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0010 HOLLY POINT ROAD
7ee! a ..r r r 14 Application number ...2: D`..'v' a uvsTasY.e, Date Issued....... 2?! ..................................... a mass. Building Inspectors Initials..... ............................ UN� �0 Map/Parcel..........; 3.3.........Qs9................... TOWN OF A S-TA LE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WAIDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY WORMATION Address of Project: /0 fife//y NUMBER STREET VILLAGE Owner's Name: .i _� Phone Number_ Email Address: Q/" YAO h ifs 9("Ca 31 n e-� Cell Phone Number Project cost$ Z- O O Check one Residential ✓ Commercial ®V9'iWlC+R9�AY.J YJCII®JItlHB!tL'�gJl®1V As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: See �-{{ �,Q nr,�r� Date: TYPE OF WORK Siding Windows no header than C!( change)# � InsulationlWeathenzation ❑ Doors (no header change)# Commercial Doors require an inspector's review ED Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CO TRACTORS INFORMATION Contractor's Home Improvement Contractors Registration(if ap licable # //Z 7 8 S (attach copy) Construction Supervisor's License# tQ 70 -7 7 (attach copy) Email of Contractor kw,ee_� q Ste@ yna Gben Phone number 4o/- 7/,/-63`?9 ALL PROPERTIES THAT HAVE STRUCTURES D YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HIST®RIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAIV BE ISSUE®. f APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected ' Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent 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 APPLICANT'S SIGNATURE Signature Date jjf�- :7 rl Z17 All permit applicatiolffare subject to a building official's approval prior to issuance. Home Improvement Agreement: Page 1 Home Depot License Number(s): Visit www.homedepot.com/c/SV_HS_contractor_License_Numbers for latest license info MA: 107774, 112785 Salesperson Name: Robert Delisle Registration No. (if applicable): Home Depot U.S.A., Inc. ("Home Depot") or service provider named below ("Service Provider") will furnish, install or service the equipment listed below at the price, terms and conditions as outlined on this form. Thomas Amy New England South 1-63F3WD5 Customer Last Name Customer First Name Store #/ Branch Name Lead/Customer Order# 10 Holly Point Rd Centerville 1 102632 Customer Address City State Zip (508) 353-9878 amythomas@comcast.net Home Phone# Work Phone# Cell Phone# Customer Email Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT HOME DEPOT USA INC., 2455 PACES FERRY ROAD, BLDG. B-3, ATLANTA, GEORGIA 30339 or EMAIL he Home Depot @ customercancellationnortheast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENTS WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: .r 05/30/2018 Customer' S gnature Date Contract Price and Payment Schedule : Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. `Contract Price: 12010.00 lincludes all applicable taxes. Excludes finance charges.* Sales Tax: 10.00 (If applicable) *Maximum deposit ONLY applicable in MD, MA, ME(33%), NJ, Wl(99%) Dep. 133 % Deposit Amount 1663.30 Remaining Contract Balance 11346.70 The Home Depot-2455 Paces Ferry Road, N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer Care:1-800-466-3337 Customer Agreement(C,E,I)(31 Jan.18) v 50.1.2 f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' a 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 15 j�i9LL S l City/State/Zip: 026-71 Phone#: .77Y 746 Are.you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑1 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. El Remodeling `ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' ' 9. comp.insurance.$ Building addition o workers comp. P _ � .insurance P required.] 5. .Q We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing'all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12Q 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 the policy and job site . information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).. Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year•imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and.a-fine of up to$250.00 a day against the violator.Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer .A unde the pain nd penalties of perjury that the information provided above is true and correct. i e j Date: Phone#: 6C 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#: r The Commonwealth of?Massachusetts Department of Industrial Accidents ' Office of Investigations 1 1 Congress Street,Suite 100 Boston,JU4 02114-2017 n ww.mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApWicant Information `� Please Print Le 'blv Name (Business/UrgmizationAndividual): ,.qoln -PJ-/ D — Address: 90 90 S7VN Citv'State/Zip: S'l tb /y olvIs- Phone#: 7 '1 7r " a Are you an employer?Check the i4propriate box: Type of project(required): am a lover with :' 4• I am a general couractor and I j �P _ r 6. ❑New construction f employees(full and/or part-time).* ve hired the sub contractors . r, listed on the attached sheet 7. ❑Remodeling 2. I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, r Demolition woe far me in any caps emoiovees and have workers' city. 9. L]Building addition o workers' coin msuranee comp'ksu ante.' 1 �] P 5. We are a corporation and its i 10.❑Electrical repass or additions requir _r I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions; myself. 1 to workers' comp. right of exemption per iVIGL 12.❑Roof repzks insurance required]t C. 152,§1(a),and we have no 13.