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HomeMy WebLinkAbout0055 VICTORIA STREET �. .,�. y 0 a '.. 4 . - .G ..., .,_ '. ,�A �� � ... *, _y ,�. � i s. „ .k u � ...x:.:. _. � n r t. fl . �. .,. J _, 3... e +N o- �.. ,. � ..:. -L.. .. ..< .� .. '.. ... d.. . -.' - �.' ., , e , . .. ,, � .. �p .. P -.. .' .. � '. �. ,.. a. � 7 ,. .. i ., ' r] � v . n � '� .,. .: ,: x+ .. .. 6 � '��. �. �' r� � .. .. i. .� . _. .. U . ' 0*1HEr Town of Barnstable *Permit# Q� Erpires 6 m nt! o i nr s re Regulatory Services Fee - i6 �� 1 Q� Thomas F. Geiler,'Director, y /, MA'ta` � 7/b1i0 h -[�8� Building Division r+I OF $ARS Tom Perry,CBO, Building Commissioner 200 Main Street,.Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X Press Imprint Map/parcel Number - Pro rty Address V)c,.Jd�f^C Residential Value of Work d Qb Minimum fee of$2S.00 for work.under$6000:00 Owner's Name&Address 1 L � 1 e . nG-11A?(�VIA t `TV Contr actor's Nam e � � ��/!/ .•TelephoneNumber Home Improvement Contractor License#(if applicable) Z3 Cons Lclion Supervisor's License#(if applicable)Woran's Compensation Insurance Check one: ell a sole proprietor am the Homeowner e Worker's:Compensation Insurance Insurance Company Name ��ffCa✓✓. Workman's Comp.Policy Copy of Insurance Compliance Certificate must.accompany each permit: Permit Request(check box) ❑ Re-roof(stripping old shingles) .All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) El Re- 'de #of doors ReplacementCins/ oors/sliders.U-Value 0/ (maxirnurn .44)#of window *Where required:.Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,"Conservation,etc. ***Note: Property Owner must sign Property Owner Letter'of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required.` SIGNATURE: 'Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc PaviccA nonQno - � i# F��af.�' i�'Sd•.X�3.3 ���4=�.Yss���-fl r _� � ��C�3�' - .TJT3hu•Fi3'- �1¢��� ' € $ 'Me F,=�bps tf 19535 F yp 0- �: n , . 4: "" i.c::'F ' <i�3'SY V �n_e v:."J V't 9 i �4zL4W`Yi NOW CUM io SS VCC-7-0 2cA Sr ro N C C-'T j�✓ i 1!F, AIA N m m V ' Cngomv N lkar Built Renevral by Mdersrn Of W.Cr.ac Care Cod 0 Add4ww r) Omer lD�/ 1t371 fed Ome m �en�1111a1 6S Agrecment �Z{ O OrJic -' o av Mumben WOon odu:.Rl uz895 Amf wiz LcN rb�1.dm �a-2qY" /e t, sme e w-3a39 a-122"MA- wn+san aardaeadsan r M�.n• _ PhooK-VFa�{c Pagr of'Da= 119535 Cr-562725- 0 1i0(, lXG /�S'r k"ntt 3 GWL{ES O t�1�tlMra n ruwts —1 M jib 16 kill I lil E � a T b 3 ` Zd 11 k L13 13 L b m ao J At 3 0) 6 coL 6 m CDL G Cl) soW�.d ,fiwe vet rA brb14 Dacq da•I NamV71.ppjrwja Der Ma Cal sw nor w�pp s rdo�adM i.i�iordl+r � � �ve.u�tr�liA$e op�d+em�Ise�JibMrlJamo�c � . sas ltaaedae siac for and of sale.Too < �Y tle � mr7 A t44 aaaea�Soo rt�9 of dee dlt (� •��+rw ddr dare d «ot6et o1 esaedldedn� _tbw MbOMWAu Cz dW or t:pes4vu — wW.r or.twa.are++ 01 jpj (pgwamdwMbLDu Col man ■brkrawhCod (/�/ IdYrode�/�• - —4 d AppwJ Span 0,&Nom irdMAmerdldAp'ee�na arre.. "mom fir■ ft"Ow iv y arda�b PA*O i iNdibMirr Ql rur�r� Md4Mlmw • ru roam rw Y /wR `/ I/` ailill[lDdRtmCggledNn 'o� R� r:�wor. wa�oroa'• d :r'w"�i.w•�s�o f•..Ivai Ris t,ado Lb.c�mne64i�daa� - e�� p�m.d. .e,.y,� wM.r�"aN�ra••�•°rrra rw�o�J.wd�pooleFproruea� *pw'� cub~ r�aaipr.e~e��s�.