Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0025 JACQUELINE COURT
.t � ; .. .. t .. - _ - t f .t ,. ., .. .,� _ ,. ._ ,,: e .� a -, . . - .. r Town of Barnstable *Permit# C �d � o Expires 6 ne tlu fnwa ��� Regulatory Services Fee_ -0 MM a Richard V.Seall,Interim Director 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 l d ` Not Valid without Red X-Pma Impdat MI/parcel,Number / Property Address / 0,r O �� wIGZ Residential Value of Work$1�� !6 Minimum fee of$35.00 for work under%W0.00 Owner's Name&Address �le�Or vj Z5 ufK.Ql ld�� ?,ro7tle, /n Contractor's Name sO UA- erp ij-F—. WilickeS M) V O Telephone Number 16�—LZ.a.,` go Home Improvement Contractor License#(if applicable) 17.32`f.0 Email: Construction Supervisor's License#(if applicable) 0 /S7o 7 JX'Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ lam the Homeowner ' I have Worker's Compensation Insurance Insurance Company Name IV lN� • Workman's Comp.Policy# W& Copy of Insurance Compliance Certificate must accompany each permit Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side P,Rcplacement Windows/doors/sliders.U-Value '3D (maximum.35)#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&Twtnwm reguWww,i.e.Siumv,Consays ion,ere. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. I 6 e SIGNATURE• TAKEVIN D\Buitdmg Changes\EXPRESS PHRi1 MEXPRESS.doc Revised 061313 Renewal R- ��� DIiYD� R®UC[11YOit D D7 -.By:VF 1I _THERSE Atd@ t a3a:.Uccrt�r eMD1by4T no AbnfsroM.5 Pbo,m 866M2?310 Fax 4I1,633.(,662 ;Pa"l1Ux�a1- nea Sosdaw#W..Fund 1>r"nkAok'A.TAG d7trALPA Z� �easv�bg�tdtes._ee o{Satsh.s.Ne•,r �t7�7�.� 1�(Je.F'rl , . j;Tj8W PA WIKDGW AND DOOR REMODELD16 AGREEMENT E9u11hudrvc s9' l,iEwt •j1` °'-�r+oma9eM�+anera�h." J, I;,se�l�n'kzr �1�': :d�+. :e Buyevia)heathy lrit.to and bumully -ara partCl�the Frrxbacat dJnr n or�ritiheTTt•mw2 i'land NArlesl0"LW dA da RmvAml by,Mciceai 5titatl�rrar NewrE harrit''{,Cu I radod},in'moanrYlmttEti.'+�arkt'alie..ts a and, d°uiions'deRefr'bed tse.;tl�fai 4t sad nti+,rae+af Aso.a rc ut aaul an ibe and ucd 4pccificaAiAsn ghee4a)(eat clitiOa,lhie` r±en }. O 1F7apsle CI C4alle:•!;0:H0A4 Ta®IJob:Am�mmc��' . '� 6 •�tgirdppd 3ereain�;t7�e¢ 6`fietlicd aar�v,�t 'l�Clr`eali •O t3'f+nmtoi! '• Dapraitlteedveal{339,k w s _ of Via• 6'efbnse.at SQft of 0 Ssk c t�e¢ ci a scrdbnrt i gp 4� r i a Qwoeitan bi€c c• ,q�,virie YOU a mhtjjd pa d6t rd�dElftft At Sratt&f j&MW d", &&frce en libswidal �s_ ' �g r P '`tldiarree an SuW07tW Careplill n OJOWeanmeta tnade'bY veft �,,,��pp cio;— and must be r eft 1 .peF&vvnt a Kmk bank dx ds,err . Cotrr�Irtlrna of}oh mu(�3Sj:��v. ' Bttyrer(s)agrees amd maecstaeds that,41 Agse'ameat eouatlwrtes-am 0'"re 2. de c Tus— 'ehe papeinR;aud.thii therm am as varhal understandiiap changing may of else t me of ebia A eteftv.BUYy a�(e).rotate Udvg that Bryye4'(s) n)has�nd d&A{ aoet.e,wadoraia�a t#e terms of*dds ree Agtirte��frar+'rpeh is a"Put�d,Jv"a,amd dotted: �Pi 9 of this Agreement,iaclud�g dte tro trtrasbad:�omicea�of C$aeell'atlo+�; t��otc'�t:.�a�nen albfve' {8)�sys�afiy inf ect,cdHuyer'sii&toeanceltbisAgsm E+ui:.DONOTSIGN,1,H1 -CONTRACT IFTEOM A ANTALANK 8RACE.L Mho&.Isfand Sal"On y)Notes to Hwyegt.(l)®o oof aagn ilosAgree ea!lf`ai.y ter sic i e A. lLe s re+±d tweme theealteatofthenavp0mide fid6rmad=arelelft:Tifsek.(2)Tonaretraididtoa # 'ad thedrneyawstilt t�.•(gb YOU May at May duo Pay of&e.firll UIglis d"am=dot andei"d�emcs�#s �-a-doing miy be e�tlDe�l w coke a partial rebm*of die finance,and i ,a de a$1ia rge (-I)'no selllsT lsCr no dot ba nEilmwfitLly ere er yam g. t; �c�c7sit tray�teaslta+f': npa=oe to ie�tre��s goo+its lrarc6a�ed md�t7�.J��® tt�a}Fa�may caurl.tL�ls.h�Eretsi, if it:baa aot•b"n signed i t she as :a.citRce or a lbrancb owe.of the gibe ,peovldnd° a6."the ernes e lils or erva4a office or brace ofte ah lt.tlur:Agi reor$tt�+jy.taegLgtaec d'or nee alf reel knttiLpiehsetall Ire Fro stedlRt¢ra�drtigbt of else third tale day-" eiv"4" h kit the buyer angora die.h ,,,W,eaclaa Satadrty anrl:sny Ibcliday$a WWA >relyaldr rsiaH i4ePves a�set wade.