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0065 JOYCE ANNE ROAD
. . a . r � . e o v � 4 Q o �, e �. �� �, a _ or _., �. ,. { ' . ,. f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION • j'� s Map 0V Parcel V �. Application # � �r Health Division e SUIL p Date Issued Conservation Division Application Fee Planning Dept. -APJ� 18 2017 Permit Fee � � I O V d Date Definitive Plan Approved by Planning Board ..."lR. � Historic - OKH _Preservation/ Hyannis ov� / Project Street Address t4 Village- Leh 46�y. ��-� Owner 9L9 2� i-yt . ,, Address Telephone 3���, /— L/a7 n Permit Request De C 1-6 �i� (C� /���.J Ds c L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation C41 0, 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 new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas '❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new , size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �rocoll 1`��� Telephone Number Address 0 `� ` ?v_ _a I � L� License# 27 b Home Improvement Contractor# Email 05�� IjJ'jfQ /(� / g14 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ice of Consumer Affairs&Busje O ff HOME IMPROVEMENT CONTRACTOR Y Registration: 936 Exp'raft P Cam' IN I CAPE&ISLAND CO� —�,, JOSHUA--KOURI 55 ELM AVE.HYANNIS,MA 02601 Massachusetts -Department of Public Safety Board of Building Regulations and Standards V UnJt111L LlV II Supervisor License: CS-074660 0LTTS JOSH X KOUI�k _ PO BOX 210 '@ CENURVEUX MA )[Ta Expiration Sad,'ZI-440` 02/12/2017 Commissioner License or registration valid for individul',use only r before the expiration date. If found return to: Office of Consumer Affairs and Business'Regulation 10 Park Plaza-Suite 5170 1Boston;Mtn 02.116 At al' without signature s-of any use Unrestricted-Building group which 991m3)of . contain less than 35,000,cubic feet( enclosed space. J Failure to possess a current edition of the Massachusetts �— State Building Code is cause for revocation of this license. 'n inform ation visit: www.Mass•Gov/DPS � For DPS License g , 5/11/2016 9:16:14 PM PST (GMT-8) FROM: 100005-TO: 15087756668 Page: 2 of 7 DATE(MM/DD/YYYY) -AC o® CERTIFICATE OF LIABILITY INSURANCE �...•� 5/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER FRANK L HORGAN INSURANCE AGENCY INC NAME: . - 44 BARNSTABLE ROAD PHONEo E No PO BOX 250 E-MAR HYANN IS, MA 02601 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# NSURERA: LM Insurance Co oration 33600 INSURED INSURERS: CAPE& ISLANDS CONSTRUCTION COMPANY INC PO BOX 210 INSURER C: CENTERVILLE MA 02632 NSURERD: NSURERE: INSURER F; COVERAGES CERTIFICATE NUMBER: 2987874.5 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�TR S TYPE OF INSURANCE NSD WVD POLICYNUMBER MM DDY/YYYY MM DDIYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE DOCCUR D A PREMISES a occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY El JECT PRO- LOC PRODUCTS-COMP/OP AGG $ PRO- OTHER: $ AUTOMOBILE LIABILITY - COMBINED SING IMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ I DED RETENTION $ A WORKERS COMPENSATION WC5-31 S-377540-016 5/7/2016 5/7/2017 ,/ STATUTE ER PE OTH- AND EMPLOYERS'IJABILRY ANYPROPRIETOR/PARTNERUEXECU IVE Y/N NIA A - E.L.EACH ACCIDENT• $ 100000 OFF ICER/MEMBEREXCLUDED7 ❑N ^ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ SOOOOO DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 MAIN ST- ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 , • - AUTHORIZED REPRESENTATIVE - &J - LM Insurance Corporation ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 29878745 1-377540 16-17 WC yogesh.pati.l@li.bertymutuaL.com 5/11/2016 9:13:58 PM (PUT) Page 1 of 1 4 � GiKifi �tA.JG6i'J • . TIM 1 1 OffWB of br dt#GIw. 600 WashhWm&re-& Baston,MA=11 k1�FVit4Lti7l�£��i`�IQ Wcrlmm' CumpeIISatiaI1Inmumice Affrr-avif-RnUde SIOMhw =/E6cu�n� �ers AppHemad finII Please Print�E�y Nam l Are} an eeuploger?Checkthe approapririate haorr rpm of project(regnireel)_ L I am a employer vzfth 4 ElI am.?general confmctor and I conztruc[ ❑Ne employees(fall a for * IMVe faired the SUB-cco m 6. ss 2.❑ I am a sole proprietor orgartaw- listed c�tha of ached shed I- ❑Rpm deEng and have sa l These soh-caatractam have �P employees. ❑Demaldsan: . . v;cddab fhr mea is any capaei�y_ =Edorw amdhave wow e- [No wodoaw comp.iasunm a camp-t^MWa**ce$ 9. El Building addition -1 S. Q.We are a•aoaporafifla and its 10-0 Eleckical repairs or addifinas Officers hm ewxcised thdi I El 1 am.a hramaovcmer doing all word 1L Plumbing repairs or$dehfiams myself[Na worlm s'camp- >iflAt of em=PSM per MM 17 Roofrgxim msarancerequimd-]i c-M¢I{4k andwelavemo employees,[NowoADEs• 13_EI-o&er comp_k=a=required.j •�apagpff�Bzarc�'6os�l�stelsaSno�thesecBoabeio�vaieau�ceis'�easatiogpor�cginaa . # sEb�i aas Aida«i g$ey���<slf�sa�s �lgxe aai ca rsamst s mic$new�da4rt mdi a=dL d'aaizU ffmt r3e-Ir fl k In mffi a an addi6�at sliest sfion ag ti�nameof the sub ca Sri stye vrltethe�a�nat Ehnse a eshsvm mpkyem gmside-teir