+mrw w11�•fl�dterll�reo !In- nsos� M� AL-0 td.t:K 1 IrIL-A It: Vr ,LIAMILI I T IIV;Z0U '°CW►N4_,t: OP ID1-40O 1 05/07/10 DDU£ER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P.O. Box 1 'ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 Phone: 401-769-9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE NAIC# INSURED Moon Associates Inc. , INSURER A: National 6range.Insuranca Co 14788 DBA Gutter Helmet DBA Renetaal b Andersen of RI INSURER 8: Beacon Hutual Insurance Co. .DBA flutter Hemet Roofing Ife�URERC: DBA Moon Works 1137 Park East Drive '' IN URERo: Woonsocket RI 02895 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIP.EMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUUMENT WITH RESPECT TO Y':MICH THi8 CERTIFICATE MAY BE ISSUED OR IM,Y PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGPEGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ LTR INSIR TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDA'YY) DATE(MMiDDJY1511 - LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 "c IV KtA I c A ;X COMMERCIAL GENERAL LIABILITY MPS26619' 09/16/09 09/16110 PREMISES(Ee%curence) $500000 IOCCURh9ED EXP(Any one person) $ 10 Q 0 0 CLAIMS MADE X❑ PERSONAL&ADV INJURY $ 1 Q Q Q Q 0 Q GENERALAGGREGATE $2000000 j GEN`L AGGREGATE LIMIT APPLIES PER: PRODUCTS-CO&IPtOP AGG $2 Q Q Q Q Q 0 POLICY JEO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1000000 A I X ANYA.UTO BIS26619 09/16/09 09/16/10 (Eaaclident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS +Per person) $ p I HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS . (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO - OTHER TH stJ EA ACC $ i . AUTO ONLY AGO $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $.10 0 Q Q Q 0' A ?�OCCUR. El r_(AIMSMADE CUS26619 09/16/09 09/16/10 AGGREGATE $ DEDUCTIBLE $ RETENTION $1 Q Q Q.Q $ WORKERS COMPENSATION, X TORCSA YlEMIS _ i 1H AND EMPLOYERS'LIABILITY Y 1 tdER B ANY PRGPRIETORIPAP,TNERtEXECUTIVE a 285M: 10/Q1./09 10/61/10 E.L.EACHACCIDENT $SQQQQ0 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY L1441T Is 500000 OTHER r d DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS .CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RENEWAL . DATE THEREOF,THE ISSUING INSURER VVILI ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NXYIED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Renewal .By Anderson 1137. Park East Drive REPRESENTATIVES. Woonsocket "RI 02895 AUTHOR! D REPRESENTATIVE ACORD 25(2009101)' 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents 7,- F Office of Investigations 600;Washington.Street Boston, MA 02111 -T www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information _ Please Print Legibly Name (Business/Organization/Individual): 50 GlR Address: f 57 Po-r/ City/State/Zip: ?YS Phone #: 6 7 Are you an employer? Check the appropriate bog: Type of project(required): 1.V] I am a employer with �?_0 4. I am a general contractor and I 6.. w construction employees (full and/or part-time).* have hired'the sub'-contractors . '2.❑ I am a sole proprietor-or partner- listed on the attached sheet.. 7. Remodeling ship and have no employees , These sub-contractors have- g., Demolition working for rrie in an capacity. employees and have workers' g Y P h'• 9. ❑ Building addition comp. insurance..= . [No workers comp. insurance M = 1O.Q Electrical repairs or additions required.] 5. 0 We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 1 L Q 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 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. ` xContractors 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: G1-C65%) (j c5 - C O . Policy.