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0118 SACHEM DRIVE
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Yes E❑ No Section 8—Zog Zoning District Proposed Use i Lot.Area Sq.Ft. 5 Total Frontage Percentage of l Coverage #of Dwelling Units(on sit.) S tba*' Front Yard Regtured Rear Yard wired Sidi Yard Rapired . Propo relief fiam the Zaning.Board in the pasO - Yes 0 : No ray WLW17 I Seems 9- Co r e i Tel. T. d P- -7p ity Lf���/�9^ rp Lase l nber %D �� Licem Type w e . Cep sEmail42I o/I401i T Sapr,ne.I-. # 6o�- Fa 8d I tm mystbes idea the rules.0d repwim. forLkensed.. hz. e- f Bullft Code. I &e . m. €R by 780 C and tie Town o€S .AUgh a:: Of jeffi'Date 9e. Secto4- loam hj&4C L e_O Telep 7^ -j® . Ad ss La ,6ha e SX Crt9 �z�/ e��ed' A Zip 2d--d R c�Nupber J LO '`/ Expiision Date /a INOMW my.respMsib tes undaft rales and 'ors for NO= C IIt be setts;ftft.Bmlft.Code. lunderimddie c by M, CUR. T° o€yam sDate �a a lL " Becim 11—He3me: s Cell or myr dies,under the rules and mans:for L 1�. CI48tt�e She-Bing Code. I wdersund f:cosmsefin b5!M'CMRaad&eTown ofBarnstable. She: Q DaW. L - . ft �� 70 n o . o ` la 1�P Sa , a1 gL .7-7— . rag M* 400 r Heal.th Department zoning Board(if ;ecluired). HWOric District Site Plai Review{if zec} 3 Fire Depaitment Q Conselvat on ❑ For.co sercrd work,pkae take yv plants dui tire,frre w - n 13-Owner's . as Owner authorize the propertyhereby maw reve to work b to act on m a VP&-a#on for: c� be4 (Addtm of job) Side a f C}wner �d a "C Q e� l� e Print Name 7. r "ding;g Dp partmeot Se to Odin Cmmn*d, ner 2(�Maui S,treet,,Hyann�s,Ia1A 0260'1 www.t�wn.is#s3ltte.�aus; , Office :508-$62�ii138 Fax.S{?$?9i23t olmm Must complete and Sign ws .Section If Uging A Binder ,, Cmett FPO as:t}umer of the>sub eat �hereby`authorize in all"rr�atters>relatitre to workaitthonzeti by this bulding:pemut ap far 11$;S chein ©nee Gentery t(e (Address of:Job):. ..;�_;r ,',ate -�hawto+• r;C.r� fi c � .,r*ccs ...- �.. _ Via»,.; .. �. Appesutx . . Pnut_Name: P�urt Name Bata I The Commonwealth of Massachusetts Department o f In dustrial Accidents , I Congress Stree4 Suite 104 Boston, MA 02114-2017 w ww►w mass gov1dia t 'orkers'Compensation Insurance Affidavit: Builders/Contractors/ElecteicianslPlumbers. TO BE FULED WITU THE PERMIT INC AUTHOWTV. AD olicant Information Please Print i:eaibly Name(Business/Organization/individual): Insulate2Saye Inc. Address:410 Grove Street City/State/Zip: Fall River MA 02720 Phone## 508-567-6706 r. Are you an employer?Check the appropriate box: Type of project(required): 1,rx' lama employer with 20 employees(full and/or part-time)-* s 7, New construction 2.Q 1 am a sole proprietor or partnership and have no employees working for ire in $, Q Remodeling any capacity.[No workers'comp.insurance required.j El 3,�LJ` ]am a homeowner doing all work myself.[No workers'comp.insurance required-]t Demolition 10[l Building addition 4;©1 am a homeowner and will be hiring contractors to conduct all work on,my property t will , ensure that all contractors either have workers'compensation insurance or are sole 1 l.Q Electrical repairs or additions proprietors with no employees. 12,0 Plumbing repairs or additions 5.C]t am a general contractor and t have hired the sub contractors listed on the attached sheet; 13. Roof repairs These sub-conttactors have employces.and have workers'comp.insurance.1 0.Q we area corporation and its officers have exercised their right of exemption per MGL c, .14,Q Other Insulation 152;§1{4},and we have no employees.