Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0387 STRAWBERRY HILL ROAD
, r 7 +�1 , u t a . s 3 :t. a e' o r y. r t • it 0.1 ay - lr u� .. �: 3J. •I+t4y,� � f f� d } � 4 i�"�� f - b r ,r,' - _ ^, 'r' �•-' .9n bAl • _' ... ,c; . d l i- - n 4, ` r1'v. ^ :- ,, ..b `: r ;: �?• � < y"-r'• � .ra � - 1, _ j � .a � 4� �F �'a 1 k t _. F fir.aJ tr Ilk 11 r , r• F x n ,. r N h.,� �. vf'' n '` i, ,s .. q �' .•AM ..� �'r bfh'. �� ,. � 1�a. °� ':� fit! r ,q .�u , u. A ,{ b a�,� �, :.'rr ',r,rr � .:L .r:A« .. � �Ar,�� �� .�1+{�` fin' ��` R., r ..r�{� �f• z r . . ,� ,� — .. _ .:, � �� n .r . �, _ r ., � . . . . . �. .4. .. � _ �— . . . . . �, . _ . . . . � : . .. �. { . - - - n -. n F, � ,. ,; ,, s s : . ,. ,� ., �. ._ .. -, ;: � .. _ .. p .. �. � _ .. ..:. :-. � ... .a ., .. .. ., - _ - ' _ `' - n „' .y _ �. ,.. .. � ,. ,., .: _ :.. ,. � , ,' � n .. � H ,> Y ... - u � .. .. .. _ ..� [ � _. - R � _ ' s i .. -:. �. �. � :". n .. a .. - - � .. .. i o � .. -. - O � - Ogg tgrf, Application number .I V �V MLgate Issued........ 4.... ............................................... + B"NSTABLE, MAM QCT I 0 2016 Building Inspectors Initials.....HAHNS-I-AB Map/Parcel............. .........o . ...................... OWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY MORIVIATIOIV Address of Project: .3e7 ��t-� , (( �c�, Gp,14-fm,Ile NUMBER STREET VILLAGE Owner's Name: Phone Number Email Address: 'Cell Phone Number. Project cost$ 4 Z 2. � — Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application fora building permit in,accordance with 780 CMR Owner Signature:, 4\4rcj<4 cage—frac-4- Dater TYPE OF WORK ❑ SidingU Windows no header=char e # ❑ .In ul( g ) /0 s ationLWeathenzation ❑ Doors (no header change)# Commercial Doors require an,inspector's review ❑ Roof(not applying more than 1-layer of shingles) Construction Debris will be going to i Ja S�P CONTRACTOR'S INFORMATION, ' Contractor's name"� Wor (,Q ,r �oStnn Home Improvement Contractors Registration(if applicable)# 1 C� 02 S (attach copy) F Construction Supervisor's License# ` OZ Z 7 7 2- (attach copy) Email of Contractor Ti S w e e j G g S e° ri . C O N� Phone number 7 `� 3•Z- q 'O 5 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER................... .. .............................. *For Tents Onlvx 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 df food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES x Manufacturer# Model/I:D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNER'S NER'S LICENSE EIEIVEJC TIO1V Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities sander the'rules and{ regulations for Licensed Construsti®n Supervisor in accordance with 780 Clot the IVlassachusetts State Building Code. I understand the construction-inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature 4 Date LtCA1�1T9 S SIGNATURE Signature _ Date All perm a ' ns are subject to a building official's approval prior to issuance. I rw u, Window World of Boston MA HIC Registration Offices &Showrooms Number: ❑ 16A Cummings Park O 295 Old Oak Street 166025 Woburn,MA 01801 Pembroke,MA 02359 Federal ID(781)932-4805 (781) 826-6281 82-4898432 www.WindowWorldofBoston.com Customer: tit,I At E �t , YNA at S Phone(n)(4;C-6 -7l S-0-4 q Install Address: 3[�j �'}rg�u�� �+P C rt� �-tti t� l� Phone(w) City: c14:3 414<ol`e M 0, State:MA Zip 02J40 Z. E-mail WINDOW WORLD GLASS OPTIONS 1000 Series Single-hung All Weld $19Gk • SolarZone Elite-Dual Pane $119 1190 '2000 Series DH All-Weld $215 . Triple Pane/Krypton $369 1t3 4000 Series DH All-Weld $240 -1-11c Z (*Series 6000 Ginty) 6600 Series DH All-Weld $260 WINDOW OPTIONS 2 Lite Slider $374 Glass Breakage Warranty(4000/6000) $15 INCLUDED 3 Lite Slider (us,va,era) (1/4,112,v4) $575 INCLUDED Picture/Fixed Lite (0-83 UI) $365 1/2 Screens $9 Picture/Fixed Lite (84-130 UI) $445 Foam Insulation on Jambs and Head $11 INCLUDED Awning $310 Double Strength Glass(4000/6000) $15 INCLUDED Casement Plus$49(DH Sash Rail)$330 Double Locks (>26") $5 INCLUDED 2 Lite Casement $595 Full Screens $25 3 Lite Casement (us.w,us) (r4.in.1/4) $910 Colonial Grids(Contoured/Flat) $65 Basement Hopper $434_^ Prairie Grids $75 Bay Window-Soffit Mount/INS Seat $2660 Simulated Divided Lite $182 Bow Window-Soffit Mount/INS Seat$2785 Tempered DH Sash(BSO) (TSO) $75 Garden Window $2040 Obscure Glass(BSO) (TSO) $75 Bay,Bow,Garden Oversize (+109 LID $975 Oriel Style(40/60 or 60/40) $75 Beige/Almond $40 Foam Enhanced Frame $35 Wood Grain Interior(Series 400016000 onfA$100 (Light Oak/Dark Oak/Cherry/ Fox Wood PRE 1978 BUILT HOMES(EPA LEAD SAFE RENOVATION) Rich Maple) (6 Lead Safe Practices Required - $30 $00 Brown Exterior(Arch.Bronze/American Terra)$100 MY HOME WAS BUILT IN THE YEAR9t Initia W Designer Color Exterior $175 MISCELLANEOUS Speciality Window $ Custom Exterior Aluminum Cladding(Two-Bend) Window Color 0 Textured$90 ❑G-8 Smooth$90 $ inside Outs/de Facing Color CUSTOM DOORS Metal Window Removal $75 NON Vinyl Rolling Patio CUSTOM 5ft.or Eft. $1095 New Construction Vinyl Removal $175 Vinyl Rolling Patio Door Bft. $1 f 95 Multi-Bend Cladding $20 i Add to base price for Custom Rolling Patio Door$1250 Mull to Form Mufti Unit $30 French Rail Sliding Patio Door 51t.or Eft. $1395 _Install Interior/Exterior Stops $50__0 French Rail Sliding Patio Door 8ft. $1495 Install Interior Casing Starts At $95 French Rail Sliding Patio Door 91t. $1595 Insulate Weight Boxes $20 Custom Exterior Cladding $300 Roof for Bay/Bow Windows $500 SolarZone Elite or