#or Self-ins.Lic.#: Expiration Date: Job Site Address: a Q J City/State/Zip /i/ �'�/d� ' GLO 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 certify under the pains and penalties of perjury that the information provided above is true and correct. / Si ature: - Date: Phone#: 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 Persons Phone#: Town of Barnstable "Permit 4t Expires 6 months out issue date gel ,��,�A81 Regulatory Services Fee © '* MASS, Thomas F. Geiler,Director s65q -97Y . Fo► +" Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 Ic '71710T-F www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 5 l� PfResidential Value of Work /Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address S5 Rl U)", lacn�,, tq--- V t� Contractor's Name ea<r 5 n- Vt�/�re)/�bYl+?.v� Telephone Number)1�5,3'6 4 Home Improvement Contractor License#(if applicable) h l �XrO' /d ' j ' Zco 9 Construction Supervisor's License#(if applicable) 9 7 S I E X D — $'3 ' Z v 16 ❑Workman's Compensation Insurance Check one: ❑.I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance_ 0 Insurance Company Name /'1 C C A vvi a c L c Q.,q _._L. �S Lw Y`�-<' e Workman's Comp.Policy# W L R C A 4.4 90 �C(51 j F ?,-06� Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) PERMIT �Re-roof(stripping old shingles) All construction debris will be taken to P I�)BRe-roof(not stripping. Going over existing layers of roof) JUL _ 3 200$ XRe-side it, I`j S� TOWN OF BAR.NSTABLE yvl iN Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: operty Owner must sign Property Owner Letter of Permission. o Improvem Contractors License is required. SIGNATURE: — G Q:Forns:expmtrg Revise071405 i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations , 600 Washington Street Boston,MA 02111 tivww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL. 32750 Phone #: 407-551-5402 Are you an employer?Check the-appropriate box: Type of.project(required): 1.❑ I am a employer with 4. ❑.I am a general.contractor and 1, 6. ❑New construction. employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet:t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp..insurance. 9. ❑Building addition E [No workers' comp. insurance 5. We are a.corporation and its officers have exercised their 10:❑Electrical repairs or additions required:] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plurribing repairs or additions myself. [No workers'comp: c: 152, §1(4),and we have no 12.❑Roof rcpai s insurance required.]t employees. [No workers' 13.0 Other h� Si comp. insurance required.] . J , `"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 hue outside contractors must submit.a new affidavit indicating such. $Contractors that check this box must attached an additional sheet.siowing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers';compensation insurance for my:employees. Below is the policy and job site information. Insurance Company Name: Ace American Insurance Company Policy#or Self-nis.Lic. #: WLRC44460798 Expiratt Da08/01/2008 Job Site Address: S:�fr P e+ City/State/Zip: Attach a copy of the workers'-compensation policy declaration page:.(showingthe policy . her 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.""statementmay be forwarded to the Office of Investigations of the DIA for insurance:coverage verification. I do hereby certi un e.pain nd penalties of perjury that the information provided above is true and correct. (Sears uth. gent) S� A Agent) Date: \ 3 - Phone# Home:860-792-8 / Ce11:860-753-0452 Official use.on.ly. 