Loading...
HomeMy WebLinkAbout0205 JAMES OTIS ROAD �, .� ., � .,� .. � � .. o ., ,. - _ .. III .. _, ., .. I' .. _ � � �. o - c - ,� �.; . IME Application number.. .. ................. yT 0 Date Issued....F) !A1.......................................... IMSTABLE ............ MAS& 1639. Building Inspectors Initials... .................... 01f; 2 I,ABLE Map/Parcel.......Z.71?.....:.. !Z.7............................... TOWN OF BARNSTABLE 5 0 EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATIqEPJZATION PROPERTY INFORMATION Address of Project: �Meilile NUMBER STREET VILLAGE Owner's Name: rtk r f Phone Number-5o 4,2,o Email Address: n, d Cell Phone Number Project cost$4 .( � (= Check one Residential v11 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: oo,:{C,4 -- Date: TYPE OF WORK Siding �Windows (no header change) Insulation/Weatherization Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CAIrife-If?a4 a SM I-aa CONTRAC%RIS INFORMATION Contractor's name (;rall -SoAe rr-1 , Lirl-1)Jow S Home Improvement Contractors Registration(if applicable)# 17 3 2-Lh (attach'copy) Construction Supervisor's License# Oj 5-701 (attach copy) Email of Contractor CT Ljee� ; C rorn Phone number �Qj- -> 2- 9 -�900 ALL PROPERTIES THAT HAVE STRUCTURE5,6VER- 75 YEARS OLD OR IF THE SUBJECT PROPERTY is 11V A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER ..:......................................................... *For Tents Only* I 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. XW®®D/C®AL/PELLET STOVES x 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 PLICANT9S SIGNATURE Signature Date P- 11- l-q All permit applications are subject to a building official's approval prior to issuance. f Renewal Agreement Document and Payment Terms ►Andersen. dba:Renewal By Andersen of Southern New England Martin Barrett Legal Name:Southern New England Windows,LLC 205 James Otis Rd. RI #36079,MA#173245,CT#0634555, Lead Firm#1237 Centerville,MA 02632 WINDOW RE IACEMENT 10 Reservoir Rd I Smithfield,RI 02917 - H:(508)420-3499 Phone:401-349-1384 1 Fax:401-633-6602 1 sales@renewalsne.com Buyer(s) Name: Martin Barrett Contract Dater 08/07/19 ., Buyer(s)Street Address: 205 James Otis Rd.; Centerville, MA.02632 Primary Telephone Number: (508)420-3499. Secondary Telephone Number: Primary Email: nlartyb8@comcast.net . Secondary Email: Buyer(s) hereby jointly and severally agrees to purchase the products and/or service s.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: $6,131 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: $3,066 Balance Due: $3,065 Estimated Start: Estimated Completion: ,. 8 to 10 weeks 8 to 10 weeks Amount Financed: $6,131 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 extreme weather are the most common causes.for delay, - Notes: Taxes paid in Barnstable, Ma. Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the'terms of this Agreement.No alterations to or deviations,from".this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby, ck anowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of This Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign.'this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 08/10/2019 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE.OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT Legal Name:Southern New England Windows,LLC dba:Renewal rsen of Southern New England Buyer(s) Signature of Sales Person Signature 'Signature Gino Montesi Martin Barrett Print Name of Sales Person Print Name Print Name UPDATED: 08/07/19 Page 2 / 12 4L,-,5W Office of Consumer affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS LLC: 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD, RI 02917 SCA t 0 20M-05/17 Update Address and Return Card. O Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card before the expiration date. If found return to: Reaistfafion Expiration Office of Consumer Affairs and Business Regulation I132'4;r=,;_ 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MAMA 0211 BRIAN DENNISON !� 10 RESERVOIR ROAD Q SMITHFIELD,RI 02917 Undersecretary aV� -� without signature Cornmon ealth of Nfassaehusetts Division of Professi6hal Licensure Board of Building Regulations and Standards Constro -dln isupervisar CS-095.707 E i res: 09/08/2020 8 BLACKWELL DRIVE . CHARLTON MA::0150T .� Commissioner e Tile Coat wnwealth of Massachusetts Department of IndustndAccidents 1 Congress Streets Suite 100 Boston,MA 07114--7017 www mass gov/dia A'orkers'Compensation Insurance Affidavit:Bullders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEkNIf1TLYG AUTHORITY. Applicant Information P jle �ase Print I.";hly Name(Business/Oreanization/Individua(): Cj(,�'�h r� VQ IA,) t-nQ�t��W I A /, r ls Address: (� UDt r tZt f City/State/Zip:S L t�-�j e lc �j�! OZg l Phone#: 4/0l-ZZ g- 9 �� Ara you an employer'Check the appropriate box: ` Type of project(required): 1. 