[No workers'oornp.insurance required;) 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners submit this affidavit indicating they are doing all work and then hire outside contractors trust submit a..new affidavit indicating.sueh. "Contractors that check this box must attached an additional.shect showing the name of the subcontractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers compensation'insuranee for lily employees. Below is the policy and job site information Insurance Company Name: Liberty Mutual Insurance ' Policy#or Self-ins.Lic,#: XWS 56418741 Expiration Date'. 12/10/2018 ' Job Site Address:. !��_aut&41C - ,. City/Statt,z.tziiO4 � .c,P<<- �_� Attach a copy of the workers'eompiniation poiicy declaration page(showing the policy number and expiration date), Failure to secure coverage as required under MGL c. 152.,§2. A 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 foie of up#o$250:00 a day against the violator,A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ati e tips of perjrery that the informadon provided above:is true and correct. Signature: mate: ' Phone#: 508-567-6706 Official use only. Do not write in this area,to be completed by city or town offiiciaX City or;T.own: Permit/Licente#t y Issuing Authority(circle one): , 1.Board of Health 2.Building Department 3.City/Town Clerk .4./Electrical Inspector 5.Pluming Inspector ' b.tither Contact Person: Phone#: . Office of Consumer.Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MV usetts 02116 Home lmproverntractor Registration Type: Corpombon ��$� � Registration: 1$0747 INSULATE 2 SAVE , 1NC. Expiration: 12/28/2018 410 Grove St gi Fallriver, MA 02720 .e f� � Update Address and return card. Mark reason for change. iCA 1 0 2OM-05J11 . _ _.........� CLA+ds in wail ©,Ertpla}�xner�t ©Lost Card • �='�+�`t�r.'�m-�ru�,,u,Q,ul� �/�a.�ac�auaeG� ..�...�._�_. 4ftice of.Consumer ltffelra&Business Regulation . HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only; TYPE,Corporation before.the expiration date. If found return ta. FURI[dtlgll. Office of Consumer Affairs and Business Regulation loft 12128/201 8 . 10 Park Plaza.-Suite 517.0 Boston;MA 02116 INSULATE 2 Roland Langev s 4�10 Grove St CNf � , Failri+jer,MA 027� j Undersecretary Not valid without signature a ConlErionweaith of Massachusetts € Division of Prefessio at Licea ire Board of Suticting-R ulatiohs and Standards ont ' visor p .. 4- GS-103861 tree t f24i4 9 FALL.RINEFt Commissioner _ r ACORO DATEPWMDrfYM CERTIFICATE OF L1BlTY WURANC . ' a7s T AWS -AS;AMMMoEN�1FOR1UMMONYAWCONSMl q-NW•S:t @N a 5... CERT#FICAFE COE$NOF/EFfBiMAFtI[ELY_E3R i3EGATtVELY Ate,EXTEN€f OR ALTER THE `. 134LE3UIf TfS CTCATE OF iIYSURANCE DOfS NOT CONSTRUTE A COAITRACT FTt �r AtL3E1E3R1ZfD QR PROW CM AND THE C19MMATE W)LDER. Nam: Ie ceel a"holder is an ADDIT OMAL DWRED;the policyoes}:tnusE i A or be padossed: K StiBROGAFION 15 WAINED,adpat to dw.tsrms and c ondfons'of tfie P�+aY�` :polkles may .an endorsement: A st� this.. cane does:lot confer.:rWft to tM certffluate holder in 6eu of such.endwse s) NAME' . Ar#holjyF.Cordeiro Insurance PtloNi 508 677-0407 N,• SE STZ=0409 171'AWasattt"Street Fall ftw,VA, -02T21 wnje$ !! A: Lilsetfy a�t3018E Ce INSURED INSURER s: Insulate 2 Save,Inc. INSURER c 410.Gsove St. I D: Fall River,MA 02720 INSWM E: INSURER F: COY! AGES` CERTIRCATENUMI ER:. THIS I IS�04C:ERTIFY,.TKATTHE:POLICES.IOF KWRliNGE LISTED BELOW HAVE SEEN ISSUED TO THE WIRED;NAmEDA FOR p.i YTERfOD I NDICATED. i40TWIThWANDING ANY REWIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTtiEIi DOCU%TW7'WITH I'TQ W{�F{FI NS CERTIFICATE MAY BE'ISSUED.OR MAY PERTAIN,THE INSURANCE AFFORDED-BY THE POLICIES DESCRIBED HEREIN IS SU63ECT TO ALL THE TERMS, EXCLI9SFON$AND'CONOfTiONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED•BY PAID CLAIMS. LTRr TYPE:OF S ANCE POLLCY NUNlBER LWTS 2.GEtiHiLLt.1JAHd1TY - EACH. . $. CLAWS MADE'.OCCUR . _ NiEDE� -•'.anepie�toif.. ..:$. �`.S�B:':: A Y Y' SKS WA18741 t2110117 : W10118 PERSONAtsiiDVtN�URY g GEWLAGGREGAMUMff APPLIES PER GENERALACaGREGAFE. $. POLICY LOC . PRaDUCTS- tOi>AGG $. .:'.