sue'—P•Pdficya—ber I am art eeiipJoyrr M&isprovhUng tvvrkrrs cauTensdian irnurazwe for my mnp�wm Hdow is flee pa&cy Md jab site 2 imforra�ra. // Paficy 41or&elf-iM Iic_ Job Site Address C4'State/Z.P- 2 Affach a copy of the workers'compensationpolfcy declaration page(showing the poficp mrsaher and ezpiratiou(ate). Fail to secure covmage as.required nudes Section 25A of MCrL c.15Z van lead to the imposed of caimmal p of a fine up to Sl,Saa t)U mWarone-yearimprisortmenk as we31 as cif penalties is fe faux of a STC) lfiT(}RK 4RDI Rand a funs of up to$250FMI a dap against the violator. Be advised f d a copy of this statement may he hrwarded fa the Office of Isvrestigations ofthe DIA f x hw=w cavemIp vecckahacL I&kff4 5y u and perms a fpediuy fhatfJer infornzad p.Mv€&d abom is true and carrect ^�ouatnr�- G - Date- Phtme rk` 2 21Q Z, �. 021cied am anfy. Do not wrkr in this area,ftt be caulked by cdp or town officiaL City or Tan= PeradtUcensef Issuing a*y(drde one): L Board of Heal& I IluffTing Dqmtment 3.f 5tpTown.Clerk 4.Electrical Iaq=tur S.Pkmbing Iaspedtor 6.Other Cooentact Person MGM#- 6 _rlal.�■•. /� .■:.•Ii! i•■■{�•. 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NI •• • ra- ■■/- .a. 1. •ii!1 •[.■! .Y.11■n w1 •I ■■.1..•�• .• t• NI n ■•••1 n- ct•. r:1•. n •• u. : ■ n•. 1 •1 7- w nun - s.+nr • .�. -� ■ Gt..• 1 Im .- :11 i■ . 1 -_• t�•i{ ••1■ - .•'■i' • N■■ /�■ a■Y.a.1• ►if.� •] •i'.•N 1 ■• :nil t• .■■ I•YII^.`w • r111.n■� A- '�I/n/1 . ••• rill - s .:Itn 1 u •■tn y. �B w. ■ ■� •tl � i■/•■ iI n rNltt. tea- r1 /!.. a- � �t • • •�+••:n•a ^•■ 1 .� n n_n. ••. n .■•.n r- u •.n ►•■■++ .n u■ at• ■•■ ■ •1 1. • -n ••:.•m ■.- �.'1 ■n ■1 :■11 inR t" �•••t■- .11• Y- .11lt{.►'. ]►•a!.t ttt i;t i !11�1.•it� t. c;r ti le • ' v Town of Barnstable Regulatory Services ihAE& � Richard V.Scali,Director a699. �+ Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must. Complete and Sign This Section If Using A Builder I ! ,as Owner of the subject property I hereby authorize to act on my behalf,. in all matters relative to work authorized by this building permit application for: 24Lt Aim Q v V, - I (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final spections are performed and accepted. r Signature of Owner Signature of Applicant Print Name Print Name Date r �t TOE» I�����`I1St��le YPermi PENN Erpi 6 mon r r issue d e MOM 0 1D1 Regulatory Services Fe BARN Richard V.Scali,Interim Director ArFVMp'ta_ �� ' . 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 PERWr APPLICATION - RESIDENTIAL. ONLY Not Valid without Red X-Press Imprint Map/parcel Number. .209 f I ( R Propert�Address 6 S .fin y c e A n r'1 e_ t �c( &/7 f-er'v I (e— [Residential Value of Work S /Z 5 3:7 Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address /Zhart Lejer,4,a ll (o S Yee- Anne R�. - Cam,-rfi y 1f e , y"l 0 Zb 5 2— Contractor's Name-5 �/t,,i Snn Telephone NumberOC)1) 2- -gkl�p Home Improvement Contractor License r(if applicable) /�t4_ Email: Construction Supervisor's License Y(if applicable) 0 5.5 7 O 7 [gWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Aremnqut Znsu<a ice .Workman's Comp.Policy 4_ WG 91-80 5S 3,S2 3 cI L4 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) - ❑ e-side Q Replacement Windows/doors/sliders.U-Value 30 (maximum.35)r of windows /O 9 of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required_ Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. X�--Note: Propertyowner must sign Property Owner Letter of Permission. A copy o the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QMVPFILESWOR SUilding permit formsEXPRESS.doc Revised 061313 A 311.R<rtiG rt3�li9 Renewal aRNEwLBy ANERSE ntu LW.#MZa5byAndeCrtknu#063.55s WINDOW atriatt.iat 26 Albion Road a Lincoln;Rl02863 tftdi"=zt23t w.( Phone 866563.2235•Fax 401.633.6602 reJernt tax iti a+aosso ther.New England Windows,LLC d/b/a: 0 Sou Renewal by Andersen of Southern New England 1 U� CUSTOM WINDOW AND DOOR REMODELING AGREEMENTAie 3uyu(s)SvmAd&vm0ry n ndZipCede/P..O_Bme V s �`��t ' . 1� _•V -- X 6` ye, &zae w,4a ceAinaaale ly4, D -3z -" .V�4rihTdeplrorte Mti�nl+a: ,. E.Mt!IAddrCt>: .q.._ ,- ;. F♦omeTekpacng Wum>ter:," - Buyrr(s)hereby jointly and severalty agrees to purchase the products and/or seiyiees of Southern Nmv England WM1 indoivs;LLC d/b/a Rene%val by Andersen of Southern New England("Contractor'),in accordance:with the terms and conditions described on the front and'tke reverse of ,.F this agreement and tin the attached specification sheets)(wllecdvely;this`Agreemene). ❑111storic O Condo ❑HOA? T6WyobAmount:/.:7/. 