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#: "4 Boar o f1 �n € la ns�an Wn 5ar sd Gue Ashburton Place - Room 1301: . .: _. -B ton . h os A assac _usetts 02108 Home Improvement Contractor Registration " - - - - Registration: 148607 Type: Supplement Card - f °Expiration: 10/11/2009 SEARS HOME IMPROVEMENT PRODUCT .Sears Authorized Agent LUBOS SVEC ��oi�e- i60-792-8106 1024 FLORIDA CENTRAL PKWY K , Cell - 860-753-0452 LONGWOOD, FL 32750 � Update Address acid return card.Mark reason for change. [`l Address L-1 Renewal E- Employment Lost Card „ ��1'iratnnzcruix,>fc`/ Q� 'ltztlartde4 `r hoard ur Ruilding.Kegulations and Standards License or registration valid for individul use only . HOME IMPROVEMENT CONTRACTOR before the expiration date- If found return to: . Registration: 148607 Board of Building Regulations and Standards - One Ashburton Place Rm 1301 Expiration: l omi t2009 �~ .Roston,Ala.02108 •. Type: Supplement Card SEARS HOME IMPROVEMENT PR _ 1024 FLORIDA CENTRAL PKWY _ LONGWOOD.FL 32750 - -- -- Administrator of Valid without signs Blared stt 5 _ One Ashburton PlaceRoom 1301 - Boston. Mass h setts 02108 Home my c tz ReXst. a..tion. �--. �tli/sir�titxn: `1=4W03 Twe: Public Corporation Expiratlem 1011 1/20M TrA 2BM-fi; SEAMS HOME IMPRO)EMENT ALFRED NYMAN JR, s% 1024 FLORIDA CENTRAL MAtY LONGWOOD, FL 32750 � ' C f' Ugh AfMrea=3 roam earl.lt4tmc^li ressaii for•t:hmr,w Lam'• Adtires� 0 Rearmad � Empeywmt Lost Cd QPAI 0 lmt-4 �stl r r • " r ,d'�rs�eiraa -o ,.�irsaarz � ' ?'"rda 0all4lingRegutgtt4 snodftadas'Eis tit 13t1rt�ratldfor`i aidt tlla + - , HOME IMPROVEMENT CONMCTOR later Ow eqdratlun date. If fonnA rehom to: Board of Bonding k rant ora.trod Semar tty. $egiotl ft, >k 14 7 t the h t mgtort lZ�IAs i 1301I11/2009 'l=sd 25 �� = Cowration _ vJ SEARSh{Oid�I�! l�tJ1~PS INC. r ' Al FRED NYMANy f 1024 FLORIDA Cf iq _ - , e .rs LONGWOOD.Fl,327. E`' Administntor Nut ant ittux� 03/19/2008 16:59 407-767-8536 LICENCE PERMITS SUBS PAGE 01 ,ACO-Q� CERTIFICATE OF LIABILITY INSURANCE DATE 3/101 006 as/o1/2 s o3/10/200� PRODUCER LOCKTON COMPANIES,LLGK CIiICAGO THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 626 W.Monroe,Suite 600 HOLDER,THIS CERTIFICATE DOR$,!JOT AMEND, EXTEND OR CHICAGO IL MI t Yf3A0f.AEFORDE (312)669.6900 INSURERS AFFORDING COVERAGE INSWRED Seam HoldingsCorporation Ca 1062193 dib/a Seam Home Improvement Products,(no. 1mam 8,Jndemnity Ins.Co.ofNo r Am '� Attn:Risk Management E3.237A j yV.RE 3333 Beverly Rd. *man Estates,IL 60179 S CERT1flGATT�� SURANCE DOES N TUTS A CONTRACT ISSUING COVfiRAG£S Sfi 00.4 C7 1 UTHCRIZED RATMEN. -ER R A.N9 THE CER7IFTCATE MOLDER THE POLICIES OF INSURANCE UST90 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITMSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, p�L TYPE OP U NCe POLICT NUImB[R DCA7E DA t�AM RDN LIM" TT OCNERAL UAINUTT EACH OCCURRENt;E S 5 OOO 0 0 A X COMMSACIALGENERALLIABLITY HDO021745078 68/01/2007 O8/0112008 FIREDAM G A omfW Excluded CLAIMS MADE a OCCUR WD T onn S EXCIUded PERSONAL a ADV i _RY L 5,000,000 GENERAL 09. $ 5,001),009. C4M AOORMTt2 LLIpIppMIT..APPLIES PER, PRODUCTS. P AGG 5.000.000 POLICY 2& Loa AUTOMOBILE NAS1Lf rY COMBINED SINGLE LIMB 3 51000,000 A X ANYAUTo ISAH08215984 08/01/2007 08101/2008 (Eeaodd-1) A ALL OWNEDAUTO3 ISAH08216009 08/01/2007 08/01/2008 BODILYINJURY : X?