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HomeMy WebLinkAbout0070 HUCKINS NECK ROAD � � _ .. � is .. � � .. .. .. .a. _ _ n. a .. _� ., ,. .. � rt. .. .: ,. �:. ., �r ._ _ � .. ,. a '. .. .. .. .. �- _ ♦. .. ,. . �. .� � ��. .. e r .' _ � ._ ., .... .. .. _.. � .. .. ,a , .� .. n .... .. ,.. .� .e .n x P � .. ," � i � $.: ' ,., ,. a. .. .� �. r, � y .. „; � -... i� f r �. o�., �. u e �..� �� r '. Y � x .. t .. � � a. r _ F ,. y� .. �.. J q e: a a' : -Application number..,-._�.......fl........................V Fee D� Qi► ................................:......................................... PRESSBuilding Inspectors Initials.............. ................... � lb34. �1� NOV O 6 2010 Date Issued................. 1�' BLE Y� n1l �j _ FOWN Ol IJAHN * �� Map/Parcel....... v O TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/S TO VES/WEATHERIZATION PROPERTY INFORMATION Address of Project: _ 7 C) 1��ck f v�) luc-t,, NUMBER STREET VILLAGE Owner's Name: Cy�,rhn-'L Phone Number (20 737—�Y 3 L Email Address: Cell Phone Number Project cost$ yU 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: Date: TYPE OF WORK - Q Siding 0 Windows (no header change)# Insulation/Weatherization Doors (no header change)# Commercial Doors require an inspector's review Q Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name mike McCarthy Construction P® Box 52 Home Improvement Contractors Registration(if applicable)# West Dennis, 62670 P ) e Construction Supervisor's License# CSK CC lattach copy�IC-169393 Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. -11W APPLICATION NUMBER .r *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No es lease attach floor plan with exits marked �Y P P ) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event 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 Fuel source being used LP tank 20 lbs. or>Yes No____, if yes, a gas permit is required. Natural Gas Yes No ,if yes,a gas permit is required. 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 AP,YLIJCW9S SIGNATURE Signature Date I l c o All permit applications ar subject to a building official's approval prior to issuance. I Town of Barnstable 3 -* BuildingDepartment s' - 60 nn�,.,s�,��, Services pop 1639. ^0�� Brian Florence,CBO •�lFd MK A. Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 +ax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Christine M Brosseau ,as Owner of the subject property �C hereby authorize /' ► ��'r �� � ���1i� ` to act on my behalf, in all matters relative to work authorized by this building permit application for: 70 Huckins Neck Road Centerville (Address of Job) Signature of Owner Signature of Applicant Print Name Print Name Date a� a. c�2i�:se�• Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,*M,0,: usetts 02116 Home i nprov.6m. r.Re9 istrafion Type: Irtf#vlduai Registration: t'fi9M MICHAEL MCCARTHY �+ Ei�iration: O61t5J2019 P.O.BOX 52' WEST DENNIS,MA 02670 3CA 1 0 20M-05/11 Update Aildress:and return card. Mark reason fouchang9. - ------- Q� ----•-'—_.171Address rl Ranswal n Emplawmant r71 ast Card C�/ee tpavnmaa��o�°C-3�a�;ta�uaelld , Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:tndivtduai before the expiration date. If found return to: Lon Office of Consumer Affairs and Business Regulation 06/16/2019 10 Park Plaza-Suite 5170 MICHAEL MCCA#�' '.`_ =' Boston,MA 118 MICHAEL F.MCCA ' 6 RANGLEY LN. SOUTH DENNIS,MA 6460 Undersecretary Not valid without signature ....-...... Commonwealth of M.assachusetts Dnrtston of ProfessionalLicensure Michael McCarthy Board of Building Regulations and Standards Constr Mir ColnstlruatMota� r isor P� v it CS-058633 Has aufx s#uliy tFornPleter�> 'National Fiber, rA ices ti 04/10/2020'Cellulose Training Course rp 20 day Of August'2011 MICHAEL J MCCAR�1Tt PO BOX 52 J WEST DENNIS MA 02870 MIIiMs.NtiBondrmu � "''�1�.t��` Noty Ikf& NATIONAL FIBER ' Not gllirlra/uaeet�sad �-••.•wcw,oc.....+.