531- IS.,di of.Payri�ent CICheck UCash. QSK.ed- Deposit Receivedt l: r 1>Z S ►gin y dOl fi Cards are a epted for deposit only—ma�ttittuin U3 of the Balance at Stirs of jiib(33%}: cost a see Cm#Cwd iliyment form,)Byslgthing this �f!G !It/�/f" Esmm�ee Co left"thte A*,ement you ovdedge that the Balance it start bf)ob and the Balance on Substjoll r �I ` Balari4`on 4 od C. pleilon of)ob cannot be irede by credit:: Completlon of lob . N d must be made by per sonai Brett bank check,ar cash. Bnyrer(e)..gyre.,.":aadeestands.tbat lhis'Agseeme :eoastitntes the entire tindentaadiag,between:the,partiee;and that cheer are no verbal Dnderstaadinga changing nay of the teems of.elud Agreement.Buyer(e) acknowledges that Bnyer(s) (1)bas.read thus Agreement;nndersmnds the tcrins of tl►iis Agreement'and has received a eompleted;.signea;and dated copyof this Agreement'iaeludirrg the two attached Notices.of Caaceliadop�on the date 6rstwritten above and(2):was orally informed of Stayer'.right to cancel thisAgeecmeot:DO NOT SIGN THIS CONTRAC T IF THERE ARE ANY SIiANR SPACES: (Knots/.,laud Satre a+yf Not<ce:to Bnyees(1)Do not asgri this Agreement tf.aiay',of the icpacea iafended for ehe'agr red_ternms to the extent of Then available infosinadon:are left blsiib .(2).too areeude ' to a copy of this Agreement at the time you sign it..(3)You may-at anytime pay off the fall'unpaid balance doe tinder this Agreement;.and in so doingyou:may be entitled to retxave s partial:rebaie'of the 6oance and,fm.ttaance ehargesr.(4)Tie treltee ha.no:rigbi to®lawfnliy enter your premises or covis"any breach of di'e peace W.repossess goods purchaaed tender thi.4reemeu't.(S)You toot'cancel ihisAgreement if-it has-not been signed at the main olBce or a branch;office of the seller,provided you notify.the seller at Lia.or her main office or,braach oilice,shown is the Ag'eeasent by re�ste:rd.or eestified matt,which ehaB be posted aot'later than mtdngl►t of the third calendar day, t day on vrliicL the'bnyer asps the Agreement;ezcluding Sunday atnd:any holiday oh ,AlCb regular mail deliveries are not made.Seethe accompanying notice of cancellation form for an explanation of buyer's eights: Buyer(s)_received the consumer education materials _e b'tlte. Island Contraclors.Regisiratiori Board (&yer'rh Ihak Reneyytt-by And- of Southern ` d S s Buyei(s}; Ei►glan oi' Signature o ct.Ivlana$er; Si :at rq; Signature Mh1 �OLda Ot Print a of Product.Uanager' Print;Vame Print dame TOW TI•I$.B[IYER(S)i,MAT CANCEL_,THIS TRANSACTION ATNYA TIME PRIOR TO.MIDNIGHT OF THE THIRD .BUSINESS DAY_AFTER THE DATE OF,THIS TRANSAC- --.... TION.SEE THE ATTACHED.NOTICE QF CANCBLIAT[O"ON FORMS FOR AM B k ANATION'OF THIS RIGHT Date of Transaction_ You may'i:ancel I Date of Transaction You may cancel. this.tran action,without' alty or otitiotion.within ,i this transaction,without airy penalty or obhgation,within' three business."days from the above date if you cancel.arq% three bustness days from the above tat$.If you,cancel,any property,traded n;airy payments made by you under the' property traded in,.anji payments made,by you under the Gontract_or.Sale;and`any_negotiable hnstrument.executcd I Contract or,SaIe,and any negotiable'instrument executed. by rots will;be returned within ten business ttajrs following I bar you will-bit•roturhied within ten business days following. F-CE". th'e Seller of your cancellation notice;and .try ' receipt br the Setter of your cancellation notice.and any out of the hatnacdoso writbe' security.interest arising out 'of the'transattlonwill bifyoucancel;yyooumustmakeavallable.totheSeller canceled.Ifyou.cancel;you'must make available to die.Seller atyour residence;in substantially as good condid-ri as when 1 at your residence.in subi' 'allyi as good'coridfEitiri as when received..try goods delivered to you under this Contract or..l 'recehred,ahry`goods delivered eo.you under this Contact or Sale;'o"r you may.$Y0uWishnywithe nse ' eryo ric o o a,ityou wlsh;comy piy with she instruettprts of .the Seller regarding the return shipment of the goods at die. the Seller regarding titre return shipment of fire goods at the -Seiler!.expense and risk Nyou do make die gg0000ddss available_ Selieh ecxxppoeraae and i-It If you do make rile gg0000ds avadabie bi hot Seller and.the.Seller does_not pick;,them up within, W 6 Seller and the:Seger tine;:not pick them,up,within; twenty days of the date of cancellation.you'may retain"or I twenty of the date of cancellation;you may retain or dispose of the goods without any further-obligation.If you 1 dispose ofAhe'goods•without-arty,further.obligation:If your fail to make the goods availabie:to the Seller.or if you agree- I fall to make the goods available to the Seller,or if you agree. to return the goods to the Seller and fail to do so;then you i to return the pods to the Seller and hill to do so,then you, remain Ule for perfi mtartce of ail obligatlons under the re,main�llabie.for perfo►rnance of all obligations under the 'Conlract:To cancel this transaction,ma()or deliver a signed Contract.To.cancel this.transaction,mail or deliver a sighted: and dated copy of this cancellation nodce'or arty other i ,and dated copy'of this cancellation iiotice.or_any other written-notiti.ortele to Renewal A f I written notice,or send a tel to Renewal hyAndei i of Southern New.Eri�Iand ail Albion Ro 6S. I Southern New England at=6Albion Road,Uncoloi R102865. NOT LATER,T ' MIDNIGHT OF 1 NOT LATER THAN MIDNIGHT`OF (Date) -., . ((Date), I HEREBY CANCELTNISTRANSACTIO . . 