�/®e aaxor�agaayetag,arobae�cmraeel3atl,aw toes t'os trp`r�IaaritLoti of.1l . li,.ysr s}re rid the asnnauJtEes• tacyl#,n rn it Pf31s' ded:tr4 4lrC p1b x$e J* niMerton .e pstmttclr•, (Wd. M016}, fir). f. �_ Rmo"by.Md�m of Sriitt>aavlmeiv.ytglatrd' Batyar�s} ti 4 ! s) S nantrf ,nctlbiaia�er' Sty Si�uttune L'ritie Nar,�:of Ftrxi c�t4sm�rr Ptl Naenc :l'mrt N�n� ' YOf4 TM 8!<IYER(u�a:l14AY CANQ�I;-T1tl 'l�All� i�OZV A3•'hNY 1'� PMOR TO: i1'?A1UDWOE .OF Tl1<F+MEMD KNINEN DAY AFTM THE 1]M OT T 'TRANEACT'ION.SM THE ATTACHED NUHCII OF CA NCEVI ll`I'l0N Fortm. FaDRAN EXPLANATIONOP..`,t`MS t14=f1 x �LIE CR ICE � gnt t' .Op 'MCELi_AT10Nt ®ate afl9ai�Ow i� •.Cll � llOu may, Pobe� Date•of R7maC�6fl u rnw C mcu# this tt znmctk ,witbrurt any pernalty or obligation,within penalty or,ob'lig,moao;withivt throe business #rerr`Harr stave dtite�if row a artc�al,refry I #hrctl.AuaCrtno bra the ab.ave+ester ff you ecrneel;rosy pr,opt ty traded 7n,arrlr paXrr�nta made:W root:iindor dti i pu�ei r W is iidars+a ae!;fPq` ..made !, "u"der,due Contract ar".Sale,and at*,hagodablsi.lniatranntnt exeouted I "Cot mot ar.;S�Je and ant dable ilrtstrum�t executed' by.you*011 be.returnW within ten<businass da,folltwel"g, 1 br l6u will he retunted,Itle'n•ten:biniress days ft swung receipt*'the Seller of'your sami dllWon a ot"a `an*wV l rebelpt by Seller.'of your cancellation notice.and4ny seeuritr Interest arvsirrg out of tlgc trarnsscei' v►01'bt security Caeerest'ofrisirt aipE ol;the oransaetion wilii:be canceled.lfyou carciky�r mwt make mrsite to the Seller, � cwtcetod:lfyou a:wsas�;r�o aittiet nwdm mailable to the Seller at your reaCKParror;;in tuba alCjr.as:'g condliltofl as�whcn I atgoerra�sia�ce,i»atr tsnta It .oi geld cr+"Isawas when r stay Roods delivered to you carder this Corytraet or I -ret:eiv!t airy goods-AWIvemd to-�sander this�Contma or Safes or you tnty6 if yait wlsfe s�omko with the Ingructions of I' Sale;or you n,I if yearvda evinptlrwith.the rwMedom,of We Seller regard"rrtt��the warn-shiprrltttt of the goods at die the"Seller re-gardier��gg ttee tam adnpmcwt of tiro goods at tine Se4ler�'s expeflsm:artd'aZk if:row do"amine die:goods available k Sdwift��xtppert# lz"rCtl�"if you-der ntim the Soo>is aaa61e fld to the Seller a •thc Seller defers not:pl�e them-up vtMin i to't*o S01icr aq 'thie Seller does:n&t, e n p withLft twnmty'dgs of the dale of e-anaellsMon;yaw may-rwain:or l twenty days of the date of Ci m6 ltattien,you may retain or die��oose ofthe�d'S without 'further obfa'V**.ta.'tf.y*u i dime ref the s -withoutwtey fniater Obligation.If.-you faitto make the goods:awadable to die Seger,or if you agree I :faifto malm the:gogds aftil blasto tM Shccr,o►if you avrte to returar the goads to the Sigler.and•fag ta.do so,'then you i• to nuturri tier goodo to the Stiller aced foul to do so,then.yaru rerrnatn Gable for perfa wwwe of all oWigations-Under•the ;ranvan liable:bat• nee',rf'trll oblIsWe"ueadrw.the ContraLfio cancel this�tvarrtcast'pr,retail oar dellver a signed i •Cantract..To eancd this t tdoaa,,maffor del9wer a s➢gned a" dated copy•of.this.cinaellstion netloe or aty outer. I .asad dated:c4* of,thiit.canoellatfzart`.`flatitxi or say ottrer• writtennosiee,o, Mate -lbo byAndeesariof I w nru�tic4,arsendt stele mtsiRengvvel byllnde�snaf" Southern Now Englamid ac 3dAlbhm , 8�3®65, 1+' Southern Flew Efl d at 26Albtoai 144ad,lirtoajlo:lkl�D2H65,; NOT LATER THAN H1DN1 T'"Cp : i SMOtThLAA�R.Tti'% IMM FDNIG$4T 0FL ate) tHER)BY`tv/1NCE THISTRAF1SACTl0f+i:' e FIER `CANCEL THISTUNSACTIOW aYMtrt ti i ' POW Ri1p _.D�Fr. ''aay�Y Sl�a' irtal.M�: ".: 'Its�• - ... a ,�A.