�Other (.J t:Jo ll) employec4. [-No workers' comp.insurance required_] I , Aee/4(.e,-t Apv applicant that checks boat 01 must also fill out the section below showing their workers'compensation policy information. Homeowners who submitthis affidavit indicating they are doing aD work and then hire outside contractors must subotit anew affidavir indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-wntwtors and state whether or not those entities have -employees. :f the arb-contractors have emplovem,they must provide their workers'camp.noiiey number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site infunnation. a ` ■ / �, J /J - �- L-tsurnnce Company Name: Police•#or Self ins.Lic. Expiration Date: 3 Job Site Address: I D y City/StateiZip,.C.Pi14e r✓•Ile /t'jA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration ate). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine un to$1,500.00 and/or one-v3 imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S-750.00 a day a ' st a lator. Be advised that a copy of this statement may be forwarded to the Office of Invesn�ations of the DLA, r ce coverage verification. I do hereby certify un e i at the infonnation provided above is true and correct Si attn•e: . Date: r 2-7'1 Phone#: — Official use only. Do not write in this area,to be completed by di or town ofjrtcial. Cin'or Town: Permit'License issuing Authority(circle one): 1.Board of Heahb 2.Building Department 3.CityPTown Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone=: f � - .��;�- _� _ C.!f�.�.C` �:=r � t�r°. ,.-p _ `� ��f ,fit" �•Ct��'E4� Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card Registration: 112785 HOME DEPOT USA INC Expiration: 04/2212019 2455 PACES FERRY RD C-11 HSC ATLAIr'TA,GA 30339 Update Address and return card. Mark reason for change. 0 Address ❑ Renewa! 0 Employment ❑ Lost Card Office of Consumer Affairs&Business Regulation -- HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE SUDDlement Card before the expiration date. If found return to: —` Registration Expiration , Office of Consumer Affairs and Business Regulation i 12785 04/22/2019 10 Park Plaza-Suite 5170 HOME DEPOT USA INC Boston;MA 02116 'J ANDREW SWEET n � ' 2455 PACES FERRY RD C-11 HSC ATLANTA,GA 30339 Undersecretary d iihou signature DATE IMMfDDmYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 02122/2018 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: ff the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- CONTACT PRODUCER NAME: MARSH USA,INC. PHONE FAX TWO ALLIANCE CENTER 3560 LENOX ROAD.SUITE 2400 E-MAIL ADDRESS: ATLANTA.GA 30326 INSURERS AFFORDING COVERAGE NAIL 0 CN1U1642069•HomeD-GAW-18-19 INSURER A:Old Republic Inswance CO 24147 INSURED THE HOME DEPOT.INC. INSURER B:New Ha shire Ins CO 23B41 HOME DEPOT U.S.A.,INC. INSURER c:HomAsk Captwe Insurance Company 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA.GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-0D4353439-16 REVISION NUMBER: 3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUB POLICY EFf POLICY EXP LIMITS LTR TVPEOFWSURANCE POUCYNUMBER MMIDD MM1D A X coNMCERCiAL GENERAL LIABILITY MWZY 312717 OM1120111 J0110112D11 EACH OCCURRENCE s 9•0W•000 CLAIMS-MADE OCCUR PREMISES Ea occurrence 15 1.ODD.000 LIMITS OF POLICY XS r I MED EXP(Any one person) �S EXCLUDED OF SIR:SIM PER OCC PERSONAL&ADV INJURY Is 9,000.000 FGE:WL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 9.000'1� X POLICY PRO LOC PRODUCTS-COMP/OP AGG s 9,000,OLYr JECT 5 OTHER: P. I AUTOMOBIIJ LIABILITY MWTB312718 03101rz018 03I01rz019 aBC`denIED SINGLE LIMIT S 1.00G,000 �i ' ANY AUTO BODILY INJURY Per person) s OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accrdenl) 5 AUTOS ONLY AUTOS I PROPERTY DAMAGE HIRED I NON-OWNED I Per acadent) S AUTOS ONLY AUTOS ONLY i S --�PUMBRELIALIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE 5 S pED RETENTION S B WORKERS COMPENSATION WC 014122577 (AN,NH,NJL VT) 03101rz018 03101rz019 X PER OTH- STATUTE ER AND EMPLOYERS LIABILITY WC 014122578 WI 031011201E 03101/2D19 5,DOD.cx B ANYPROPRJETORIPARTNERIEXECLfTIVE YIN ( ) E.L.EACH ACCIDENT S OFFICERIMEMBEREXCLUDED') D NIA 5 000,1X)0 (Mandatory in NH) EL.DISEASE-EA EMPLOY 5 11 yes,describe under Continued on Additional Page E.L DISEASE-POLICY LIMIT S 5.000.000 DESCRIPTION OF OPERATIONS below 4.000. o3 C Excess Auto 297-1-10011-00-201e 101rzo1E o31o1n019 Limit. 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA.GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 42016103) The ACORD name and logo are registered marks of ACORD 1 AGENCY CUSTOMER tD: CN 101642069 �., LOC#: Atlanta ,4`oMo® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY MARSH USA,INC. NAMED INSUREDTHE HOME DEPOT,INC. POLICY NUMBER HOME DEPOTU.S:A.,INC. 2455 PACES FERRY ROAD BUILDING G20 'CARRIER ATLANTA,GA 30339 NAIL CODE EFFECTIVE - ADDITIONAL REMARKS DATE: THIS ADDITIONAL REMARKS FORM 1S A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier.Indemnity Insurance Company of North America Pdicy Number.WLR C64783191(AL,JCR,FL,ID.IA,KS.KY,LA,MS.MO,NE.NM,ND,OK,SC,SD,TN,WV,WY) Effective Date:03101/2018 Expiration Dale:03ID12019 (EL).Limit:S1,000.000 Camer.New Hampshire Insurance Company Policy Number.WC 014122576 (DC.DE,Hl.IN,MD,MN,MT,NY;RI) Effective Dale:031012018 Expiration Dale:031012D19 (EL)Lirrtic 51,000,000 Carrier:ACE American Insurance Company Policy Number.WCU C64783221(OSI)(AZ,CA.IL.NC,OR,VA,WA) Effective Dale:031012018 Expiration Date:031012019 (EL)Limit:S1,000.00D SIR.$1,000,000 SIR for the stales of AZ,CA,IL,NC,OR,VA,WA Cameo National Union Fire Insurance Company Pdicy Number.XWC 4595580(QSI)(CO,CT,GA,ME,MI,NV,OH,PA,UT) Effective Dote:03/01/2018 Expiration Dale:0310112019 (EL)Limit:$1,000,000 S1,DD0,000 SIR for the states of CO.ME,'NV,MI,OH,PA,UT 5750,00D SIR.for the state of GA 5350,001)SIR for the state of CT Cartier.National Union Fire Insurance Company Pdicy'Number.XWC 45%21.