITIONER: __ - - REGISTERED LAND SURVE;;A