�6,pp'.t�ll(GA,. ,"'"'•frY7 Y'811�aV •�,��C�1'.inic» Southern New England Windows d.b.a Massachusetts-Department of Public Safety Board of Building Regulations and Standards j` Construction Supervisor 1 License: CS-095707 r. BRIAN D MlKmaSoN 7 LAMBS POND SIR Charlton MA 01507 r . J.•G.��. .1a iaa`' Expiration Corm. issioner— 09/01112016 Cis Affairs r :,fin Office of Consumer Af f s 6d Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type_ Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2016 DENNISON BRIAN 26 ALBION RD LINCOLN, RI 02865 , Update Address and return card.Mark reason for change. SCA 1 201A-0s<ri I E Address F-1, Renewal f Employment Lost Card ' ��e�a71'17iraleurClR�rR a�r�ri�i,ett/rcue/11 , f6ce of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: W"M Office of Consumer Affairs and Business Regulation egistration: 173245 Type 10 Park Plaza-Suite 5170 Expiration: 9/19/2016 . Supplement•.:ard Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD � — LINCOLN,RI 02865 Undersecretary r Not va ithout signature i A`C>R b� CERTIFICATE OF LIABILITY INSURANCE DATE 2014 Y, oa/1a/zo14� 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 Willie of New Jersey, Inc. NAMEA T c/o 26 Century Blvd PHONE 1-877-945-7378 aC No:1-888-467-2378 P.O. Box 305191 E-MAIL _ Nashville, TN 372305191 USA ADDRESS,cartificataa@willim.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective insurance Company of SE 39926 INSURED Southern New England Windows LLC INSURER B:The Beacon Mutual Insurance Company 24017 D/B/A Renewal by Andersen INSURER C:Argonaut Insurance Company 19801 26 Albion Road Lincoln, RI 02865 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:W529169 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCURDAMAGE TO RENTED A PREMISES(Ea occurrence) $ 100,000 Y MED EXP(Any one person) $ 10,000 S 2029459 08/10/2014 08/10/2015 PERSONAL BADVINJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY a JCa a LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBBIINdED SINGLE LIMIT E $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUUTOSS AUTOS S 2029459 08/10/2014 08/10/2015 BODILY INJURY(Per accident) $ X HIRED AUTOS Ix NON-OWNED DAMAGE AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000„000 EXCESS LIAS CLAIMS-MADE S 2029459 08/10/2014 08/10/2015 AGGREGATE $ 51000;000. DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N X STA t1TE ERH B ANY PROPRIETOR/PARTNEWEXECUTIVE E.L 1,000,000 OFFICER/MEMBEREXCLUDED? a NIA 0000068028 08/21/2014 08/21/2015 EACH ACCIDENT $ (Mandatory In NH) E.L DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 C Work Comp/EL Covg: WC927938352394 08/21/2014 08/21/2015 E.L Ea. Accident - $1,000,000 Statutory Limits - WC B.L. Disease Policy Lmt - $1,000,000 .L Disease Ea. Employee - $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) own of Hattapoisett is included as an Additional Insured as respects to General Liability when required by written contract/agreement as per policy orm. 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 Town of Nattapoisett 16 Bain St (1.� liattapoisett, NA 02739-0000 but ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks Of,ACORD SR ID:6629625 BATCH:Batch #: 79627 't s F ; The Commonwealth ofMassachuseits Department ofdndusdzal,gcddents Offrce ofInva gahions 600 Washington Street Boston,M4 OZlll wwwanass gov/dia Workers' Compensation Insurance Affidavit: Buiilders/Contractors/Electrician /Plumbers Applicant Information PIease Print Legibly Name pp&css/ftmizatimIndividual): Cl-0 r )•2151_l .FIA/ Al . _Address: o2 L �Ct i t'riJ City/StateMp: L/N&eo ItJ 0-;L965 Phone#: Ll0l e pop an employer?Check the appropriate box: Type of project(required): -1.wam a employer with 19-P 4• ❑I am a general contractor and I employees(full and/or part-time).