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HomeMy WebLinkAbout0832 SOUTH MAIN STREET cg,4 Ayi P1 F .Mw5e,�k N, W, w FA, IMIN WON ,�44i On 4p, R-1 tl, 'TA yj, P�f MN �y, J 11 0�1 �16 TPA WIf 'jp "I Ri j,w" Mgt ag L! VV! ORIN A,Oli� It, r�K -MM vf;l� -ig M T-f 1-0 gi;q �pi"Q, A, 4 1, "ItI, sm, t f! ,"am" -J�g� IM �W M Effil Mo R ng M-1 ME- ,AV u- PER gr qg 4V r Rl. A 'lit ................ i!M elf" g", gYYA r. I FI ,ONE Deli `i 1!3IM117 M"I fol V'Ic ,1-M R I QI 2 Fuller St: Carver, MA 02330 mcmahonnsulation@gmail.com. 781431 12,14 September 16,2020 Re:Permit#B-20-363 832 South Main Street Centerville,MA Attn:Building Inspector for the Town of Barnstable; This letter serves to close out the.open _insulation permit! We installed:. the following;nsulaton/completed the following work according to current codesl.and! best practices: • Attic Flat: 12" Open R-42 Cellulose. Attic Hatch:Seal and Insulate o Bath Fan:Thru Roof • Air Sealing:Sealed areas of the home against wasteful,excess air leakage This work was completed to stretch energy codes applicable<:at.the;`time of:instaflation. It was inspected by an independent third party named:Rise.En..gineering,a.utility funded agency.that audits insulation _. and weatherizationwork. Please don't'hesitate to contact us.with any questions! Respectfully, Michael T. McMahon Owner,CSL.Ho.lder for Project CS-068111 { Town of Barnstable Building a �, � ; Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and#his Card Must be Kept 1� Posted UntilFinal Inspection Has Been Made. a t `, Permit '� . Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made 1 1 111 i. Permit No. B-20-363 Applicant Name: Michael McMahon Approvals Date Issued: 02/06/2020 Current Use: Structure Permit Type: Building-Insulation- Residential Expiration Date: 08/06/2020 Foundation: Location: 832 SOUTH MAIN STREET,CENTERVILLE Map/Lot: 185-056 Zoning District: RD-1 Sheathing: Owner on Record: WALLACE, BRIAN B TR Contractor Name: MICHAEL T MCMAHON Framing: 1 Address: 832 SO MAIN STREET Contractor License C5=068111 2 CENTERVILLE, MA 02632 Est. Proj ct Cost: $5,451.00 Chimney: Description: Weatherization, Air Sealing, Weather Stripping, Cellulose., Permit Fee: $85.00 Insulation: Project Review Req: Fee Paid:. $85.00 Date: 2/6/2020 Final: Plumbing/Gas Rough Plumbing: r \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized,by this permit is commenced within six.months after issuance. All work authorized by this permit shall conform to the approved application and the�approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. 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 Final Gas: 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:p rmit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or FootingL Rough: 2.Sheathing Inspection ,..-s.,- ^ 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. r 4 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 0IV U , 3 Town of Barnstable Building HAMSrA Po st This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted Un6 Final Inspection Has Been Made. Permit ibsa av� ' 1 1. Where i rtificate'.of Occupancy is Required,such Building shall Not be Occupied until a.Final,Inspection has been made. Permit NO. B-19-4188 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC Approvals Date Issued: 12/20/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 06/20/2020 Foundation: Location: 832 SOUTH MAIN STREET,CENTERVILLE Map/Lot: 185-056 ' Zoning District: RD-1 Sheathing: Owner on Record: WALLACE, BRIAN B TR Contractor NameSOUTHERN NEW ENGLAND Framing: 1 Address: 832 SO MAIN STREET WINDOWS LLC 2 Contractor License: -173245 CENTERVILLE, MA 02632 ra Chimney: Est.'Project Cost: $7,421.00 Description: 3 replacement windows Insulation: "Permit,Fee: $37.85 Project Review Req: - 'Fee Paid- $37.85 Final: Dater 12/20/2019 Plumbing/Gas /J Rough Plumbing: ( Final Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authorized by;th'i§permit is commenced within six rnonths'afterissuance. Rough Gas: All work authorized by this permit shall conform to the approved application,and theapproved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures�shall be in compliance with the local zoning by laws a'nd codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open fo�`public inspection for the entire duration of the work until the completion of the same. Electrical .f Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: d 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. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT S , .l t IME 1 R' BUILDING DEPT FDatefssued number......................... .....:�.... ................A. ?�,.. . ea MAS& i.E DEC 19 2019 hYASS, a %639. `�0 ectors Initials............ .. .................. TOWN OF BARNSTABLE ......... �... GL3 TOWN OF BARNSTABLE � 35 EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHE=ATION PROPERTY FORMATION Address of Project: 7 7 ; /�r �,/ / e � /P NUMBER STREET VILLAGE Owner's Name: K w,-v, �( ,i � Phone Number 7-7 - �'c�-/- Email Address: K'-- 'k Cell Phone Number Project cost Z 9 3 — Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: 5 e �-{�Q � C' -(��-�- Date: TYPE OF WORK iding J Windows (no header change) Insulation/Weatherization Doors (no header change) # I Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) / nn Construction Debris will be going to Ifias4e--1r7al a CONTRACTOR'S INFORMATION Contractor's name (�t�Gn `7R��,'so r, - Sov 2 rn AfP,&J Fr l q,4 Home Improvement Contractors Registration(if applicable) # 17 3 2..L,_5 (attach copy) Construction Supervisor's License# OJ S 707 (attach copy) Email of Contractor Phone number L10I- 2 Z R -�X00 ALL PROPERTIES THAT NAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER ............................................................ *For Tents Only* Date Tent (s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pim Commercial events may require Fire Department approval. *WOOD/CO.A,L/PELLET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HO MIE® ER'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 PLICAN 9 S SIGNATURE Signature A Date /Z —/g -/ 2 All permit applications are,subject to a building official's approval prior to issuance. r Re�,n�ewal Agreement Document and Payment Terms byA IderserL dba:Renewal B Andersen of Southern New England Y gl Kevin&Dawn Booth M.E.M. ern New England Windows,LLC 77 Gemini Dr �j�i RI#36079, MA#173245,CT#0634555, Lead Firm#1237 West Barnstable,MA 02668 w.roow RE 10 Reservoir Rd I Smithfield,RI 02917 H:(774)994-8380 Phone:401-349-1384 1 Fax:401-633-6602 1 sales@renewalsne.com Buyer(s)Name: Kevin & Dawn Booth Contract Date: 12/06/19 Buyer(s)Street Address: 77 Gemini Dr,West Barnstable, MA 02668 Primary Telephone Number: (774)994-8380 Secondary Telephone Number: Primary Email: kbooth077@gmaii.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document, the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $4,293 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: $1,430 Balance Due: $2,8C3 Estimated Start: Estimated Completion: Amount Financed: $0 12-16 weeks 12-16 weeks Method of Payment: Cash/Check 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: 1/3 paid now, 1/3 paid at start, 1/3 paid at completion.taxes Barnstable 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 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 12/10/2019 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 i dba:Renewal B of Southern New England Buyers) Signature of Sales Person Signature Signature Kevin Desmarais Kevin Booth Dawn Booth Print Name of Sales Person Print Name Print Name UPDATED: 12/06/19 Page 2 / 11 Office of Consumer Affairs and Business Regulation 1000 Washington Street = Suite 710 Boston, Massachusetts 02118 Hobe Improvement Contractor Registration - -_ Type: . Supplement Card SOUTHERN NEW ENGLAND WINDOWS, LLG Registration: 173245 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD, RI 02917, scn i :, z Update Address and Return Card. orwi�-osinl � ��/GP. rC/)7/YL/'/L1L'PO.G!