1 am a employer with ��employees(full and/or part-time). 7. []New construction 2 am a sole proprietor or partnership and have no employees working for me in $: Remodeling gany capacity.[No workers'comp,insurance required] ❑ 3. I am a homeowner do' all work myself, 9. ❑Demolition ❑ mg y [No workers'comp.insurance required.]r 4.a 1 am a homeowner and will be hiring contractors to conduct all work on my property. [will 10❑Wilding addition ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions I am a general contractor and I have hired the sub-conawtors listed on the attached sheet These sub-contractors have employees and have wor ken'comp.insurance.= _ 13.[]Roof repairs 6❑ n/. We are a corporation and its officers have exercised their ri 14.Ether-&,ti,,& 1S2 c.J ,g i(Q.and we have no era •e".to o workers co 3�of exemption per MGt,c. rap_insurance required]• employe".(N ' Arty applicant that checks box#I must also fill out the section below shawing 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. tContraotm that check this box must attached an additional sheet showiag the name of the sub-contractors and state whether or not those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp,poficy.munber. 1 am an employer that is prav►iding workers'compensation L urance for my employees Below is the policy and job site information. Insurance Company Name: r Q ny— Lp p� W9 Policy#or Self-ins.Lic. #: C , _ 1. 02 t�� Expiration Date: �' 1•—'Z D ZO Job Site Address:- 20 i�: City/State/Zip: (! Pe 4�✓:i/� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. I S2,J25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a,STOP WORK ORDER and a fine of up to$2S0.00 a day against the violator.A copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. !do hereby ceV under the p ' penalties of perjury that the information provided above is true and correct i re: Date: P._hone#: 4 n) 7'Lf� 9M 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#: CERTIFICATE OF'LIABILITY INSURANCE DATEIMM/DD/YYYY) �( 1 Z/2B/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: CoBiz Insurance, Inc.-CO PHONE 303-988-0446 F 1401 Lawrence St., Ste. 1200 ac No:303-988-0804 Denver CO 80202 -MAIL COMail@cobizinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURERs:Firemens Insurance Company of WA,D.C. 21784 dba Renewal by Andersen of Southern New England Southern New England Windows, INSURERC:Homeland Insurance Company of New York 34452 em 10 Reservior Rd INSURERD: Smithfield RI 02917 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER:787175890 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SU R . POLICY EFF CY EXP LTR POLICY NUMBER MMMD/YYYY) (MMfDDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/112019 1/1I2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a OCCUR PREMISES Ea occurrence $300,000 MED EXP(Any one person) $10,om PERSONAL&ADV INJURY $1,0o0,000 MOTHER: 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,0W,00POLICY❑JECT LOC PRODUCTS-COMPIOP AGG $2,0D0,000 $ A AUTO MOBILELUIBILITY CPA3158728 . 1/1/2019 1/tI2020 COMBINED SINGLELIMIT a accident $1 000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Por accident $ $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,0D0 LIA EXCESS R CLAIMS-MADE AGGREGATE $15,000,000 DED I X I RETENTION$a- , $ B WORKERSCOMPENSATION WCAW5872924 1/1/201g 111/2020 AND EMPLOYERS'LIABILITY Y/N - X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑N N/A _ E.L.EACH ACCIDENT $1,00o,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $1,0o0,aoo DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,0w,ma C Pollution Liability 7930073340000 1/1/2019 1/112020 Each Occurrence $2,000,0oo Calms Mada Policy ABgregete $2,000,000 Retroactive Date 06120/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) . CERTIFICATE HOLDER CANCELLATION' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE fv� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD � F Town of BarnstableBuilding ( i• Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept RARN Posted Until Final Inspection Has Been Made. 39��0 Where a Certificate of-Occupancy is Required, such Building shall Not be Occupied until a Final Inspection has been made. Permit Permit No. B-17-4133 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals Date Issued: 11/30/2017 Current Use: Structure Permit Type: Building—Siding/Windows/Roof/Doors Expiration Date: 05/30/2018 Foundation: Location: 205 JAMES OTIS ROAD,CENTERVILLE Map/Lot: 170-207 Zoning District: RC Sheathing: Owner on Record: BARRETT, MARTIN W&CLAIRE Contractor Name: BRIAN D DENNISON Framing: 1 Address: 205 JAMES OTIS-RD Contractor License: CS-095707 2 CENTERVILLE, MA 02632 Est. Project Cost: $ 7,806.00 Chimney: Description: REPLACE 5 WINDOWS,.29 U-VALUE Permit Fee: $39.81 Insulation: Project Review Req: Fee Paid: $39.81 M Date: 11/30/2017 Final: Plumbing/Gas Rough Plumbing: Building Official - Final Plumbin a g Rough Gas: ix months after issuance. g Thispermit shall m abandoned and invalid unless the work authorized b this permit is commenced within s pe t be deemed a . y , 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 structures 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 road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 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 V Town Of Barnstable Permit# Expires 6 aroniks front issue date 1 Regulatory Services Fee aAMSP ate. } a a,°i Richard V.Scali,Director + / i63¢ ,0 1 I � 5L RFD MA't ee Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,14yannis,'NIA 02601 www.town.bamstab le.ma_us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERTWT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Lfap/parcel Number -] Property Address ")O'J z!;/ge_S D L-, �rX �.��'�/✓i`le v�Residential Value of Work$ Minimum fee of`$37.00 for work under$6000.00 Owner's Name&Address Contractor's Name—IrWhaw ALE ',17JQ JA52q11 �Lnw t:5o/T Telephone Number (q o t) 2 Z-$-qkO Home Improvement Contractor License#(if applicable) 73 Email: Construction Supervisor's License#(if applicable) Q6 70 7 �Workman's Compensation Insurance Check one: ❑ I am a sole proprietor m the Homeowner LY I have Worker's Compensation Insurance Insurance Company Name �; f �'i'1 e-a, In S Workman's Comp.Policy# 5 8 7 2-9 — 2 L ' Copy of Insurance Compliance Certificate must accompany each permit. B 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) Q Re-side eplacement Windows/doors/sliders.0-Value • Z1 (maximum.32)#of windows J #of doors: ❑ Smoke/Carbon Monoxide detectors 4 Moor 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: PropeitykOwner must sign Property Owner Letter of Permission. A copy cKthe Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: I C:\Users\Decollik\AppData\Local\iiticrosoft\Windowffemporary Internet Files\Content.0utlook\2P10I DHR\EXPRESS.doc Revised 040215 Renewal Agreement Document and Payment Terms byAndersen. dba;Renewal By Andersen of Southern New England. Martin Barrett Legal Name:Southern New England Windows,.LLC 205 James Otis Rd RI#36079,MA#173245,CT#0634555, Lead Firm#1237 Centerville,MA 02632 wixoow nr ince:xcsr 10 Reservoir Rd I Smithfield,RI 02917 H:(508)4203499 Phone:866-563-2235 1 Fax:401-633-6602 I sales@renewalsne.com Buyer(s)Name: Martin Barrett Contract Date. 11/07/17 Buyer(s) Street Address: 205 James Otis Rd,.Centerville, MA 626.32 Primary Telephone Number: (508)420-3499: Secondary Telephone Number: mart o8@comcast.net Primary Email: Y. 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 b 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: $7,806 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: : $3903 Balance Due: $3,903 Estimated Start Estimated Completion: 8 to 10 weeks 8 to 10 weeks Amount Financed: $7,806 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 extreme weather are.the most common causes for delay. Notes: Taxes paid in Barnstable, Ma: Buyer(s)agrees and understands that this Agreement constitutes the endie 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)hereby acknowledges that Buyer(s) 1).has:read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER:Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,.MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 11/10/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern.New England Windows,LLC dba:Renewsjrnders n of.Souihzrn New England Buyer(s) Signature of Sales Person Signature Signature • Gino Montesi Martin Barrett Print Name of Sales Person Print Name Print Name UPDATED: 11/07/17 - Page 2./ 11 Massachusetts Department of Public Safety OP Board of Building Regulations and Standards License: CS-095707 ''`` bx �t�.