*,. 6• New construction have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp co insurance.: 9• 0 Building addition insurance comp. 1eqed,] 5. We are a corporation and its 10.(]Electrical repairs or additions 3.ElI am a homeowner doing all work officers have exercised their A 1111 Plumbing myself[No workers'comp. right of exemption per MGL M Roof airs or additions insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13(( Other G�lNq�o�o t A ao comp.insllsance required.) ZP ���v-K *Any applicant that checks box#1 must also fill out The section below showing their worloas'=gcusatiou polieyinhmmation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside ccntraetors must submit a new affidavit indicating such tContractoss that check this box must attached an additional sheet showing the name of the sub-=tract=and state whether or not those antis have employees. If the sub-contracUn have employees,they must provide their workers'caa3p.Policy,der; I am an employer that is providing workers compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: ,t�" 5 Vr-a'Wev Policy#or Self-ins.Lic.P ' 9:.,;� 7 Y3 el 3 S'a 3 ` V gxpiration Date: Job Site Address: c //�[ ' City/StateMp:�B�P�'V� 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 ofMGL c. 152 can lead to the in3position 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. -do hereby pains and penalties of perjury that the information provided 150Te ' true and correct Si ature: Date: Phone#: L10 .®fficial use only. Do not write in this area,to be completed by city or town official City or Town: 4 PermitUcense# Issu ing Authority cyrcle one e I.Bo f and of Health 2:Bwldung Department 3.City/Town Clerk 4.Electrical Ynspectar 5.PIumbing Inspector 6:-0ther N TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2 Parcel / atio 9T�_o Health Division Date Issued W /`/ Conservation Division Application Fee Planning Dept. Permit Fee L4 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Z '/d�_ 6eLT Village �J eek_4 - Owner 4tz" �wtx� Address 25— Telephone Permit Request 7V C2d�fiT� Tl/�.grn�'" i�t �� j0lr s 6NJf 70 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay :Project Valuation Construction Type ``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: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) ` Number of Baths: Full: existing new Half: existing r ew Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor o m Count- Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/ oal 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 ❑ r Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT-INFORMATION - (BUILDER OR HOMEOWNER) q G Name ' Telephone Number �y� Address (D �'�"� 2 License# el-elm-a' Home Improvement Contractor# J3�� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO lOd J��✓ jF SIGNATURE DATE �� �� l FOR OFFICIAL USE ONLY APPLICATION# s.i DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: E i ;PFO.UNDA-T.ION ;��..,IbYv,::, i }, zj!tk1 FRAME _. d 9 Zq .y r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING O DATE CLOSED OUT ASSOCIATION PLAN NO. f 77je CommonweaM of Mossachusefts rtment of Indust?ial Acciden& 7-1 Offwe of Inwestigations 600 Washington Saver Boston,MA 0211I wmv.masxgov/dig Workers' Compensation Insurance Affidavit:Builders/'Contrachws(Ehwtricians/Plumbers Applicant Information Please Print Lezih Name MhsineMfi013mkMfi0n&&UkW Cw Address_ •0 0 C Are you employer?Check the appropriate boa: TyPe of project(required): 1.Mefam,a employer with Z--�- 4. ❑ I am a general contractor and I 6. New constzuction employees(fall andlor )s have hired the sub-comtractois . - 2 ❑ I am a sole proprietor or partner- listed on the attached sheiet. 