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0069 HALYARD WAY
.•.. ,;.YY' r 4 Y.. !xs ,.,:a ,.. y ;-... � ,,. e '. - ..: '.,t' `� � �, ..ter ziV _� 1., � ,,tom' r c q y a T d a it I � NO Application number...............�/.,......... ..� h o.P DateIssued.................................P ................................ EARNSIABLE, MAS& °o 39. .�� (pJ Building Inspectors Initials....................................... Map/Parcel.... I Z/ Do MAR 2 6 20�� ................................... TIF8 - 0- 6f1hNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: l-I �/�/vG� Wk NUMBER STREET VILLAGE Owner's Name: �C�'sa �ar- on Phone Number 5ok _ _ q q 1 U Email Address: (R e eme e d ne- Cell Phone Number Project cost S_/S 8 3 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Sep �-{(Q�� C'�r.-� -�- Date: i TYPE OF WOE Siding 0 Windows (no header change)# ❑ Insulation/Weatherization Doors (no header change)# I Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to Grl rife-/'')Gila I e,,Ym CONTRACTOR'S INFORMATION Contractor's name l�t�an `7�n.�,'so� - So ern Af,. Ccrs (er„fl rf'n�(owS Home Improvement Contractors Registration(if applicable)# 17 3 Z.q 5 (attach copy) Construction Supervisor's License# 01 S`7 0 7 (attach copy) Email of Contractor Q St,,)ef- 9 q S@ ; . C 6 M Phone number �'0/- z 2- ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IIN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *For Vents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent XI X 2 X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICAI T'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. f Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England- Lisa Pearson ���� Legal Name:Southern New England Windows,LLC 69 Halyard Way ���i RI#36079, MA#173245,{T#0634555, Lead Firm#1237 Centerville;MA 02632 WINDOW A.UCEMIENr 10 Reservoir Rd I Smithfield,RI'02917 H:(508)367-4910 Phone:M6-563-22M I Fax:401-633-6602 1 sales®renewalsne.com Buyer(s) Name: Lisa Pearson Contract Contract Date: 03/17119 Buyer(s) Street Address: 69 Halyard Way,.Centerville,,MA 02632 Primary Telephone Number: (508)367-4910 Secondary Telephone Number Primary Email: Syenska619.@eomeast.'net Secondary Email; Buyer(s)hereby jointly and severally agrees to purchase the products and/or services.of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor'"),in.accordance with the terms and conditions described in this Agreement. . Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to-this Agreement Document, the terms of which are all agreed to by.the parties and incor orated herein by reference(collectively, this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under.this Agreement. Total Job Amount: B si nin this Agreement;you acknowled a that the:Balance Due,and:.the Amount 1 $4,583 Y. g g g Y g Financed must be made by personal check;bank check,credit card,or cash. Deposit Received: $2,291 Balance Due: . . $2,292 Estimated Start: Estimated Completion: 6-8 weeks 6-8 weeks Amount Financed: $4,583 Method of Payment: Financing • We schedule installations based on the date:of the signed contract and secondarily on the date in which:we complete the technical measurements;The installation date that we.are providing at this time is only an estimate.We will communicate an official date and.fime at a Later date:.Rain and extreme.weather are the most common causes for delay: Notes: 50 °/D,deposit by bank, balance on completion by bank . Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the,terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,,written consent of both the Buyers) and Contractor. Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the iernis 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. : . NOTICE TO BUYER: Do.-not sign this contract if blank..You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL.THIS TRANSACTION AT ANY TIME NOT.LATER THAN MIDNIGHT. OF 03/20/2019 OR THE,THIRD BUSINESS.DAY AFTER THE DATE OF THIS TRANSACTION; WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT' Legal Name:Southern New England Windows,L.LC dba Ren I By A d rsen'PPSouthern New England Buyer(s) n Signature of Sales Person Signature Signature Paul Sandrey Lisa Pearson. Print.Name of Sales Person Print Name Print Name PDA 17 U TED� 03/ /19 Page I �— � s Office of Consumer ,affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Name Improvement Contractor Registration Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS.LLC Expiration: 09/18/2020 10 RESERVOIR ROAD SMITHFIELD,RI 02917 ,Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card 'before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 173245 09/18/2020 1000'Nashington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS.LLC Boston,MA 0211�-1� 1 BRIAN DENNISON - 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary 1'w� vau without sigriaturE �a 4 � r 3 1 �. y `�+frhiu ti�V ri.•I: [ 1oY �/U esad�6". O: A+1:1v5 ai Board pit. �,°'t. l 41C.`j"i.a � 7`iJ .T�6! 7'd S,i,+'�..'i� l'l::Gi:.;S �ottStILICt.:i.0Jq S9 er•'l CI RIAN D ®E NBSON = . 8 BLACKWEL !DRIVE CHARLTON A. 01507f 1' Commissioner 4 i The C'oinntonwealdt of Massachusetts �'- Department of Industrial Accidents 1 Cona ress Street, Suite 100 ` a Boston,MA 02114-2017 www nws.gov/dia 11-orkers'Compensation Insurance Affidavit: Builders/Contractors/Electriciaas/Plumbers. TO BE FILED WITH THE PEIZNIITTLYG AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Or aanimtion/Individuat): e Address: lU SPA U�t City/State/Zip:S m 11%A eJ�,R-J OLg l 7 Phone#: M�yaa employer'.Check the appropriate bpi: Type of project(required): a employer with ;ZQ-t—employees(full and/or part-time).* 7. New construction 2.C]1 am a sole proprietor or partnership and have no employees working for me in $: Remodeling any capacity.(No workers'comp.insurance required.] 3.[]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9• ❑Demolition 4.rJ I am a homeowner and will be hiring contractors to conduct all work on nY property-e I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. i.®[am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.0 Plumb ing repairs or additions These sub-contractors have employees and have workers'comp.insurance.* 13. Roof repairs / 6.a We are a corporation and its officers have exercised their right of exemption per MCG c. 14, ErOther PAA'D c`DO 4 152,§1(4),and we have no employees.(No workers'comp.insurance required.] ng p 14 e P.n *Any applicant that checks box 91 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. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is pravidin,workers'compensation insurance for my employees Below is the policy and job site information. /� Insurance Company Name:_-i l r 171s u a A 1 _ (,O , O , f >. (i Policy#or Self-ins.Lic.