(X70QOC SOMEOULEDAUTOS (ParPwm) HIRED AUTOS BODILYIHLIURY XXXXXXX NON-OWNED AUTOS (Par noGOen11 1 PROPERTYDAMA*9 (Peraoe9aeral GARAOE IJAMUN AUTO ON Y_EA AOCIOENT @ X)QQQOCX A X ANY AOM S.I.R.$5,000,000 08/01/2007 081011200$ EA ACC 0 X-X)00= AGO 0 X)QQQCXX Excess UAB111TY EACH OCCURRENCE 3 000 000 A :X3 OCCUR ❑CLAM MADE 02 38 82 310 09/01/2007 08/01/2008 AGGREGATE a 10,000,000 UNaaEUA DEDUCT'ID,E 0 FORM XX)00= RETENTION 5 g A WORKERS COMPEWATION AND WLRC44477282(CA) 08/01/2007 081011200$ X wo sTATU B EMPLOYERS'UAeTLm SCFC44477270(W1) 08/01/2007 08101/2008 ELL,EACH ACCIDENT 0 1,000, 00 B WIRC44477269(AOS) 08/01/2007 08/01/2008 -OyEF C 1000 00 1:.L.OISEASE•POLICY UM Pt C 1,000 000 OTHER DR"PT10N OF OPERATIO0WCA=XSAtM4LESl=WS10NS ADDED BY PRWWONB Alfred W.Nyma%Jr.,Liomac OC00012538 located @ 1024 Florida Ccmral Parkway,Longwood,FL 32750 and Alfred W.Nyman,Jr.,Licease 9CM0249510 located®1024 MOO Central Padcway,Longwood,F4 32750 G 1C ADO ONAL INCUR UD,INSURER LETT • CANCELLATIO 2268002 SNOULD ANY OF THE ABOVE DEMISED POLICIES BE CA14CPI1 9! BEFORE THM EVIRATION Sears Home Improvement Products DATE THeOP THE 151AUNG INSURER WP L ENDEAVOR TO MAIL—V— DAYS WRITTEN LongFl Parkway Longwood Fl.32760 N(MCETOTHECOMICATE NOLDER RAM!OTOTH9LeFruvTFAILURETODO sosRALL IMP09E NO OBLIGATION OR LIABILITY OF ANY MO UPON THE INSURER,I"AGENTS OR REPRIZERTAYIYSS. AUTRORNMO RMESENTATIVE ACORD 25•9(7197) 4,Quanemspaau,oeasWA-4.wmtlINmm„(WMinw"asfe.imam,eenw,n,aIMMIMelbmw6'BUHDW. OACORDCORPORATION%sa Received on 3/19/2008 10:19:44 AM ,'JUL-1-2W8 02:2813 FROM: TO:18668156330 P.4112 .I�Sears Nome Improvement Products,Inc. JOa len 1024 FWAa Cenral Perks 4 Lengpeadl,FL 32730 "me My". mod Prods" Phone 0: FEIN 2b1896691 . Uoanee Numbers:AI.8yg1;FL 2e39:LA 84/8a, Location: MA 141I6W;M9 5 NC♦T�Ar Pat.3C 1068a8; TN 2410; W GA p1 01T T HIL1.oaMe a Siding .�6-` Hama Phone: s(4&- Address: go azjelilta City: St.: JAL-77p: IANe,ft owners of of the premises described below,harablafter referred to es°p urchaser offer to contract with Soars Home,Improvement Products hereinafter referred to as'Contractor,to turrdsh,deliver,end arrange for installation 01 all materials rAmossary to Improve the premises a (Sheet) {Gly) (State) (7Jp) According to are following apedNcellons: e- NOT INCLUDED INCLUDED SPECIFICATIONS 1. Q ❑ Obtain pal rlacessary permits end a%urences. 2. ( ❑ Inepeol sluices In work area•WWI locos wood,replace rotten surfece wood where nnessary In work area excluding tool,decking or raters, d a ctnasl m 3. (� [3 %—Eximhuo sidling: TYPa Q 4. [] out waft on bddr,dock matol or akrcco areas:Loatlon: IF 5. Q / Cavik and seal wound d a0 windows 8 doom In work area as necessary. 6. ®/ ❑ Install approved rbncorrosm starter strip. INfallLArION: 7. Q]/w Wm Insulation on 1(etwell areas ID sided with-W4'1-Ar sided P*81yMne Insulation.jcirps One) COST TRIM: g, ❑ Vyne-Kfad aluminum latch system: Color. . e. ❑ Aemovs and r aamechrglepoea of totaling guttering, to. f7 (D/MWW son arand 61 horns wile*rA son aystam.mosict than areas rutted below. /�_ Wharbeater 0 Mox 0 Pdb 0 Weathertoollor 11 Other ..�-�.- iehedc orre) m , 11. ❑ ' custom Vyna-mato aluminum ideas hoards COlort 12. .❑.,/� window trim: Lopsrlon: 13, ❑ U Diatom wrap windowelelllaAmdls/headers with vyne-Mad alunliman: 14. Removo and rehletal eldspng Sipi1MYM/Ol ehut[ers, 15. U V l,-CCu*m wrap door ladnge with Vyns-load alumin= 1B. ❑ W t:uelom wrap garage door locirgls singlefdoude with Vyna4(iad aganiram 17. © move and reinstall storm drw e M/ uxa comer poets: C 19, ❑ Cllp locking system: La S1Dlflta. (r ()ldinp,r{cheek on20. 