- AWOMODU11ABUZY $ 4atoo ANY AUTO BODEY 1t tJtfftY(Pet pernj $ ' SA omNLY X y y am 568741 12MWi7 1210118 eoaLY wsutzY(Per ae ruj $ 'NON-OYNED AUTOS my. X"AUTOS ONLYUUBRELLAUAS $ X OCCUR EAc h g Q' A ! CLAIMSMADE Y Y ' USO 56418741 _ 12M0117 12/10118 AGGREGATI s 80G.:" RETENTION SJ. AIID LIABILITY SFATtRE' E ANY PRDPR{ET{$MARTNERf�CU IVEYIN r A oI TC ERExcxclD>D� NIA XMWA18741 121t0/17 12/10118 : EL.EAcxa saT $ 5 00lI; Mandatoryia E-L DsSF MPLOYEE $ :.. D CRIPnot aF oxs blow E.L.DISEASE;—: LIMIT- S. 588,8�1 t DESCRtFF10N.OF.OPERATICN5/LOCATIONS)VEHICLES(ACORD 404,Addkmd.Remaft Seim,maybe attached dame space is rega&ed) CEWMATE HOLDER CANCEI:LAIi I SHOULD ANY OF THE ABOVE DESMISED POUCIES 8E p'M.MU.9D BEFORE.. THE'EJCI EON DJUE a: a$E. Proof of Msw=ce :POE DAY PRE. AUT'jtORIM' ACO$D 2S{20 I6103) The ACORD mmne and logo are registered aaarks of ACM Town of Barnstable -7 Building PoSt,This-Card So.That&�t.is.-Visible From the-Street mApproved,.PlansINust be;Retamed on Job andthis Card Must be.Kept � Permit M" Posted Unt161 ilFinal Inspection Has Been Matle ; �i a Where a Certifice of Occupancygis`Requed,su,chBuadmgshall Not;°be®ccupied untilaFinal Inspect�onhas been made Permit No. B-18-378 Applicant Name: WINDOW WORLD OF BOSTON, LLC. Approvals Date Issued: 02/09/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 08/09/2018 Foundation: Location: 118 SACHEM DRIVE,CENTERVILLE Map/Lot 229-094 Zoning District: RD-1 Sheathing: Owner on Record: POLIA,CARMEN& MARY. Contractor,Name:`_ ,Jeff C Steele Framing: 1 Address: 118 SACHEM DRIVE ContractorUcense CS 072772 2 CENTERVILLE, MA 02632 % Est Project Cost: $4,385.00 Chimney: Description: replace 9 windows.29 uvalue _ Permit Fee: $35.00 Insulation: Fee Paid: $35.00 Project Review Req: Final: Date 2/9/2018 N I z ,, _ Plumbing/Gas Rough Plumbing: " -•- Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within siz months after=issuance. Rough Gas: All work authorized by this permit shall conform to the approved applcaon and the approved construction documentorwhich this permit has been granted. All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zom g by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road nd shall be maintained open for'publiciris PIP ction for the entire duration of the work until the completion of the same. . Electrical Ji The Certificate of Occupancy will not be issued until all applicable signatures bythe Bud`dmg and Fire Offcials are provided o this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: I ; Rough: 1.Foundation or Footing tom_ _ � _; ,_ �� 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 T Town of BarnstableBuilding Post:Th�s CardSo That it is;Visible`From,.the Streett Approved;PlansMus#be'Retamed on Job andahis,�Card Must be Kept v�M Posted Until Final Inspection--a' enkMade y �� � s �� y a Where a Certifi ateof`®ccupancy sRequired;such BuildPermot ghall Not be Occupied un#al6a FinalInspectlonahas been made 1 Permit No. B-18-378 Applicant Name: WINDOW WORLD OF BOSTON, LLC. Approvals Date Issued: 02/09/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 08/09/2018 Foundation: Location: 118 SACHEM DRIVE,CENTERVILLE Map/Lot 229-094 Zoning District: RD-1 Sheathing: Owner on Record: POLIA,CARMEN&MARY