#: WC A .3 15 g 7 ZGl 2 L{ Expiration Date: Job Site Address: 61 1 et v, City/State/Zip: C Pam+ /✓�l�� ✓� Attach a copy of the workers' co pensation polic9 declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c_ 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER.and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certM under the pal d penalties of perjury that the information provided above is true and correct Sianature: ' Date: —� Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/`Town Geri: 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: '.1 C.oZb CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 12/28/2018 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 CoBiz Insurance, Inc.-CO NAME: 1401 Lawrence St., Ste. 1200 PHCNNo,E t• 303-988-0446 Alc No:303 988-0804 Denver CO 80202 ADD 1RELss: COMail@cobizinsurance.com INSURE S AFFORDING COVERAGE I NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO.01 -INSURERS:FlremenS Insurance Company of WA,D.C. 21784 Southem New England Windows, LLC. dba Renewal by Andersen of Southern New England INSURER C:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER 0: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:787175890 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 LTR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/112020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a MAGE OCCUR DAIORENIED PREMISES Ea occurrence) ccurrence $300,000 MED EXP(Any one person( $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE $2,000,000 X POLICY 0 ECT 17 LOC i PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE LIMIT Ea accident 1 000 000 X ANY AUTO I BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS t NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/1I2019 1/1/2020 EACH OCCURRENCE $15,000,0D0 EXCESS LIAR CLAIMS-MADE AGGREGATE $t5,000,000 DIE I X I RETENTION$ $ B AND KERSEMPL C MPENRS' A TIOI N Y/N `NCA315872924 1/1/2019 1/1/2020 X SPE TATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OF-FICERIMEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEq $1,000,000 Ir yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 7930073340000 1/1/2019 1/112020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000.000 Retroactive Date 06/20/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r. -Map' "/7 Parcel ��'� oC ^' EP- ys'-VENn �s�i Met#t -q. i y � _ INSTALLED IN COMPL.I M+�a�th-9iisiea �S 5�0 �1,"� �1`�i�`YIl'L'E 5 Date Issued 4 - a( n ' `7 II OI�ME!-ATAL C001IRFee Tax Collector fl /�7/ Treasurer 41 Date Definitive Plan Approved by Planning Board Histerie-�9af1 i Presfiorrfllyannis Project Street Address (9q Village C_T7h) .Owner Av',P� 'C R{9 C L Address y Telephone 2 rI5 — 9401 Permit Request; R t C S PS (��f�L W Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cost 43 QZJ Zoning District Flood Plain. Groundwater Overlay Construction Type GJ� Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Q� Two Family ❑ Multi-Family(#units) Age,of Existing Structure Historic House: ❑Yes W40_1_,_ On Old King's Highway: ❑Yes awe 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 Number 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 Detached garage:❑existing ❑new size Pool:❑existing ❑new 'size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ " Commercial ❑Yes If yes,site plan review# Current Use Proposed Use ° BUILDER INFORMATION Name l J)ZZ( N7t4-- Telephone Number �� Address ( �(�_ AbE&7u J)LJ :Rlbl License# S 0 Home Improvement Contractor# 10 D _Q CIO Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE )�ga- DATE FOR OFFICIAL USE ONLY PERMIT NO. �_ r: `� r;� �, '• •, _ � ', j y _ - i ' DATE ISSUED . MAP/PARCEL NO. _ 41 ADDRESS , r< :, a ,VILLAGE. OWNER M Yi �• !� r -� ' r "k DATE OF INSPECTQN FOUNDATION FRAME ` t ', :'? k� "? T ` INSULATION. ` FIREPLACE- E ,ECTRICAL«y " ROUGH FINAL , PLUMBING' ROUGH FINAL u GAS: $, ROUGH FINAL FINAL BUILDING. DATE CLOSED OUT ` ASSOCIATIONTLAN NO. M f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map fGW Parcel t`3� - Permit# V D�� Health Division • Date Issued - r `o Conservation Division �1�4IeM Fee Tax Collector Treasurer 1i_ C0 1 SEPTIC S°lSTE",q NI PST BE Is MISTALLED f�� Planning Dept. E ®ra�Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis AUG 2 9 2001 Project Street Address a .Village Owner tA '�c NN-Ak-i-. Address L09 Telephone `f I p 4 Permit Request 'If�oPos�A \i — i1 " k I !! 3 s vx1C—ZS6M p- N or,Z , 1 b� l� Square feet: 1 st floor: existing� proposed t g 2nd floor:existing proposed Total new 1 4 Estimated Project Cost t ozs Zoning District Flood Plain Groundwater Overlay Construction Type S Pl, Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: O Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout- ❑Other 3 ,Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count r Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other.. Central Air: ❑Yes ANo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes O No If yes, site plan review# Current Use Proposed Use 3 S I-asCIYA "x\; 0` 3-1 Y BUILDER INFORMATION Name Telephone Number o`� — 3 �( 3 �`1 G�s Address SVd, License# '] C�!3� $� V� O \ •2 h 3 Home Improvement Contractor# 1 a S I 8 Worker's Compensation# 5 LJ L 3 q ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO is S Ce'2F_ c� SIGNATURE DATE i FOR OFFICIAL USE ONLY- Y= " Nei +� PERMIT NO.- - DATE ISSUED t - " , MAP/PARCEL NO. ADDRESS R .�`v VILLAGE OWNER-... r _ DATE OF INSPECTIO:I�, , FOUNDATION FRAME - INSULATION t }} FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL = FINAL BUILDING DATE CLOSEDl}T ' r ASSOCIATION PLAN NO. I f. LOT ?_2 ... . a a� s E 1 . AjhA s {v � � T 2��•, o r�. pRp E .LOT 31 LOT 29 ���� � ; 0$ �• T .--7 t i 43' LOT 30 -5w V �M 00, Nw eta''` RCS ZQ 'E PG' This MORTGAGE IPEC7I4N 'Plan is >°' FLOUR mn n:rr �� t mnnt Hank Use Only, - T1�4��'++*1 .