11 'f WERE13Y CANCELTHISTRANSACTION. hurry s f�mtwe; Pratt NMI Date aww's signa— Print nYms i_Dote RhA copy:white Buyer Copr':rellow Buyer Copy:Pink Southern: New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-095707 •1`�ter.rr. ��� _ BRIAN D DEMIS6N 7 IAMBS POND CIR._ s Charlton MA 01507 11. , 2 Expiration Cornfnissioner 09=2016 Office of Consumer Affairs d Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9/19/2016 SOUTHERN NEW ENGLAND WINDOWS LL DENNISON BRIAN 26 ALBION RD _ LINCOLN,RI 02865 _— Update Address and return card.Mark reason for change SCA1 a 20u-0sni _ Address C Renewal 0 Employment Lost Card �` :;%'6�'(oo,.ano.H.u•..rlfsc�'C-Y<fa:,ncfiu:r!!a �1 Rct of Coose.cr Afrairs&Business Regulation License or registration valid for individul use only E IMPROVEMENT CONTRACTOR before the expiration date lffound return to: % Office of Consumer Afthirs and Business Regulation - sRegiatraUon: 773245 Type 10 Park Plaza-Suite 5170 r! Expiration: 9119/20t6 Supplement•and Boston,b1A 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN - 26 ALBION RD LINCOLN.RI 02865 Uodtrstcrtury Not valid without signature f The Commonwealth of Massachusetts Department of IndustrialAccidents : Office of Investig ations (' 1 Congress,Street,,Suite 100 Boston,IdIA 02114 2017 5 www mass,ovIdia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/PlumbersApplicant Information Please Print Legibly Name (Business/O rganizationadividual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are you an employer?Check the appropriate box: Type of project(required): r?' 20+ 4_ I am a general contractor and I l.� IZaut a employer with ❑ � ❑ 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 g_ ❑Demolition working for me in any capacity_ employees and have workers' 9 ❑Building addition [No workers' comp_insurance comp.insurance: required_] We are a corporation and its 10.❑Electrical repairs or additions 3.El am a homeowner doing all work officers have exercised their 11_❑ Plumbing repairs or additions myself. [No workers'. comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c- 152, §I(4),and we have no 13_Q.Other Window Replacement employees. [No workers' comp. insurance required.] *Any applicant that checks box nl must also fill out the section below showing their worke&compensation policy information_ Homeowners who submit this affidavit indicating they-are doing ail woes and ehen hire outside contractors must submit a new affidavit indicatiqg such- Contractors that check this box must attached an additional sheet shonine the name of the sub-contractors and state whether or not those entities have employees. IF the sub-contractors have employees,the}'must provide their nor`.<ers`comp.policy number_ I anz atz employer titat is providing workers'conzpezzsatiozz izzszcrarice for zzzy etzzplovees. Below is the police and job.site Information. Insurance-Company Name:ARGONAUT INS. CO. Policy#or Self-ins.Lie.#:WC 928058352394 Expiration Date:8/21/2016 . Job Site Address'" &O ; �'TUY e e Ann P f Lc City/State/Zip: Qa�eri%l(e_. ► A 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 259Vr*GL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 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 forinsurance coverage verification. I do hereby certi under the p 'is and penalties of perjun>that the infor�natiotz provided above is true an[I correct. Signature: • � - Date: Phone#: .40 1 2289800 Official use only. Do not write itz this area,to be completed by city or town offrcial. City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SOUTNEW-01 PARKERNATHCO CERTIFICATE OF LIABILITY INSURANCE °A911 312015 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 I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED i ' REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER - j IMPORTANT, If the certificate holder is an ADDITIONAL INSURED,the poiicy(ies)must be endorsed. If SUBROGATION IS WAIVM 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 Rau of such endorsement(s). PRODUCER Willis of New.Iersey,Inc CT Willis Urtlficate Center clo 26 Century Blvd 1!AP!PHONE eal:(SM 945-7378 Tor{$$8)467 2378 P.O.Box 305191 ! t Nashville,TN 37230 6191 INSURER AFFORDING COVERAGE I NAIL F Ie sunitA.Selective Insurance Company of Southeast 139926 j INSURED INSURER a:OneBeacon Insurance Company 21970 Southern New England Windows LLC i iINSURER C:Argonaut Insurance Company 19801 0181A Renewal by Andersen 26 Albion Road INSURER D= Lincoln,RI 02896 INSURER E: i INSURER F; 1 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO N@iICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEFM. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. f TYPE OF INSURANCE - POLICY NUMBER PI111D D YiY fYY FF POLICY D(P (MMIDDIYYYY) Lam A X COMMERCIAL GENERAL LIABILITY ` E i EACH OCCURRENCE $ 1,000,00t I I CLAIMS-MADE X OCCUR j X j �.S 2029459 08110/2016 08110/2016 I PDAMAGE To RERTED ier a $ 100s8 i t . Ii MEDEKP(Anyoreperson) i$ 10s00# PERSONAL&ADV MFJPY I S 1 sue: GEPrt AGGREGATE LIMIT APPLIES P62: ,GENERAL AGGREGATE f$ 3,� PRO- PduCY®.JEGT C LOC I i i PRODUCTS-COMPiOPAGG F$ -3,000,000' OTHER: AUTOMOBILE LtABitt'fY COMBED SENGLE LMIT saentl 1,Qt>4,t1 pt X ANYAUTO X S 2029459 0811012015 08/1012016 BODILY INJURY(Per person) S ALLOwNED SCHEDULE AUTOS AUTOS I ( i I BODILY INJURY(Per ant} $ `X ;HIREDAUTOS � N-Q AUTOS I i PROPERTY DAMAGE g Per accWenp I j i g i lI UMBRELLA LIAS t OCCUR FAbH OCCURRENCE r EXCESS LA8 CLAIN S AGGREGATE I S D=D RETEN710N5 - S IVMRKERSOOMPENaATION i 'AND EMPLOYERS'LtABILn 9 UTE _Y I X ER13 ANY PROPRIEfOR1PARTNER/EXECUTFVE r—� ( OOOOBBO26 10812112015;0612112016 EL EACH ACCIDENT s 1,�0,00 OFFICERAAET>�R EXCLUDED? I N k.1M1 l A (Mandatory In NH} Ji EL DISEASE-EA EMPLOYEEs 1,MI0, 'If yyeeaa descr�e under i OESCRiPTiQN OF OPERATIONS below ! i E.L.DISEASE UMtiT $ 1 A00A00i C Workers Compensation i ; C9280585523" 0812i12015 i 08/21/2018 See Attached IosscRIPTR)N of OPERATIONS i LOCATIONS i VEHICLES(ACORD 11H,AddWonat Remarks Schedule,may be attached If mom space Is required) T141S CERTIFICATE VOIDSAND REPLACES THE PREVIOUSLY ISSUED CERTIFICATE DATED-8H1P2015 Auto Policy includes additional insured when required by written contractlagreement as per policy form. HSS Holding Corporation,Ino-and any subsidiaries are included as an Additional Insured as respects to General Liability when required by written III cormactlagreement as per policy form. I CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE i THE EXPIRATION DATE THEREOF, NOTICE MLL 13E DELIVERED IN i ACCORDANCE WITF!THE POLICY PROVISIONS. I I I j AUTHORIZED REPROENTATME ©1MB-2014 ACORD CORPORATION. AR rights reserved. ACORD 25(2014MI) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I TO WN OF 18 A , TA,60¢ Application # Health Division FT 27 ._ ,G Date Issued ly ur Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 6- Jot4e 4,v j Village 6�j eE2v�/l� Owner 46,6 .' L���,QEn�i✓ Address Telephone 903 - 3 2- Permit Request 1�,fmavC- la4j7 &)&/I 41tJeej XjiCh_ 4)1, 64 A/� %dig)l m. .0//q fi44 of GdL f Azy ele4j0 ,Qu vse s NS . /l AM,0 A1tfd40J elatIr1ye6 ' /,,SAfi Square feet: 1 st floor: existing/foo proposed 5'9,7E 2nd floor: existing proposed Total new y�! Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size /`/,, 000�s� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U!"' Two Family ❑ Multi-Family (# units) Age of Existing Structure 2; 09 i014"1 Historic House: ❑Yes &"No On Old King's Highway: ❑Yes C o Basement Type: Urfull ❑ Crawl ❑Walkout ❑ Other a� Basement Finished Area (sq.ft.) N Basement Unfinished Area (sq.ft) wa /206 Number of Baths: Full: existing / new Half: existing I new Number of Bedrooms: existing _new Total Room Count (not including baths): existing ( new First Floor Room Count 6 Heat Type and Fuel: ®Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: 2"e"xisting ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes &rNo If yes, site plan review # Current Use 6 m a y ,Qes Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number 5-08- �3o rd'/°C Address joP cJ UJ1ii 4/ License # C S - n b6'y y� dZ63/ Home Improvement Contractor# Email ��� ,0�!' w6L o Ne it Worker's Compensation # ,2.00/ Ob 3J/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO_ iliJ< SIGNATURE J140-- DATE /-0 / FOR OFFICIAL USE ONLY APPLICATION# DAiE ISSUED' MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING . DATE CLOSED OUT ASSOCIATION PLAN NO. ]� October 23, 2014 M�cKENTI�E ENGINEERING Mr. Thomas Perry . CONSULTANTS Building Commissioner structural civil envdronmenta Town of Barnstable 200 Main Street Hyannis MA 02601 RE: Bearing Wall Removal, 56 Joyce Anne Dr, Centerville Dear Mr. Perry, a McKenzie Engineering Consultants, Inc completed a site visit to review the requirements to remove the bearing wall between the kitchen and living room for the house located at 56 Joyce Anne Drive in Centerville. The wall is supporting attic/ceiling joists. The beam required to span the 12'-6"opening G created by removing the bearing wall is either(3) 1 3/4" x 9 1/4"LULs or(2) 1 3/4"x 11 1/4" LULs. Use double 2x4.studs as posts to support both ends of the beam and ensure the interior post aligns with the lally column in the basement. Use standard joist hangers to flush frame the ceiling joists to the new beam. If there are any questions on this matter, feel free to; e at any time. Sincerel IfFlo MAW i(X M A. Mc nz>e „Pa� Pres., McKenzie "11 eering Consultants, Inc. cc. Paul Davis Restoration s 1279 Millstone Road Brewster, MA 02631 t 774.353.2144 f 774.353.2142 www.mckengineers.com dT ,Aek-d atv y Se rvvices Ric harrd' . Scali,Dir&thr BUllt xng lylsio Torn Perry,Buildang•;' bu m ssi'oner 200 Main Stre&t,.Hyaums,MA.0250`i wwwAown.barnstabie:ma.us ..o Office: 508-862A038 Fax. 5.08-790-6230 Property Der Must CompIcte and Sigh This Section if Using A Builder as C�a>�er,of thesul�ecr. ra"e _ l p P hereby all'60riM Pjktk l �i S u' M t� �Yi ta act on. y be�alf 1 a : in all mattezn relative to auchorized.by this'bu dmi g permit application for. f (Addkss rfj6) k Pool fences and alarms are the responsibility of the applicant.'Pools;". are not to be filled-or utilized before fence is installed and all final ecuons are performed and accepted.: of Sid ur,`e `Ovm.er Szguature't�f pltcant 0 t � tJ P int Name Prctit Nas e I P ` Z "d Date. e C (n �. O n � o D D. .