�..,� - -- Commissioner • Y OSHA 001558712 � � U.S.Department of labor '. 0=Wtonal:Selety and Health Administration _, d Michael McCarthy 7 ' �DfalSe Camt Aig has Successfully oompteted;a;1011our Ooa,pational Safety and Health ClewiBut7dioggy&tlum6ustioq Safety T�ntngCourse 3zAonrsofClauTm Course cult Constn/ on Saf 8,Htaaitfr , J �UkVw✓unuy„i� R • h . (Date) :: , - .: . The CoatruttottwmM of Mawd=M Dqwbwd ofludsOM eddeaft 1 Cot{grM Sit OA.Swe 100 Bastons MA O21141.2017 wwR v/db Workers'Compensation Insurance Affidavit:BulderalContradmWFhdriclauffilumbers. Ton FILED VI M THE FERN T ING AUTHORITY. AMdjWd Nam w ondadMduan: Address: Q-Cr 4�r S City/ptatftop: we n•.-, l''I�- o��phone#' sza Are you an amployer4 Ch=== ox: Type of pro (regvb' vd): 1,�am a oployar wttb (tidi aadkr puW uw)* 7. ❑Now tMstatction 2.0I ama"ptapdetorer pu mft oad haveno m plgw a dit form in B. Remodeling MW OF*[No wettest'COMIL Wnnnaa N*M&l 9. ❑Demolition 301 am a 6oataowtmr doles oU work aWwM(No wwhW oougt.Mauna reOM&I t 4. I a u end wm be hhinS coobaotm to anhat aU wotk on uW p Wotty. I wM 10 0 am b Bttildiug 8dd1tl0n mf @==flat aU co s eidmr have wMkw,eontpattaadat►fmtmtaee m era solo 11.0&eetrieal repairs or additions pmpW=wbb no awloym• 12.[]Plumbing repairs or additions 5i0o I am a pwd comer and 1 have hkW dte aab•confradtom ihsod on dto aaaaitad atUL 13.[]Roof repair6 Them udrenntraamrs have emplayaas and have wod{ms'vamp.worenat 6.0 We ere a and its officerahava mtm k d tha(r right of exetapthm per Mt3L G. l4. Other " IA I I M and we have no mwployem.[No wodms'oottq.hesutttna required.I *Any gWgunt do d=lm box#1 must also fill nut die nodon below dtowiog tbeir wor>aus'0011VIUM90 Polley bhM& on. t Homgowaets who m6ralt this aftidwitindicaft they am doing all work ad than bite ouW&wmreatora mast submit a mew affidavit bxiicatiag such. tpoaftom dmt*A*Pots box man attar an addit oW Am dowingdw name of the"man and oft whadwor not tboss oddas have aaploym Ifdte ators have employes,tha3r mace ptovhle tip wotkata'antp.poUay . I am anwg&ya that is providing wottber ,cmremadon fnstmaaee jrr nW employes. Bebwis the poft aW job sW k 6rmadon. hmnancet7ompanyName: � •�� L><<t��,�, �..9 rYc �lti,s. R J 5 W G7' '7 S7`f Expiration Data: 1� ,.— 1 Pclecy#or Self-ineo.Lie.#:� Job Site Address: t qr Zip: Attach a copy of the workers'compensation pulley dedaratton page(showing the policy number and expiration date). Faihne to sectue coverage as required raider MOL c.I A 125A is a criminal violation pinMAle by a fma 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 00.00.a day against the violator.A copy of this statement tray be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do het+eby dhatthe�PMvtdedobove k tree arrdeormft rt Phbtie 79�4 Offal use 0* Do not wrb in this am,to be eoiMWed by ci4D or town offldrL City or Town: PermWIAeense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector S.Plumbing Inspector ti.other Contact Person: Phone#• f' P Y MCCART9 OP In:TH CERTIFICATE OF LIABILITY INSURANCE DATE 1/201 8Y) 03/01/2018 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 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 endorsements. PRODUCER 508-398-6060 NCEACT Dennis Office Bryden 8:Sullivan Ins Agency PHONE 508-398-6060 F^X 508-394-2267 of Dennis Inc. ac,No,Ext: Arc,No 486 Route 134,PO Box 1497 E-MAIL ESSO So.Dennis,MA 02660 Bryden&Sullivan Insurance INSURERS AFFORDING COVERAGE NAIC# INSURER A:National Liability&Fire Ins INSURED Michael McCarthy Construction INSURERS: PO Box 52 West Dennis,MA 02670 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE 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. ILTR NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS.MADE OCCUR DAMAGE TO RENTED el $ MED EXP(Any one rson PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY jPCOT 1-1 LOC PRODUCTS-COMP/OP AGG HE AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY Perperson) OWNED SCHEDULED AUTOS ONLY AUTOS BODILYBODILY INJURY Per accident