k Coritractor`Narne .,,Jeff C Steele Framing: 1 Address: 118 SACHEM DRIVE � � Contractor License CS-072772 2 CENTERVILLE, MA 02632 Est. Project Cost: $4,385.00 Chimney: Description: replace 9 windows.29 uvalue: Permit Fee: $35.00 r Insulation: - ',',Fee Paid:` $35.00 Project Review Req: Final: Date 2/9/2018 55, % Plumbing/Gas Rough Plumbing: Buildin Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work author Zed by his permit is commenced within six months after issuance. Rough Gas: 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 str"uctures'shall be in compliance with the local zoning by lawsand codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or 46d"nd shall be maintained open for pubIi6!Jn p ction 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 nd Fire Officials are provitled on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work R t� �, , . 1.Foundation or Footing �� � - Roug h' 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 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. 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 u �\ OFTME TDly� Town of Barnstabl Expires 6 nrontks jr�m issue Jute s — � y Regulatory Services Fee S s + t BARNSfABLF- v� jL639. �e� Richard V.Scali,Director r� Building Division " Tom Perry,CBO,Building Commissioner 07 ��ill 200 Main Street,Hyannis,MA 02601 FEB0 xvwvv.town.bamstable.ma.us �(�`J�(� � . ��H�� ABLE Office: 508-862-4038 Fat U! Fax: 508-790,6230 " EXPRESS PERMIT APPLICATION__: RESIDENTIAL ONLY Not Valid without Red Y-Press imprint , Map/parcel Number Z 7—10 7 Property Address Residential Value of Work$_ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Aw P,)14, 4 11 '3�h errv�y au 3 Z" Contractor's Name W DW wOt 1Jr5-FF �/�F-,6 Telephone Number 78-/ Home Improvement Con)ractor License"(if applicable) 1&( OZ.6' Email: Construction Supervisor's License#(if applicable) 87 2-:77 2� ((dorkman's Compensation insurance Check one: ❑ I am a sole proprietor ❑ .I am the Homeowner I have Workers Compensation Insurance Insurance Company Name A&KrFP I Re 10r tt (ri 9�t� Workman's Comp.Policy# 22 W�.C-I—T 2-!o aJ,5— Copy of Insurance Compliance Certificate must accompany each permit. .ti Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debiis will be taken to " ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value • Z-_(maximum.32),,#of wind #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections required. Separate Electrical&Fire Permits required. *where required: Issuance of this permit does not exeiupt 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 equired. SIGNATURE: C!,Uscrs\Deco)i atat cal\Vlicroso + mdo�vs\Temporary intemet Files%Cbntent.outlook\'PIOI DHW\EXPRESS.doc Revised 0402E r z 'WlndoWVdrld of Boston,LLC FAAHIC.Rogrstration Offices&Showrooms Number: k�' 015ACumrningsPaik 7295OIdOakStreet 166025' Woburn,lMA 01801 Pembroke;MA02359FederallD::#V81)932-4805 (781)826.5281" est for Less±' wwlu.WindowWoridofE1oston.com Customer Phone(hy68 InstallAddress:Z C E/Tl Phonalh); city:CE !E Statei MA Zip O26 Z'E-mail NDOW WORLD GLASS OPTIONS 1000 Series Sir le-hung Ail-Weld: $189 SolarZone Elite $1.19 07 2000 Series DH ech/Welded Sash V15. _TrjpI6Glazed TG2" $195 4000 Series OH 14Weld $2257�' j ('Seises 6000 ony) GD00 Serles:DH IFWeld $260 WINDOW OPTIONS _2 Lite Slider $354 less Breakage Warranty $15`IVCwDED _3Litesllder w +iarR IiAv4yjdj $545. 1/2Scra is $9 N Ltiom —Picture/Fixed_I te- $354 Foam Insulation nn Jambs and Head $11 INCLUDED _Awning $280 Double Strength:Glass 515INCLUDED, _Casement $31p. Double Cocks(>_26"),, $51NCLUDED _2 Life Casemen 95: _Full Screens $22 _3 Lice Casemen dra;m.