1-1 ❑ install Wentherbaeter O Max uOembeeler (]Ome COO1RW PeHorizontai I Vertical L PORCH 21. yrchCallings: Color Pa� _....-- C ❑23. Poich Pero,traerrna: color CLEAN UP 24. O ❑ Clean up and removal of all 1Db related debris: 25. 91 ❑ Each lob to over shipped to avoid delays.Remove access materials and re-slack ' WMBANTIF 26, ❑x ❑ Manufacturefs warranty Sent upon complallOn. work not tD be 11" J AO ol tts abO r! dare•eadtbn have bash reviewed and eltptakned t0 me. Ix TIME FOR COMPLE"ON OF WORK.Colrorector shall commence work within approximately twemy(20)days Iron ills data shown herein will be substantially completed wilt lorry-rive(45)days thereafter unless a di6erani estimated completion date is shown herein. Appnmdmate sWlhg date It: completion data Is: _ NQTE;THE WARRANTY PROVISIONS AS STATED ON THE REVER,aE BEEN EXPUNNEp AND IIWE UNDERSTAND ADDITIONAL PROVISIONS AND WARRANTIES ARE STATED ON REVERSE AND ARE PART OF THIS CONTRACT. X Please read the lotlowbng bold type am Initial corresponding line. - - Verbal understandings end agreements with representative shall not be binding.All understandings and egreements, If or In writing in this CorntpeL Purcha Iniads:X The TOTAL PRiGS for ell Labor a MWArWil"tiding any epplxade dlscounQ b $�� ser Confrw Price 5 - ' Selernee Payable`s�I'/70yf�sSY_nn Slots Setae Tax .// (t applicable) Terms: Condit 1S'(6ub)sd to tiro approval of the Credit Department) Total Contract Price $ Cash O (Final peymeM peyahle to Installer upon is"piellon)Funded by: Bw* City St.— Accl 0 10%Preferred cegiorm oW atut(PCD)awarded tar any term Soars Home hmprewame"Products purchases.(anent Pricing arallebts far wide il)year. It this Is a credit transaction,the egresment rot credit la contedrad In a aepareta document which Is incorporated herein by reference and made a part hereof.Witt the undersigned are hereby aWto Wg Sears Home Improvement Products to verity and ravlew my/our credit record with an Independent ctedh repo"agency and release fll0m from all fabmly roamed from Irmdverlent omklalons or IN WITNESS WHEREOF PwdwWe)hews hereumo signed their neme(e)this_IS—day of 20Q�t and adowledge receipt m of a true copy of this Contract and unless cO wiss spedFlad.0 Isunderstood that the owner kw ready thlo work to begbL THIS MESSAGE APPLIES TO DOOR-TO-DOOR SALES ONLY.You the Purcheaer(sl may camxl this transaction any time prior to midnight of the third day after the date of this transaction. we SCOMPanying J`1911 $ of canceilation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 6 stars arrow sal u oenc�al . /vBr;Rryhnrnh � Data h 2L D Z�'Ao A=P=Dr Aegdnd Iv Eaen tricot bprowmerx Pmdwaa,bw Doh pwoaw ow. D¢-BO -Ror.0a08 R•c;eived cr, 7/1/2008 2:54:57 PM i� . : Town of Barnstable BAPJWABM MAW �.� Regulatory Services Thomas F.Geller,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I I(i J''C-' ,as Owner of the subject property Ili hereby authorize SO✓5 1401111 e- —� �D. ' �u ,�- Cf.to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) r 7ZI4�' )J-4, Signature of Owner Date � 4 Print Name Q:Fmms:expmtrg Revise071405 Assessor's office(1st Floor): n O r j r YNE Assessor's map and lot number ff 1, e�Q�oF Board of Health(3rd floor): Sewage Permit number Z ISLUSfADLL i Engineering Department(3rd floor): r+ua House number i639• Definitive Plan Approved by Planning Board 19 �Fp MA-1 a• APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR t APPLICATION FOR PERMIT TO A6/2/C7 1(15 %1171d ),Gk TYPE OF CONSTRUCTIONoe Frtf t~!Q� rz_ 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Locations lG T sa7l.