AURTED OS ONLY AUTOS ONLY P OeLaxRdent AMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB HCLAIMS-MADE AGGREGATE DED RETENTION$ A AND EMPLOYERSENLSABTIUTY X PER OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 9WC747574 12/15/2017 12/15/2018 E.L.EACH ACCIDENT 1,000,000 pFFICER/MEMBER EXCLUDED? �Y N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 1,000,000 If Yes,describe under DES RI TI N OF OPERATI NS below D E- OLI Y LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddlUonal Remarks Schedule,may be attached If more space Is required) Michael McCarthy,President,has opted to exclude himself for Workers Compensation benefits CERTIFICATE HOLDER CAN CAPELIG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Box 427 Barnstable,MA 02630 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r MMCCARTHY CONSTRUCTION CO. MMC Date: �li mjmccarthyconst@gnail. com Building Commissioner Building Department PO Box 52 West Dennis,Ma A-5S 02670 To whom it may concern, -3 GO t This affidavit is to certify that all work completed for Permit J Location: &�Wo -�D Aluee4l)j fucr—C- 2� Has been inspected by a certified Building Performance Institute(BPI) inspector. All work performed meets or exceed Federal and State requirements. Sincerely yours Mich A cCa y 5 of Town of Barnstable *Permit Expires 6 nror Ir froir ue date Regulatory Services Fee tT i63 9. Richard V.Scali,Director �� 'OlED MA'S Q Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY _ Not Valid without Red X-Press Imprint Map/parcel Number oZ S Z - O 3 8 Property Address 70 ►4 u(.K�n S Neck Residential Value of Work S / ,Z Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address CI)r i 54,- e o -k1 ur •� S IT CX . L Contractor's Name mArE zkf;/7Joj5. A8 /( Telephone Number(!t(0 l 2 Home Improvement Contractor License#(if applicable) 73 Z L/ S Email: Construction Supervisor's License#(if applicable) O n r� MCrkman's Compensation Insurance S Check one: EP 212017 ❑ I am a sole proprietor � T®❑ W I,�m the Homeowner J A H N S I A B B E I have Worker's Compensation Insurance LC _ Insurance Company Name �; f° ,�me,n s -n sur°an C e Workman's Comp.Policy# W C 8 3 1 S R 7 2 9 ---! 2-0 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) . ile-side eplacement Windows/doors/sliders.U-Value 2- (maximum.32)#of windows_ #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit,does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property .weer must sign Property Owner Letter of Permission. ' A copy the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\DecdllikAppData\L.ocal\Microsoft\Windows\Temporary Internet Fi1es\Comcnt.0ut1ook12P101 DHR\EXPRESS.doc Revised 040215 Y i Renewal Agreement Document and. Payment Terms Andersen. dba:Renewal B Andersen of Southem New England,. Y g Christine Brosseau Legal Name:Southern New England Windows,LLC 70 Huckins Neck Rd RI#36079, MA#173245,CT#0634555, Lead Firm#1237. Centerville,MA wigoo 10 Reservoir Rd I Smithfield,RI 02917 : H:5087379436 Phone:866-563-2235 1 Fax:401-633,-6602 1 sales@renewalsne.com Buyer(s)Name: Christine Brosseau : : Contract Date: 09/09/17 Buyer(s)Street Address: 70 Huckins Neck Rd, Centerville, MA,. Primary Telephone Number: 5087379436 Secondary Telephone Number: Primary Email: christinesmiles@comcast.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 incorporated 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: $11,426 By signing this Agreement,you:acknowledge that:the Balance Due;and the Amount Financed must be made by personal check,bank check,credit card,or cash.. Deposit Received: $5,713 Balance Due: $5,713 Estimated Start: Estimated Completion: Amount Financed: 6 to 9 weeks .6 to 9 weeks $11 A26 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 time at a later date:.Rain and eittreme.weather are the most common causes for delay Notes: 50/50.gsky depo gsky,bal gsky'tax,paid Barnstable Buyer(s)agrees and understands that this Agreement