7. 345Qde1mg ship and have no employees 'Iimse sob-�ors have g. ❑Demolition woddng for we in any rapacity. employees and have waakers'. [No wodmrs'comp.insure comp.iasmanml 9. Budding addition required] 5. ❑ We we a corporation,and its 10.❑Eleet<ieal repairs or additions 3_❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions o warlters' right of lion Per MGL required,] y P c.152,§1(4? and we have tea 12_❑Rrtofrepairs employees-[No watkers' 13.0 Other comp.insurance required-] ' Y applticser tbae cbedm bra#1 mmsr also till ow*e 9Kdan behw shm mg tbeu workers'onspemsadam palky infmmadam T>$ameavt¢ets who Sol ' Ih s af5davu indicating lbey we datS Q work and the►We m mwft connu n nmsr mb=a m w affidavit mdicavng such. TCont<acmrs mat check this bra mmst attached m addioim sheet ahawft the name of&e and score whether or not those en ities ha« ®players. If the sub-c�bane ewes,flW taunt pwvMe the workers'comp.policy number. lam an emplaywrtheisprovi&Wnvriws'comWensadoninmrmceformyewplqem Below as the ptaug and job site information. Insurance.Company Name: ° Policy#of Self-ins.Lic.#: Expiration Date: Job Site Address: Z� � �U�Zlarcr e' CitylStateJTp: t!a ;;�l/o'!_!e' t'tif/t Attach a copy of the worms'compensation policy declaration page(showing the policy mrmber and ezpiration 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 imprisoriment as well as civil penalties in the farm 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 Imresti DIA for*++muance coverage verification. I do h theparns a allies of pedury that the information provided above is true and correct Date: tZ� cc�d Phone#: - Official use only. Do not write in this area,to be completeud by city or tower a,,lcaaL City or Town• PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4L Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#• 6 ACORO® DATE(MMfDD/YYYY) `..� CERTIFICATE OF LIABILITY INSURANCE 5/28/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the pollcy(les)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 to lieu of such endorsement(s).. PRODUCER ONT CT ME: F. Cordaro NA Andrew G. Gordon, Inc. PH NE (781)659-2262 FAX (781)859-e725 306 Washington Street E-MAIL .bill@agordon.com INSURERS AFFORDING COVERAGE NAIC If Norwell MA 02061 INSURER A-Reerless Insurance 4198 INSURED INSURER B:Pil riM Insurance Company 1750 Lux Renovations, LLC, INSURERC:Star Insurance Company- 80.23 60 Shawlmlt Road INSURER D INSURER E Canton MA 02021 INSURERF: COVERAGES CERTIFICATE NUMBER:SANPLE 052814 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 LTR TYPE OF INSURANCE POLICY NUMBER POLICY p EFF POLICY EXP. LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES E n $ 100,000 A CLAIMS-MADE F OCCUR 8512851 /5/2013 /5/2014 MED EXP(Any one n $ 51000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,0.00,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PFCT LOC $ AUTOMOBILE LIABILITY COMBINED SINUff LIMB (Ea accident) $ 1 000 000 B ANY AUTO BODILY INJURY(Per person) $ AUTOS ALL OWNED X gUTpSULED GC10007161409 . /1T/2014 /17/2015 BODILY INJURY(Per accident) $ X HIRED AUTOS M NON-OWNED PROPERTY DAMAGE $ AUTOS n Uninsured motorist BI split limit $ X UMBRELLA LIAS OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB X CLAIMS-MADE DED I X I RETENTION$. 10,00 CU8511953 /5/2013 /5/2014 AGGREGATE $ 1,000,000 . C WORKERS COMPENSATION $WC STATU- 1. OTH- AND EMPLOYERS'LIABILITY YIN X ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? El N/A E.L EACH ACCIDENT. $ 1 O00 000 (Mandatory In NH) 610428715 /24/2014 /24/2015 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1 000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space la required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE'CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lux Renovations, LLC. SAMPLE ACCORDANCE WITH THE POLICY PROVISIONS. SAMPLE SAMPLE, MA 02,021 AUTHORIZED REPRESENTATIVE F. Cordaro/CORWIL , ACORD 25(2010/05) 01988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).Ot The ACORD name and Innn are rpnlat.