ETC Glass $305 Existing New Const.Ext.Retro Fit $150 Grids Patio Door $210 Removal of Existing Say/Bow $250 Woodgrain Interiors $395 Repair Sill,Jamb or replace sill nosing $75 Exterior Designer Colors $595 Full Sub-Sill (Single)replacement $175 Interior Casing 2112 3112 $275 Mullion Removal $50 Handleset Options $ Bay/Bow Conversion Ext.Retro Fit $450 $ (New Siding Will Not Match) Door Color J =@ROUND-UP FOR WINDOW WORLD(CARES inside OutsideSt.Jude ChHdma's Research Hospital . $ r ItVa r+a anv�w a vac avVaa av�a..rr rr as vtvvrry �avv aALVa aV Congratulations on your decision to increase the comfort level,value and appearance of your home.To maximize your investment and enable the installation to take place as smoothly as possible,we have created this handout to acquaint you with what to expect when our installers arrive. f.Expected Delivery I Ime.All of our windows are custom made at one of our manufacturing plants located around the country and shipped to any of our over 200 Window World locations.The time between when your order is placed and when the windows are ready to be installed, though not guaranteed is typically 6 to 8 weeks.At that point we will call you to set an installation date.If for some.reason you need to delay your installation for more than a couple of weeks after notification that we are ready to install your order we Will be happy to work with you.We will need to collect the remaining balance before•instailation if the delay you request is more than three weeks. 2.Access to the Windows and Doors.We will need approxlniately 2 feet in front of each window,inside your home,so we cah place our drop cloths and tools necessary to perform our work.When the old windows are removed,gusts of Wrid`typically flow through your home. It Is advisable to gather together important papers,and other small items that can be disturbed by the wind and relocate them.Computers and other electronic equipment should be covered or relocated temporarily. Please move aside any furnishings that are in the way of our work.If any furniture items are too heavy to move easily,we will gladly assist you. 3.Window Coverings.To gain access to the interior of the windows,we need all mini blinds,vertical blinds,roll-up shades,shutters;drapes and any other window covering removed prior to our installation.We are not responsible for removing or reinstallation of these items and are not responsible for damage resulting in the removal and reinstallation.We also are not responsible for any window covering alterations that may be required to reinstall them. 4.Plants and Bushes.Occasionally we need to work in planters and other landscaped areas of your home that are adjacent to the windows and doors.Please surrey your yard prior to us arriving and look for potential problems.Some trees and vigorous bushes need to be pruned back to give us access to your windows.Delicate plants and shrubs in areas right below a window should be temporarily relocated if they cannot survive being stepped on and you want to preserve them.We strive to be careful when working around vegetation,but our priorities are to focus on our work,your windows and our safety while working on your property.We are not responsible for any damage to plants,shrubs or landscaped areas. 5.Arrival and Departure Times.We will advise you of the expected arrival time for our crew at the time we set up the installation date with you.We generally stay tip the job is done,unless it will be a 2 or 3-day job,in which case we may work as long as there is daylight.It is our policy that our Installers get a sign-ofl form and collect the outstanding balance at the completion of the job.We ask that you be available to approve the job and make final payment at the time of completion.If this Is not convenient for you,we need to know before we start the job.Inclement weather and other unforeseen hindrances are a fact of life and as such we ask that you understand if the weather,traffic,etc.cause a delay or cancellation of an installation appointment.We typically do not schedule more than a day or two In advance to try to avoid such issues. 91 L 1-L99.9EE 6uMd selsH iawolsnC)-Adoo Nu?d aty-Adoo Mona), leu161i0-Adop ailtlM 9��o uono9 oleo •saaeds luelq Aue ace aiagl 1!ubls lou oa:ieuMo oleo 'ssoeds)iuviq Auv eie weir uSIs iou oa:uswsa{eg o E •sea ds ue due ale i i o s >I 14 a aql;,u6ts tau ad:j MQ . 'ouI'ppoM mopul!A utoy asu N iapun•oui' ugeia o uolsog d V-1 AQ pa o pue pauMo puapua apul 9!as!gaueid OppoM MopwM 9141 •lisp ssnuisnq pugl 6tiilxoliol aql to 1g6jup1w'tfegl ialel ou paijtewlsod Bwllim tit aq lsnul 1110111111119311123 to aagoN •uoilaesueil sigl to elep a iage Aep ssauishq it j a { o i 6tu Iw of Jasal'awl I(ue-le uoilaesueal Sigl la3uep Aew.oAnq oql ooA, 'Ta.1.Mi.xldego dq Pegsngeisa Aunt Alueaen6 ai 1 tatul uopmIlos io ugga a ar!ew of paimus aq 1ou ium(Mvismound aqt`tuawAuduou pue wauwbpnL°alnlp a 10 Juana 241 u!iM4f'p98!npe Ageia4 sl(S)y3$VH3lifld 941 `ssolaeilueo paiaisibaiun glpm steep io wawaoifie slgl rdpun paq!iasep Miom agliol silmed palelai uo€Iatulsuaa umo SM su!elgo(S1113SVH3Hnd 2411:0011ON 'slenp{A!pul io sa!l!ioglne'sa!oua6e 6ugueA vwiad'Atolelnb9i Aq pesneo luawoei6e slgl U!paquasop Niom etil-ul sAeppio;alq!suodsai pawaap aq lou pegs uolsoa to ppoM Mopu!M'sl!uaad palelai-uogorulsuoo lie welgo pue ioI Aldde of pafmbai s!smq lerauab aql to VZ#+#ialdeg3lo uo!s!Aoid iapun ualsa$10 ppoM Mopu!h!t •taeiluao qms 10 Adoo a to jaumo aql of letpiusueil pue 