(QSI)(MA) Effective Date:031012018 R Expira600Date::0310112019 (EL)Link$1,000,00D SIR$500,000 TX Employers.XS indemnity. Carrier6linios Union'Insurance Company Policy Number TNS C4916693A(TX) Effective Date:031012018 Expiration'Date::031DW019 (EL)Limit:S10,0DO,D01) SIR:S1,D00,00D 1CORD 101 (2908101) ©:2008 ACORD CORPORATION. All rights reserved. The ACORD name.and logo are registered marks of ACORD Town of Barnstable t„ .�� .. �..'. 'c, a i , t, t • a i i !:Vrs�blehFrom the Streets A. roued:Plans Must:be.Retained on gob an„d;this,,Gard,M;u"st be Ke, ,t Building gPost This Cacd So,Th t�t s� �„ pp � ��: � y� p � f� „��.,,?'a^`z. .;,,e: .����^t„ :s� .�. ,.r F�;; s u" "/ 3,�'_� „a 9� .:'� .r_; .� � E 'r�"� rPosted Until Final;In's eetion Has Been;Made�, � � ,.,fig; � x� � ;�? €� fPe Where a Cert�fieate-of Occu ,anc �s Required;such:Bu�ldmgshall Not,beOccypiedbuntiLa Final.lns.pection, hasbeenmade r It Permit No. B-18-1628 Applicant Name: INSULATE 2 SAVE, INC. Approvals Date Issued: 05/23/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 11/23/2018 Foundation: Location: .10 HOLLY POINT ROAD,CENTERVILLE Map/Lot 233-059 Zoning District: RD-1 Sheathing: Owner on Record: KELLAND ROBERT G&MARY C Contractor Name, INSULATE 2 SAVE, INC. Framing: 1 Address: 10 HOLLY POINT RD Cont�actor'Li erase i80747 2 CENTERVILLE, MA 02632 ect Cost: $3,910J0 rf J Chimney: Description: INSULATION/WEATHERIZATION 'I�Fee: $85.00 e Insulation: Fee Paitl:' $85.00 Project Review Req: Final: a Date 5/23/2018 V A Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorzedi by this permit is commenced within six months after issuance. Rough,Gas: All work authorized by this permit shall conform to the approved appl tion a'nd th approved construction documents for.hic t s permit has been granted. All construction,alterations and changes of use of any building and strfuctures shall be in compliance with the local zoning by laws antl codes. Final Gas: This permit shall be displayed in a location clearly visible from access street of road and shall be maintained open for publ c�spection for the entire duration of the work until the completion of the same. t ; Electrical s 3 Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and�Fire Officials are provided ......is permit. Minimum of Five Call Inspections Required for All Construction Work: r Rough: 1.Foundation or Footing g _. _ 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department' rY Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT t r R� a>_ - a .:ac � ♦ :. 3_ � ::atis::d si>:: `y ::vi z-- i :. �:•,:� .s: .,f�=' -- - ® - •YS.\I 3. -L L`f � Q - - •W.94� � YV�.`�3' `2 i-tl3_ - � �:._?::� '- ® i-:lei 8sL t f 3!a• ♦ � !!a." .f:,•�i tt•t � -s.� 3 Bar! 8• f -E:a;4i�e •iA�! O.Vt f t — , � • Yi •i: -_- t 4 ' 8� >H n S �. •:6 .!:_- •'tfi9 r:'_.L- C,�i:.tt L �d.s"_ _ : _ �2 Al i Section 6—Pr04ed S Q.Whing (ail Tank Storage ' [ Smoke lCtors Plumbing II Fire Simon Q:Heating System Q Masonry Chimney ' Q Add�ocate.b . E j Water SupplyQ PublicPrivate Serge.Di stil Municipal Q on Site Historic District ❑ Hyannis Historic District Oid. . rwa: Debris IIisposal Facility:.�e�'e I ' a crane Yes". .NO ,"A eeq =r of" Y--�� Q Lv U Section 7—Flood Z Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes:❑ -No Section"8—zoning District Proposed Use ! Lot.Area Sq.Ft 761011�Total Ftontage Percentage of Lot Coverage #of Dwelt Units site)"_, :. Setbacks Front Yard Required.— Rea�Yard Side Yard � fief from the Zoning.Boat in#�pasf? �. " } i ora rSec# 9-C r eOl L� D d 7d �ho ile- c'd . . Lkewe.Number16�/ License Type �� � &dd 4�/9 Coa tors ail Ql f 6��r K S�e la a SQ 4e-p4 - fw Licensed u tl�e rules,�r accoe f CAR e . State Bafift Cow. I�the , P , boa re ed'by 780 CUR and the Town of.�.A a ofyou Vie. X-/Z Daft section to-Home or 7- R o Nt bar / 0 Expgaton Date d lF sees a the raks aid regol3dM for l o3ne W� Idly . C t - 4assa sel S�e,B�Code. I t sto d ft b 9St1 CA9R, To .A ay PLC... . Sae .. Home:Qwne�s.Ivame: �--� Tei one,.Number -�S -9� ? Cell or WO under ft ndes and reguladOW for Lich c e ssacl State Bing Code. I wW d ttee reqmhvd by'78t?'CMR ad ft Town of Barnstab D 0 rSu �a S� UC , e . 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Af+D O RN CR�J+{S Aft SATlSFACTORY:TQ SAS ,4i�i�RE HEREBY AG?�EPTEQ:YQ�t �t9T�3£�fx#Zft3'i•O�k�f�THE VOFif4AS$i'ECiFEE(3:PAYdAENT41X BE MADE+i�S OUi i#�i li ABOV# | . ^ ~ -----------------------------. ............... .......---^-...... ...........................-.................................................................. ......-.......---.......... ----- ---- ................--.......................... ------------� � ------------� . ------------------------�`--- ��n°vvw�.p���r�m^�u�mnm�u��ue ` Regidatory Services ' ' � � Richard V�0C4Dbwntor-- ....-'---'----------'........ -----'�---------^----' Building Division � ' uom.umM,Bmmmmlug CommMomr � 200 Madu---~-~__k-_----_- ............................ ......... ....................-- .................--................. -- ----------- ----------------^--^----------- -----------------------------.-----�---------.------------------------' ' K�M�� -------------------'`------------. �w��m�~*m�m ��o � � Property- - ' --------------^------ ...... Co ' ------------------------,-----------................... ----....................` ........................------------------- ---------- ' � '� - _ '_ --' � �' ----------------------.-------^ � ` ' . . ' Amy Thomas as Owner of the=bjprr Property. hereby W �ze tO act ou........�� ... --_--------------^----------' .......................... ' nmm�`snuho�o��b�'�� ^ `----�'�-�--���'-'----.