/7 ��II2ri LC//.LGJC`Gi Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Regis4ratibn. Expiration Office of Consumer Affairs and Business Regulation 1:73245_=_:._ 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLANb WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON IN,e,- 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary 1?4.— without signature Y � Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constru_ lon Supervisor CS-095707 i res: 09/081202.0 BRIAN D DENNISON 8 BLACKWELLDRIVE : :4 �.-- CHARLTON MA-01507 Commissioner . r The Com twnweatltll ofMal±ssatchusetts Department o,f Indu stria1 Accidenis .1 i'ong Tess Stree4 Suite 100 Boston,MA 0-71.14'017 www.nzms aoYMa 'Warkers'Compensation insurance Affidavit:Builders/Contractors/ElectricianslPlumbers. TO BE FILED WITIf THE PE1lLilfi• OM Ai1THORM. Apolieaut Information r Please Print LeQibiv Mayne(Business/Organizuion/Individual): � lAd Address: 60, ?C=se,VD-1 err City/State/Zip.S ni r-t4 e-1 t P! 0 Z-Q !7 Phone#: �— Are you an employer.'Check the appropriate box: Type of project(required): t. l am a employer with 20-1"empioyees(full and/or part-time).' 7. ❑New construction am a sate proprietor or partnership and have no employees working far me in 8: Remodeling any capacity.[No workers'comp.insurance required.] 3. 1 am a homeowner do' all work m sel£ 9• ❑Demolition ® rrtg y [No workers'camp.insurance required.] 4.0 1 am a homeowner and will be hiring contraetats to conduct all waricoa m [will 10®Building addition y piny ensure that all contractors either have workers'compensation insurance or are sole 1 l.C]Electrical repairs or additions proprietors with no employees. 12.QP[tunbin;repairs or additions 5.®1 am a;eneral contractor and I have hired the sub-con rwtors listed an the attached sheet l3.®Ro repairs These sub-contractors have employees and have workers'comp.insraance.t � //�� 6. We are a corporation and its oEficershave e:ceroised their right -14. Other ,'o ZOO L of exemption,per MOL c. 152,¢44),and we have no employees.[No workers'comp.insurance required.] L 'Arty applicant that checks box p I must also till 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. rCantracmrs that check this box mast attached an additional sheet showing the name of the strb-contractors and state whether or not those entities have employees. Ifthe sub-cotnractors have emplayees,they must provide their workers'camp,policy number. ' I am an employer that 1s proWding workers'eompeasatdon insurance for my employees Below is the policy and jab site information 11 r/� Insurance Company Name: `i'1 i*tA/fI&-15 LS UtrQ ae— L0 - or W t�"' , Policy#or Self-ins.Lic. #:W(,A,.31,��0?y Expiration Date: Job Site Address: 7 7 l—,e�i n r �� CiWSWraip: w"34,117 Ste dle �-IA Attach a copy of thew compensation policy declaration page(showing the policy number and expiration date). Failure to seethe coverage as required under MGL c. 132,J25A is a criminal violation,punishable by 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$250.00 a day agailut the violator".A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby cortunder the"I �7-alwo: ofpegisig that the informatdenprovided above is bue and correct 4 Date: 2 Phone#: Official use only: Do not write in du's are%to be completed by cdty or town offutal City or Town: Permit/License t« Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing inspector t. 6.Other Contact Person: Phone 1#: \ � DATE(MMIC01YYYY) CERTIFICATE OF LIABILITY INSURANCE�- 1 zrzarzol a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the 6ertificate 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). PRODUCERCO A CoSiz Insurance, Inc.