10ealtt03 04110 WAR 841 allolid ul5aq eegs VIOM ON 0018-£L6(L 19):uogd'9I1ZO VI `uois(1ff oLi9 ailnS`e2eid glad 1180011etn68H ssau!sn8 pue 211e11V iawnsuo3 to ealH():ol palo;ulp aq pino4s uo1lei1s!68i a of 6ugelai aolaeiluoagns io loeiluoo a inoge saimbui Aue leg#pue poials!6ai aq pegs siolaeiluoagns PUB sioiseiivao luawanoidw!awog!ly sallied gloq to uogoa;slies aqi of paioldwoo sr lawluoo eqt pon pepuewep aq Ilegs luawAed pup oN•olnpagos uo paaooid ll!w loaloid a4legl ainsse of tliom 941 p pels aql to eouenpe ul paiapic aq isnw go!gm`eirgeu spew wolsn3 io iapio le!oods e.I uawd!nba io lepalew Aue;o lsoo prilae o4tio aopd isvluoo pool,ogl;o eW/l CC paaax ION 11VHS NiOM agl Io sick 0g1;0 aauenpe u!pailnbai psodap My oN—`sak gswaltq AlynaeS'Sht�p jl u!paleldwoo Allelluelsgns 6uieq pue 9� uo�lioM s14!6ugiels saledloque uoisog;o p!ioM mopu!M sb rr $ paoueuy iunowy [, '$ uo!lelpaisul to Aea an(]eoueleg — t;J Li M 1 I tf P '$ %B£suewlitaa VVIS soa[oid M Z fi! $ vC i!sodea iapip wolsna iu�9,F� �- $ lunowV}elo.L r!� 00'68£ $seaj AiaAilea'8 lesods!a'Vuiiad `dn-teS$ slt3!ialuiti 11 ioclel siix3 all :snnollo;se jusWed;o suu %stp aj seai6e jewolenC) I 19NI11aM NI 1014 dl XIdOM ValX3 ON uollellelsul 411m uo!loauuoa w sea;llwiad rlleMap!s V 6upped uolsog to All3'lenoiddy lo!gs10 ouolslH'IeAoiddq uopeaossy opuo3 io pue iauMoawoH'00'SZ$to sseoxa ul seal llul!ad 6u!plmt! iaouuooai/loauuoos{p walsAg uuely'6utu!elg'6uque<!:laeituoo still guns uo!laauuao u!6UiM0!{o;ag!io1�q€sucdsaJ sl iawolsn�:1td n f" 1 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construetlon Supervisor CS-072772 Expires: 04/07/2020 JEFF C STEELE 24 SHERWOOD.AVE DANVERS MA 07923 t: (� ' Commissioner r`y�ir `�i;rrr.�rrfrufe�ra�l✓r r?/�^..�tiad,;ut�irrte�f,,- Office of Consumer Affairs_&.Susi ess Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Exvimuam 11 r 04111/2020 WINDOW WORLD OF STON-LLC. JEFF C.STEELE �iZ C --- 15A CUMMINGS PARK WOBURN,MA 01801 UndersecretiVy r The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston, ILIA 02114-2017 n " www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders!Contractors/ElectriciansTlumbers. TO BE FILED VVITH THE PEliMITT NG ALT MORITY. Applicant Information Please Print Legibly Name (Business/Organiraiion/Individual): l4Znda,J a f-/d a.,rr sl,,, a 1 L C Address: 15�f1 C ten,..-I rt s r K City:/State/Zip: J(),p6tj1,A MA 01go J Phone #: -78 1 — 9 o S' Are you an employer?Cbeck the appropriate box: Type of project(required): l.[gl'am a employer with� 0 mployees(full andlor part time).' 7. ❑New construction t.❑1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers comp.insurance required.) ' °. Demolition .71 1 am a homeowner doing all work myself.'No worker,. comp.insurance required.;' .. �4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will l 0 Building addition ensure that all contractors either have workers-compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. J 2.Q Plumbing repairs or additions I am a general contractor and I have hired the sub-contmctors listed on the attached sheet. j These sub-contractors have employees and have Workers'camp.insurance.' 1-•O.R.0of IEpatrS 4.utter i%t �6-In 1 E.F7�kre are a corporation:and it;officers have exercised their nigh`o;exemption per ivIGL c. j i 5.:§i(4),and we have no employees. ?io workers'comp.insurance required.; l •� - I I I 'Any applicant that checks box*1 must also fill out the section below showing their worker`'compensation policy information. Homeowners who submit this affidavit indicating they are doing all 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. Lithe sub-contractors have employees,they must provide their warners'comp.policy number. I am an employer that is providing workers'compensation insurance for mr employees. Below•is:'he policy and job site information.Insurance Company Name: 14 CAI l*-Cord &I'e -Tf S J Rt�t�CIE Cep Policy 4 or Self-ins.Lic.#: Z 2— W C C L l Expiration Date: Z 7— I q Job Site Address: CitylStatelzip: Attach a copy of the workers' compensation policy declaration page(sbowing 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 FORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi 'on. I do hereby cer under a pal erjury that the information provided above is true and correct 1 Signature. Date: 3 1 k Phone# "3 Z-•- 0_5_. a use only. Do not write in this area,to be completed by city or town official City or Town: PermitrLicense f Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Towu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f CERTIFICATE OF LIABILITY INSURANCE THIS CE"FICA M IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE'HOLDLDER.THIS CEIMFICATI= DOES NOT AFFIRMATIVELY OR NEGA71VELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CE127l ICATE PRODUCE INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING TNSURER(S),AUT HORRZ� REPRESENTATIVE OR PROD ,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(es)must have ADDITIONAL INSURED provisions or Be endorsed If SUBROGATION 1S WAIVED,subject to the terms and Conditions-of•the policy,certain policies may require an endorsement A Statement on this certificate does not con#er rights to the certificate holder in lieu of SI3cIt endom merdis}. PRonuc t CO, ACT Marsh&McLennan Agency LLC I7A de Carli wAtctlsr,clC,CISR_C61A 3625 N.EhT)St, PRO o 336-544 6850 Greensboro NC 27465 E-MAIL FAx zuo:242 647- i16 A66REss, Carl€.FMtche. marshmm-a.com ►NSURER(S)AFFORnVanCrumo E NAICP INSURED INSURERA:Ahmerica Financial Benefit j 31634 L RIJDO 2 - A4ndow World Of Boston,LLC MuRER P:Hartford Fire Insurance Company ! 