� � � CD. v, D ` N C=7 m a I ."3 . O y .v v �,3 �Ll �tiA,i. 0 o � m.� o � � ur m 4 Cn ri G fD LJ -� b '•� to y �' t 7 ~'•D o (�, - - `. It � C ,ra y .,� r1SgtF >i �{{^low ."� N m D . ���; p. I ``sY X l;ifj' T O1 T m _ _ _ .; rn Ltcen &r(Peg stration m valid or divi 1 use onl ' Ae%Kp ration date.J. found e n to: z' ` a v �i y e o4w. ns mer Affairs a d Bus ► Regulation �. ; ~ 0 1 I10 par Plaza Suite 5170 1m c u+ -Boston,MA 0211.E I n. m •I w o `4, m ' o � Not vali ithout signature n Iz° > ` Massachusetts -;Depattmsent of Public Safety, F board of.Building Regulations and Standards Construction Supervisor Y n:; License: CS-065.949 }` DAVID ROME - OX 1382 POB. South Dennis iA 02666'�M r, ,ri .Expiration _ c cJ J1 `' 10/05/2015 e Commissioner . 'Tie Crtos•xrmonwmd of Massachusdtr -94�trfmmt raf ardm&ial Accidents - - Offwe-of nvesagaf[ons 600 WasIfington meet Boston,M102HI wnm ma—mgoWdira W,orkers' Compensation Insurance Affidavit:Biulders/C-�Gntr-a:Etors/E ectricians/Plumbers Applicant Information Please Print Legibly Name O _ -on�bxRvidna 0_ .ros eke,✓ _.Zje ` �� �uo'� ��fUlJ' e�es�✓�-7io,.� Address_ J��7 /,!'W//Z.) !/N!C /2 _ CitylStatrJZip. 114 01,f 4./, / 006 y,T one 47 ,Sb�? Are you an employer? Check the appropriate bow: Type of pro ect r• 4_ I am a contractor and I L[ I am a employer with f 6_ New constra im employees 1�6111 andlorparl-time.}* have hired the sub-cantractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet" 2_ ❑Remodeling ship and have no employees These sub-contractors have 8_ ❑Demolition ees and have workers'employ working for m,e in any capaerty- 4_ E]Building addition eranr [No workers' comp_inme comp_insUrarice 1 reqaired] 5-❑ We area corporation and its ' 10-0 Electrical repairs or additions 3_❑ I am a homeowner doing all Work officers.ha-.e exercised their 11-0 Plumbing repairs or additions rnysea [No workers'tip- right ofesemgtionper MGL 12 0 Roof iusumnee required]t c_152,§1(4},and we lase no repair, employees_[No workers' 13_❑Other comp_insurance required-1, *Azzy Wplicwt cut checks boa tr1 mustalso fin outthe sectianbelowshnceing their voeices'coapexsadoaE poHLT infat=o¢i- ` �Hnmeo —orho subnri't this sfhdsv9-&-ling they are doing all uca k and Sign hire outy&eost:wnrs nm snh�a nets afdazit indir�maL tees thst chock they box m¢St attarhar€ffi itiCiihnnal sheet showing the name of the s 3c0or6 and StatE whether rnot il,,,Fi,1eeS have etuplayees. If the svlrieautmcturs have employees,they nnest pmvide their warless°comp.policy number I am art etrrployer that is prm idhw workers',compe un'hm ir,=,arrce far my*amlvtayees $etow is the pvTic}artd}ob site infotmaluart_ Insurance Company Name: ,4 A,41 / Iv.4U �Ln/lv/rdNC£ Poliop:9 or Self inn_Uc 2©d)/ I,✓6 3 J,L ExpirationDate: Job Site Address: y�Oxa /aNrj Cit1V/StaWzip= Aftach a copy of the rsorkers'compensation policy declaration page(ShOwiRg the policy 7ruttttber sutl exiration date). Failure to secure coverage as requimdunder Section 25A of MUL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.0a and/or one pearin4 ri as well as ciz,1 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 statemeat may bt forwarded to the Office of Im es4ptions of Vae DIA for mzar-ance coverage tirerffication I do hemby cedify itndeeJr thzpn ns arrd pen aWes of perjury thatAe irz orrtta d n prewided abase is true and correct Sieuattrre: Eh/ �Uh� Bate_ Phone#: ✓`�� y�vQ a iWE at use only. Da not mrite in this area,to be campleted by.do or town official City or Town:. Pt rridbUceuse# Issuing Author4(tdrele one}; ' L Board of Health 2.Building Department I Cif�TTatrn Gerk 4.Electrical Inspector 5.Plumbiing.Inspector. " 6.Other CorrtsctPerstm. Phone#: 6 Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.. pursuant-to this statute, an anployee 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 enterprise,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 sus 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." Applicants Please fill out the workers compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)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 eLriployees 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 ofinsu nce coverage. Also be sure to sign and date the affidavit