� x Construction Supervisor " BRIAN D DENNISON 7 LAMBS POND CIRCLE :. , CHARLTON MA 0150, .: Expiration: Commissioner 09/08/2018 je, C? U[ J!iCGG L� Office of Consumer Affairs nd Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improven epl�Contractor.Reg stration �:. Registration: 173245 Type: Supplement Card 1 = Expiration: 9/1 912 0 1 8 SOUTHERN NEW ENGLAND WINDOWS,L�` 1+, BRIAN DENNISON ' + 26 ALBION RD LINCOLN,RI02865 Update Address grid return card.Mark reason tar cLauge. SCAT c• 20M-05/11 Address -❑Renewal ❑Employment G Lost Card --" ffim of Consumer Affairs&Bsi uness Regulation Registration.valid for individual use only before therdh �OMEIMPROVEMENTCONTRACTOR expiration date.If found return to: . €; Office of Consumer Affairs and Business Revelation Reglstra0on-73245. Type: 10:Park Plmm-Suite 5170 ExpuOY6-k 9/.19/2018`: SupplemenfCard Boston.MA 01-116 - SOUTHERN NEW ENs .6--,'NbOWS,LLC. R ON ENEWAL BY ANDERS =_ BRIAN DENNISON ._ UNCOLN,RI 02865 lD6de Not valid without signature I The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED R'ITH THE PERMITTING AUTHORITY. ApOicant Information Please Print Le 'bhy ?game (Bu5ine5510rE-anizaiion'Individual): eEPMLAi4. �lL>S Address: CAy/State/Zip: /J Phone 0. Are you so employer?Cbeck the appropriate box: Type of project(required): 1..I am a employer uith 20 femplovees(full and/or par-timel.- 7. New construction 2.F1 I am a sole proprietor or lip-mershir and have no employees working for me in S. Remodeling any capacity.[Ale worker'comp.insurance required.) �. ❑Demolition O1 am a homeowne;doing al!work myself.;l:o'workens comp.insurance required.: l0 Building addition 4.❑1 am a homeowner and wil;be hiring contractors to conduct ai'•work on my property. I will ensure that all contractors either have workers-compensation insurance or are sole I LE]Electrical repairs or additions pron:iemrs-with nc emplovees. 12.Q Plumbing repairs or additions r 1 am a genera],contractor and]have tired the sub-contractors listed or.the attached sheet 1-'.[]Roof repairs These subconuactor have employees and have worker'comp.insw-ance.= � r E.7 We are a corporation and it--officers have exercised their right e.exemption per MGL c. 5L,E 1{4i,and we have nc employees.[No workers'comp.insurance required. i I re—P�Clc�►l C/� -Any applicant that checks box;".must also fill out the section below showing their worker'compensatioc polio-information. Homeowner whc submit this affidavit indicating they are going all work and then hire outside contractors mus submit a new affidavit indicating such. lConvactors that check this box mast attached an addition:sheet showing the name of the sub-contractors and state whether or not hose emitiL-have employees. Lithe sub-contractors have employees,they must pro-6de their worker'comp.policy number. I am an emplover that is providing workers'compensation insurance for my employees_ Belam-is the policy and job site information. Insurance Company Dame: `11re me S Policv i=or Self-ins.Lic.4L �f!�8E87 Z. Z. Expiration Date: FLl O Job Site Address: s �eti''P_3 ( Tr S�7 �' City/State/Zip: ( di<�� I`1 Attach a copy oftbe workers' compensation policy declaration page(showing the police number and expir lion date). Failure to secure coverage as required under MGL c. 152:§25A is a criminal violation punishable by a fine up to$IZ500.00 and/or one-near 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 ofthis statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. I do hereb} certif} under ih airs and penalties of perjure°that the information provided above_is true and correct. Si mature: Date: Phone#: Official use only. Do not.write in this area,to be completed by cih°or town offcciat City or Town: Permit/License-4 r Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cir Town Clerk 4.Electrical Inspector 5_Plumbing Inspector 6. Other Phone*: Contact Person: � ESLERCO-01 SANDERSO l DATE(MMIDDIYYY1� A CERTIFICATE OF LIABILITY INSURANCE osro7i2017 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)- CONTACT PRODUCER ME CoBiz Insurance,Inc.-CO PHONE 303 988-0446 jac,No):(303)988-0804 1401 Lawrence St,Ste.1200 &MJAIC-IL E,Q):( ) E-MAIL COMaiI cobizinsurance.com F Denver,CO 80202 ADDRESS: INSURERS AFFORDING COVERAGE NAIC K INSURERA:Acadia Insurance Company 131325 I j INSURED INSURER B:Firemens Insurance Com an of WA D.C. 21784 Southern New England Windows,LLC.dba Renewal by INSURER C:Libe Surplus Insurance 10725 Andersen of Southern New England 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. I ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR' POLICY NUMBER MMIDD MMIDD L I TYPE OF INSURANCE INSD WVD 1,OD0,000I LI A I X I COMMERCIAL GENERAL ABILrrr EACH OCCURRENCE 5 DAMAGE TO RENTED 300,000I CLAIMS-MADE OCCUR CPA3158728 01/01/2017 01/01/2018 PREMI E Ea ocarrrence S 5,0001 1717 MED EXF An-one erson c I ` PERSONALS ADV INJURY 5 17000'0D0� j GENERAL AGGREGAT 2,000,0001 E i5 GEN•L AGGREGATE LIMIT APPLIES PER: I I 2,000,000; X ❑ R PRODUCTS-COMP/OF AGG POLICY P S JIEf I LOC I EBL AGGREGATE 2.000,0001 OTHER I COMBINED SINGLE LIMIT