19692 1IS Shaver Street RISURmc:flassachusefls Rmp Insurance CampaM 223DB North%,'TfIkesboro NC 28659 1rsurRD: W'SUREP E-: COVERAGES 1NEPF: CERTIFICATE I`,1Ui11i3ER:9016015772 RI_1/ISIOt1l NE311AB�' THIS IS TO CERTIFY THAT DIE POLICIES OF 1N5URANCE'LISTED•BEZOVU HAVE BEEP:ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NUMBER— INDICATED- NC)TU,V"IHSTANDLNG Al�.y P,EQUIPJWENT,'TERM,OR CONMON OF ANY CONTRACT OR OTHER.D000MENT WITN.RESPECT?O lAB-!ICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJi=CT�i+Ll THE TERPlS, EXCLUSIONS AND CODIDITI 7idS OF SUCH?OLICIES.LIMITS Stf4UNU MAY HAVE BE P.EDUCED BY PAID CLAIMS. lim i TYPEOFS7SORANCE PO m F rPaea�ioa Ex? i rdSTS 'PDLICYNUMgEP CO MERCtALCMaRALUABILnY ODcr..L`2x"3 4�7t2J18 9R2D99 EACHOCCW.RENCE 57.g0,00D CLAll�5 biC7G �OV^CUR j` DAvagG O REN7Eo ((("' ! 1 I � I PAEh1R5Es 5590,000 o f i t •� 1dE0 E:(P(Ant 9n:t I?ecsdn) S 5,000 1 . 1—i I :'PERSONALS+TwIP1J 'Y $;A0 = i GWLAGGREGATE' LIAWP,PPLESPER: =-�POLICY Ci i.1 LOC } i _ Gcut3L�LAQG "C-ATE $2000,0^C 1 I PRODUCTS-MAP)OPAGG 52000A00 , OTHER: 1 s - A !AU`r1D6A0BILELIAB)LM i AUV6B7S7Gto! ANY AC70 gHS20s7 ! et16!m±e 'q.S$4VEJ 31NGLE UMrT r [ � 1 I OWNED WHEDULEC I 1 cODll.Y1;VdHr,Y IPerFeren) ; -,i AUTOS ONLAUT Os Y HIRED O N-_;N -OWNED I j �I-� LYIWURY;P?-?<e�6er,1) 5 r-.- AUTOS ONLY AUTOS ONLY I �''tc. OPERTY DAMAGE -- i Pe ^Ciderm ll � � 5 i l� r�gREI LA UAB• x _ EXCESS LIAR OCCUR 1 OT7E7°-02527 erlp.017 A 1209E EACHflCCURAENCE S2d00.000 CLAWS—IdA � AGGREGATE 52 000.000 TAD ONS - � ITtORiQeRSCOPAPENSASIOD! i 5 - AMDEAIIPLDYERS'iIABlLiTY YIN i I 122b1�I{289'0 1127:20F8 •U27I�'19 1 SIR. i ERA ANYPP,OPRIE70r2/PAFMXRZ(e-Sl iVE OFFICEP/MERAPEREXCLUDEi I r7/Ai# i ELEACHACCIDEW SE00000 (wtaddatory in NH) 1 Lfy85.Cesc7lbaul)dor I i( i Ea-MSEASE-EAEMPLOyE p5=000 DESI'RIPTi01+lOFOPERAMONSbda.� ! ': ELMEASE-POLICYOOT S.,7C= DESCAWr10yOFOP_FiATtONSfLQCpT1OH5JNEFf1CF,ES(ACORD9aJ,Add`eipA,7lRelpar7�$cggdvle,artybegtpchedif�TforespacPis�egYirodJ - i i CERTIFICATE HOLDr=R . CANCELLATIflN SHOULD ANY OF THE ABOVE•DESCRIBED POLICIES BE CANCELLED BEMFM 7HE MATION DATE THEREOF, NOTICE INILL BE DELIVERED IN ACCORDANCE WITH?HE POLICY PROVISIONS. AUTH0RM0 REPRF.CS EWKnVE I 01988-2016ACORD CORPORATION. All rights reserved. fACORD 26(201 GM3) The A COR' D name and logo are registered marks of ACORD Application numbe ................................................ VKMIIM ® .. Fee S S........................................................ .....................:................... MAn ' . "T Q 9 2013 Building Inspectors Initials.. 01 0; bAKN8IABLF- Date Issued.....toho'J�......................................... l' a T Map/Parcel...................... Dti1........................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: F-7 _�nk,+w3u gy h4it Ab, Celyw,U�1iy� NUMBERn SA ET VILLAGE Owner's Name: Phone Number Email Address: Cell Phone Number SOS -Sd / 0al3 Project cost$ a1 kayo— 0—o Check one Residential �� Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize L.:1733 to make application for a building permit in accordance with 780 CMR r .. Owner Signature: ' (� . �� Date: t7 TYPE OF WORK ED Siding 0 Windows (no header change) # Q Insulation/Weatherization 0 Doors (no header change) #' Commercial Doors require an inspector's review ERIIRoof(not applying more than 1 layer of shingles) Construction Debris will be going to V A-RivWur-t 6&ah F'14- CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration (if applicable) # 1 l9 ?6 �o (attach copy) Construction Supervisor's License# 0 4� (attach copy) Email of Contractor b 1AyVc-mG f�. P61NA-)4.�pm Phone number -ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. i y ' i r �.%. '. ! • ` . t �..(��.' WORKERS' COMPENSATION AND'EMPLOYERS: LIABILITY,INSURANCE POLICY- qd Information ,Page' ...., .. .. WC 00 00.01 Atlantic Charter Insurance Company- VDAC I NCCI Co. No. 29211 Policy Number WCV01243703 1, INSURED: Prior Policy Number WCV01243702 Robert Tyndall Producer: Tyndall Roofing Miller McCartin, Inc. DBA Dowling & O'Neil PO Box 1093 PO Box 1990 Forestdale, MA 02644 Hyannis, MA 02601-1990 Federal ID Number 999100972 Business Type: Sole Proprietor Risk Id Number: SIC 9999 - NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured:See WCE106 Other Work Places See WCE107 2. POLICY PERIOD: The Policy Period Is From: 07/15/2018 To 07/15/2019 12:01 A.M. Standard Time at The Insured Mailing Address 3. ' COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here:MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates & Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: , $550 $7,194 Total Estimated Premium $g 085 Interim Adjustment: Annually Surcharge(s) 395 _ Servicing Office: Total Premium and Surcharge(s) $9,480 25 New Chardon Street Boston, MA 02114-4721 Issue Date 06/29/2018 _ J ycc . rte_f Countersigned By: C Date (Copyright 1987 National Council on Compensation Insurance Form: 100mvnt4 The Commonwealth of Massachusetts Department of Industrial Accidents — — Office,of Investigations 600 Washington Street - - Boston,MA 02111 www.mass.gov/dia - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): .• 13,- VV ZE323 Address: P O • 63d X Ll If City/State/Zip:0FP4- /VvA 00 5"1& Phone#: -al Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ 1 am a employer with 4. I am a general contractor and I . employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g,'❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.