��L+'1 -X-D- iC-icL�tS`Iic`�� l.i 1:�f R Lr! _. D.ATt1 I11,t�cf alt� i; RCI' '70 I Hr a FQ THAT TEIE BUILDING ��bF L��dliULr SUi�i V Y: SHOWN ON THIS: PLAN IS LOCATED ON THE GROUND: AS SHO'01 ANND THAT ITC POS{TIO v DOES C01\FORM o� :;PAU4 :`.ys G©NSULTANT : fit? 114 Z6NING :LAW SETBACIf 'Rl',6111RpRiIE lS OF Tab �� a 143 ROUTE :149 TO�t OF : l'1rAr�TA7'/1' ,1N1 Ti1RI NoP�32o e �tAR�ION `v41LL5 Mah 02648 r�fJd a� 4i'f`ft9j� i I!I 55RECIA! I I.i OC) 114�tlf'i7 aS. �1 hZ '.c �O�S tz\ T1i 1i U 111 MAP DA FI)._t? ��� F'11�t: ;�Q Ue in.6,111: . _T t,}el rt .. ,,ODU/ C,0l5 L 2�r1s S l' y _ 7r�� f'LaN i\OT: M tiD ERfi�t a.; h1JtiEV7 F AIsL A.:IAERM Pl SLtttiE;Y. \TO!,T(3 $E C1 Fi3 FGF iI NCI E,G � %3 f oFZHE To,,, Town of Barnstable *Permit# 33 D ti Expires 6 months from issue date �ARNSTABLE. = Regulatory Services . Fee 0--51 9 MASS. 1639. .0 Thomas F.Geiler,Director ATEDN1°`A . Building Division Tom Perry, Building Commissioner X.PRESS PERMIT 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 JUL 3 0 2002 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIALWkWOF BARNSTABLE Q Not Valid without Red X-Press Imprint ✓lap/parcel Number ! y — 0(.7--7 'roperty Address / 714Ct 'U 0 W esidential Value of Work 't/0, Oro (f� )wner's Name&Address M-1. Vn ,Ika u j d Lhau- to .7 44alw 0 nj Gj Ce a 4f-r f/1 U :ontractor's Name ! (�% Z1 /�O y�!1F. ,� �(/Q An 0 1\4 Telephone Number Some Improvement Contractor License#(if applicable) / X)7'10 ,onstruction Supervisor's License#(if applicable) Ct5 05 7O 3Q orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I the Homeowner have Worker's Compensation Insurance nsurance Company Name Vorkman's Comp.Policy# a,SQa,Q 7 'ermit Request(check box) re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 3ignatur' ; �,Formsexpmtrg e`vised 121901 rt £ sgi SK � ; y t.0 C::A T 1;0N: S VE4 E PE R M I T NO. T 3 a 'O.AL VILLAGE 1NSTA LLER'S NAME L ADDRESS - s R UILDE R ® OWNER DATE PERMIT. ISSUED : DAT E - 00MPLIANC'E ISSUED - o .a r+-+,., - . 'tirt.i-'�"Ya-w - ^ti'k[f'�.'iM1P ti±.'� w. -tr' -w �. +t ...s+,. i i � ,.. -.f•.-n•:- -• ..�;�K. y.�.,-.^.1 ''4r.==,yro` z; •TMt TOWN OF BAItNSTABLE Permit No. ---------28037 { n Building Inspector Cash 161; OCCUPANCY PERMIT Bond ------------x� Issued to .dames K. Smith Address lot #30 69 Halyard Way, Centerville r Wiring Inspector - Inspection date M-- Plumbing Inspector✓ Inspection date Gas Inspector `y.? �/ t Inspection date ...... _ C Engineering Department ` -ter , �r �/ , ��? Inspection date :.. .. `ti Board of Health y ,� Gl�lL �Y�Y I A Inspection date ii THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. C.....................f . -s-'O 19..�� // �,� ._, __. ._.. .......». �........ ........ Building Inspector �a. .,. � �� i t w� 1 ..'x Kam... �.. �G4.,yz.� S �. y` .;f .i:?'. .> .ti - fit'• 471 TOWN OF BARNSTABLE BUILDING DEPARTMENT = D ryARa. 0 TOWN OFFICE BUILDING HYANNIS, MASS. 02601 '�o cur�• n MEMO TO: Town Clerk FROM: Building Department DATE: Ll{lJ. . An Occupancy Permit has been issued for the building authorized by BuildingPermit #... tea'-.. C�..r .. ........... .......... ...................................................»................................._..... �'Z f ' . t .:z .issued to ,,;�.�� ..... ..x:.. ... .. ............................................_.:........._..................._...... Please release the performance bond. e f Assessors map'-and lot number" ,..... . PU,�1� r � �F TN E Sewa'9 a 'Permit-number .....:... ............. 0 °jf .� ��"�..5.'7.�?�. �. �...� C L'�h, •tE/e ..� �Qy O ° z. ... � .......................+ � INSTALLED IN coh4pL� Er Z9 MSTA nLEA House nUmber ... .... . . ... yy.. . MM6 9 � q T i IEWRONMENTA TOWN ', OF B/A�RNS BUILDING INSPECTOR ,. FAPPLICATION FOR PERMIT TO . . I :TYPE OF CONSTRUCTION ............. . A....................19..s1�:�� TO THE INSPECTOR OF BUILDINGS: The undersigned h.. reby,applies for a p.er it according to the following information: Location ......� . ....... ...... .( .... . ................................... Proposedy Use ... ...................................;......................... , Zoning District ../—. *. .... . .... .................Fire District . .. .. Name of Owner .. ..... . .... .....11..s..... ....Address ........ ....................... . Name of . . ......Address ........ . .... ......................... Nameof Arc it ct ....................Address ...................................................................................... k , Number of. Rooms '.:. ...:.: .:. :..................................................Foundation .... Exterior ..(,. . ... ......... .... .:..:.Roofing....... Floors s, P1` r�. ,................::..........:Interior ....... . . ............................ Heating .... AIL.... ...... . ........�:.... ....Plumbing i " Fireplace ........................4;�.:.................°.................Approximate Cost ......... ..� ........ o-�� . Definitive Plan Approved by Planning Board __ 'I-_____-____'__19 __ Area /`./.... ...®...: � . ... Dia rom.of "Lot and Building with Dimensions: y d g 9 - Fee �......�. SUBJECT TO APPROVAL OF BOARD OF HEALTH y w - OCCUPANCY. PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform .to all the Rules and Regulations of the Town of Barnstable regarding the above construction.' Name ... Constr ction Supervisors License ,1.. <... .. JAMES K. 1,, tNo . Permit,for .One, StorY.............. d ; Single Family...Dwelling. . ............... _ y Lot 30 69. Ha1 and Wa ` Location .................c.........:.... Y.............Y........... .. . ............................................................... Cetrie ................. +a -,; ` n Owner James K.,Smith........... -'; Type of Construction .....� ......................... , a. Plot ............................ Lot.................................. c' r; I?etmit Granted .June 17 ........19 85 4 r• Date of•Ins pectiori 3 19 a Date"Completed you ,y,aY� ... ^• . ', ; • � t a , a�b ICES/G/V 42,4 7`.4 z! S/N6L:E. F�tiy/LY_.-� 3 BE0,2aOr�1 zZ- N`e �C)o.Oo � OA/LY:�LOW = //O"X3 LD`Tr d/.SFS.4G /T.-='IUSE %404 iS'�1� 2-j /f-o s x. Z.s = 3T G.�o. CorcM• G- Ba TTo�►-1 A.2�.�1: - So :5..� DE.S/Git/ �.E.2000QT/�N:2.�JT� ! f N 0 M mat nkf., rh(I STiN 6- Zo* _ 'Y ., RICHARO PETER u, � N . �r A. o SULLIVAN `:'� o BAX7ER, - NO.24048. No 29J33 • 9�tAc R�O� .c . �pF . . < w° '�.l. 40� � .F Pq v � /vs.g o r �*��° � ' /STAp b D O OP ZIP , %sTff` n`w• f aq �G E^/��oo. R� _. . ar / . S/ONAC �S oo' r�sT f/c p- 3 g 5T 4- 04 R.O tit �. �loyi 6•ac. /.YY BOX /.v✓. GAt-. /o '• t�ac4 fir . i Gz v. W/ 'Zzll TO/% • CC�Ar1 s W.Q.�s+Ev /iS/t/ hw. _ �i,v[�' •; .ST�wE .Job¢,L ; /04,:,¢• G'E,2T/F/EO f�G OT pLA,✓ Santa c L.oc,�Tiaw C(=,urc�2 vi C�C.L �'I--- '-,-�i��-- /9 Y Z z, i98s L�7- 3v �No WaT�'�..' qL EX�ST,v lr _ /�C9A1! /Obo,C, 1246C" 7o / GE.eriFY Tf•'QTT/�� , o uv 1Tv,V S�/aW.V /h/E,G�E�.V G,Gi►IPGY.S /,t//Tfi�Tj�/E',S/lOEI�/it/E ,BsIXT�,e F',C/yE, /NG. AAvv.OE5r .,9,44 & .2E"4U/�Ek1ENrS.d� Th'� ,2EGisr�eco.C�vo.SU,e,iEya,P,� m- LOC.QTEO .W/Ti5///S�. A.�,Gice,vr- MGs �ZZ /9�S I � �0 ;T//ls�l..s�f/ /.S iVoT 13.4SE0 Gi✓.4iV/iY,S7,2— -i/.tilEs/T.Sv.2dEy.4�c/O 7 A/E S�limit/,�E.e�'4N•S.w�000 I>yaT LSE USEp 00 Assessor's map,and lot number " .� T r .....:... F TN E Sewage Permit.