I S I 1,0W,000i A AUTOMOBILE LIABILITY Ea accdent /l ANY AUTO CPA3158728 01101/2017 01/01/2018 BODILY INJURY Per erso n X75 OWNED SCHEDULED I BODILY INJURY Per accident',5 O A UTOS NLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED I Per accident - AUTOS ONLY AUTOS ONLY 5 1,000,0001 A X UMBRELLA L.IAB X OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADEI CPA3158728 01/01/2017 01/D112018 AGGREGATE s 0 Aggmg e I s i,000,000I DEED) X RETENTION 5 PR 1OTH- B WORKERS COMPENSATION X STATUTE ER AND EMPLOYER$LIABILITY Y/N WCA3158729-20 0110112017,01101/2018 1,000,000, ANY PROPRIEfOR/PARTNERIEXECUTWE '-i I E.L.EA ACCIDENT OFFICERIMEMBER EXCLUDED? ` N 1 A I 1,OOD,000' (Mandatory in NH) E.L.DISEASE-EA EMPLOY 5 If yes,describe under 1,000,000 i DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT WCA3158730-20 01/01/2017 01/0112018 1,000,000' B Worker's Compensabo 1,000:000 117 01/01/2017 01/01/2018 17ES18 Workers Compesnation Inc S 7AII states ex ept ND,OH,tM I Remarks WA,WV WI�'ol�maybe attached a more space is required) I I I 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 POLJ6j'PROVISIONS_ I AUTHORIZED REPRESENTATIVE 1 ]FOR lnf-QrmatiQnaIPurposes ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD O:ficial Website of The Town of Barnstable - Property Lookup Page 1 of 5 Select Language v Assessing Division Property Lookup Results - 2013 367 Main Street,Hyannis,MA.02601 «BACK TO SEARCH« Print FPIe Owner Information - Map/Block/Lot: 1�j70 / 207/ - Use Code: 1010 Owner `q)) �qp Owner Name as of 1/1712 BARRETT,MARTIN W&CLAIRE Map/Block/Lot G/S MA PS 205 JAMES OTIS RD 170/207/ CENTERVILLE, MA. 02632 Property Address Co-Owner Name 205 JAMES OTIS ROAD Village:Centerville Town Sewer At Address: No GIS Zoning Value:RC Assessed Values 2013 - Map/Block/Lot: 170/207/- Use Code: 1010. 2013 Appraised Value 2013 Assessed Value Past Comparisons Building $140,400 $ 140,400 Year Total Assessed Value Value: Extra $56,200 $56,200 2012-$303,500 Features: 2011 -$304,100 Outbuildings: $3,400 $3,400 2010-$304,000 Land Value: $105,700 $ 105,700 2009-$330,800 2008-$370,700 2013 Totals $305,700 $305,700 2007-$369,400 ' Residential Exemption Received=$87,244 Tax Information 2013 - Map/Block/Lot: 170 ! 207/- Use Code: 1010 Taxes C.O.M.M.FD Tax(Residential) $452.44 Fiscal Year 2043 TAX RATES HERE Community Preservation Act Tax $57.41 Town Tax(Residential) $1,913.67 $2,423.52 Sales History - Map/Block/Lot: 170 / 207/ - Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: BARRETT,MARTIN W&CLAIRE 6/15/1988 6290/222 $160000 LEBEL&SOLLOWS CONFIRM , 2/1/1988 6123/190 $0 SMALL,ALAN E TR 2/15/1986 4922/324 $1 SMALL,A E 10/23/1978 2806/74 $0 Photos 170 1 207/- Use Code: 1010 http://www.town.bamstable.ma.us/Assessing/propertydisplayscreenl 3.asp?ap=0&searchpa... 2/11/2013 OWicial Website of The Town of Barnstable - Property Lookup Page 2 of 5 http://www.town.bamstable.ma.us/Assessing/propertydisplayscreen 13.asp?ap=0&searchpa... 2/11/2013 ¢f icial Website of The Town of Barnstable - Property Lookup Page 3 of 5 f http://www.town.bamstable.ma.us/Assessing/propertydisplayscreen 13.asp?ap=0&searchpa... 2/11/2013 Official Website of The Town of Barnstable - Property Lookup Page 4 of 5 http://www.town.bamstable.ma.us/Assessing/propertydisplayscreenl 3.asp?ap=0&searchpa... 2/11/2013 Official Website of The Town of Barnstable- Property Lookup Page 5 of 5 Owned and Operated by The Town of Barnstable-Information Technology. Home Departments&Services Boards&Committees Residents&Visitors I Doing Business 17own Calendar I Phone Directory Employment I Email Town Hall p t I http://www,town.bamstable.ma.us/Assessing/propertydisplayscreen 13.asp?ap=0&searchpa... 2/11/2013 1HE Town of.Barnstable *Permit# T� Expires'6 s from issue e Regulatory Services Fee . ice" E Or,J3 s MASS. g Thomas F.Geiler,Director 0CT � foxa+s�� IOIIgIIo Building Division TOWN OF BARNSTA1314E Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 Property Address Residential Value of Work bwo Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address "QLC Contractor's Name �_„� l/ ,Z_ y� Telephone Number &D 4 (o Home Improvement Contractor License#(if applicable) 1'28/5.1 Construction Supervisor's License#(if applicable) I� i ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner dI have Worker's Compensation Insurance Insurance Company Name �1 -C(J�``�. ,� .1 Workman's Comp.Policy S Z,3 06 (�.' Q'1� 02 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 iqxM N—{ ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors El Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is ,required. SIGNATURE: ��AQ, C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet F es\Content.OUtlook\DDV87AAZ\EXPRESS.doc Revised 072110 ?