$ required.] . '5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. ' right of exemption per MGL Y �o workers comp. � 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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 andjob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce under the airs and penalties of pe 'ury that the information provided above is true and correct Signattffe: Date: 1 D `_ 9 97 Phone#: J r �GG — 3 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector'5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint 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 states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." 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 employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The 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, an applicant that must submit multiple permitllicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Cornram vealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0211.1 Tel,#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.nmas. .,gov/dia 0 ' N vl a � o - a d c � M w N c o 11 m c Q m c o t ,o o O Construction Supervisor - Unrest _Unre stricted Build � � �. �.Bui ldings of any use group which contain a o m � �= less than 35,000 cubic feet(991 cubic meters)of enclosed = 3 c _ space. o c a mJr\ E 0 5 o � ) timYO o•> m U WU2 — C V o0 2 c J Q O LLLu y O co m 0- W E O 0 U ..i U State Building Code is cause for acusetts --..._._...- Failure to possess a current edition of the Massh ----revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl Office of Consumer Affairs&Business Regulation _ HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYP,&.Individual before the expiration date. If found return to: Regisfrafiar.- Expiration Office of Consumer Affairs and Business Regulation t19766 -;05/22/2020 One Ashburton Place-Suite 1301 DAVIDHWEBB"r=_-'' =_ Boston, A02108 DAVID H.W EBB•"?;.,, ' -- " 179 TEATICKET HIGHV✓A i EAST FALMOUTH,MA 02536 Not valid without signature Undersecretary ! 9 Assessor's map and lot number .. t�- 3e -73- Sewage Permit number. ............... y�FTHET TOWN OF BARNSTABLE • BARNSTd➢LE, i ,o�039.a• BUILDING INSPECTOR ��Ep MpY ` APPLICATION FOR PERMIT TO .....�Y.i+.C.,F••Q ............................... ............................................................... TYPEOF CONSTRUCTION ........................ -'� ..................................................................................... ... ..........19. ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...................�.IJ...�............ �.. iQ .l~............ ........ .......F1„�.................. ............... Proposed Use .. . ..4 <......... : ..................... ..................................................................................... ZoningDistrict .............�� ..................... ...........................Fire District .......(..... �..................................................... ova:. ,......Name of Owner Address ............ ............................................ Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ................... .............................................Foundation .............................................................................. Exterior ....................... .I... ....................................Roofing .................................................................................... .Interior Floors ....................................�........................................... ......................................................... Heating ..................................................................................Plumbing .................... J ................................ l Fireplace ..................................................................................Approximate Cost ....... !........... ...... ................i........ Definitive Plan Approved by Planning Board --------------------------------19--------. Area IrV . �� ... . .. ...... .. .................. Diagram of Lot and Building with Dimensions Fee 9 O j SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................... White, Walter �~ 17664 enclose porch No ................. Permit for .................................... ............................................................................... Location ....... 387 Strawb. ...erry Hi11. . ...Road. ........... .. .. .... . . ...... . Centerville . �.:........................ ................................................. Walter White Type of Construction ..................frame....................... ..• ................................................ ........................... t Plot ............................ Lot ................................ J =r April 30 75 Permit Granted .......................19 ".` Date of Inspection 1 L ' Date Completed ..: ... 7®................19 �. PERMIT REFUSED , t ..........................................................:..... 19 ............................................................................... ............................................................................. .l ............................................................................... i . ............................................................................... Approved ................................................ 