—r.... 1. s Annon I M6ssachusefts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor I & 2 F.ami1} 09gnse'CSFA-047809 PETER M MONAD 136 RIDGE ST: . : MILLIS:MA 020s'.4 Expiration Corn nissioner 07/22/2015 d�� d Office of Consumer A fairs n Business egu anon 10 Park Plaza - Suite-.5170 Boston, Massachusetts 02116 Home lmprovem'nt Contractor Registration Registration: 137943 Type: Supplement Card Expiration: 1/29/2015 OWENS CORNING BASEMENT FL I w 4 PETE MONAGHAN ? 60 SHAWMUT RD CANTON, MA 02021 r �w Update Address and return card.Mark reason for change. sca �, 20M-osi>> Address Renewal Employment ❑ Lost Card ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT,CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistration a7�43tl Type' 10 Park Plaza-Suite 5170 , Expirat',11". Su lenient(::ard << � �j:� PP Boston,MA 02116 OWENS CORNING��i�1SEM - tJISHING SYS l4f , PETE MONAGHAN , %1 60 SHAWMUT RD CANTON,MA 02021 Undersecretary Notivalid ithout signature , ., —. 1ARNSTABI2w i 3 9. Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property _ hereby authorize '� ��2N� to act on my behalf, in all matters relative to work authorized by this building permit application for: .. t (Address of Job) Signature of Owner Date Print Name r If Property Owner is applying for permit,please complete the Homeowners_License Exemption Form on the reverse side. TAKEVIN_MBuilding Changes\EXPRESS PERMIT MPESS.doc Revised 061313 76 1 dZ v a ; qejti —�� K1 151AIQ tlb.�'3'CZRI°,ro=�Y'LF�L'°wXm'�L�+Rf!etlx:M'21GtlC�k9W4> - l - ' �j < i it, --r. Lavin, Gregory&Anne 25 Jacqueline Ct. Centerville, MA 02602 508-424-8762 CONTRACT Customer Name �i �>+�i]z. ��t Customer Signature SKETCH Contract Date S Lt Sales Representative Si nature • � ,tre ATTACHMENT Customer Phone p 9 Contract Price 2S7 —4 1 2 3 4 12 13 14 is ,s "17 18 19 20 21 22 23 N 25 2s 27 29 .29 30 31 32 33 34 i, 36 '37 39 39- 40 41 �42. 43 '44 45 46 47 48 -49 50 51 52 53 s4 65 5s 57 s9 s9 90 Aj 2 - , L/NQ - �_ t" " 44 3 ! 4 9 ... VG C•P/� s " t � A 12 13 i I , Y �ry�q M1 15 �s is ' 9 3• .. , 4 1:1 ' 1 1 20 _ e : , " rw 21 Y IIIWJ:f 23 , 24 , " —'l/S, S 30 l[- c.J�z�s 7v B�: .2—i9 '..�' j df�s'31 '� 32 33 34 351 NOTES, 'Each box' equals one toot unless otherwise noted.This sketch is a good faith representation of the work to be done, it is understood that all dimensions derived from(his sketch are approximate,and that all locations of outlets,light fixtures,plugs,jacks and/or switches are subject to chanoe if necassarv. P TOWN OF BARNSTABLE permit No. ----------_--------- Building Inspector �msr.n Cash OCCUPANCY PERMIT Bond ------- No0 building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date 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. ..................................................... 19......__ .................................................................._............_.........._......._....._._ Building Inspector ,1' IaGit L�! FtJ✓w a tto v. 3 • 33O G.pt7. /fir -rnN k- - SSo,. Ir o % • A-i 5 6.P .D.- �U use- t o0o sat_. ,� �..� o uSE (oC) Gam. i s W^_ALL A1r._ei.� - ISO Is•P. f� "a` 15v ��F ' 2.S • I �-�S G.P.D. sU 20� r tA so 5+j=.. rz., ,t •oo L.. K_>o s-Pv. 0 9p� j ; TOTAL Sld-W = 426 G•pa L j TOTo 0 {, t�iZG�L�TIOU c2eTE : lay-2�t�c t u' otz 1.