- number �1S .. / Z 33AUSTGDLE, i House pumber. t "naa ..............................1.........................................., 9 �O s639. TOWN OF BARNSTABLE • R 1 ' BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....:........... .....:........:...........................................................:.. ......... TYPE OF CONSTRUCTION 4V4� .. ................................................................................ ......... ......./.,.....................19-1 TO THE INSPECTOR OF BUILDINGS: The undersigned.hereby applies for a permit according to the following information: Location ..... � ...... R ��/,®e%rl �f �r'�-'.. /�... /I ./41G -! ='`-4�........................ ProposedUse .. «:-^�...�. ..': ... !�..................�..... ........................................... ...................... Zoning District ... . 1� !-''z.......... ..Fire District �?'�[.� ✓¢4x/i.� .!..�,,!-+!r�e/!C . -, > Name of Owner ...:............:.. -C/..../1..t......� •R4 .Address ......... ...?.....s,'� .... . . /f ....Address ............ �'- d..:.,r'........................... Name of Builder ( .�GG� ........../.a,m.:..,...,_.. M..... . Nameof Archit� ..................................................................Address .................................................................................... Number of Rooms ................- ...........................Foundation ....Exterior . (_ / 7t/i.. .. .... . ....��........Roofing ....... .. .�!. ,,: r � Floors CA% �;� �� `.%,� ..............................Interior ........ •...��- - fly .................................... ...................... ...:.. Heating ....................................................... .... ..............Plumbing ...........�.. ............ ...................................................... Fireplace ....................... . :....�°°.....................................Approximate. Cost .........�..�f?:.......... �� -, ............................. Definitive Plan Approved by Planning Board ___ __�1______________19 __ . Area .... 'a............-. .. ........ Diagram of Lot and Building with Dimensions Feer SUBJECT TO APPROVAL OF BOARD OF HEALTH �y .�A.. y OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. 0�.... .'1!. .�. .nJ.�. .. : 1 ....... Construction Supervisor's License .......�,, . �................. SMITH, JAMES K. A--194- 28 037 A-19 0 One Story No ..... Permit for ............. .............. ....... Single Family Dwellin ...................................................... ....... ........... �r Location ..Lq�..301..... ..... ..... . a 0 ..... ..... . ... .......... Centerville ............................................................................... Owner .....Jams K. Smith ............................................................. Type of Cc;nstructi.on ..Fri.............................. ................................................................................ Plot ............................ Lof ................................ Permit Granted .....!T.�?9.17x.'.................19 85 Date of Inspection ....................................19 Date Completed ......................................19 f WC( R(c) . �oFtr Town of Barnstable *Permit# pEYpires 6 m n'ths fronr issue date * Regulatory Services Fee * IARNSTASLE, 6 9 `�� -Thomas F. Geller,Directorh od ' Buildingi sio Di v n . .. . -PRESS PERMIT Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 AUG. k 9 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 TOWN OF BARNS7"A1�X�RESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ` Zential Address //V/f e l� U G S' �Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Names /Y1 G.� /i/.�14/t� Telephone Number 40)--Cl Home Improvement Contractor License#(if applicable) 7ik ction Supervisor's License 4(if applicable) man's Compensation Insurance ' Check one: ❑ I am a sole proprietor , havethe Homeowner 'Worker's m Compensation Insur cc. P Insurance Company Name Workman's Comp.Policy l# 'J Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) N El Re-roof(stripping old shingles)-All construction debris will be taken to . ❑Re-roof(not stripping. Going over existing layers of roof) ❑ R.91side #of doors Replacement:Windows/doors/sliders.U-Value - _ (maximum,44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulati bn s,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. SIGNATURE: Q g p nnit forms\EXPRESS.doc 1WPFILES\FOI2MS\buildin e Revi.cPd n9nQn9 The Commonwealth of Massach usetts, Department of Industrial Accidents F: 4� Office of Investigations t ton Street 600 Washington r g ' Boston, MA 02111 �E J www.mass.gov/dia Workers'.'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individua1) ` 50 e-fR Address: J 7 .pe�r/C7 90,6 City/State/Zip: J 'o KS Phone#: '�(O1 71— ,6 l �` Are you'an employer? Check the appropriate bog: Type of project(required): 1.9 I am a employer with g 0 4. ❑ I am a general contractor and I *' have hired the sub-contractors employees (full and/or part-time). 6. ❑,N' construction listed on the attached sheet.. 7. Remodeling 2.El I am a sole proprietor or partner- ship and have no employees These sub-contractors have , 8.. ❑:Demolition workingfor me in an ca aci employees and have workers' y p, �' t 9. ❑ Building addition [No workers' comp. insurance comp. insurance. re wired. ' 5. ❑ We are a corporation�and its 10.❑,.Electrical repairs or additions q ] officers.have exercised their. : I L Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ _ g P • myself. [No workers' comp. right of exemption per.MGL; 12.E]',Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑.Other comp. insurance required.]-. *Any applicant that checks box#1 must also fill out the section below'showing their workers'compensation policy information. t Homeowners who submit this:affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and_state whether or not those entities have. employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation,insurance for my employees. Below is thepolicy and job site information. �� r Insurance Company Name: O Policy#or Self-ins.Lic.#: Expiration Date: % /0 Job Site Address: / City/State/Z 4,9 �8 Attach a copy of.the workers' co ` ensation p declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25N 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`under the pains and penalties of perjury that the informatio_n provide d�jabove is true and correct.9 Signature: Date: Phone.#: q >-C 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 q3. City/Town Clerk A.