19 .............................................................................. ............................................................................... -�„ ._ >.c'. -n a.. 1"Y��"� -4..."'7Ry �'�''�"T,t a .Y�.. �..»•�.�4.,q«;. ;.rzyh`� '�--. r _.- �. .... �l i.. Assessor's .map and lot number ......... ......... ......... .. ........ _ �f 36 Sewage Permit number / .................................... Qyo*THET TOWN OF BAR.NSTABLE t 89HHSTADLE. i M6 E N o'' BUILDING , INSPECTOR PY APPLICATION FOR PERMIT TO .... a.. '. .fJ.s ...... TYPE OF CONSTRUCTION .................. �...:..................................................................................... r fi � r .19!� t/ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .................... ............: -n. � ..... .;+'��h� .. ... 1 i:................ ,L ? ................... `�r�.., ., ProposedUse . .. ... .. !:,,?��! :at..........Cwl(..4':4..,..,........................................................................... . Zoning District ��................................. ............Fire District ....... .... .....".............................................. Name of Owner G/� .. c• ... ./, /,J..? ...................Address ..........: ..a............................................. Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ................................................... ..............Address .................................................................................... Numberof Rooms .................../.............................................Foundation ............mr- ........................................................... Exterior ....................... �.�?'41.. .,�....................................Roofing ............`. .................................................................. Floors ..................................................Interior .................................................................................... ............................ Heating ..................................................................................Plumbing .................................................................................. Fireplace .............Approximate Cost ............. t, , .......Definitive Plan Approved by Planning Board ________________________________19________. Area 4,yf 4,f (wr .. ................................. Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . 1 r V ,;�W. (V:.``..................................... �..�., u White, Walter 'j�O ? No 17664 Permit for .....enclose porch ' ............................................................................... Location 387„StraFberry Hill Road ................ I Centerville ...... ..................................... Owner Wa.lte. . .JWhite. . ........................ ..... . . ......... . .... Type of Construction ..I.......frame ........................................ Plot ............................ Lot ................................ Permit Granted ................Ap it 30 19 75 Date of Inspection ..........................19 .. Date Completed ......................................19 PERMIT" REFUSED .................................. .I..................... 19 ............................................................................... .................... .................. . ....... ................................. .................................. Approved ...... . ............................. 19 ............................................................................... ............................................................................... TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION JA f�c I t'�K I IYD r1 11 Map "7 Parcel B Application 1 (2 &j Health Division ' �4/� Date Issued Conservation Division T q�16w� �i'o�A Application Fe Planning Dept. �oice ��®,6, Permit Fee Date Definitive Plan Approved by Planning Board�. Historic - OKH _ Preservation / Hyannis Project Street Address r'OAA) Village 0___Q 1,n �' -t why Q will Rem ,Tn��i' Owner t n ne, Address na-escaP 11 Telephone Permit Request M C 0 r= t?�> ►,DeN t E. Nk�. N _ C � brLr\K �cJ ��£.U(` t���l�� F.�.;.[�5 i�E 1 r�Sc't k�t� . uJ��4nc Z) Square feet: 1 st floor: existing 1/%proposed 2nd floor: existing proposed Total new ..Zoning District Flood Plain Groundwater Overlay Project Valuation GO Wb Construction Type Z_X�j Lot Size 40i Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure I / aN Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: A Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) 10 Basement Unfinished Area (sq.ft) Rt'n/_� Number of Baths: Full: existing I new _ Half: existing new Number of Bedrooms: existing aew Total Room Count (not including baths): existing 6�� 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 N No Detached garage: ❑existing ❑ new size_Pool: ❑i exi/tin ❑ new size Barn: ❑ exisfinl'0 new size_ Attached garage: ®'existing ❑ new RP- -.'Shed: ❑ existing ❑ ew size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes i;�No If yes,, site plan review'# Current Use Proposed Use R=N� - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name C*C1UAP_ I-e!s-,-->62A1 Telephone Number Address -DCC'_�e License # Q� 55 S Home Improvement Contractor# Worker's Compensation #ix_Y-'-1C0-Lo01g2QQ —a01(oA ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO - --� SIGNATURE DATE FOR OFFICIAL USE ONLY ;4 APPLICATION# DATE ISSUED y MAP/PARCEL NO. y ADDRESS VILLAGE -OWNER ` DATE OF INSPECTION: i .,.