�5�s, i i — � �r,. AL `t�Q CAXTER 1g... 1 e�� AL M ST Tot" rwv s loo.o a tuv• 97. oo :L L o y y tt��Oe I OcG 114V •'� s soil. 4�p,PP 1W. -Box r:,9�•6i tce nc to oDO 96,Ow tuv tW 't. Q' GAL r 9Gy SSG � . ,r�. , P 5A A ' = cleA ve PRT s, .i V'/I '� 9 stout= 90.v MED�VM' /o G.o• -S.9/V D. C-SZTtt✓tGv Ptro�t'�Pt-.!L1�3 ' Pcz o7=-t I._..E LoGhTlo>J u o S L�•-.c a. C E N,'�-ER�! c� I 40Ft r�lA.' t— �D(lo(Sa ;4r -7//4/6o pt.A1�1 Rt=�=itR �.10E ; ------- . , t• jEj (_oj_j GC.)v4IPLgS- W t 7t-i T►-•t►: S t D t_t►.tE: L O 1- 1 <o = At.ID SCTL�AC1: Vr-QUjVeML.WTs olw T"t PLC N SK z 9 0 G, t✓A'fa 1010 ✓� . t31s.ETC tiZ. �;. u'-(t= t2GG(S tt r,Lzt> LA,Wo 15UCV aYoe= 1 T1-115 PLAW IZ UUT L:ASCU Ua..! AN osTEev%L.Lr-- O ArCASS. s lt41rco.v%r-t ti Wgz%/t_�{ Ta�tr UFt=';rT�, il�L't:JLD _ �AP��S � SMITK A _ nNat_t r_n,a.�-r .} - r.. n r-'r r.C_M.►W LU"t I-t o.di.�., . As,.Ossor's�,rrapp and lot number a PC/ ........................... f-7 NO=sysTEM MUST 14E TOE Sewage Permit number WsirALUD WCOM ............................................... WM qfm 5 House number .# . Ft LE, ................... . . . .. RAL TOEIYYIOWN 639, a NO Ar. -OF BARNSTABLE — t-.. TOWNrs BUILDING..' INSPECTOR APPLICATION FOR PERMIT TO .......13RO-A... ........................................... TYPE OF CONSTRUCTION ...............Wood..f.rzne............ ............................................................................... ................. ..................... .. .. .... ...... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ....... Location ...............L ot...1.6...Jaaque2ine...C.ourt,....Ge tervi e................................................................. Proposed Use .....aingle...family...dwelling........................................................I..................................................... Zoning District ...re.sid.entlAl........................................Fire District .........O.e.nt.e.r.viU.e.inOs.t.er.vill.e........... Name of Owner ....JAMQ.$.X....5M;Wa.............................Address ..............13arnatable........................................... Name of Builder ..JAMe.,q...K......9mitla.............................Address ...............BarMt.ahle........................................... Nameof Architect ..................................................................Address ................ .................................................................... Number of Rooms Foundation .........pnured...concrete............................... Exterior .....white...cedar..shingles..........................Roofing ..............asphalt...shingles.....*...................... Floors ......wall...ta---wall................................................Interior ...............dr.ywall................................................... M: ... ............................... .......:.Plumbing.......... 2...bath-s................................................. . Fireplace ..One........................................................................Approximate Cost ......$4.5-t-GOO................................... Definitive Plan Approved by Planning Board ----------------------------- Area ...../2-121AF. �............ Diagram of Lot and Building with Dimensions Fee ...I.......::27,2AL................ SUBJECT TO APPROVAL OF BOARD OF HEALTH Y, I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............................ ,S'4ITH, JARES K. I 1 10 . 26.9.4. .. Permit for .S ae..S:�.P,:y........... ' .............. 'Location ,.Lot #16 25 Jacqueline Court .. Centerville ................. ... . ................................ ! Owner ....James K. ..Smith........................ Type of Construction Frame w. .............. ............................................. .............. 4, Plot ........................ . Lot'................................. , i y Permit Granted ...November 1:9, .19 .0 Date of Inspection ...1 .