consfitutes: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 Buyer(s) and Contractor.Buyer(s)her acknowledges that Buyer(s) 1).has;read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellauon,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 ANYTIME NOT:LATER THAN MIDNIGHT OF 09/13/2017 OR THE THIRD BUSINESS.DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER.DATE IS LATER.SEETHE ATTACHED NOTICE OF.CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT Legal Name:Southem.New England Windows,LLC dba-Renewal By Andersen of Southern New England Buyer Signature of Sales Person Signature Signature Cory Scanlon Christine Brossea.0 Print Name of Sales Person Print Name Print Name . UPDATED: 09/09/17 — Page 2./ 11 office of Consumer Affairs and BusinessRecrulation 10 Park ]Plaza - Sete 5170 Boston, Massachusetts 02116 Home 1r �pr�ver egt !Contrac-tor Registration. Registration: 173245 Type: Supplement Card Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS.:.'LL- BRIAN DENNISON 26 ALBION RD LINCOLN, RI 02865 _ Update Address and return card.mark reason for change. Address Renewal Employment Lost Card - -0ffice of Consumer Affairs&Business Reen9abon Registration expirationd for individual if found return to: only before the - -- =^ -HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration 1 r°�d5, Type: 10 Park Plaza-Suite 5170 Expiration. 49-12018 Supplement Card Boston,�La m3116 SOUTHERN NEW ENGLAND WNINDOWS LLC. RENEWAL BY ANDERSON BRIAN DENNISON 26 ALBION RD ,1� [ __is.c dersecretary Not valid without signature LINCOLN, RI 02865 ;r— MassachusettS Department of Pubi:ic Safety Board of Building Regulations and Standards License: CS-095707 -ns ion S!jPer•-,eisor - BRIAN D DENNISON 7 LAMBS POND CIRCLE CHARLTON MA 01607 (� Expiration: ..A.A Commissioner 09/08/2018 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 ,Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation lnsurance'Affidavit:Builders/Contractors/Electriciaus/Plumbers. TO BE FILED V1'ITH THE PERNUTTINIG AUTHORITY'. Applicant Information Please Print Le 'b) Name (Business/Organization(Individual): e K) f zowz Address: 2(o ALzw J irl City/State/Zip: Lftj P Phone 4: *1 Are you an employer?Cbeck the appropriate box: Type of project (required): I XI am a employer with Zo femplovees(full and/or part-time).' 7 New construction 1 <7 I am a sole proprietor or partnership and have no employees working for me in S. Remodeling any capacity.(No workers'comp.insurance required.l . - 9. ❑Demolition ;.�1 am a homeowner doing al work myself.[No workers'comp.insurance required.)7 0 �]Building addition 4.❑J am a homeowner and will be hiring contractors to conduct all wort:on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole I p proprietors with no employees. 12. Plumbing repairs or additions '_..❑I am a genera contractor and]have hired the sub-contractors listed on the attached sheet. 13.DRoof repairs These sub-contractors have employees and have workers'comp.insurance-! 14.dOther lJ�✓16G5-�.J �. 6.❑we are a corporation and it officers have exercised their right of exemption per MGL.c J JL: f l(4):and we have no employees.[No workers'comp.insurance required.) /`Plfa cel"ey� •Any applicant thai checks box;]must also fill out the section below showing their workers compensatior policy information. Homeowners who submit this affidavit indicating they are doing all wort:and then.hire outside contractors must submit a new affidavit indicatin€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. Lithe sub-contractor have employees,they must provide their workers'comp.police number. I am an emplover that is providing workers'compensation insurance for ml.emplopees. Below is the policy and job site information. Insurance Company Name: �ev S Policv# or Self-ins.Lic. 3 2— [ — Z' Expiration Date: I Job Site Address: 70 �I uc r✓l S nreck e City/State/Zip: C& fP Mlle M Attach a copy°of the workers' compensation policy declaration page(showing the police number and expi atiou date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violatior 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 ofthe DIA for insurance coverage verification. 