}FOUNDATION . FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING e I DATE CLOSED OUT ASSOCIATION PLAN NO. ti•, k a Tice-bf Cousmner Affairs&Business Regulation License or registration valid for individual use only ME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation eglstratlon:;,;i6 1-2-1. Type 10 Park Plaza-Suite 5170 - V Exp'rra�ialt Eil9/2018 Supplement Card Boston,MA 02116 OCEANSIDE,INC. STEVE TESSIER 217 Thornton Dr - Hyannis,MA 02601 Undersecretary Not valid without signature Massachusetts Department of Public Safety 'n Board of Building Regulations and Standards License: CS-055571 I ` Construction Supervisor i .. r STEVEN M TESSIER 18 DEE BEE CIR MIDDLEBORO MA 02346 Expiration: Commissioner 09/1712018 { •, • s i ` III Client#: 586925 26CEANSIDEIN ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) o4/(MMIDO 6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NA E:COLT CT Dowling&O' Neil Insurance Ag PHONE 508 775-1620 F X 5087781218 AIC No Ext: AC No 973 lyannough Rd, PO Box 1990 E-MAIL ADDRESS: Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC4 508 775-1620 INSURER A;Arbella Insurance Company INSURED INSURER B: Oceanside, Inc. INsuRERc: 217 Thornton Drive Hyannis,MA 02601 INSURER D': INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE ADDLSUBR POLICYEEpFF POLICYEXP UMITS LTR SR WVD POLICY NUMBER MMIDDMVY MMIDDIYYYY A GENERAL LIABILITY 8500061423 0110112016 01/01/201 EACH OCCURRENCE $1,000 000 X COMMERCIAL GENERAL LIABILITY DAMAGFC70 RENTED PREEMIS S Ea occurrence $1 OO O00 ' CLAIMS-MADE a OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/0P AGG $2,000,000 POLICY PECO LOG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accdent) $ HIREDAlIT03 NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS40DE AGGREGATE $ DED I I RETENTION$ - $ WORKERS COMPENSATION WC STAM TS �RH AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N l A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is requited) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the .coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ' C. 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S167993/M167992 LS1 r t '`��?"® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03/30/2016 THIS CERTIFICATE 1S 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 poiicy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME; Linda Sullivan DOWLING &O'NEIL INSURANCE AGENCY PHONE 508 775 1620 AA1C No; ADDRESS: Sullivan@doins.com 973 IYANNOUGH RD. tNSURER S AFFORDING COVERAGE NA1C N HYANNIS MA 02601 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B OCEANSIDE INC INSURERC: INSURER D: 217 THORNTON DRIVE INSURER E; HYANNIS MA 02601 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 41040 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL S BR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WvD POLICYNUMBER MMIDD MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ E E T CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 JECT PRO- ❑ LOC PRODUCTS-COMP/OPAGG $ OTHER; $ AUTOMOBILE LIABILITY ' - COMBINED SINGLE LIMIT $ Ea accldenl ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A _ BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIREDAUrOS AUTOS Peraccldent $ $ UMBRELLA.LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION YIN /� PER ERA AND EMPLOYERS'LIABILITY _ ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED7 NIA N/A NIA VWC10060198022016A 01/01/2016 01/01/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under OE SCRIPTIONOFOPERATIONSbelow - - E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS f VEyICLES (ACORD 101,Addttlonal Remarks Schedule,maybe attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass,gov/lwd/Workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.' AUTHORIZED REPRESENTATIVE Daniel M,Crq ey,CPCU,Vice President—Residual Market-WCRIBMA ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 1 Congress Street, Suite 100 x Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address:_ a r ar n-{- �i ye- City/State/Zi �; o U Phone M S U$-771 1(a Are you an employer? Check the appropriate box: Type of project(required): 1.g I am a employer with M- 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• []Demolition working for me in any capacity. employees and have workers' insurance. 9• ❑Building addition comp.[No workers' comp. insurance required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LM Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers 13.0 Other i -$- comp. insurance required.] 41 vu O+ *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information• t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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: A v' oe,1 Policy#or Self-ins,Lic• #: 60—60 19�562-— r �� !CA, Expiration Date:/. / j`7 Job Site Address; 4,J4Ra City/State/Zip:-Ob.Jn ,Lu i l(p CN Attach a copy of the workers' compensation policy aration page(showing the policy number and expiration date). C1 Z43'z 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby:e:erMtifJyderains andpenalties of perjury that the information provided above is true and correct. Si ahire: �516Q�r'� Date: Phone#: 15-6S-7-7 _31( Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.PlumbingInspector 6.Other P Contact Person: Phone#: THE RIGHT CHOICE -.