+n� t+ro;n r t Q880 _Colonial Grids(Contoured/Fiat) S45 _BaswnenfHop r $334 —Prairie Grids $51 _Diamond Grids; $69 Bay Window ait&fount!INS Seat$2660 Simulated Divided L(e $182 Dow W ndovr ff t.UouniGlNS$eat.V _ _Tempered DH Sash(BS%.(TSO) $65 Garden Windw '$2040_ ,Obscure Glass'(BSO)(TSO)_ $35 _Specialty Wind $ _Odei Style(40l6O,or 60/40) $30 Beige/Almond $40 _Foam Enhanced Frame $35 �Woed Grainlmeri r(Series 400016000 onryJ$10Q OO PRE 1978 BUILT HOMES(EPA LEAD SAFE REMOVA7fON):- (L ght Oak[ ark Cfieir�I Fox 1V6oty _Load rSalle Practices Required $30 Rich Maple) MY HOME:WAS euia IN THE YEARZI&J Initial_ 8rovin Exterior(Arq.Brar¢a l Artti:ripn Terra)$100 DesignerG0,(- erjor 5175 MISCELLANEOUS _CustomExterlorAluminum;Cladding Windovv Color Or,t 1{ /% O'Textured$75 O Smooth$75 s . In ide owsdo Facing Color .NO CUSTOM DOORS _MetalNlmdowRemoval $50 _Vinyf RoIlling Patio Door:`5R.or 6R. $f095:.. -Flew Construction Vnyl Removal $1.75. �Vmy1RolfrigPatio oar(8R. $7195 iSpeciairyWrndow;Exterior Trim $. Add to bass, ka ` -Mull to-Foao btulti Unit. $30 to fa Ctntwr+Ralhm�.Patio,0acr$125Q French Flai.Shdin• Patio 0ccr sR.or:6W. $1395 Install.interor/Exterior Stops: $50-. Installlnt�ior Casing Scans At French Rill`Slidm. Patio Door BR: .'p1493 .. 9 $95 _French Raft Slkfln PatioDoorgh $1595 _Insulate WeightBoxes $20 Custom Exterior C adding 3150 Rcof for BaylBcw;Windoivs $500 _SolarZone Elite or ETC,Glass $205 _Eadshng New 0dnst.ExL Retro Fit Sf56 _Grds Patio Door,, $149 Removal of Existing Bay/Bd'rl $250' woodgrain Inane i Repair Sill,Jamb or replace sill nosing$50 —Exterior Designer ciiors 11395 ` _lr,teiiorCasing 2r '3+a sy75 _Full Sub S41(Sinyle)replacement $150 Muhion Removal $30 _HandiesatOpGon S Bay(BovvConversion,Ext.RelroFit $35D. S. (New Siding Will Not Match) Oaor$o!or:. j,, .•r AQltN4dlP FOi�]IIflND E3 in are Ouftle s Sa1141oCtll1AreKtfftPoareflHwW1W?$i_ a:. Customerdecline [exterior wrap and understands painting and/or repair,may be required initial ; ustomer declines grids on ivinclotvs/doors initial OISCLAIMEB:Custamerlsra nnsialztor+hatoaawiag-inearnraEon�ti1'h!hzeapyail;Parleig;SW¢dnq,Alarm:SysumoiaedlneeGrecenneclIluildingPemt fees in excess;at$25.00,Hameavrier e d or Condo AssaciaOeuApprm:ai,t6star'c 0 str ai Aparovai.Cla/of aasten mrdng a s denote Pz mk teia in carracCon s'nu In>�Iwt on: NO EXTRA WORK NOT IN WRITiNGt. Customer agrees,to the terms of payment as;follows: Extra Labor&fNateriais $ Site Set Up,Perms,Disposal&,Delivery Fees.$'j. $3B9.00 Total Amount — Custam Order DeposA 50°fi p Z/92:Ckd Balance Paid to.nstatfer upon Completion Amount Financed $` Ylinci vr'NorfO of Baton arMcip tes starting vus u'ofk on 'B�S and being substantially completed in/Zdeys.Security,mhuesh Yes Ile.101 - Any deposit required in advance 1 the start of a:e tvoik SHALL NOT exceed 33113%of the tarn contract price or.0te actual cost at any matefial of equipmentof a special order or custom mado a which mustae ordered Inadva nee ofthe start ofllrexarkloassure that the projeckAgprcceadonschedule:Nolimlpayment shae Ire damardednn0lthepnt atsoompleiedlolne satisfaction of.boNpariles:. All homefmpmvemeudanttado acid:subcarbaclum shall beregbtered and lhalanyinquire§`abmta contract prsubcorhactcr relating to:aregisliation.s_houldbe directed toiAlReeof consomer Rairs and Business Regulation;:ran F3ik Plaza,Suilo 5170 Boston,MA 02116.Phone.'(617)973.8700 No work shall beginpriartothe fgningoftheconlracl and transmittal to the owner ofa Copy 61 such caatract. Windovr Vforfd of Boston under javision of chaplar142A of the general laws is reilufiedto apply,for and obtain all eonsli mionwra!ated permils.