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: "Phone#: JQN is f 5 3:- K • 5 c 1 Lt6iosa, Cs SL SOW - . . Dod w 0 DAMES UWI VOW_ -. SOW k-eCK I It-K..A I C VI✓ LIAMIL1 I T 1MVKAM.A: Po0J 1 05/07f20 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'S UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Iunville R! 02938-0001 Phone: 401-769-9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE LAIC9 INSURED Moon A sociatos Inc. INSURER A national cramp Frw=ance Co 14788 DBA Gutter Helmet DBA Renewal by Anders L of RI INSURER S: Beacon mrtual laeurance ea. D Gutter Helmete*Roofing INSLHRER�^ DBA Moon Works - 1137 Park East Drive INSURERD: Woonsocket RI 02895 INSURER E: COVERAGES THE POLICIES OF INSUTANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING A14Y REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THEE INSURAPICE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRN TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/1'YYY) DATE I'%DA A UMr S GENERAL LIABILITY EACH OCCURRENCE $10 0 0 0 0 0 .A IX CAMMERCIALGENERALLIABILITY MPS26619 09/16/09 09/16/10 PREIv11SES(Ea oocurence) $500000 CLXIIAS MADE rXj OCCUR MED EXP{.Any one perso) $ 10 0 0 0 PERSONAL&ADV INJURY $ 10 0 0 00 0 GENERAL AGGREGATE $2000000 GE'NL AGGREGATE LIMIT APPLIES PER' PRooUcTS-COMP/OPAGG $2000000 POLICY SM El LOC r AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANY AUTO $1326619 - 09/16/09 09/1S/10 (Es accident) $1000000 A. ALL OWTIED AUTOS BODILY INJURY SCHEDLLED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Peraxident) $ PROPERTY DAMAGE $ (Per weim) GARAGE LIABILITY AUTO ONLY-EAAOCCENT $ c ANY AUTO OTHER THAN EA ACC $ � AUTO ONLY, AGO $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $1000000 A X OCCUR FICLAmsMADE CUS26619 09/16/09 09/16/10 AGGREGATE $ DEDUCTIBLE $ IX REHEtkMON $10000 r $ WORKERS COMPENSATION ER AND EMPLOYERS'L"tLITY Y I N X TORY LIMITS B ANY PROPRIETOR1PaRiNER/EXECLMVE ❑ 28S86 10/01/09 10/01/10 E.L.EACH ACCIDENT 3 S00000 OFFICEWMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE.-FA 154QLOYEE $50 Q000 If yes,AL PROVISIONS below B under SPECIAL PR E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RZUE 4AL DATE THEREOF,THE M)M OMRER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Renewal By Anderson REPRESENTATIVES. 1137 Park East Drive AUTHOR(MD REPRESENTATIVE Woonsocket R1 02895 ACORD 25(2009M) c4 1988.2009 ACORD CORPORATION. All ties rimed now ww.rrsws Q i Ile. atwnalnr 9 mom all Sim SSW •� ' as w[w►�r/a,r► . � � 1 ni 'S .MtUeswlM p �4 .dL*=M" OP 3 � � � � � � .• I d ih NAde V (P ❑ ❑ w AM � -C � KMyedAOrle► S. � r R'd 2929TL9TObT:01 969L-b9S-B0S 1-139NU 1100S:WOW 20:LT 0T02-z-E)nu _ The Commonwealth of Massachusetts � = _ - Department of Industrial Accidents 600 Washington Street _= Boston,Mass. 02111 Workers'Com ensation Insurance davit name: location " " v city C-� \Ll, .J ' (DU --- phone# ❑ I am a homeowner performing all work myself I am a sole Proprietor and have no one workin in aav Capacity IN / I am employer m,.:..:;.::..:y;:.e;:::.:.�:: Pla3eeo.:.:ringo::..:.:n this ::;.;;: ..........:.pt ;::.;;:..;an emP1oy . ... .... :.:.::.......:::::::......::.::::.........::::.:::::::::,........,..:.:::::::.......,:..:::.::........:::: ....,.::..::.......:::::::::.:.:.......: .....::.................::::::::::......:::. :.::::.:.. .....:.. .::................ ............................. .............:.............:.::.;.::.;... CO*m anv addre ... ;:::. .. tom.# ....... . ::...:.,..'"��'�'?' :::;.���:. ' :•.-::::::.:,,:,.�:;.:.:,:;.>;::,..:,,.::.... ......... of insurance co;>: i////// circle one and have hired the contractors listed below who ❑ I am a sole proprietor,general contractor,or homeowner'( � 1 have thefollowing workers compensation f ..............:::::::::::...........::.::::::.�:.........�::::.:.,.........:::::.::.....:.:.:::::.........�:::::::.......::.�:::::.:_.:...................... .. .:::.::::::......::.�:::::::::.::.;:.;:.;:.::.;::;.:::;.><;:<:>::>>:::::.. m vn am .. . <;•>:•.: dress. .......... .............:..::::::::::.::..:::.........:...... :•:::::. :..................:.................:.. ..................... e on _,....: ..:.. .�::.:;:;;:.;>;:.;-•rxc•:::..:.::mar::>::•;::......::. �.✓L// tnsnt•anee ca COUTPH. ................. i .. ..::::•i:;:}i}i}:i}:iiii:;:;i:;:;:;i:;:::ii:?i::iiii iii:?i;w.�..::.; !1 Ai:: 4 ,:+.�......... v name: :.::, .:.... ss. .... .........: hone#: :...::................. :;:;...::.. 1 c ;:;.>-->:.,..,. .;::<.:��;:.;:::-;:.::;;;;;;::;:;:.;»:.>:;;;::>:�:>:;:>>:<:?::»:�:=:«::<�::��>>�;:>::.;::.ter::•>:;,:-;•;:::;.;:.:;:.:•::-:. ..:.::.i::::T..::i::b:::::{:•:n?::::::: ::$iii'i�:`•:Ji:?}4:4iii:::i::i i:::i::i:::4ii:•ii::i::::::4::•:��•iY.•iii.'•::>.::r::�:ii7i:v.:......:.v.•..::.......... of mad or Failure to secure coverage as required wider Section 25A of MQ.1S2 can lead to the imposition of esitttutsl penalties ga a Sae up to Sr,500.00 that a one years'imprisonment as weal as civil penalties is the form of a STOP WORK ORDER and a�eriSts<tioa00 a day against ma I tutderstand that a copy of this statement may be forwarded to the OfStx o estigatlo�otthe DIA for eoverag 1 do hereby eerti the p ofpalurythat the information provided above is true and tort d Date -Z, Signature Print name HEMUM oincial use only do not write in this area to be completed by city or town oindal permit/llcense# ❑Building Department city or town' ❑Licensing Board �� ❑Selectmen's Office ❑checkif immediate response q ❑Health Department ❑Other contact person: (reused 9/95 P)A) Information and Instructions 'on 25 requires all employers to provide workers' compensation for their sects . Laws chapter 152 qunre ntract Massachusetts General L "l to ee is defined as every person in the service of another under any co. employees. As quoted from the"law",an emp y 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 association or other legal entity, employing employees. However the owner of a trustee of an individual,partnership, house of dwelling house having not more than three apartments and o resides therein,or the occupant of the dwelling grounds or another who employs.persons to do maintenance, construction or repair work on such dwelling house or on the 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 coveragew required. Additionally,public wo until the commonwealth nor any of its political subdivisions shall enter into any performance have been resented to the contracting acceptable evidence of compliance with the insurance 1eq of this chapter p authority. Applicants the box that lies to your situation and Please fill in the workers' compensation affidavit completely,by checking applies supplying company names,address and phone numbers along with a certificate of insurance as all affidavits.may be submitted to the Department of hndustrial Accidents for won of insurance coverage. Also be sure to sign and or town that the application for the permit or license is date the affidavit. The affidavit should be returned to the you have any questions regarding_the"law"or if you being requested,not the Department of Industrial Accidents.: call the Department at the number listed below. are required to obtain a workers' compensation policy,please 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 has to contact you regarding the applicant. Please affidavit for Yon to fill out in the event the Office of a reference number. The affidavits may be returned io be sure to fill in the penmitlliceose number which will be used as the Department by mail or FAX unless other arrangemm"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. 