--_ ----- - Since 7971 1 :: Office Use only. :. r?' anside. :JOB NTJMBER l Restoratim, 217Tkoniton Drive,Hyannis,Mass.02601 508-771-3110 800-464-3318(MA.Only),774-470-2211 Fax ASSIGNMENT AND AUTHORIZATION TO PAY The undersigned, herein called claimant, has authorized and ordered from Oceanside, Inc. , the materials and/or services requested. Undersigned hereby assigns to Oceanside, Inc. any unpaid proceeds due or to become due, under the claimant' s policy with the insurance company to pay direct to Oceanside, Inc. or to include its name on a check or draft, for all requested work. In the event that Oceanside' s .claim herein is not covered by, or paid by, an insurance company, claimant agrees to pay Oceanside, Inc. within sixty (60) days after work has been completed. Claimant understands that Oceanside, Inc. is working for them and not the insurance company or the adjuster. Payments :>remaining due and payable after the claimant has received payment from the insurance company shall bear interest at one and one- half (1-1/20) percent per month. In the event that there is a breach by the claimant of any of the conditions of this agreement, Oceanside, Inc. shall be entitled to recover, as additional damages, attorneys' fees, costs and any other collection expenses reasonable and attributable to said breach. If payment is not received within 60 days, collection action will commence without further notice to the claimant. LOSS/DAMAGE ADDRESS MAILING ADDRESS (B LLING) CITY STATE ZIP INSURANCE ADJUSTER' S NAME/CO,. LOCAL INSURANCE AGENCY NAME PRINT NAME INS. CARRIER/POLICY UNDERWRITER 6tAAiNQ- 0 DATE: C IMAN'T' S SIGNATURE PHONE: EMAIL: Print Page Page 1 of 4 Print this page • Owner Information -Map/Block/Lot: 248/049/-Use Code: 1010 Owner Map/Block/Lot GIS MAPS DUMAS, LYNNE A TR 248 /049/ Owner Name as 564 OLD STAGE ROAD Property Address of 111115 387 STRAWBERRY HILL ROAD CENTERVILLE, MA. 02632 Co-Owner Name WHIPOORWILL Village: Centerville REVOCABLE TRUST Town Sewer At Address: No GIS Zoning Value: RB • Assessed Values 2015 - Map/Block/Lot: 248 /049/- Use Code: 1010 2015 Appraised Value 2015 Assessed Value Past Comparisons Building $ 128,800 $ 128,800 . Year Total Assessed Value: Value Extra $ 38,700 $ 38,700 .2014 - $ 270,900 Features: 2013 - $ 270,900 2012 - $ 228,300 Outbuildings: $ 0 $ 0 2011 - $ 225,500 Land Value: $ 103,400 $ 103,400 2010 - $ 230,500 2009 - $ 309,800 2008 - $ 332,100 2015 Totals $ 270,900 $ 270,900 2007 - $ 355,300 • Tax Information 2015 - Map/Block/Lot: 248/049/-Use Code: 1010 Taxes C.O.M.M. FD Tax $ 419.90 (Residential) Community Preservation $ 75.58 Act Tax Town Tax (Residential) 2,519.37 Fiscal Year 2015 TAX RATES HERE $ r 3,014.85 http://www.town.barnstable.ma.us/assessing/Printl5.asp?ap=0&searchparcel=248049 3/18/2016 Print Page Page 2 of 4 • Sales History -Map/Block/]Lot: 248/049/-Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: DUMAS, LYNNE A TR 2014-09-17 28386/334 $10 WHITE,NORMA J ESTATE OF 2014-01-30 27962/24 $0 WHITE,NORMA J 2013-07-23 27561/348 $1 WHITE, WALTER R 2012-06-27 26449/24 $10 WHITE,NORMA J 2010-08-13 24748/210 $1 WHITE, WALTER R&NORMA J 1964-03-12 1241/129 $0 • Photos 248/049/-Use Code: 1010 • Sketches -Map/Block/Lot: 248/049/-Use Code: 1010 Z' T. 22 l do- AsBuilt Card N/A • Constructions Details - Map/Block/Lot: 248/049/-Use Code: 1010 Building Details Land Building value $ 128,800 Bedrooms 4 Bedrooms USE CODE 1010 http://www.town.barnstable.ma.us/assessing/printl5.asp?ap=0&searchparce1=248049 3/18/2016 Print Page Page 3 of 4 Replacement Cost $157,065 Bathrooms 1 Full + 1H Lot Size 0.29 (Acres) Model Residential Total Rooms 6 Rooms Appraised $ 103,400 Value Style Cape Cod Heat Fuel Gas Assessed Value 03,400 Grade Average Heat Type Hot Air Year Built 1962 AC Type None Effective 18 Interior Hardwood depreciation Floors Stories 11/2 Interior Drywall Stories Walls Living Area sq/ft 1,698 Exterior Wood Shingle Walls Gross Area sq/ft 3,584 Roof Gable/Hip Structure Roof Cover Asph/F GIs/Cmp • Outbuildings & Extra Features - Map/Block/Lot: 248/049/-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value FOP Open Porch-roof- 192 $ 5,700 $ 5,700 ceiling BMT Basement-Unfinished 864 $ 17,400 $ 17,400 GAR Attached Garage 528 $ 11,800 $ 11,800 FPL2 Fireplace 1.5 1 $ 3,800 $ 3,800 stories • Sketch Legend Property Sketch Legend B2N Barn-any 2nd story area. FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area SOL Solarium (Finished) BMT Basement Area FUS Second Story Living Area SPE Pool Enclosure (Unfinished) (Finished) BRN Barn GAR Garage TQS Three Quarters Story (Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area (Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUA Unfinished Utility Attic http://www.town.barnstable.ma.us/assessing/Printl5.asp?ap=0&searchparce1=248049 3/18/2016 c Print Page Page 4 of 4 FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in PRT Portico WDK Wood Deck Porch PTO Patio http://www.town.barnstable.ma.us/assessing/Printl5.asp?ap=0&searchparce1=248049 3/18/2016 Main Level CC 50' 3" b 21 7" 10' 8" 5'4" 11' Kitchen Bathroom Great Room oo Bedroom a O (V , �--8' 15'2" 8' 10" � T - Hal y N o` Close 1 V � N Y K os�t 14'6" �--3' 8" N N 1 u 4 � Living Room'- 10 i---- ' " _ ose 1) . bedroom frt rt N oo • f-3'4, Closepx 18' 6' N 36 4" . u Main Level 20160254 REPAIRCOPY_ � 8/25/2016 Pagel 2nd floor 33' 41' 1 121711 31 311 4' i 11' 10" Closet (1;)t. • R 1 Bathroom oN 2' 1' 3,� 00 ° Closet bedroom left 5 3 bedrroom rt `o ' " �-- HI 2' 6" 71711 2' 6„ Hallway loset (1 ose'�( 15' 1" c� q 15' 5" _ 4' 7" 12' 2 _ - 1 . ; Stairs 2nd floor Pa e: 20160254 REPAIRCOPY 8/25/2016 g 3