-Ni do i+,Vorld:or Boston shall not be deemed rtsblefcr delays inthework described in this agreement causedbyregulatory,-permit granting agencies,aNhanbesariudividuals.: Nalite 0thePURCHASEfl($)a ins his awaii consilliuctIon related permits for Ifte work described under this agreement or deals.wilft unregistered conlraclatij ibe PURCHASERS)Is heraCy a ised Iliat Inthoevent of a dispute,Judgement and aaapayment;The PURCHASERS)r lO not Willed to make a clafio of datleatonfrom[hegitaranryto aslatriahedbpehapier142A,'tit:G.L. You Me uyecmay cane F this transaction at anytime prior to midnight of the third business nayafterthe date otahis transaction, Notice of taboo must beanwifting postmarked no later Than Arin it of the foilOwing Writ business day.. THIS IS M r This Window Vfaft franehise isinde aides mvned'and operated by Widow Waild of Boston,LLC.order license fmon ViNdm14arld,'Inc. ai avrer:Oo not +gn it There are any blank apacea. Da e am Dono + mare btank;spaoes. na& Ownec.eu sat sign alkeio are any blink apecea. Jalo Rcz ,4z'+r- While Copy-Ouglnm 'Yellow Ccpy.-File FlmiCopy•Cusioner Nd,ei Vrrkag aE856)•+Si6 Massachuseatts Department or f,PUOiIC Saretj Board of Building Regulations and Standards _:tense: CS-072772 JEFF C STEELE 24 SHERWOOD AVE _- ._..__._ DANVERS MA 01923 expiration: • ✓ommissioner 04/07/2018 Office of Consumer:Afl'airs&Business Regulation ='HOME IMPROVEMENT CONTRACTOR Registration: 166025 Type: _. r Expiration: 4/12/2018 LLC WINDOW WORLD OF BOSTON,:LLC. JEFF STEELE 24 CUMMINGS PARK SUITE.15-A WOBURN,MA 01801 Undersecretary License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 tNot valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents 0 1 Congress Street, Suite 100 a Boston,MA 02114-2017 www mass.gov/dia «'orkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / Please Print Legibly Name (Business/Organization/Individual): /rl „ db /D r,✓ k1d/p �S�n/) f L L C Address: /5'fl C�n„�.�'r►� S r�� K City/State/Zip: 0o L,r n M A O 1 o Phone#: -78 I -1i 3 z - H R o Are you an employer?Check the appropriate box: 'Type of project(required).- 1.[1311 am a employer with_5- employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.FJ I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]Building addition . 4.[:]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.; 14.FE 60ther W t n do� 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] I P 6i C>°,- t�m *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 al]work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors 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 job site information. Insurance Company Name: SJA19JVCE CeD . Policy#or Self-ins.Lic.#: Z C _ Expiration Date: 1- 2- 7— Job Site Address: City/State/Zip: Attach a copy of the workers' co ensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A 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$250.00 a day against the violator.A copy of this s tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi lion. I do hereby cer ' under a par erjury that the information provided above tru and correct. Si ature: Date: Phone#: a 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#: DATE(MMIOONYYY) aco CERTIFICATE OF LIABILITY INSURANCE „25,2016 THIS CER11FICATE IS ISSUED AS A DOES NOT AFFIRMATNELYER OF INFORMATION 0 OR NEGATIVELY VELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED NLY AND CONFERS NO RIGHTS UPON THE ABY THE POLIC ETE HOLDER. IS CERTIFI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE 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 