1 do hereby certify under th ains andpenalties ofperjun that the information provided above is true and correct. Si ature: Date: d"� Phone Official use only. Do.not write in this area,to be completed by cifi or town of icial. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health I.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector [6. Other Contact Person: Phone#: J �'1 ESLERCO-01 SANDERSO '4`oRo CERTIFICATE OF LIABILITY INSURANCE DATE 107120Y7 06/07/2017 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 CoBiz Insurance,Inc.-CO PHONE FAX 1401 Lawrence St,Ste.1200 Arc,No,Ext:(303)988-0446 A/C No:(303)988-0804 Denver,CO 80202 E"""IL SS:COMail cobizinsurance.com ADDRE INSURERS AFFORDING COVERAGE NAIC# INSURERA:Acadia Insurance Company 31325 INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 Southern New England Windows,LLC.dba Renewal by Andersen of Southern New England INSURER c:Liberty Surplus Insurance 10725 26 Albion Road,Suite 1 INSURER D: Lincoln,RI 02865 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE IINSD SWVD POLICY NUMBER MMfDDY EFF fYYM POLICY D rr LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,00o'050 CLAIMS-MADE OCCUR CPA3158728 01/01/2017 01/01/2018 DA AG ET REMEr0ence $ 300,000 MED EXF(Any one rson) S 5,000 PERSONAL&ADV INJURY S 1,000'600 GEN'L AGGREGATE LIMIT APPLIES PER: 2,000,000 GENERAL AGGREGATE $ X POLICY PET LOC PRODUCTS-COMP/OP AGG $ 2,000,000� OTHER: EBL AGGREGATE $ 2,000,000 A AUTOMOBILE LIABILITY EOM�BIINdED SINGLE LIMIT $ - 1,000,000 X ANY AUTO CPA3158728 01/01/2017 01/01/2018 BODILY INJURY Perperson) S OWNED SCHEDULED AUTOS ONLY JAUTOS BODILY INJURY Per accident $ AlRT05 ONLY NON- DIVE° - Pe�a�GtlentDAMAGE $ A X UMBRELLA LIAB X OCCUR - EACH OCCURRENCE $ 1,000,OOOI EXCESS LIAB CLAIMS-MADE CPA3158728 01/01/2017 01/01/2018 AGGREGATE - S DEC) I X I RETENTION$ 0 - - Aggregate s 1,000,000 B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y`/N - - STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE - CA3158729-20 01/01/2017 01/0112018. 1,000,000 (mFFICER/MEMBER EXCLUDED? NIA - E.L.EACH ACCIDENT $ andatory in NH) 1,000,000 If yes,describe under E.L.DISEASE-EA EMPLOYE 5 DESCRIPTION OF OPERATIONS below. E.L.DISEASE-POLICY LIMIT $ 1,000,0001 - B Worker's Compensatio WCA3158730-20 01/01/2017 01/01/2018 1,000,000 C. Pollution Liability EDE654299117 01/01/2017 01/01/2018 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 17-18 Workers Compesnation Includes-All states except ND,OH,WA,WV,WY CERTIFICATE HOLDER CANCELLATION ` SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ]FOR Informational P ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. L_ The ACORD name and logo are registered marks of ACORD Town of Barnstable oFI MWE,�, Regulatory Services r - 1% Thomas F.Geiler,Director Building Division BnRxsznate, ; v MA g Tom Perry,Building Commissioner s6;q. i0)Ep M A 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Approved: - W- V Fee: f R se Permit#: 9 (03 HOME OCCUPATION REGISTRATION Date: Name S14,A- 1-4` 1 hone#• oC�� Address: yGk k Y1 S e-Je_ I�J�^ Village: , ✓ l Name of Business: ��(.t�0�-aC c j a) L fit: �5a}- o 38" Type of Business: � �S\ � V ap , Zoning Districtd,,P1 Zoning Districts RF and RGl require Special Permit from Zoning Board of Appeals. INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. t After registration with the Building Inspector,a custom home occupation shall be permitted as of subject to the � � P � �' P P � J following conditions: • The activity is tamed on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. A • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. ' I,the undersigned,have read and a ee Athe above restrictions for my home occupation I am'r ' tering. Applicant: Date: 0 O— Homeoc.doc Rev.5130