- ® CERTIFICATE OF LIABILITY INSURANCE °A�` 2"'"' ACORD 010 1SRODUC6R DOWLING &ONEIL INS AGCY INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PO BOX 1990 ONLY AND CONFERS NO RIGHTS UPON THE "CERTIFICATE HYANNIS, MA 02601 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (508)775-1620 INSURERS AFFORDING COVERAGE NAIC# INSURED OLIVER KELLY INSURER A: LIBERTY MUTUAL GROUP 127 EVERGREEN STREET INSURERB: SOUTH YARMOUTH MA 02664 INSURERC: INSURER D: INSURER E: •COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL-THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR- 001 ._POLICY�FFECTIVE POLICY EXPIRATION -- --" --_"— LIMITS ' POLICY NUMBER M D " GENERAL LUIBILr Y I EACH OCCURRENCE S DAMAGE RENTED " - -CO.IMERCIAL-GENERAL-LIABILITY ._.. _ -- . _ ..-_._...___-PREMISES Ea occwrnnca-- -- CLAIMS MADE L OCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE - S RETENTION S S A WORKERS COMPENSATION I WC2-31S-3388Q4-029 12/28/2069 12/2812010 ;/ I ^CSTATu- ',OTI+ AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNFJLEXECUTIVE YIN E.L.EACH ACCIDENT ER I S 100000 OFFICERIMEMBER EXCLUDED," (Maridatory"In'NH)-" "— -- ___.__._____ .W_ __, .. .,__.. _...., ___..- --_ E:L'DISEASE=EA-EMPLOYE 5- 100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Workers Compensation Insurance:Part One of the policy applies only to the Workers'Compensation Laws of the State of MA. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR OLIVER KELLY CERTIFICATE HOLDER CANCELLATION ., SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF FALMOUTH DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 59 TOWN HALL SQUARE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL FALMOUTH MA 02540 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jeff Eldridge ��+ ACORD 25(2009101) 01988-2009 A_CORD CORPORATION. All rights reserved. &ERT NO.: 6862363 CLIENT CODE: 1329955 Anne Chandler 2/17/2010 6:01:04 AM Page 1 of 1 r D-,i7ili'tinenl of Pui-hc Sarel.' '3t! 't'( �ti {!!i 'inr� C"Uiill!(!!is and sI!!?(�ti{is License: CS SL 99167 Restricted to: RFA 3 OLIVER KELLY 9 PEREGRINE LANE SO_ UTH YARMOUTH,"MA 02664 � Expiration;•9I28/2011 ✓fie.��� �! rtG!'uelc��U"a" .•r>ac•ra". Boara�.4--al't�RIONlaho�and 6'tandar �s License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 7 a Board of B•uiiding!Regutations and Standards Registration: 128957 One Ashburton Place Rm 1301 Expiration: 6/14/2011 Tr# 284841 Boston,Ma.02108 Type: Individual Oliver Kelly Oliver Kelly 1. "9 Peregrine lane_ South Yarmouth,MA 02664 Administrator Not valid without signature f - I r saxxsTnsi.E. t' NAB& Town oarnstable Re 'atorf Services Thomas F.Geiler,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 Thin Section If Using A Builder as Owner of the subject property hereby authorize _� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner.is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. e � C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Inteinet Files\Content.OUtlook\DDV87AAZ\EXPRESS.doe Revised 072110 - V The Commonwealth of Massachusetts Department of Industrial Accidents Offlce of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information fv Please Print Leelbly 4 Name(Business/Organization/Individual): Ou y,9 "V, Address:_C6 .LlytL1 iAO City/State/Zip:* U P ", Phone#: 5Q% �S � t{ � re ou an employer?Check the appropriate box: 1.iType of project(required): I am a employer with toy 4. I am a general contractor and I employees(full and/or part-time). • have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These subcontractors have. g. Demolition working for rue in any capacity. employees and have workers' co insurance.$ 9. Building addition [No workers'comp. insurance mP•. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ ing repairs or additions myself. [No workers'comp. right of exemption per MGL 12. . Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.0 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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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 fob site information. Insurance Company Name: U Pszy-,w Policy#or Self-ins. Lic. Expiration Date: Job Site Address: +`LS City/State/Zip: MA- 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 S 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invcstieations of the DIA for insurance coverage verification. I do hereby cerip%fy under the pains a penalties of perjury that the information provided above Is true and correct Si Lure: Date.