0/0171 The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents otllce of Invesugadons 600 Washington Street _ Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 7W CMR Appendn;1 - Table.I=b(Continued) pmeriptive PackgM tar Oae and Two-Family Residential Buildings Hated with Fossil Fuels MINIMUM MAXIMUM Slab Heating/CooIing Ola>sag Wa1I Floor Baste Petim� Equipment Efl m=wY' Arce(y). U-vaiuet R valaet R value' R vataes Rwvalnue` R valae' Package 5701 to 6500 Heating Degree Days' Normai 19 10 6 Q 12% 0.40 38 13 Normal 6 R 12% am 30 19 19 IO aS AFUE 13 19 10 6 S 12% 0.50 3a 13 25 NIA N/A Normal T 15% 036 3a 6 Normal U 15% 0.46 3!i 19 19 10 tls AFUE 13 25 NIA - -NIA v 15•/0 0.44 38 19 t9 10 6 95 AFUE W 15% 0.52 30 13 25 NIA NIA Normal g I S% am 3E N/A No=31 y 13% 0.42 38 19 2S NIA 90 AFUE 13 19 10 6 Z Ig•A 0.42 31 19 19 10 6 90 AFUE AA TX: -ZL 00 off' G Affl� " 1. ADDRESS OF PROPER 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-See chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAH ABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a 780 CMR Appendix J Footnotes to Table J52.1b: ` Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass or, thelg gross al basement windows if located in walls that enclose conditioned ar maY pea but doors) excluded from the U-value requirement. area, expressed as a percentage.Up to 1/o of the total glazing glass may be excluded from a building design with 300 ft of glazing area. For example,3 fl of decorative 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 11.5.3a. 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 plus insulating sheathing (if used). Do not include •Wall R-values represent the sum of the wall cavity insulatio For e imple'an R-19 requirement could be met EITHER exterior siding,structural sheathing,and interior drywall by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass.(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. '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. •T a 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 must sliding the door U-alue requirement bz.lements must be included with the other glazing. Basement doors d-scribed in Note b. The R-value requirements are for unheated slabs.Add an additional R 3 heatedor , or SbsIf you plan to install more If the building utilizes eleetric resistance heating use compliance approachY P 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 J52.1a 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 t door token nofra avom ailable,door ude the in Table J1.5.3b.If a door contains glass and an aggregate U-value rating for at 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 edarea-weightedoocomponents comply if the ue area-weeght d average equal U- the R-value requirement for that component. Glazing value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 Inc I °j The Town of Barnstable tgA MSTAB MAS&I.E. g Department of Health Safety and Environmental Service s 039• Bwlding Division jED MA{ 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissicn:_ Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPRO__ MENTTCCONTRACTOR T TIONW SUPPLEMENT To c. 142A requires that the"reconstruction.alterations,renovation9 repair,modernization,conversion. MGL 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 siruc alon h with are adjacent to such residence or building be done by registered contractors,with certain exceptions, g requirements. estimated Cost �o Type of Work: q ,� Address of Work: Owner's Name: Date of Application: 8 4 O 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 O IMPROVEMENT WORK DO NO CONTRACTORS FOR APPLICABLE HOME INiPRO FUND UNDER MGL c. 142A. ACCESS TO THE ARBITRATION PROGRAM HAVE OR GUARANTY SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 1 � � Registration No. Date am n OR Date Owner's Name a:forms:Affidav EST/MATED PROJECT COST WORKSHEET Value LIVING SPACE (high end construction) square feet X $115/sq. foot= (above average construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X$25/sq. foot= PORCH square feet X$20/sq. foot= DECK square feet X$15/sq. foot= OTHER square feet X$??/sq. foot= Total Estimated Project Cost IAHFORM 1/3/00 r _ E0 �i �� � Resc��C� SLID E MVI 3, • .F,cl kAt,:Y 90 WAY ; C C-NI T�-F-VI GEC MA 3? ! l0 { i - j. _ l�lpAi�l� Th Q�f�i�JF F.X�SZ�f�I � .�Et� �4 °; _ �_ -,� �,' ��_ _ G'_6<, 1_vH E 14-tc t-EDG�2 R�fe� .•�����rr..t..bP�1.. 3Z.° d f`; I , ., :52 OIL AT PC-6mo i L I. TizI e r Tx o P C-1114rpv C7 ot-eP of 1404((. 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(711(.1I:(Ihf 1)OC)I: .�il.'G110114VI111 10 t r� . i'fl:(15;!tYKa 61i;i lSt{ SI{%I.i.CUNII>KIJI_ I.Y/II V LOWS •:40 N(il' V.AI;131 kVIA E , , > G/ U IIIJII Ik1.11: Ull; II; D SO 1,11iQj 'I' ? JU IS ;s);p . I ISY fl;(�1i7 I{II I)1 Itllll'nCllll;iblt;CUI;II'nIJY UI '`,[)I Or11^i [S I'il l)Irl .1)OOI I ills I ItJP) L Al U4VAM MEMOS S AI E VA':1J)U1`QH a UOt R MID ID 4Vlbll)pIV LOU',1101;1;� YJ 1'llfll)U4'J, I\ it ..:j- 4' �•(II;IVC-11?hr111!.!.I(Jh! ; ^� C � UI'I(1 3I C'I IOhI IlII I! �(q U!' IIfL'I11.SILIAII LOAD/2„5 \I:15ILIILI:(:Ili\11Cil=/N31I°. IIDIIIO;t)(;nllr - )I I I II'l;(1AI)AI 'il'r\Id(12.0. 1(il✓1SS KI WE 50116 AIJ. IJ II(;I Ir11II II'I_ li(, 1,1(III tCl)LII+I'rV•II,L::7 YHi121(\t `_ I .._ .'....... ....... .........hG!Icl�.,'I'0 CI:AI°('-13lL'I.511:UG'IiJl:nl. _... ..------ Itd'I'LI',L'hl/\I•IGI?r`,131.I:.1A/l'fl"II'r\I•Ill.;i LI'5='hill.(;ilYf:fIII Pid!CLS i`>511, f't(It,irl<<i I'I;U,)I_CI'i CO(IIRAGIO1'.: 2' (,\IdlL;S 4VIII I ALIJi IIIJLIl.I;il;llI$13QIIUI'V'Ip (i "'1VILI01>I';iVALL IAAi YAf t I H' II=. II II I I Inl Ll'-L>I:OIU:bI �}}' 1101 II:YCOLf6/I'OI;(i(YIT ll_COR Ci(,i I A" POOR/MI II)OV-1 I-AYOITI IJL I O 2,11'1', \LlJlrl 11311f`I'hI`IIi1Z �' cltana d t ,: n Afili y"II IICI;I11.iLiL;I G.). ; '(, J.AllI'I lOi'III 1)1'OIZ ISI°TI!