-CO NAME` 1401 Lawrence St., Ste. 1200 PHc°N o E t• 303-988-0445 JC No:303-988-0804 Denver CO 80202 A ORE s: COMaiI cobizinsurance.com INSURE S AFFORDING COVERAGE NAIL 9 INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:Firemens Insurance Company of WA,D.C. 21784 Southem New England Windows, LLC. dba Renewal by Andersen of Southern New England INSURER c-Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER 0: 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 WHIGH 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 ADD SUBR . POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/112019 t/112020 EACH DAW—G OCCURRENCE b 1,000,000 CLAIMS-MADE a OCCUR PREMISES Ea occurrence $300,000 MED EXP(Any one person) s io,000 PERSONAL&ADV INJURY 5 1,000,000 e GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000.000 X POLICY❑JEST LOC PRODUCTS-COMP/OP AGG 3 Z,Ooo.000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 VV2019 1/112020 COMBINED SINGLE LIMIT' Sident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED / PROPERTY DAMAGE X HIRED AUTOS Ix AUTOS Per PE dent S A X UMBRELLA LIAR X 1 OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1s,000,000 DED I X I RETENTION$ $ 13 WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X SPE TATUTE ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000.00o OFFICER/MEMBER EXCLUDED? N❑ N f A (Mandatory in NH)It yes,describe under E.L.DISEASE-EA EMPLOYE s 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY OMIT $1 000,000 C. Pollution Liability 7930073340000 1/1/2019 1/1/2020 Each Occurrence s2,0oo,o00 Claims-Made Policy a Aggregate $2.000.000 Retroactive Date 08/20/2013 Deductible $25,000 OESCRIPTION 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD y Town of Barnstable *Permit# oo-7OU,4 Qt, Expires 6 months front issue date Regulatory ServiMASS ces Fee t 3C) Thomas F.Geiler,Director Building Division `f Tom Perry,CBO, Building Commissioner L X 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 v Map/parcel Number / �—t/ Property Address 'J oZ S�y-l—h C�I r"1 C e r�f E V u 1 (� t(�,t>✓i} , 0 3 D Residential Value of Work J 1 O 0 C) 'ov Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �—b r V l Ce: Q G Gt r-f.C 9-3 Contractor's Name Telephone Number 7�' I—�i- Home Improvement Contractor License#(if applicable) 3 Co 3 Construction Supervisor's License#(if applicable) 5Workman's Compensation Insurance Check one: X-PRESS PERMIT ❑ I am a sole proprietor ❑ I am the Homeowner OCT 12 2007 ( I have Worker's Compensation Insurance nn Insurance Company Name ft-T TOWN OF BARNSTABLE Workman's Comp.Policy# ^L.J C 7 O;2 ,a , 9 C / Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ruGt - [ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows. U-Value (maximum .44) •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. Home Improvement Contractors License is required. SIGNATURE: Q:Fomu:expmtrg Revise071405 I f JUL. 11. 2001 143P NJAI ASSOCIATED INSURANCE N0, 0318�P. 1/1111 ~ mom, ISSUE DATE 07/l1/2007 P UUUCER THIS'CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND The Insuranec Agency Of CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Cape Cod Inc DOES NOT AMEND,EXTEND OR ALTER THE CGVERAGH AFFORD)r)BY THE POLICIES 13FLOW, PC) Dox 960 East Sandwich,MA 02537 COWANTP AFFORDING COVERAGE l INSURFA) Barry M ICcene P 0 Box 1517 COMPANY A.A.I.M..Mutual Insurance Co Sandwich,MA 02563 LETTER THIS IS TO C"'F.RTIFY THAT THP POLICIES OF INSURANCE LISTF,fj BELOW HAVE BEEN ISSUF,D TO THE ENSURED NAMED ABOVE FOR THE POL CY PERIOD INDIC`A I RD.