--� ' op � -' ' _ ��� Holly� V�� UU«�U�� �-K�UKUt Road (Address ofjob) ----..................... ........ - ��� ,�� ---------..----------------�--- ' _�_ --_ -_' ---p-_-__-��~~~^~. l�1�~� � -----------------'-'^--� ---`------------� �--not^-^ �----'�~~ �^�~~~�~�~~^~~^~�~°~"=`=°� �w ` �^al ���__�______`'_�_�.`__��_�__ erfouned and � - - ^ � ' of -----,-----------------------------------------------------------------------'� ' ` ' __'____�_____ �1 ____________'__________`_________ ____^�`_____. ............. � --ih Print Name hint Narm ' ` . -----'------_--. ----`-----------------.........--.... ------------ .....................----. '^. ___.8_� _,____________________ ____� .`�'_-'�-�.................... ' ^� � -' --`-� ------ � .----------^-----_---------------------------------------------^-------------���-.'-�-.�---''�'�-��-'� ' -----`-------------------------�`------------------------------------------------'�-----^--_�-`'�`..-.-, The Commonwealth crf Mtrssachusetts' Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, CIA 02114-2017 a www massgov/dia 1't0kers.'CompensationlnsuranceAffidavit:Builders/Contrsctors/Electricians/Pttimbers. TO BE FILED:WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lea bit Name(Business/Organization/Individuai): lnsulate2Saye Inc. Address:410 Grove Street City/Mate/Zip: Fall River MA 02720 Phone#: 508-56776706 Are you an employer?Check the appropriate box: Type of project(required): I.M t am a employer with. 20 employees(full and/or part-time).* .... 7. ®New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in $, ®Remodeling .any capacity:[No workers'comp.insurance required.l 301 am,a homeowner doing all work myself..[No workers'comp;insurance required.]t 9. El Demolition 10 O.Building addition 4.[3 I am a homeowner.and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insumncc or arm sole I ITT F-lectrical repairs or additions proprietors With no employees. 12.E:Plumbing,repairs or additions 50 1 am a general contractor and l have hired the sub-contractors listed on the attached sheet; Thesesub-contractors liavc:amployees and have workers'comp, 13.QRoaf repairs surance.t � 6.Q We are a corporation and its officers have exercised:their right.of exemption per MGL.c. 14,tJOtheT Insulation 1521 00),and we have no employees.[No w•orkers:.'conip.insurance require&) 'Any applicant that cftccks box 41 must also till out the section below showing their workers'compensation policy information. $'Homeowners who submit this affidavit indicating they are.doing all work and then hire outside contractors must submit'a.new affidavit indicating such. *Contractors that chuck this:box:must attached an additional sheet showing the name of the suh-contractors and state whether or not those entities have,: employees. tf the sub-contractors have employees,they must provide their workets'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site ,information.. Insurance.Company Name: Liberty Mutual Insurance — Policy#or Seif•ins.Lic, XWS 56418741 Expiration Date:. 12/10/2018 Job Site Address; O t%C. o #ytSiate/Zip: L11 Attach a copy of the workers' .mmnsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage.as required under MGL c. 1:52. §25A is a criminal violation punishable by a .fine up to$,1500.00 and/or one-year imprison rent,as well as:civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage,verification 1 do hereby certify` under the . , an e lies 0 Pf rjury thdt the informadon.pkevided above is true and eorreci. c t nature: Date: Phone#: 508-567-6706 Official use only. Do not write in this area,to be completer)by city or town official: City ;or Town: PermittLicense.#. Issuing Authority(circle.one): I.Board of Health 2 8nilding:Department 3.City/Town:Cierk 4.Electrical inspector. 5.Plumbing Inspector 6.Other Contact Persmn: Phone#: Office of Consumer Affairs and Business,Regulation 10 Parr Plaza- Suite 5170 Boston, Ma usetts 02116 Home Improvem tractor Registration Type: Corporation ° Registration: 180747 INSULATE2 SAVE , INC. Expiration: 12/28/2018 410 Grove St Fallriver, MA 02720 r m card. Mark reason for change. Update Address and return sCA 1. 0 20M-OW11 .._............. L7dd w1 newel Clio ent ❑Los#Cei ri °w•�ie c�nn�r,�y>rurna�� ��iraxct�u,�se�1 , �- Office of Consumer Affairs&Business_Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration data. if found return to: Office of Consumer Affairs and Business Regulation Ion EXR11311100 " k 1212 10 Park Plaza-Suits 5170 r Boston;.MA 02116 INSULATE 2*V- N�f Roland Langl4i 5per' 410 Grove St y Fr> Faiiriver,MA 027 -" Undersecretary. Not valid lot tFtout sslgnatufs ,_ A",#° Commonwealth of Massschusetts Division of Professional Licenswe Board of Building itrlations grad Standards rvE3nSttir r�JISfiC g' . CS-103861 i Rt1t ANC3 t:A l`jV is HwtG FALL RIVER;Mi D j .. Commissioner ACORif C DATE�uLpDMYY" CERTIFICATE OF LIABO-ITY INSURANCE OWO7118 THIS'CERT4C,ATE IS;ISSUED.AS A;MATTER OF INFORMATION ONLY AND CONFERS NO-RIGHTS:UPON THE CER31fi£A31 HOLDf i.THIS CERTIFICATE,DOE$NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND ORALTER THE COVERAGEAFFORpEp BYTHE P13LiCiE8 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE'A CONTRACT.BETWEEN.THE ISSUING MSU} 'Sj;Ai1THORIZfD REPRESENTATIVE,OR PRODUCER,AND THE CERTIFICATE HOLDER. iMPORFANT: If the,certificate"hoider•is an ADDITIONAL INSURED,the policy(es)moist ha me-ADDITIONAIL.INSURED Provisions or be endorsed.If SUBROGA�iS'WAIVED,subject to the terns and conditions of the policy,certain policies may recluve'an endorsement: A s#atiement on this,eertlficate does not confer,rights to the certificate holder in lieu of such endorsenientls). PRODUCER