-ID t aQ i 0 Phone #: c gS EX09 �b Offlcial use only. Do not write in thisarea,to a completed by city or town offlciaL 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterp�riise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicant Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you.have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Deparhnent has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 www.mass.gov/dia -.r f w.'&;+':5�'.ss+j�,y,�'•� `.+» K:.lji 'frY• _. ` _ ' _ a. _ tMETO. TOWN OF BARNSTABLE Permit No. .,3.169,1 BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash 659• ..1 .. '.. HYANNIS,MASS.02601 Bond ..... CERTIFICATE OF USE AND OCCUPANCY Issued to Alan E. Small Address Lot #15, 205 James Otis Road Centerville, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND,IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. June 29, 19 ..$ ..� / "-r--^�-. ........... Building Inspector °°. TOWN OF BARNSTABLE BUILDING DEPARTMENT = rAR1 TOWN OFFICE BUILDING rut 3039' HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by Building Permit ... ................... »...... ........................ . issued to - ... ! f:.: © ` ••i .6 t.......fsYi .»..._ _..__. Please release the performance bond. K w TOWN OF BARNSTABU;70 1 . BUILD ( G". P _ ",: ERMIT DATE 19 rj fJg � Z h;3 I ` PERMIT APPLICANT ,( ADDRESS I. C'Y'',J'i 1 •:� .i:(� 1 Ci•77 t- _.� - t (NO.) (STREET) • (CONT R'S LICE CEN NSE) PERMIT TO L+t;•+ w-:-i 1:1i1 t i�.:.1.i N MBER OF 1 (_) STORY " , ( I v ayiXYT,� (Y ELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) 1 '1 v 'j /e ZONING t�Iry. (NO.) 1 (STREET), DISTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) i 9 i SUBDIVISION LOT LOT j BLOCK SIZE i BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION' TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION - I (TYPE) I REMARKS: c::t;.'tJ: '.' S:. F•I :� . I -- AREA OR VOLUME :_'1 1.1 t) ;;;.i .%.i. , �.I I_)�}a (.1�) PERMIT .r,. . (CUBIC/SQUARE FEET) v _ESTIMATED COST '-' ''' FEE V v• - OWNER aJ i.ti ADDRESS --*'-i;L'f?17%7 BUILDING DE PT, BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE 'APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETA INSPECTIONS REQUIRED FOR INED ON JOB AND THIS WHERE APPLICABLE SEPARATE ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS._ 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL FINAL INS RE INSPECTION TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE ' OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 2 �. 12 . 3 HEATING INSPECTION APPROVALS ENGIN RING DEPARTMENT 0�e OTHER µ ` � '�"f/rV �•, n BOARD OF H WORK SHALL NOT PROCEED U!:TIL THE INSPEC- PERMIT HILL BECOME Ui_L AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIOUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN BE CONSTRUCTION. PERMIT iS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITTEN NOTIFICATION. I , : . Lo-r- OT t5448S.F. Sz' 14 - - F+.1D ' 1 Z'A 12z AD I Oi�3 I CERTIFIED PLOT PLAN LOCATION I CERTIFY THAT THE r QDKI-10 SHOWN HEREON COMPLYS WITH SCALE DATE Iz_z THE SIDELINE AND SETBACK REQUIREMENTS OF THE TOWN OF PLAN REFERENCE '3aQ�j ST4 BL.E - A N D I S QQ:::,`S-- L o-T- , LOCATED; WITHIN THE FLOODPLAIN, DATE : Z $� G U` ���1 BAXTER a NYE, INC. THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OSTERVILLE^- MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINES. APPLICANT AL ; �� ,r1A L-1- - C:71-y Ur I L r 4` © C p �T � a ' � S �jN OF 7 + ��.. PETERSFNCHAJ SULLIVAM1t i >�o: 29733 i" f BAXTEA moo,-� y `I2\' 4_1 ;. ,l ��FSsoNa L 1 -... , Tl=�-57 1 ' 1 +_ 1 WIaY lc,I9 G - — t__. T. r _ 4 1�_ t71ST I NA i $ . ..- ij �, i 4e DI_4 ,;--� - i ,_ 1 - _. 1.: :- SCE; . 1- -T-• J�II.. S, �98� Uw I G�1zT' - Gt✓� V l Ll..� a-1.1G N I�.IJt��- (5Tk�" V).LLL—: ^ MASS, 7 IM-' - P - -- `'► -2�_��. 1 - PL-4 U. l 5 NOT FAs.an e N LO GU30E LINE d �4.. .. EPTIC SYSTEM MUST BE Assessors map and lot number' ...... .... .. .. . " of T EINSTA IN ... .Sewage Permit number .......... WITH To'fO °� ENVIRONMENTAL CODE A NAM TABLE. House number ........................................................................ z TOWN REGULATIONS °° i639. �0 mo y. TOWN OF : BA-RNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....:... ......... ... TYPE OF CONSTRUCTION ........,,�.� .................. .............................................. ................. r.........19.�CC,� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a it accordi g to the following information: Location ....... ... ...... .............................:............ ......... ..................,......................................... ProposedUse ......................... ....................................................... Zoning District ............... .. .