•.19 r ' Date Completed ...1......... ..........j.. 19 4 PERMIT REFUSED k . . .... ..................................:.... 19 - I. L. ................... • (7), -.. µ .. .......................... to ffived .............................................. 19 l M , ......................................................... E Assessor's map and lot number iTHE Sewage Permit number ....::...... . .............................. Z 13JHH9TAXLE, House number. ...................::T..... ................................... 900 1639. c ; TOWN OF BARNSTABLE r C,# BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... a?: ,?� :P, ` ?�1I. "0we:l1.. .ng .................:,............................................. TYPE OF CONSTRUCTION ................\..1." �........................ 1` TO THE INSPECTOR "OFBUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Ce ntenni..!.Ie........................................................................ Proposed Use ...-,5t.rrTle...T?.Tnj, AA ..c 3,ze.1l:5.m ............................................................................................................ Zoning District ...x'PAI!�e,'nt, _ ..............................Fire District Oe. !=. _7_. - �Ts�r is �::P........... Name of Owner ....R7 1 t Y. . T;!I t%�.............................Address . tab..le Name of Builder ..s1 ?•?"! .` ... �r.... L? :f; . ........Address .Name of Architect ..................................................................Address ............................................................ ........................ Number of Rooms ......... .............Foundation ........eta?Are�....t'crrrn r :.F'.............................. Exterior ....................... .Roofing ......... errh�li- ltiricr! r' ........................... ....._ Floors ....... ...............Interior ............... ,................................................... t-.............. ..........................:.Plumbin `?: * ?t. ::..:.............................................. g :. - ..-.Plumbing--..: y;n ......................................................................Approximate Cost ..... '',+F; () f?........................................... y Definitive Plan Approved by Planning Board -------------------_-----------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH k I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................3...... ....................................................... t' S'41TH-, MIES K. (:r!1210-180 22694 dhe Story No ................. Permit for ............................. ...... Single Family Dwo�.j�.� q ................................................ .. . ... ........... J AZ Location u ine Court .................... Centerville ............................................................................... Owner .....James K. Smith ............................................................ Type of Construction FXAMe.............................. ................................................................................ Plot ............................ Lot ................................ Novefiber 19 80 Permit Granted .............. .....................f...19 Date of Inspection ........ ... ......................19 Date Completed ......................................19 PERMIT REFUSED .......... .............................�....................... 19 �....... . ... .... .. ../... ....... .......... ............... .......... .................. ....... ...4.Y9.......Y .........................P.N.? Q�.J.r ............. ............. Approved ................................................. 19 ............................................................................... ...............................................................................