WANED,subject to the terms and conditions of the policy,certain policies may require an endorseriient. A statement on this certificate does not confer rights to the certificate holder in lieu of suc`hh endcorsement(s). PRODUCER NAME: Carfi Wdcher,CIC,CISR,CBIA Marsh &McLennan Agency LLC PHONE 336 544-6g50 AIC No:212-607-6 16 3625 N. Elm St. EMAIL Greensboro NC 27455 ADDREss: Carli.uVtche mars mma.com INSURE S AFFORDING COVERAGE NAICS INSURER A-.Hanover Massachusetts Ba 22306 WINDO-2 INSURERS:Allmerica Financial Benefit 31534 INSURED 19682 Window World of Boston, LLC INSURERc:Hartford Fire Insurance Com an 118 Shaver Street INSURER D: North Wilkesboro NC 28659 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:1206598961 REVISION NUMBER: ED ABOVE FOR THE THIS CATED.CNOTWITHSTANDING ANY REQUIREMERNT TERM OR CONDANCE LISTED ITION OF HA BANY CONTRACT OR OTHER DOCEEN ISSUED TO THE INSURED NUMENT WITH RESPECT TOLWHICH ICY PERIODTHIS 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 F PAID CLAIMS. LIMITS ADDLSUBR POLICYNUMBER MM/DD MMIDD INSR Type OFINSURANCE 4/1/2017 4/12018 EACH OCCURRENCE $1,0M,000 LTR OD67902527 q X COMMERCIAL GENERAL LIABILITY DAMAGETO a o rr S500,000 PREMISES Ea occurrence CLAIMS-MADE a OCCUR VIED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGG $2,000,000 POLICY ECOT El LOC $ OTHER: AW68757615 6/162017 6/162018 COMBINED SINGLE LIMIT $1 000 000 - �acradent B AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ X ANY AUTO BODILY INJURY(Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE g HIRED NON-OWNED Per accident AUTOS ONLY AUTOS ONLY $ 0067902527 4/12017 4/1/2018 EACH OCCURRENCE $2,000,000 A X UMBRELLALIAB X OCCUR AGGREGATE S2,000.000 EXCESS LIAR CLAIMS-MADE $ OED RETENTION S PER OTH- C WORKERS COMPENSATION 22WECLJ2635 1272018 1272019 X STATUTE ER AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $500,000 ANYPROPRIETOWPARTNER/EXECUTIVE ❑ N 1 A E.L.DISEASE-EA EMPLOYE $500,000 OF FICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $500,000 If yes.describe under .DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Addkional Remarks Schedule,may be attached if more space s required) The Board of Trustee's of 7-21 Aberdeen Street Condominium Association are included as additional insured with respect to General Liability as required by written contract and in accordance with policy language. } CANCELLATION CERTIFICATEHOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE IMIr� IJ�`�r� ©1988-2015 ACORD CORPORATION. All rights reserved. ~4 ern t% The ACORD name and logo are registered marks of ACORD f—_AAAIL/ - LC-fir_-17-2pv/u' Wry�AR�3A�� C :J�E2 cs I P 7 _ v5� (SOO Gam vGAc.. PT I oa �2 �ti SF op 3T7 Sr- x 4 �o, z / / L 15"1 oe Jai.T �' T O �L 'Dej t�N i log Ci l�Pp °K o_ 9. 'r /03 `� r ✓ � � �•' .DA rcoly 'Totem L t�y 147 oll OF�y � ` RICHARD v' DAVID yvy II =( A. C.d, I c`, THULIN W / / 99.?i e. A� I5 SAX 7El3 v, F� No. 29970 `T\• 'r, { NO.?.;OHO 'A CIVfN �" ! � � ►t %'10 To? OF SU ONA TOP FNU= NO .il � T���T P Sot n - . • , ; G= �ylx No�.F zl►S��d o q c. =loo.g rG - 4- INV. LOAM .I 1600 ►Nv• S AIL- z A - A1sT. cap. Icb, I�uK lN�. �fiPTiL 8 Z I Doo INS TANK' IoL.a - PITS INY, INV. i W17U Ioe, IoL,4 r 1 K I WASN6D Met), Sd1 I ooi-aO CE2.TIFtE0 P1.-cnP7. PL:A1.1 "P'ROFI L� {(SB8 }2+ �0• 5 CALE �j C,C.t_E f II:L�L7 AT (�pPos p L.A t`1 R E D E Ze GE p�tiJt�.[r�N G CE`�?'C►FY THAT 'T1+E 5No4YN b{6.REDA1 GOMC�L`(5 1nlITN THE S.l oE�1N.-� LO.T.. 8 Ii Aug 56T�GK 2:6 UtR.irMEN_Q'. DF t! 'jo Yd N O f= Alt T3 L,� A N le Q L0C;ATED .'At TIAIW TµE G1. 