�........................... .........,....Fire District Nameof Owner . ....................................... ............ ...........Address ..............................................,. .................................... Nameof Builder ..........°.�.....................................................Address ............. ......................................................... .... Nameof Architect ........................................................... ...Address ......................................................... Number of Rooms ....................................................Foundation ........... ..,........� ........................................ Exierior ...... ... ........................................Roofing ........... .4:-411 .......I.............................. Floors ............................Interior ..........! ..... .............. ...................................... Heating ...... .. /�?/....( >.a......................................Plumbing ....... ......... ................... ....... Fireplace . ....... ....... .....Approximate. C st ......./��,�:. ''a, .... ..... L� Definitive Plan Approved by Planning Board ----- --------- ----------19 _. Area ,ln. .................r. Diagram of Lot and Building with Dimensions Fee ........../. ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regard' he above construction. Name .. ....•......... ....... i Construction Supervisor's License 0�C 7 SMALL, ALAN E. ,j-,No ....316.91 Per' it for .... Story ..... ..... M ........................ S.inaje..)Fapily Dwelling ........... Location Lot . -# 5', 205 James, Otis Road ..... .... ................................. .................. ...........t.....Centerville rvA.....11...e .. .................................. Owner ....Alan 'E. Small .............................................................. Frame Type of Construction ....................... .......... . ................................................................................ Plot ............................ Lot=:.-:.............................. Permit. Granted .........Ma.r.ch....lJ...........19 88 ..... .. .... Date of Inspection .................................19 Dote C �Ietecl ..... �.. .,....dam �.�......19V, y tT 0 1 P M M 0 fm Assessor's map and lot-numbe 'TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO. ......... .. ............................................................. -~�~ TYPE :OF ='�=`����o�w�o�v� --..`*��^^.o- °. -------''----'' ' ------~~----''' . /�'� .~... --..�—^�...,..lgl�/�/ . � TO THE INSPECTOR OF BUILDINGS: / The undersigned hereby applies for o permit according to the following information: �`�� _ ^~^~'~°' ^ ~ r~^� '-----'—'-----------^^---''`--' ' ' '�e�"�� "� ''-=—'' `':i^�� --' ~^'--'------`------~--'~—^-^~—'--^—'---^^--^ � ^ . Zo����Di-str��� District _---------_----._—_—_,____. No of ^c ----,'���...�����—.A66res --------_--.......—.......-.~.—....' ' . . Nome of Builder -------.^--- ................................ ---------------.—.---.-------. , Nome of Architect .r--..---------------,—..A6dres .... ..,--------.,-----.,_........................ | -� '--� ' Nom6e� of Roomu x^ -----------_----Foun6otion ..... ..... Ex!erior —�, .����_---__----_�; 'RpoGng ---���r�� �� --.._-----_--.' ~ - . R ................. Interior ^} Heohn' g z ~e . .....................................................Plumbing ...........e` � Fin�p|000 :�� � ._~���'����`��`��'��—^^^-'—^--''^` ' y ~' / '' ' / ' � ^ 4I� Definitive Plan.', by, l9/L/, . A,ea � ------- � ' ' ' ^~ - '—� ,~- . �/ '.~ Diagram of Lot and Building with Dimensions Fee ---7^—'/ /l0 z ~ -' ................... - -~ — SUBJECT TO APPROVAL OF BOARD Of HEALTH ` \ ` � .- ~~� ' | � ' `- � . -- � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ' ~ ' | hereby agree to conform to all the Rules and Regulations rnuhzUl above construction. - ' ,� ._.—,~'� ..................................... ' '' � Construction �,ucion Supervisor's <���.,�,—.=�,---. ' ���� E. A=l70-207 "~�^.�, . " -No ..]l.�.9I.. permhfor __D.z�e .Stozl'__ . . Si���le Faoil� Dwelling �����'' �����'� '����������'' Location .....�mt...�.l5.�......20!5_.Jaoues_Ot.is iRoad . l ------. ��. .-------- . --,'------ Dvvner -. ........................................................... . . Type of Construction -.������-------- ' - ' -------------------------- . . . Plot ............................. Lot`............... ................... � ' ' ` - - - 'Permit Granted .......!larch� �-ll-'�---lA 88 Date of Inspection ....................................lV ' Dote Completed .---..-�.------..lP _ - ' ' ' . ' ' ^ - ` . ` ' . . NN ~ mm'