The afada«t 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 obtail-r a workers' compensation policy,please call the Departneat 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 Department 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,am applicant that must submit multiple permiYhcense 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 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 burn 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 CommmwWth of Massachusetts Depaztoaejnt cif hid-ustdal AQcldents Qfce of juvesdgatians 600 Wad au Street Ragton=MA G2111 TeL A 617-727-4900 W 406 or 1-3 MAS. E F�ix#617-727-7 74 Revised 4-24-07 WWW.Inass gav/dia ® - DATE(NIMfDDtYYYY) ACO L CERTIFICATE OF LIABILITY INSURANCE 11/14/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CE@TIFTCAT-24 DOFF, NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE CovERAOH AFFORDED BY THE POLICIES RI LOW. T1418 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the c®►liflcetw holder is an ADDITIONA6(N&URED,the pollcy(ies)must be endorsed. If SUBROGATION 13 WAIVED,subject to the terms and conditions of the policy,certaln policies may require.an endorsement. A statement on this certificate does not confer rights to the certNlcate holder In Ilau of such endorsamen a. PRODUCER CT Sarah O'Neill Mark Sylvia Insurance Agency,LLC 508 57•ziz6 0 608 967-2781 404 Main Streat Centerville,MA02032 ADki markamasksylvlainsymnc.e.-o-orn Il(UAZA AFFORDING COVERAGE NAIL N INSURER A•Farm Family Casoalty Insurance INSURED 1tnSURER B.Crum&Foster JOAI� en Inc„ Dba Paul Davis Restoration INBUR c: Of Cape Cod&The Islands 572 Main St.,Unit 12 t R HarAch,MA 02645 I U COVERAGES CERTIFICATE NUMBER: REVISION NUMBER, THIS IS TO CERTIFY THAT TI1E 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 M&Y BE.ISSU90 OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOrrIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, Fv I SR TYPEOFINBURANL'B AO POLICY NUMB MD p I eXP LIMITS .. GENERALUABILITY - EPK-102301 _ li/17120131/1 l2014 EACHOCGURREN� - 1000,000 X COMMERCIAL GENERAL LIAJNUTY MA $ CLAJM84AADE L.^1'000UR, - MED001 on® eleon 5 5,000 PERSONAL a ADV INJURY S 1,000,000 OENERALAGGREGAFE $ 7,000,000 . GLNLAGGKQAEUMITAPPLMSPER PROOUCTS-OOMPrOPA60 $ 2,000000 X POLICYiMLOC $ A AUTOM U OBILE AOu.nY X 2001C38363A 11/17/2013 11117/2014 MelNED 81N ANY AUTO sopILY INJURY(Perperson) $ 1,000 000 - - - - AUT03 EO X AUTOS U BOOILY INJURY(PereoclWI) S 1.000000 NONdwNEO - —. - OPT 5 1-000.000 X NIREDAUTOS X AUTOS UMBRELLA UAB occuR X EPX-100875 11/17/2013 11/1712014 EACHOCCURRENCE $ 2,000,000 EXCESS UAB CLAIMB-MADE - AGGHCGATE 2,000,000 - $ A. WOR1(ERSCOMPCNSATION 2001VV6351 11/17/2913 11/1712014 w aru. X oThF AND EMPLOYERS'UADMITY N - ANY PROPRIETORrPARTNEMXECUTIVE E.L.FAC1i ACCIDENT S 500,000 �MCERIMEMBEREACL OCO? NIA 500J300 Fca,dmary In NHi - E.L.P16EA&E.EA P1utPL0YE IF ,4�odbeNutdet E.L.pieEA%.POLICY LIMn• S 500,000 IO OF OP I mr S bel B CONTRACTORS POLLUTION LIAR X EPK-102301 11/17/2013 11M7/2014 $1,000,000/$2,000,000 AGGREGATE OYSCRIPTIDN OP OPLRATIOM5I LOCATIONS I VEMCLES(Allech ACORD 101,Additional Ranmnva 94hoeuic,If mote apaea is required) BAILEE PROVIDED BY AMERICAN SAFETY INDEMNITY COMPANY.POLICY NUMBER ENVO30453.12-02 DATE EFFECTIVE 11/17/2012.11/17/2013,. LIMIT$250,000, DAVID ROME IS COVERED BY THE WORKERS COMPENSATION POLICY(CONTRACTORS POLLUTION LIABILITY IS PER OCCURRENCE. SEE ATTACHED DESCRIPTION OF OPERATIONS OVERFLOW _CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TOP ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Crawford Contractors Connection THE EXPIRATION DATE THERFOF,•NOTICE WILL BE DELIVERED IN. ACCORDANCE WITH THE POLICY PROVISIONS, Attn: Joyce Wf6iams $022 Gate Parkway SuRe 304 a1)Tt4OMzeo REPRESENTATWr Jacksonville,FL 32256 01988.2010 ACORD CORPORATION, All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE Permit No. -------_--�__- �Wn.0 Building Inspector ...� Cash -------------- 00 MONO OCCUPANCY PERMIT Bond ----__---_--_✓1 "No 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 _Uy W.Lt::.LLA. Address iiiC�_'v= �-=r -�- ;d133:_ Wiring Inspector G�! = ��/✓,- Inspection date t 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... .-- ........................................................................IL................................................. ....... ._...._....... . .._._ Building Inspector ,Assessors map and lot number ............................ .... - Bp%TM E TD♦ Sewage Permit number ...........4.......3t.1..k:........................ ��SEPTIC SYSTEM MUST BE (0 5 ,STALLED IN GOMPUANCE = 33AM TABLE. i House number ilyt ........................................................ s rasa � WITH TITLE 5 °oo,1639. \00 ENVIRONMENT �FE MPY a' TOWN OF BA1� 4= i0 BUILDING INSPECTOR APPLICATION FOR PERMIT TO 0�'1. 1r� L� /, Q ........... .................... ................................................... 