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 'I O WI1101 THIS 0-,,0If'ICATE MAY HE ISSUED OR MAY PERTAIN,THE INSURANC R AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI,'I"HE TERMS.I:XC'I,IJSIONS AND CONDITIONS GF SUC'H POLICIES.LIMITS SHOWN MAY HAVE HEEN REDUCED BY PAID CLAIMS. ro TYPE uF INRtIRANCE POLICY Nun1dCR POLICY EFFECTIVE POLICY EXPIRATION LIMITS I.Tn DATE(MM/13131M DATG(MMIDn/YY) UNEItAL LIABILITY GENFRALAGGREGATE - PRODUCI •COMP/OP At I =(Uk1MF.RCIAL GLNLItAL LIA BII.ITY PERSONAL&ADV.INJUkY �[=]C"I AIMS MAD1!)=O('Cll0. ' FACII OCCURRENCE �OWNL•It'S A CONTRAOFOR'S FROT.; I'IXE DAMAGE(AIIyalle tlrc) Q - MD.MOHNSE(AnyonePersaq AlrroM(IDILELIAUILI Y COMDINCOSINCJ.E -- - LIMIT ANY AU r0 OODILY NJURY AU OWNLU AUTOS (Pcr Person) SCIIGDULLU AlrrOti Il lkilb Amos JURY IN DILYLY NON-OWNED AUTQi hU UU ,I IN I - 6ARAGL"LIAUILITY FROPFRTY DAMAt7r- Ex(:cca LIADILITV BA01(XIAIRRFNCE IIMRRFI.I,A FORM - AGfSRr:GATII TI 0THLR'I HAN UMDRCLLA I'UKM - - `1 - WORKEIIS COMPENSATION AND WATUTORY LIMITS THER EMPLOYCItS LIABILITY X I HE PROPRIETOR/ CL EACH A(:C'IDENT 100,000 A PARNF,RM5XECUTWL 171,1ul-Its ARE; 7022219012007 02/13/2007 02/13/2008 El.DISEASE-POLICY LIMIT S 500,000 IN(L ©FXCL EL DISEASE--EACH 100,000 EMPLOYEE COMMENTS/DES0(111TION OF OPERATIONS OR LOCATIONS: BARRY M ICERNE.IS NOT COVERF11)RY THE WORICERS'COMPENSATION POLICY. I llf ICA`I` Ht)I1�L�lLce;' I ur";,1•„1„ t;ri't,R I':,i Fn1•�l;i;I IT111111 I I•Ioui.D ANY OFTIIE ABOVE DESCIU BED POLICIES BL'CANCELLED BEFORE TH EXI�IIiAT10N DATE TOWN OI'BARNSTA13LL THEREOF.TNC ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 WRITTEN NOTICE TO THE CERTIFIC-AT 1OLDRR NAMEDTO THE I,ErT,BUT I'AILIJRR'rO MAIL SUVI I NOTICE SHALT.IMPOSE NO UDLICATION ATTN: 0111 LDI NG DEPT. R LIABILITY OF ANY KIND UPON•1-11C COMPANY,TTs AGENTS OR RFPRESENTA•nvu. MAIN S'1 HYANNIS, MA 02()01 UTI"IURIZEDREPItIiSr;NTATIVE �.iV of lnvesauga>suons . 600 Washington Street Boston,MA 02111 www.atassgovl a Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aoulicant Information Please Print Lesu'bly Name(Business/orpoizationrt dMduai): Address: M SOX ( 5 1 City/State/Zip: S���l(,� l�U I C�1 , ��/14, aao3 Phone#: 7J`6/ �3 /" CIA 0 � Are you an employer?Check the appropriate box: Type of project(required): 1. I am a empkiyer with -2--,_ 4. ❑ I am a general contractor and I 6. etuployces(iirn and/or Mime).' have hired the ❑New construction 2.❑ I am a sole proprietor or partner- listed on die attached sheet t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demo}ition working for me in any capacity. workersI comp• 9• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10. required.] officers have exercised their ❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of excmptim per MGL 11.0 Plowing repairs or addidons myself[No workers'comp. m 152,§1(4),and we have no 12. -ftoofrepairs insurance required.]t employees. (No workers' 13.❑ Other comp.wee required.) ;Any applicant that checlm box#1 must also fill out the section below showing their worlmn'motion policy information: t Homeowners who submit this affidavit indicating they ere doing all work and than hire outside contractors must subn1it a new affidavit indicating such =Contractors that check this box must attached an additional sheet showing the now of the sub-contractae and their workers'cam.policy information. I am an employer"1s providlna workers'compensation Insurance for my employees Below is the paAW and job site Information. Insurance Company Name: I� bLl 0 trd I n 6 o"s* 6S Policy#or Self-ins.Lim M —7 0 �� 1 Q- D Expiration Date: C) Job Site Address , %Awk>� S+fie City/State/Zip:�' C] r l j�I va Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pales and penalties of pedury that the Information provided above it true and correct Si attire: Daft: t Phone Offleial use onlj% a110 not wrltar In dd s area,to be completed by city or town qhk&L City or Town: PermibUcense# Issuing Authority(circle one): 1.Board of Health L Building Department 3.CityfPown Clerk 4.Electrical inspector