Anthony F.Cordeiro Insurance NAM: 17'I PleaSarlt Street N : so$477-0407 N, .Sob-s77=oaos fall River,.MA 02721 Ate: haouga@cordeiroinsurancse.com INSLRtEKSj AFFORDING,COVERAGE NAIC S INSURED' INSURERA. Liberty Mutual Irlwi lace INSURERS: Insulate 2 Save,Inc. INSURER C: 410 Grove St Fall River,MA 02720 INSURER D: WSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION`I!EJMBER: T'WS`IS TO CERTIFY THAT THE POLICIEVOF INSURANCE LISTED BELOW HAVE BEEN:IS SUED TO THE INSURED NAMED,ABOVE,FOR THE"POCi CY,.R ERI QD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITtI=FiESAEGT T-6-'WHICH THIS CERTIFICATE_MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT T6AL:L THE TERMS, EXCLU$ION8AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED.BY FAID CLAIMS. LTR TYPE OF INSURANCE WV0POLICY NUMBER COMdJERCULL GENERAL LIABILITY LIMITS EACH OCCURRENCE $ 1.008,000: . CLAIMS-MADE,X OCCUR UA PREMISES: •;bcamence: $' ..' ` 30O,OBQ;> . MEb EXP one peraonl $. A Y Y SKS 56418741 12110117 12/10/18 PERSONAL&ADVINJURk. GEN'L AGGREGATE UMITAPPL.IESPER - GENERAL AGGREGATE: ' $ 2,flOQ,QQQ X POLICY a;ERO- LOC PRODUCTS- $ .:;. 2,AQ@,W- OTHER; $ . 'AUTOMOBILE LIABILITY G- L ANY AUTO acadenc A OWNED.' SCHEDULED BODILY INJURY(Per persool $ : .AUTOS ONLY X AUTOS y y BAA56418741 12/10/17 12/10/18 :BODILYINJURY. HIRED.'-. � {Peracadenl) $ X:AUTOS ONLY X AUTOS ONLYWNON-OWNED $. X:'UMBRELLA UAB $ X OCCUR EACH A EKCESS'L1A6 CLAIMS-MADE Y Y USO5641874t 12t10M7 12/10I78 OCCURRENCE $ 2000.11A0. AGGREGATE' DED RETENTION W0,WCERSCQMPEN ATION $ AND LQYEWLKWLM ^'STATUTE FOR ANY PROPRIETORIPARTNER/mcurIVE YIN A 'OFFICERIMEMBERS(CLUDED? Q NIA EL.EACHACCIDENT IM-0.0 ry.hi,NFlj XW5 56418741 12NOM7 12H0/18 Ryyee��"desaibe'under E.L.DISEASE=EAEMPLO. DESCRIPTION OF OPERATIONS below EL DISEASE.POLICY LIMIT•'$ rJBBi QO: DESCRIPnON OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101.Additional Remarks Schedule,may be alba:hed if more spew is reQuired) • J i i CERnRCATE HOLDER. CANCELLATION I SHOULD ANY OF THE ABOVE DES,C,RISED POLICIES BE_CAidCELLED BEFORE THE EXPtRATION.DATE THEAEOF NOTICE WIi L BE.DELlV£REIYIN' '. Proof of.Insurance ACCORDANCE-W 9 THEROLICY PROi/lSlOjitS AUTHORIZED ,a W 0;t 2a15 ACORE?CORPORATION: AB• its I�ese>Yed;. ACORD;25{2016103) The ACORD name and logo are registered marks ofACORD Town of BarnstableBuilding Past This Card:So Th 3r I� �ndahis. , .. �...:.• . t - at rt , Uis�ble From.the Street �Approved:Plans Must be Retained on�Job a Card Must be Kept M FostedUnt�IFinal Inspection HasBeen>Made E_ ¢¢ " ,Where a Certificatekof�� ''� � � `� ` it a Fin I Iris A ect�onMh tle.�Rt Permit �, Occupancy�,is Required,such Bu�ldmg shall Not be Occupied unt a �p as�been ma Permit No. B-18-1179 Applicant Name: SWEET,ANDREW Approvals Date Issued: 04/25/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/25/2018 foundation: Location: 10 HOLLY POINT ROAD,CENTERVILLE Map/Lot 233 059 r Zoning District: RD-1 Sheathing: AW Owner on Record: KELLAND, ROBERT G&MARY C x Contractor, ame SWEET,ANDREW Framing: 1 Contract,16 License 112785 Address: 10 HOLLY POINT RD 2 CENTERVILLE, MA 02632 Est Protect Cost: $9,914.00 Chimney: Description: replacement Windows(uvalue.29) 14 Windows ; Permit Fee: $50.56 Insulation: Project Review Req: Fee Paid ' $50.56 r Date., 4/25/2018 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: -° Rough Gas: This permit shall be deemed abandoned and invalid unless the work autho¢ized by this permit is commenced within sixtmonths after issuance. 6 All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and str' ctures shall be in compliance with the local zoning by laws°and codes. Final Gas:: This permit shall be displayed in a location clearly visible from access street or oad and shall be maintained open for public mspetion for the entire duration of the work until the completion of the same. a Electrical TL Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are o provided wthis permit. .Minimum of Five Call Inspections Required for All Construction Work:` , f . .-.. Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: .All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT I . Town of Barnstable =rermit Expires 6 monthsfroat issue date Regulatory ServlceS /Q{�� Fee 9eb MASS.039 0�' Richard V.Scali,Interim Director ' e n Building Divisiol APR 19 T om Perry,CBO,Building Com 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 -- EXPRESS PENT APPLICATION - RESI QENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number /D(,)S d1 Property'Address / / �y �it �d! 7u yi /r✓ (Residential Value of Work$ ,q t�� Minimum fee of S35.00 for work under$6000.00, Owner's Name&Address AM o f �'�� R ; M Z Contractor's Name? O� r/CSSav Telephone NumberIR1-71y"6.30 Home Improvement Contras for License is(if applicable)__//2 _ Email: ` l - Construction Supervisor's License (if applicable) /O DS yL Xworkmin's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name !�/�T�/�i¢� �jlJ/8AJ !�s Workman's Comp.Policy# }. Copy of Insurance Compliance Certificate must accompany each p mit. p Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not strippin1g. Going over existing layers of roof) ❑ Re-side PReplacemenf-Windows/doors/sliders.U Value •Z (maximum 5).