0o1D PL.A1N r ' BAXTEIZt l i ` ` REG I�SZ fG26•�'G.AN v 5 u ZV E`(oe� - , P L o,N 15 Kl OrT E t\P o►d A tJ _ o s-►-E 2Y 11_� IN5-r'R;uMENT 5 e V e y -rt-1E n1=1=5ET5 Swou►,D .. No T, .D,fc v 5 E D To f�t=-T E(Z.�^t N t` o'r " i N E5 A P P L I C A►-J_r 3�1 Lp VA of RICHARD TER • t�Q/STVVt�QQ, r y 41�r • � Dy�,•HD S�Jltd�. w ear ���$ r �1 ICE; ,T 44 Y �k cE.�Ti,�Y T,G/AT. Tf� , ,S'f�OWit/yE.2E0.!/CO�s f.�G yS k//T/V, S CAL: TE 7"i�/E �$"/OE.0/N,E !LINO SETB.4 C�G f»G.QiV •�'E�'EiC,E�C�' 4 x iG � �Egvi.2EMEMrs o.�" T.yE ToWA .S sra �c .ANo /-I ' nh7- ,L oT �3 :,[OCAT,E'Ac, W17-y/it/ ,d E OA TE:. .�yj 6A XT�.E?E •VYE lNC: ' '� � A407" BASED Oic/ AV .eEG/STE�2E! L �Q SU�j/63'b �, /N.ST,2U .�it/l.SU•2✓EY Th!E E.21-//- 5—a Mr4SS. -y t O•� SET.S.SyOI✓/1/Shlov[D it/4T' OT . .. .., •u'�( is ti ff s r x: - �-•� /v` /vJ , S Assessors map and`lot number ...... .... .7.... -( THE Sewage Permit number ....... .................. ..................... ° e S l J ��?�ri °do /� ` /�'/ i a Z AHHnSBTADLE, ouse, number ...:.:.:...... 9po 63 .................... Y. \� TOWN OF BARNSTABI ® ��� � Q, WITH TITLE 6 -"VM1c NhA T L CODE AND DUILDINO INSPEC-T0R �� ��� (3$,eULA7,r1l0NS / ,� APPLICATION FOR PERMIT TO ... �1.}��lJ .:..... ..: J% d � 1 d.a C��V6-' 1CC TYPE OF CONSTRUCTION ......P .°..../....:.... ...................... t ............ .. :......... ....... a�.........�_......�............ ,ate............................... 19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies- for a permit according to the following information: h- ����....� A...... R gsC If..SL' Proposed Use `? /..:��' Zoning District ... p..-j............................Fire District ............................. Name of Owner .....1 . Address ...... ....... �'� v� l<� ... !�f!!.......Y: � Nameof Builder ....................................................................Address ...................................:................................... "f ... ......�w...................... ........ Name o fleet . �'...�.... ..r.........Address .:................. ..............,T...,...........l.".....� Number 'of Rooms ..q...... ...... ..�.� ! .............. ....v��.....��,1/y.......Foundation ...:... ................... r Exterior ...1-��4.1 ....�fr//r/��—� .....:......................Roofing .... 1. . . �N7%....�L..�........ .................Interior ........... `�/ .../..lrO fir. .. Floors :.W Q.O..tT........ ..... ....................... Heating .. ..... ........... ......... Plumbing ' .............................................. .... Fireplace .. ...�... . '............... ................................... ..Approximate Cost ................�... .U©o..... . Definitive Plan Approved by Planning Board ________________________________19________. Area ... �-1��....................... Diagram of, Lot and, Building with Dimensions Fee 117.1 SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS Thereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nae .......=6� ... .......................... Construction Supervisor's License ........... c �-y�TT7� - LVL1C�, /kJ�,J.62JS -! .'� ...:.�. .... �„� F an-w...-.....•.rv?� � �� .. - -. � , 51, No 2'6938 Z'Story .f Permit' or . ...:: le ;Family' Dwellin ... g. ... ..... . ° = 118 Sachem Drive Location r . Centerville .... .......... t Carmen Polia Owner ... TYPe yof-Constructiorn Frame... . ..... ✓....................................... .... - ..... : { Plot{}'�........................... Lot .................... .. l W . �r:l' .. .5 +.K _ � jai : - � - • .N .. - - S Pefetemb 6, m.i.t Granted: p ......er............... .f19 84 Date of;Inspection .19 Date Completed ................. L9 41 : o r s.,.:: .-.....,. - .. - •