6Wd TYPE OF CONSTRUCTION ........U11 ... � ............................................................................ (..... ....................19. �. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: L,&r' l 9 Soc4ce— C�cn Location .........................................................................................`...,............................................................................................... ProposedUse .... . ..... . . ............................................................................ ZoningDistrict ........................................................................Fire District ... :........................ ...................................... Name of Owner `. :. ...................Address i� ` "`:: ........................................ Name of Builder C��ij ,f ..- �� t. .........Address ........................................ Nameof Architect .......'.........................................:...............Address ..................... . . ........................................................... Number of Rooms ............0.................................................Foundation ...`,6„Et..06 C✓ ' a... ................ Exterior ...... l�1-07 2.........................................................Roofing ....7` ,.... r!o................................................... Floors !t � ..:../LQw!: C �j 7i .....................Interior 6�'1�� ...........................!....................... Heatingh.......P/ ................Plumbing ....../.... ...... ' ."...'�� ................................... Fireplace ...... 1 �.. - ,1? Approximate Cost a..,qo ��� '`' Definitive Plan Approved by Planning Board ____________________________19________. Area ... .�... v...f'........... 00 Diagram of Lot and Building with Dimensions Fee "_� SUBJECT TO APPROVAL OF BOARD OF HEALTH S t I hereby agree to conform to all the Rules and Regulations of t*T,.on Barnstable regarding the above construction. Name .. ............................................................. COLETTI, GUY t s 23115 One S/rie-A-ald.. w �'•No . Permit for �. Sin le Fami _ i t Location L..Q.t...#.1.9. ..55...J.QY. .Qer i ............Cen V?�� 7......................................... Owner ..9AY...!oQl ,tt .............. ....•........... Type 'of Construction' ....FXZLAle.... ................................................................................ N _ .Plot ............................ Lot ................................ 71 7 � ^ • Permit Granted ......May 15,...........................:.....:19 81; ..� Date of Inspection ................ 1q..QF:19 01 Date Complet cl ............5. .,, ioff REFUSED- 4rh e........................ .. 19 :/ / p✓� .-! ..................... .......... }... ................. " -.r ......................:.'`............... gn ft \ ................. ..... h5$............................................ .................. ..... ............................................. . ~ ',"_� •. " Approved ................................................ 19 may,. .............. ............ ................... •................ ` ' ' THE TOWN OF BARNSTABLE BUILDING INSPECTOR - TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Name of Builder Floors .../ ...................Interior ...................................................... Heating /,41 .....(0/4. .................Plumbing ....../..&...... ................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH � I hereby agree to conform to all the Rules and Regulations of the Town of. Barnstable regardingthe above Name................. .-------------.------.,^ COLETTI, GUY .. .... ..... Nc.i 23.1.15.....,Permil for .,,One Story......... Single Family... Single ...... ............ Location Lot19...65..Joy ce,.-.Anne Road ..... .... ... Centerville ............................................................................... Owner .......9U...Coletti. ................ ................ .... .......... Type of Construction ....Frame.... .................... .................................................. .............................. Plot ........................ Lot ............ ................... �Ma y 15 Permit Granted ....... . ................................. 9 81 Date of*Inspection .................. .................19 Date Completed ................. ....................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ .................................................................. ..... . ...... ........................................... P. ... Approved ................................................ 19 ............................................................................... .............................................................................. or--StC,�Q t>A,7-A. StLAC?L-, -S;&MVL>f - 3 'f-'A V-n0M uo GA2$AG� C�fz14,?D 2. 2Dat U4 .PLOu/ I to 33yo G.pv. � /o ._. i C. 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