#of windows `7 T of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Ltsuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. "Note: Pope caner must sign Property Owner Letter of Permission. , o y f the Home Improvement Contractors License&Construction Supervisors License is it SIGNATURE: Q.1WHILESVORMStbuildingp fo 1DTRESS.d c G I� Revised 061313r-�� 7 9 4 M i� Home Depot Contractor License Numbers: MA: 107774, 112785 Salesperson Name and Registration Number: ROBERT D DELISLE Home Improvement Agreement Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: Amy Thomas New England South 10745034 First Name Last Name Branch Name Lead# 10 Holly Point rd rENTERVILLE MA 02632 Customer Address City State Zip (508) 353-9887 Home Phone# Work Phone# Cell Phone# amythomas@comcast.net Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip Or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S). WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE.CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Ack dged by: 04/04/2018 X Customer's Signature Date 1 Q M • M to 'of O et .:�:fix s,i ac h •4 N •Jp„ - CSSL- rL SOUTH YARMOU N �. 06/18/2018 9 - • p eat o'rmwstidA Office ofbmMgadem 600 Was&>=,S4v t Bascom,MA 02HI wrvr��rs�g�v�d�u � i Wcwk-ers' Cumpensatim Inmrance AffidiviL AA p. puma#lufmmmfinyff Please Print - Addre f _O S'73 • ei�'��So�� ar�� �A 6T,�6 p �. 3��f-gbZ-69yZ. Are you an emplager?fheckthe apprepriate bay 4 I:ata a Type o#��(re4�d)'` L❑ I mn a emplcspet� ❑ - general coaftsctar and I • (�tl amlfor gart-timed* bage �e s�r�am�act�s- - � 0 I�ie� 2. I am a sole g�opFietaur argartaarr- listed oathe attgrbed s ?- El�ode�g au td have fin emPla ees Thew sub-confractars ham 8. ❑Demalifion wodm2g, forme m any capacdy_ emplace andhave warms' 9. ai�fiou . INO wodm&camp. a comp-craw# El Bssildmg -� 5. 0 We are a capasafiva and its 16-El E[ecftical aepaim nr ad as 3.❑ lam.ahamecrmierdaingallwarlc 1LQPlnrabingrepaimaradadam mysaf[No Wasiaes'camp- rtht of ammpli=per MGI. VIE]Boafrepaus insma>,cezd�j c. ,PMandwehavesra I3.0 bier emplOyeM[No�earkess' cam msacaa requim&] *maySPF6Cwt9aca=U' =#1mnstelseiMcatlhesecti=bdaxslo gmewedamip--taapuHgy-nrmsaaa 3neavra vft subm*clan sFiidaea`i &eg sm ao-mg all Ww&seei&m bim=t n&caawa==,s t snir�tsaeZvaffida�t ind�ine'sacb_ fCaatrsctmsffwf Awl;tYm b=mtst s m sddigmil shea dmvdngjhm ra of the sob-c�c�s�d stye�che8�ec a<mrt4iose eeti�eshs� e�loyees.7f8se sab-�e kz a egPlayee%&eynsst pm-Vj &Eft arose'—mp.PCHU-MbEt �ant m�sUig�iicrrr Sud`is pravidu><g uq�nrkets'avugressa�imt irtsrlrascs,�nr��Fl°S� $etaav is Yli�gaficp arm ja&site irc,�armattna; I>Sn=CeCamp2myir2me- Toncy.cr f-imIic� ` n = Job Site Addre= CitglSt p Attach a copy of the warkare compensatioapoI4 de'claratioa page(shoving dLe policy number and expiration late4. Fame to secure coverage as requ iced urjder Section 25A o€MGI.cL l�tea lead to iffm imposition of criminal pffm .. of a fm up to$15d0:tla am&br are-gearimpfisa as wa as cia$penallies,si Se fQ=of ai STOp WDR]K 4RDEZ and REM of up to$250M a day ab filie viiolattrr. Be advised tl a copy aft6is sfatemeot map be forwarded to the Office of Investigations of gm DIA for h2smame coveage vedficaficdL Ida her-aitp uzadsr t#a pgins ialiirs�ger�u tp fiiatilie it far�r�iiarigrm dtd alrnu�i�bus and amxred Simmtam- Late Phmleg D�962-69yy t)BEff#we wh'5L Do ant wrks in dds=ar be cvirigfeta by clip arlbipff affidal � City or TQa = Permiff-keme;9 EWUing y(d¢zie flse): L Board of Head g Deparbneat 3.grown Clerk 4 Electrical Fispectuc 5;gig l r ' C'otr#act Person: theme�- - -- 6 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type, Supplement Card HOME DEPOT USA INC Expiration: 112785 Expiration: 04122201-0 455 PACES FERRY RD C-11 HSC 2 ATLANTA.GA 30339 Update Address and return card. Mark reason for change. ❑ Address ❑ Renewe! ❑ Employment-C Lost Card - Office of Consumer Affairs€Business Regulation v HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:8UDDie.rent Card before the expiration date. If found return to: . '_ _ Registration Expiration , Office of Consumer Affairs and Business Regulation 112765 0412E-2019 10 Park Plaza Suite 5170 46ME DEPOT USA INC Boston,MA 021116 JF - ANDREW SWEET 2455 PACES FERRY RD C-11 HSC o ATLANTA,GA 30339 Undersecretary d iiho—ul signature The Commonwealth of-Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,AL4 02114-2017 www tnass.gov/dia Workers'Compensation.Insurance affidavit: Builders/Con tractors/E lee tricians/Piumbers Applicant Information Please Print Le •blv Maple(1Lsinessiorganizatiorvindiridual): ,. O Q� ve; � Address: * -e g o s City/State/Zip: s�/�Cu��6Ur{/ IVA • 0lssys' Phone r: 7 / LI 7,� ire you an employer?Check-thP- oropriat x: 2 Type of project(required): I 1;, am a employer with t 4. I am a general contractor and I &�Zmplovees(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 shipand have no em to ees These sub-contractors have P 3' S. 7 Demolition working for me in any capacity. emoiovees and have workers' 9. ❑Building addition [No .workers' comp.insurance comp.irs,ranCe.• i required.] 5.❑ VVe are a corporation and its 10.]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 111.(]Plumbing repairs or additions I i —myself TIo workers' comp. right of exemption per iviGL 12.❑Roof repairs insurance required.]? ' c. 152,§1(4),and we have no �,/ employeeg.j�io workers' l 13.�ther 4 1n' 454 tti) comp.msurance required] '_'s:y upplicant that:Meeks box 41 mrust also fill out the section below showing their workers'compensation poUcv information. Homeowners who submitthis 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*he sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'camp.policy number. I amp an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information �_/ / / , /- - - /! LLstirance Company Name: �j!'/rlt' /Y 2T1 ottic#J V M!o�/ Policy ii or Self-ins.Lic.#: r✓ y�9 Expiration Date: Job Site Address: zO f-/0//V r e i✓I / /'t p1! City/State/Zip: Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,S00.