_I'I.B'iFl(i (J/I1=0V I I IAIIG I< Jo,cS -_ AIMACI IV t'Afll'sl$AI;E COldlll(I I I)`II III( DIALER USE 01•II;r'. r5F roe ID5/5Q.F(JOI �+. - Iasi I '. STUDIO EMIC O`)UI� YII I'rl.t LliAl'5)01:11 I'm 1'Ahll 1. t \��.9 / Uf:Atl/l•I!3Y:L,!,J, (A1,10 Ho.! ;. j F.I. I I'GY i cln!)0-11�r.1:?.rltvcl L_I�II-1�A1 m IOU P/VIcull nLur,aual)r,I I ; t' , : 1=°11J2/J x 4 L 0 T 4 � i t .i ! h; k L. LOm LOT 9, . pv° [tixr�, LOT 90 l - �. � `'` Z ct.. :�-�,_ C i..t•i;-;•o` ,��i'��{��,• ,�: Y .j �9.I 7�``:. ;�< �,E�.--.i"' i .. � C23 %i �v [f G04'E Thts Ill�'?Tf 4CF i��jyc7vCl2C� �1C��.��n� • e• n.tt n TFr i r f ® f Ztt! 7 °T r'�� �6„ — F Y 1t 't-.fnr?t I' €'r'1 'f �_f f� d{(�t�!/ t_f' ("� ._' t; 4 { kr 3T ThE 3—lUI . I t� u 7 t i xrz L} Ci uT r tr SEly 0q THIS rL�N, {� AfRD fit. e wl r,, lh i uEl v vsr1,} . � i t T f Y _]H Vi`7u6ND A`R : 8rsv,1� -,uND ^I IT �Sfifv 4 J�1K r G. < r j, r tr7i~ ac�I� x ,f, �.F I PAU ELT NHS ttt ' E'iA: tFil �1TRMZxtISr� 4r T3 -,'F. it)UT1' f II L iTYS�eF j i t nto.32^3R to � � �ti'LS 2-1t� 1.9r �� ��L� r ',f R_.;I..� +7L. _ � ,tv�, . ,rim �"�.: is , (}FZ fi S.C. r �7-z�i L'a(i` •.� 1 �' f f` 6 F `?v,f�t 3,/A 0163Z- 1, t f P _ f Fk r fr I 3 i. I t j �� t�..—� ---�•--..vim.-_ ��__. --r --� F r r tv i " j s 2K8-PT f` f• Q�� �t F'F-F[ 1 f�' _ y - ' � •, t�-`@ ar � 6€�/��p 1�tit--c.����E�`-"'° �'�`zi. ZttG t Ef•(}.3 i I . i ;• ,rf 1, ;�� --- "{ t ,! „ li i .i. _ , i 11 t 7I F ,ram i �fa m rr,, `F A (^ r A w , d : ) •_ r �+ � � ,�{ .. _ ,gip -;1 _� I FIN 7D, ,: ' 1 IN f _ Y f L i _ �J � r •' o �� i �J _JA : I _ I J Y I M !Iin i .. - t�l _ x: d — ti _ — _ - . I. \\ I 1S.LTMR,.0R'1T�1 TT�N FOTtM TII�200MS" .��� y F _ , I huset__;rS LOBuililuiG{oe(78U�Ch!E�tAppenJ' 5 f�onr 1.1 7 T''The?.iassachusetts State Building Code (780 CAfR) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroorn" additions to a_-, existing house (780 Appendix J, Section J1.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom" of any size, configuration, orientation, for-sn of constriction or percent glazing, but rat-her is only intended to assist horneowners in becoming aware of some of the important-energy conservation and year= round comfort c01;siderations involved in selecting and utilizing a "sunroom"addition. The connection of `suihroom" structures to residential buildings may create comfort and energy consumption issues flue to uncontrolled solar gain or uncontrolled radiation cooling oi, the main house. In the selection and con struction/instalIatioil of"sunroorris", included belouJ is a rioih-'r'quired, open-ended list of product and design considerations that a (homeowner may +Fish to consider before actually consfaucting/lnstalling a "sunroom". It is reconhin--nded that consumers carefully review these options with their designer, builder, or contractor, in order to mirhiinize potential energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO "SU-NROOIVIS" Y Solar Orientation and Natural Shading . . e Type of Gfnzincy C • insulating v::lue • Solar heat gain Frarne materials ® Glazing to frame sealing and gasketina materials/seal durability and/or weather tightness of the sunroom • Adequate ventilation - Operable windows and fans t, Applied Shading Systems • Insulation level in floor, walls,and ceilings Possible S nr Ciih'iSClarCn ir'oiil iiie iiiairi ""use via a Yvall and/or floor or slider heating and Cooling Methods: Efficiericy,Zoning and Controls Homeowner Ackriowledgrnent The Massachusetts State Building Code, Section JI.1.2.3.1, requires that the actual property oA.ner..(not the owner's agent or representative) acknov✓icdge receipt ofthis CONSUMER INFOI2MATION FORMM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the fQrr-nation in this documerht concerning smiroom co'n f rt and e.� C a, ver rjT,' conservation. (44 natures Actual Building O•,�Jncr bate Cet4f;111 Miq Print name Address of Perr itted Project 01b32, k-1 SUS 3�F5 � I LZ Owner Address (if different than project location) Owner's telephone number �?t�li� c�'���,,.�:��.�[��►`'�� ���T,rf�� �,�, r,..` '...�'.,�`� � .�-��,�aYlc nil vuddr�c.an;d,au�nro oiu� :, , -.:, Exce tion: Srcnroom Additions I Consumes`Notification ,Sunrooms, as defined in 780 CMR . AppeiictLx ix:o Ilr7r�i I IE7N , alutl f�i exisinES! i�cii:rY tho cdinpliancc tdq�iiremnts set forth in 780 CMR Jl.l. .3.1 `and J1.13 Irovided that the actual proDcrty owner (not.the' owner's agent or representative) of the structure onto which the sunroom addition is being made, provides a signed copy of the Sunroom "CONSUMER INFORMATION FORM" (found in 780 CMR, Appendix B) to the Building Department. This signed "CONSUMER INFORMATION FORM" shall be submitted to the building official as a requirement of building permit issuance, and shall remain as part of the Concirti--tipn rincuumPnfc if such cfnrpnpt addifipnC are S,pa-ratPd from the rrtatn horse by a wall and are eonditioned.spaces, then a readily accessible manual or automatic means shall be provided to partially restrict or shut off the heatingund/or cooling input to the sunroom addition space. That portion of a,vall that separates the sunroom addition frorn the existing �•_ tt c _ c' 11 a oLilartligic we!!ing unii, i i Lill �.'r_i ji frig exier or vJalt, )IJGLU Ue ait0 r'�eu Fv^ rei2a0.in and iteitther that portion of said wall or any fenestration within said portion and common to die sunroom addition, need comply with the thermal envelope requirements of Appendix J. *--.-,._ .. ... -.... ,�s'E•-r— r:rF""""_, g }�T `FT�� �,�C`�.F e �- �g, JG� 1.7 ^ig�rEC tL4t;JL V 33�A E1\RbL NS cv 780 CMR J2:0 DEFINITIONS SUNROOM: An addition to an existing building/dwelling unit where the total area (rough opening or unit dimensions) of glazed fenestration products of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. 16,e ecsou,°Stcpr ' ,c�u �`�OdSI( E` kil UY � ...��,,,�.r-� t vim. ���; c� t.r:'•�'.��� b, ��,r �, c*c:..+, �y,.�:.nvtaKZY'GU': �..',dXS a. Este � � ��venc2s�ili,csfrtlae�ode,�mctlta��e,�cae$t�d FsrrnsPdz$te�ya�"'� rah=n��a :C� �.: • r atlo nos .. 4M'-R I t A C:�hrn e roryourSout. 100 Oils St-eet+'-N-orfrioo_o,2vLA 01532•Phone(508)393-04.00•Fax(508)39340340 visit us at.,www.D'atios.com HOME, alPROVEMENT CONTRACTOR LICENSE —^ Orr -;p9!1U=M{9T CO1;TR?Ci0?-,� PTO �00!?S.Or BOS !t;! 't�C Gc cam^ � yv1% r ji - F � �JR�UV of 0iI" ? Au. /� ��� ✓/ N :� J� 1JM'!Lr'I.OiI7.l!