S.Plumbing Inspector 6.Other Contact Person: Phone ft 7 Board of Build r'°�✓�/ g t - �-� L g Regulahons anti ry#and'a ;7 FIbME'IMPRdVP ENT C T r L►cedsi or r g raho Registrat on �, s.. GTOR , ' Cefure thz a ist h val►d for►ntlrv►dpt- _ I ,50,763 w - exprrRtion dates" use BG}. Mi- 3�¢s �° I►�tt r3 Of B If fOUld retLPn t0 uyra►d = � ErTton, 3/27/2008� i A k l `dne A�t:burtod g Regulahons Ark ;andards ; YPe ^3q s r a ti� 4 Ptace Rm 1301 r . #kCEE NSTRUatesOn,Irrla 0210$ T NEE EO C7 tON A ." xE3ARF2' �r< G84 KNOTT AVENUE t ft a � �" �£ f s: .;a- r.,tp.:r yu p+kk.,`. Si� z2 �YItIlOUt Slg►`atUl'C s, f �r1'� � _ 'Ps1.�•,,,e ",r}:m.�---s 7�'��.dl°1 � ^s +�L.�=�!„ v I rBOARD OF�UILU1NC+REG'ULAIIONS � License GONSTL3lJCTION SUPERVISOR i . 5 f � 049941 � j BirtHclate 05/29/1944: r �• ��'' '` vEzpires 05/29/2k1Q$S" Tr no 25217 �I £ R - 4 ' BARRh 84 KNOTTgAVE/PO BOXk1517 �j" °r $q, + SANDWICH MA 02563 - r Commissioner t !' r - > aMMAWK _ Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder w LL I' G fL�� c:l� ,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 4r Date 'Lon,, � p���r ccA Print Name Q:Forms:expmtrg Revise071405 kJ�/i�pi n•c �S�`�cTo� - �1.c�nJ a/= �Qi✓,STR��c vL�T !09 G"E�Tl��cr�T� aF L./t c oPAv t 41 14-6,� /� f�LWt�LL/n. C �C0 cog TL'o fJ% J . yo GV OU?J alc i?00m F /,7...1j��� � u T faJ O uL o> hIP?✓�[`G/ATZ` y0 U.� .� 4''FOrr/ 7"�/is ri f7'ZrK /�,�y JIL ale- e • , �. �.- :�� t� �,. , �.❑.' wrA :_sy+v .�,� ,',.�c 1 `'� a i'ti' � � 1,. ,e: c'�c r.l',;r�d,�cf�,F $.`7' k�' .l, b.... Ai'.. d �" 15 it A ,tl pi 10 �..uf,.. �� r, x. w .1cµu, ':F w�;�,�.e„' +•r m: m N ku�v.et ..) �.�}Ih ��I, �r .:5 ��1�Yx3?t'er,� k T. �• y„r ^fwmeR�rn'Ta+tiare. .p+,w a � ..� P' ':.{ 7... L .� fr rp :r i ,.. A s s ° cip N l A�,�� ,0 0� b Maintenance CF- Ea3ftTant �'1 i20:001 f' Rrf ..yt,�9 0 \N (n p �✓ y 11 _ " �' 10° 15 00' W _ llo4g ' s 192.00 g I , `36.2 2 , kf s.' y N`_ ���? '� N 02^30'00.. I w O I N 10" I5-'00"W I TDrive o�� _ N 02. 30'0,0-W O o � • 2-10.00 . / �r 314.00 ioa.o O' ,3 N _ S o u, .,ur 2S6°.S o�. �� 182.3CD 1 n,R w a S1.96 S07 S 10°59'00"E � � tic o N O Z .:1. 00 Z. 13596 r s . 45.,91. Wit! VOD . m f ' S 10'3' 00"E n �� .v S Or 07'00"E, Rol N Ao v 'i + R.."M"�,F:'!' �1~.15 F IS''�.�'..�t,?� '1.. ":'T r '.. :ri.� ,.�.::: ., r•:::1 .:... :. :i r�O-'.)' ,," � -'f'' �: .:1• . ... P. . . !� ."R:,.S "� ..'•T�, i 1, .. ,I r .« i . . , ,, , a xk tl:.:, _..�H� 5� . x, I � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO �ASFITTING (Print or Type) �- ' Cej.J7r—d:(it Ile— Mass. Date Permit Building Location s- .e,w ��`" Owner's Name s �A^-1 4t G�/NoIO Type of Occupancy NewX Renovation ❑ Replacemen# Plans Submitted: Yes❑ No❑ O i o 61+s (3,Isfuu 41S W& vt 4,4-An N Cr V1 cc N ¢ W N N N V 0 0 zz ¢ N ¢ h z ^" W N ¢ O (1 •v O u h 4 ¢ _ O F' W ccO O f- 4 m N h �! W O 6 ¢ tl ¢ W < h N > N ¢ W 2 V W = N W 4 Cr F, c !- W W W 0 J 4 = ¢ ¢ G7 ¢ W W V V h = J ~ _ ~_ F' > N m > O h W O N S 1' 4 W 4 ¢ ¢ 4 4 O O W G O kl h SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 9RDFLOOR I —1 4TH FLOOR . I STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name_ So%3-%,ASk-kake 1A0N-%-%*AQ COouaf. Check one: Certificate Address ts'7'0%k 42�S Qa POZA X Corporation oC s.`iA�LMOVT1r� ❑ Partnership Business Telephone 3AS —(bg01 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter .S'AME� 0. OE1Gpt2r�yt;" INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of Indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent owner[] Agent 0 I hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By T e of Ucense: Plumber gnature of Licensed lumber or asWitter Title slitter ster License Number._� - .3 7 cZ CCityP own t S N Journeyman _ • :I • i . i , i • i BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE F , NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER fb LIC. NO. , PERMIT GRANTED DATE `L f 19 GAS INSPECTOR