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S'250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigarions of the DIA for' -tuance coverage verification. I do hereby certYfv under : airs and pep allies of er'u that the information provided above is true and correct Siattne: Date: Phone : 5_V_e Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: PermitlUcense Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City7town Clerk 9.Electrical Inspector :5.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) oz22/2o1a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,INC. NAME TWO ALUANCE CENTER PHONE FAX 3560 LENOX ROAD.SUITE 2400 arc No: ATLAtITA,GA 30326 E-MAIL ADDRESS: CN 101642069•HaneD-GA W-18-19 INSURER(Sl AFFORDING COVERAGE NAIC 9 INSURED INSURER A:Old Re ublic Insurance Co 24147 THE HOME DEPOT,INC. Jj jew Ha shire Ins Co 23841 HOME DEPOT U.S.A..INC. omeRisk C live Insurance Com n 2455 PACES FERRY ROADBUILDING C-20 ATLANTA.GA 30339 INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353439-16 REVISION NUMBER: 3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rER ADDL 7SIR: OF INSURANCE LICYNUMBER POLICY EFF POLICYEXP L GENERAL LIABILITY MMIDD MMIDD LIMBS 03/D12018 03/012019 MADE �OCCUR EACH OCCURRENCE S 9,000,000 DAMAGE TO RENTED ICY XS PREMISES Ea occurrences S 1.000,000 MED EXP(Any one person) S EXCLUDED PERSONAL&ADV INJURY s 9.000.000 E LIMIT APPLIES PER: PEa LOC GENERAL AGGREGATE 5 9,000,QCO PRODUCTS-COMPIOP AGG S 9000,000 A. ' O 7AUTMOB ABILITY MWTB3218 S 03I012018 03/012019 COMBINED SINGLE LIMIT S 1000.000 X ANY AUTO � Ea aaident OWNED SCHEDULED BODILY INJURY(Per person) S AUTOS ONLY ❑AUTOS SELF INSURED AUTO PHY DMG HIRED I NON-OWNEO BODILY INJURY(Per accident) S AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE S Per accident UMBRELLA LIAR OCCUR S EXCESS LIAB CLAIMS-MADE EACHOCCURRENCE S DED RETENTIONS AGGREGATE S B WORKERS COMPENSATION WC014122577(AK,NH,NJ,VT) 03/01/2018 031012 119 X PER OTH- S AND EMPLOYERS'LIASILITY STATUTE ER B ANYPROPRIETOR/PARTNERIEXECUTIVE YIN WC 014122578(WI) 03/0112018 03/D12019 (MandaOFFICEtory inNEREXCLUOED? � NIA E.L.EACH ACCIDENT g 5,000,13M (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE S 5.000,000 DESCRIPTION OF OPERATIONS below Continued on Additional Page 5,C00,000 C Excess Auto E.L.DISEASE-POLICY LIMIT S 297-1-10011-00-2018 03/01/2018 031012019 Limit: 4,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached if mom space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA.INC 2455 PACES FERRY ROAD SHOULD.ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING C-20 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATLANTA.GA 30339 ACCORDANCE WITH THE POLICY PROVISIONS. i - AUTHORIZED REPRESENTATIVE of Marsh USA Inc. I ManashiMukherjee }ltQy,�ypt ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN 101642069 LOC#: Atlanta A`CO'R"® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY MARSH USA.INC. SURED THE HOME DEPOT,INc aoucv NUMBER HOME DEPOT U.S.A.,INC. PACES FERRY ROAD BUILDING G20 ATLAPITA,GA 30339EEg:2455 ADDITIONAL REMARKS EFFECTIVE DATE: THIS ADDITION7REMARIKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER FORM TITLE: Certificate Of Liability Insurance Workers Compensation Confinued: Carrier.Indemnity Insurance Company of North America Policy Number WLR C64783191(AL,AR,FL,fO,IA,KS,KY,LA,tdS.MO.NE,M.i,ND,OK,SC,SD,Tp4,WV,WY) Effective Date:03f012018 Expiralion Data:031012019 (EL)Limit:S1,000,000 Carner New Hampshire Insurance Comparry Policy Number.WC014122576(DC,OE,HI,INAD,MN,MT,W,RI) Effective Date:03/012018 Expiralon Date:031012019 (EL)Linut:S1,000.000 Carrier:ACE American Insurance Company Policy Number.WCU C64783221(QSI)(AZ.CA,IL,NC.OR.VA,WA) Effective Date:03101/2018 Expiration Date:03/01/2019 (EL)Limil:S1,000,000 SIR S 1000,000 SIR for the states of AZ,CA,IL,NC.OR VA,WA Carrier.National Union Fire Insurance Company Policy Number.XWC 4595580(QSI)(CO,CT,GA,ME,MI,NV,OH,PA,UT) Effective Date.03/01/2018 Expiration Dale:031012019 (EL)Until:S1,000.000 S1,000,000 SIR for the stales of CO,ME,NV,tdl,OKPA,UT S750,000 SIR for the stale of GA S350,000 SIR far the slate of CT Carrier.National Union Fire Insurance Company Pdicy Number XWC 4595581(QSI)(MA) Effective Date:0310120 p Expiration Date:03l01201019 (EL)LimiY.'S1,000,000 ,rl SIR:$500,000 TX Employers XS Indemnity. Canier illinios Union Insurance Company Policy Number.TNS C4916693A(TX) Effective Dale:03/01/2018 Ecpiralion Dale:03/0112019 (EL)Limit:S10000.000 SIR:SI 000,10% ACORD 101 (2008/01) 2008 CORD CORPORATION: All rights reserved. The ACORD name and logo are registered marks o ACORD F r� �a Town of Barnstable,., OFtHE Tp� do Regulatory Serryiee� Thomas F.Geiler,Director .11, 29 . BAMSTA13M � MASS. Building Division 039• AT fD MA'1 A Tom Perry,Building Conumssione 1J1'fiiCt(t 200 Main Street, Hyannis,MA 02'601 Office: 508-862-4038 Fax: .508-790-6230 00 PERMIT# G (v FEE: $ � e SHED REGISTRATION 120 square feet or less iO Location of shed(address) Village. de,ef 6 1°l/Wz1P 76 Property owner's name Telephone number a33 9 Size—of Shed Map/Parcel# aigpnature Date Hyannis Main Street Waterfront Historic District? j Old King s Highway Historic District Commission Jurisdiction? Conservation Commission(signature required) -7,0 6 k PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE.SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 LOCATION OF PROPERTY L N Y NOT BE CCUP"A-FE STANDARD LEGEND NOTE:not all symbols will appear on a map Ma �=�=_:� GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH ORCHARD OR NURSERY v.....,y.....V EDGE OF CONIFEROUS TREES MARSH AREA ., .4 y' - EDGE OF WATER DIRT ROAD ' s DRIVEWAY PARKING LOT I %E�— PAVED ROAD -- \�\ DRAINAGE DITCH ————— PATH/TRAIL r �a3 PARCEL LINE** `� a - 23 Aim 110_ —MAP# 21z—PARCEL NUMBER #1860 —HOUSE NUMBER ----- 2 FOOT CONTOUR