{2CLliLf'L 0��-���OfLC42ccorr26 - , BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS. 070998: - Expires 02/20/2003 Tr.no: 7227 Restricted To:-,.j.G ANDREW T MALONE 41 WASHINGTON ST#2 NATICK, MA 01760 Administrator DATE(MIJUDM7.) AGC H0. CEIRTIFICATE OF LIABIL1 I Y II�ISl�1�ANCE 07/26/2001 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR JP McKeone Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE INSURED Patio Rooms of Boston, Inc. John Esler I INSURERA: HARTFORD INSURANCE OF THE MIDWEST 100 Otis St. INSURER B: Northboro, MA 01532 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRI POLICY EFFECTIVE °OLICY EXP!P.ATION LTR TYPE OF INSURANCE POLICY NUMBER ..DATE MM/DD/YY I DATE.MM/DD/YY LIMITS A I GENERAL LIABILITY 35 U UC 35019 11/01/2000j 11/01/2001 I EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY I FIRE DAMAGE(Any one tire) $ 100,000 ICLAIMS MADE _J OCCUR i - I MED EXP(Any one person) $ 5,000 - PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE I $ 2,000000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY n JECT LOC I i A AUTOMOBILE LIABILITY 35 MCC 302718 11/01/2000 11/01/2001 COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ 1,000,000 I ALL OWNED AUTOS BODILY INJURY $ X SCHEDULEDAUTOS (Per person) — X HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ iX � I PROPERTY DAMAGE- $ (Per accident) GARAGE LIABILITY _ AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ SS EXC OCCUR,LIABILITY I -�CLAIMS MADE AGGREGATE OCCURRENCE S DEDUCTIBLE - I $ RETENTION $ IWC STATU- $ A I WORKERS COMPENSATION AND 35 WBC FI3935 08/01/2000 08/01/2002 TORY LIMITS I OER EMPLOYERS'LIABILITY - E.L.EACH ACCIDENT $ 1,000,000 - E.L.DISEASE-EA EMPLOYEE $ 1,000,000 E.L.DISEASE-POLICY LIMIT $ 1,000 000 A I OTHER 35 UUC 35019 11111/2000 11/01/2001 PROPERTY DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate Holder is additional insured CERTIFICATE HOLDER I X ADDITIONAL INSURED;INSURER LETTER: _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRE§�ENTATIVES. AUT 6IRI D REPRESENTA AV ACORD 25-S (7/97) OACORD CORPORATION 1988 J e� , I RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 � S � • Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE 0 180 square feet x$96/sq:foot= Z x.0031= 3 B S-6 8 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft., >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) . Deck _x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool - $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if.applicable) 3 5 Permit Fee projcost JUN-04-2001 11:34 EL HAROEY AND SONS INC 1 800 212 0300 P.02 &"nMYiT in accordance with Article 1 Section 114.1.3 of the Massachusetts State Building Code, Z certify Chat all debris resulting from work associated with Pe=ni.t will be properly disposed of at Ei-• licensed solid waste disposal =atility as defined by MGL C11. S150A_ r IVP Signature of Permit Applicant E . l . HARVEY & SONSiN r ZLOAr 68 HOPKINTON RD Print Name of applicant E S T I3 Q R Q. IAA 4tof-M&I-1 i�1G .�`�►7 L __ AE 135) 1561 Firm Name (if any) Address Effective September 12, 1991 the Department of Realth?Code R aforcement acting under Chapter: 2 Article 13 of the 1986 vorcest d_ €. of ai�rinQa; of er Rev lsed Ord iG.juir c.:a proof •��--�-�•• debris generated as a result of this permit_ The proof shall be a dated and signed receipt from the licensed disposal facility containing the following i=iformation. A. description of the debris, the weight and volume of the debris and the location of the disposal facility. The receipt must also have a signature of the owner/opeiator of the disposals facility. Failure to comply with the requirements of Lb-is ordinance wz 11 result in enrorce_Ment action by the City. TOTAL P.02 n n I Mg 5 I " " K m w ro 8116 O L *�' � n• v 4k r 1 ait x rl OL r � s s die e F � GhSe 6q IIYP�Q ce�Te- .r T n n l7tgv ' /6 OL 5e are W fl s 5Tee la VA GhwSe 6q llak yo, cer,Ter q--2 �v - C (,�► s� - ci l Vh' The Commonwealth of Massachusetts Department of Industrial Accidents OIJfICCDIlMSPfASUODS r-��- .600 Washington Street Boston,Mass. 02111 Workers' Compensation Insnrance davit / /M,OF MI ..- name: oration: ty ohane# 7S'— l �`-'/ ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity -------------- I am an employer providing workers compensation for my employees working on this job. t:omaanv name: address: � /ILeuiM d/lrl city: CO Mir �� oato.3s phone#: ',or) insurance co. olity# ❑ 1 am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have . ' . , the follo«ing workers' compensation polices: eomaanv name* address: dtv: phone#: insnrance cn. eomnanv name- .....:::...... address* dh- phone#: . ..•:risurance co. .. olicv!l .... .. ... Failure to secure coverage as required under Section 2SA of MGL 152 can lead to the imposition of criminal penalties of a tine up to SI.S00.00 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 e copy of this statement may be forwarded to the Orace of Investigations of the DIA for coverage veripcation. I do hereby certify under the pains anddpp�enaltier perjury that the information provided above it trae and correct Signatureeo: y' — Date 6 16 Print name oMcW use oniv do not write in this area to be completed by city or town 0mcial . city or town perndeNunfe 0 ❑Building Department QLlcensing Board ❑eheckifimmediate response is regdiml - Selectmen's Met — -- ---' OHealth Department contact person phone QOther (rmwc 9,95 PJA) The Town of Barnstable . . . . . 9g Department of Health Safety and Environmental Services 1619. Building Division Eo rud' 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 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 be done by ordwelling lli contractors,units r to structures which are adjacent to such residence or buildingregistered certain exceptions,along with other requirements. c9 . LTI�ai Est.Cost Type of Work: � �.. � L �� � ' C Address of Work: i i /a-,' " � �' ' C`Pn Owner's Name �� C Date of Permit Application: r' �� y S I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under 51,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OR DEALING WITH OWNERS PULLING THEIR OWN PERMIT E HOME IMPROVEMENT WORK DOREGISTERED NOT HAVE CONTRACTORS FOR APPLIC,�.B ACCESS TO THE ARBITRATION PROGZAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: D Q Contractor Name Registration No. Date OR nwner's,Name - ✓lze T�arumzarzr�ierall�. o/:, 'l/�aaane�u�elle ,iiNjTRG_?IOii SU"ERt':SO}: .'r'k__ �/ee'[Oommont�ealde o�✓�aaure%use!!a R2S�r1C �d 'O: HOME IMPROVEMENT CONTRACTOR xorw THOMAS CAPi'Zi Registration 100740 16e? NEWTOWN ;?C- Type - PRIVATE CORPORATION Expiration 06/23/00 `._. _ A_. ,_._._--- CAPIZZI HOME IMPROVEMENT, INC �hh as Capizzi, Sr. ADMINISTRATOR 1b45 Newton Rd. - Cotuit MA 02635 - —_._.-.._--.._-- ✓�ie -Va»zorzo.�uuer�lt�. o��..�/lrr:;:aac�cr�ellJ I ' DEPARTMENT OF PUBLIC SAFETY X.. CONSTRUCT-ION SUPERVISOR LICENSE Number:_ Expires: r Restricted To:. BB THOMAS % -GAPItdI JR 280 PERCIVAL OR W BARNSTABLE, MA 02668 - ✓fie �o�rrziaozzu�eafl�. o/�.�lLrzvanc�u;;n.(,YJ k - DEPARTMENT OF PUBLIC UBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE 4umber: Expires: Restricted To: A0 _ FREDERICK V RASCS ii x -'i866 BOURNE RD PLYMOUTH. MA 02360