LINE 10 !0 10 FOOT CONTOUR LINE Elevation based on NGVD29 Map 2 3 3 4.9 SPOT ELEVATION 4 0 STONE WALL -X----X-- FENCE 20 RETAINING WALL I I I RAIL ROAD TRACK STONE JETTY P SWIMMING POOL PORCH/DECK 0 BUILDING/STRUCTURE DOCK/PIER Q HYDRANT e VALVE OO MANHOLE `. Mano POST OFP FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T .a SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetarian were interpreted from 1989 aerial photographs by GEOD o UTILITY POLE R TOWER w e ry p P physical I ptopography, vegetation were mapped to meet National Map Accuracy Standards Q ?Q 4U National Map Accuracy Standards at this do not represent actual relationships to h rml objects Corporation. Planimetriq and s 1 INCH=40 FEET* enlarged scale. on the map. of a scale of 1"=100'. Parcel lines were digitized from FY2003 Town of Barnstable Assessor's tax maps. G LIGHT POLE O ELECTRIC BOX ee � •y ,� Assessor's Office'(1stfloor) Map_ 3 Lot �L� y"- Permit# /r 00(0 " Conservation Office(4th floor) Z Date Issued L3 D Board of Health(3rd floor)(8:30-9:30/'1:00-2:00), Fee Engineering Dept.,(3rd floor) House#1 ® A L/ Planning Dept.(1st floor/School Admin. Bldg.) ���;r, �� � :.<,�• � �' '►�6f•� ^ •-'BARNSTABLE. DefinitivD&ned by Planning Board `� t 19 � , pp ` MASS dg �9 64 `�. `.'. s6s9• � rEDMA�A TOWN OF�BARNSTABLE E• Building Permit Application Project /® /Vd/ Village �,�r�� a - ` b Owner Z-'gSPA,,, 7-f - Address 76 _ C_o,_.,.AL'v Telephone Permit Request -Gec J. Total 1 Story Area(include 1 story garages&decks) square feet � a peck- Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ Fri) Zoning District 1� (� — Flood Plain Water Protection Lot Size Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other / Builder Information d Name ��y /�/� r- Telephone Number 5- Address 9 7 ,C r, 44 License# D 6i^ S A-?1, O Z G S 49 Home Improvement Contractor# /O 6 y 10 Worker's Compensation# 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 Ye"_/ SIGNATUREaTE AC) A.S BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) t FOR OFFICIAL USE ONLY PERMIT NO. -10 0 6 7 DATE ISSUED 8/3 0/9 5 ` s MAP/PARCEL NO. 233 059 i ADDRESS 10 Holly Point Road VILLAGE Centerville OWNER Sidney A. Salamoff DATE OF INSPECTION: _9 - FOUNDATION �� FRAME G INSULATION FIREPLACE ELECTRICAL: ,.ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDINGO�- y , s DATE CLOSED OUT ASSOCIATION PLAN NO. k . . The Town of Barnstable. Department of.1101th Safety and Environmental Services Building Division .- 367 Main Street,Hyannis MA 02601 Off= 508-790-6227 Ph Crc F= 508 775 33" Bttddtag For office use only Permit no. Dale 8 3 o s AFFIDAVIT SOME MOROVF.MENT CONTRACTOR LAW SUPPLEBIMaTO PEMWAPPUCAIM14 MGL c. 142A requires that the"reoonstrnctiatt,altemtimm renovation.repair,In °n'aoavesn impzovQaeat, recamal, demolition. or aonumcdon of an addition to any pm-ccisting owner occc; building enntaiuing at least one but not mote than four da dliag units or to sCroWuQ which are adjac to such residence or budding be done by mgh=cd aonteactoz,with certain©ooepriOas+ along with oc v fpqrd Type of work: 11, G Est.Cost �AdofVbdc f -ner.Name: ate of Permit Applied= I hereby certify that: Registration is not required for the follosing=soa(s): Work c=fudm by law ob umkz SL000 nilding an awna ooc cd Owner polling own pamrt Notice is hereby Sh-cn that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGIS�CESS ,� FOR APP ICABLEOGRAM HOUE RA ARBIl'1tA OR GUARANTY FUND UNDER MGL VEUEqT WORK DO NOT c 142A SIGYED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 9 No. Date cauraetor zone OR ' 1%.Mom►a name 11:0_'94 1 :02 V8177277122. DEFT WD sW-ly ' 1.:013ZlY101Zll/P.aLUL O� Q,f�QCI7,f�Ql� 600 .names�.compbsq � , � 02f It Commissioner Workers$ Compemdon ibsmmuce Affidavit zip Zo a ` /�/vv.►�ary T�i 9 /�f / r / ��� s with a principal place oMmsnew= . c�►isrmrzt� _ do hereby certify under the pains and penalties of perms►, that: (� I am an _saployer providing workers' anupens2don coverage for my employees w, thus job. , Insurance Company Policy Noinber [ am a sole proprietor and have n one woricing for me in any Waft- 1 am a sole proplietors, general contractor or homeowaer (drde one) and have tui (� contractors listed below who have the following workers$ con3pensauon poNaer. Contactor iasm=ce yfpoficy Contactor losiiraace tompany/poficy Contractor lnstt =ce, Companyfflc icY O I am a homeowner performing A the work myself. I ennne.-- u s C= of dais sr cnert will be twnrded=d•.e ORke of ImMft ftW of ft OTA for cover a irerifinsion and sha: ssld ace.se=rt�:—ed under section Z5A of MGL 152.an lead M she of aaedmf P��e of a OW of ue=°S .rt=,IM;ft--nang as well as civil aenaides in the tom:of a STOP WORK ORDM Ltd a fte ct St00.00 a d3v aim n+e. is g.4' Signed this �v day of �4Hc-�„s r✓ ' wonent Ucensee/Permirme B Ucensing$ Seleccmeos Office Town of Barnstable Building Department ComplainVInquiry Report Date: /`�`�/�� Rec'd by: ,Iel Assessor's No.-RS 3 Complaint Name: GZ4 a3� - //O /> Location Address: M/P sTGo7 - �/OGG Originator Name: 1—�-�. Street: Village: State: Zip: Telephone: D/E Complaint a / 0 /� v s Description: CY Inquiry 0 Description: For Office Use Only Inspector's Z�` Inspector:Action/Comments Mae: c" � Follow-up Action Additional Info.Attached Copy Distribution: White-Department File Yellow-Inspector Pink-Inspector(Return to Office Manager) Lo 7 9 /d PO/A.) T 2p , �1CI,ST)hI !Y t 33 �q /3 i 4 s lG° 3�� 1 RA i� S)PAC1NG" biV ,(iA4-,57'LPL$ OEI ' �XO /'Ll�.`T�� 1®i465 S ew/L6 �L.6�1 T5Q �-yX�f PosT EeC/STieA/G- awc 7'� cp C3 yat4;0, C,"4- FEET io a14, l� 4 — — 33 of z� C 43 " - — 34 " � e 40 0 y 58 I I 61 39 3 38 / c:/barn/clemens/base233.dgn Aug. 25, 1995 09:07:23