� 9% IGZE Proposed Use �CC��c�t/E ��� AEC"k?, Zoning District c Fire District Name of Owner 15.- '3,i5AA&Z 15"/4ZeU B➢/� Address Name of Builder Scz Address Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors , Interior �j Heating Plumbing Fireplace Approximate Cost q1-366d- Area {� Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. e Name �l.0 vim' Construction Supervisor's License SIGALOVE, C. BERNIE ADD ROOF TO No 310 3' Permit For DECK Single 'Family Dwelling Location 55 Victoria Street Centerville Owner . C. Bernie Sigalove - Type of Construction Wood k r.r w Plot Lot Permit Granted July 5 19 89 ` Date of Inspection 19 ` ��� Date Completed /Ts 19 Y qS i f 1 • Assessor's office(1st Floor): Assessor's map and lot number Board of Health(3rd floor): Sewage Permit number 7 Z Beaa9?oDtL J Engineering Department(3rd floor): �. rnas House number Oo 'bsq• Definitive Plan Approved by Planning Board 19 �o war d APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only I TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION Id OOJ r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �� /�Tall/� ' S' % Proposed Use Zoning District CA Fire District ` r yy�' Name of Owner />. r`3ER.I✓/E �`/ .0 D✓E Address l6�//v S� Name of Builder �5cj L' Address Name of Architect Address Number of Rooms Foundation Exterior Roofing I � Floors Interior Heating , Plumbing Fireplace Approximate Cost 36OQ- 40 � Area Diagram of Lot and Building with Dimensions Fee .t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �� 9 ? ouy �•�/�.�� '`'� jf Construction Supervisor's License SIGALOVE, C. BERNIE A=148-044 ADD ROOF TO No 3 3 0 3 3 Permit For DECK Single Family Dw _l1 ; na Location 55 Victoria St Centerville Owner C. Bernie Sigal ov Type of Construction Wood Plot Lot Permit Granted July 5 1989 Date of Inspection 19 Date Completed 19 h c Assessor's map and lot number . ... tNE o� e % T Sewage Permit number ................ y.. ... .-..j.j ` c� Z BASBSTAXE, i House number J�"...............................�............................ y� Mae& � p 1639. \00 o MPY a` � F TOWN OF BARNSTABLE BUILDING INSPECTOR � r APPLICATION FOR PERMIT TO .... ..... ...... . .... . TYPEOF CONSTRUCTION ................... ............................................................................................................... s ...G .... . .............19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according o the following information: Location ................ . l..e...e.klel .... .......................................................... Proposed Use, ........r... ./ ..... '!1 .... . Cl/�`( ...................... .. ... ZoningDistrict i ���YlY �` ..1/................................Fire District � � . 6-69� E' . 3... .......... ............ Nameof Owner I ......Address............,1 .............. :.........,........., c........... ......................................... Name of Builder .. .w.f.. ....41904N ......................Address t ..:................................... Nameof Architect ........ ...................`...................................Address .................................................................................... Number of Rooms ............ .............y..................................Foundation Exterior .. ...t-.�'�..C�� l...le...... ........................Roofing .. ...7 �`� / f1�f2 ......./.............:............... Floors / ....Interior ...... ...... .1.Y:. ............................................ Heating ....`............ ...... .. .................................................. Plumbing :Q .. ... ....... ... Fireplace V +...........r. .. Sc `1 y.....................Approximate Cost ........ .. �......©,�...................... .............................................!. Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ,/.....:....:....� :.�....�... Diagram of Lot and Building with Dimensions Fee .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH r� f� ,f 3 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To of Barnstable regarding the above construction. Name .......... ...r ............................................... Construction Supervisor's License�N)0 COOLIDGE HOMES A=148-44 No 25667 Permit for ....One Story ................ Single Family Dwelling . ..... ........... Location Lot 10, Victorit ......55........................ a........S........reet.. Centerville ............................................................................... Owner ..Coolidge Homes ..................................................... Type of Construction ..Frame ............................. ............................................................................... Plot . ......................... Lot ................................ Permit Granted .., October 19, 19 83 Date of Inspection ....................................19 Date Completed ......................................19 1 :t- e TOWN OF,BARNSTABLE,.. Permit No. -___2 5 6 6 7 Building Inspector .s cash gal OCCU PANCY*-PERM IT Bond` ________. 1 _ fl Issued to Coolidge H&eS Address /sr* J`�W v . « Lot 10, 55 -victoria Wiring Inspectors- s�. Inspection date W Plumbing Inspector'/ / Inspection date Gas Inspector �J I Inspection date Z-� D t C. A 3 Engineering Department '+���� Inspection date f - � Board of Health 7 f Inspection date//, , THIS PERMIT WILL*NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .................................... . _.. ................Building Inspector:.. ._ ......... e - i 1 FROM — TOWN OF BARNSTABLE ' BUILDING DEPARTMENT. Mr. Francis Lahteiue „ F ,w_ . T, MAIN STREET HYANNIS, MA ,026011 Ivan Clerk , ; ... M t�. Phone. 775-1 i 20 4 SUBJECT: FOLD HERE n DATE Feb: 1 1984,- MESSAGE Work has Sz: _La? er, � 47. G d Omers}. Please release Band. - SIGNED k DATE - - - _ - f • `_ �,. ..r .,..---S � �, ff r rLF 1 REPLY I SIGNED - Ne7-RMI '~ _ R RECIPIENT: RETAIN WHITE COPY,•RETURN PINK COPY PRINTED IN U.S.A. <. SENDER: SNAP OUTYELLO.W-"COPY,ONLY.SEND-WHITE AND PINK.COPIES WITH CARBON.INTACT. y t o 43+4 OD t a0• 00- I r I t "bCATYv C S LL T R V"L ti� MASS PG 61s KEPT t= ✓d� i�'�Z'!Y G*1�'�"'7" s�Y" TA/AT r.L/E sA-''e WA -AaA�1-4WAW r.�f„,qAV ra t r ; d ---.. C"•QNf�'t;Ti�."Aw! '!'10 !'i/19!i VOAIIIA.1 QI$T�� �� •'r' WAI OF'- `.51I 0,7 H va � ` .. •. a ..... .� +,__1. r , i � J G f 61a 7145 0 Assessor's map and lot numberi ..���/.�ll............ Sewa_ ge Permit,. number ..............:..................... ..-.. ww •. d�Q ~� trt v BASBSTABLE, i U J Z House number ......................................................................:. ro n a 1639: a MAX TOWN OV-, BARNSTABLE x -BUILDING INSPECTOR POOopt C APPLICATION 'FOR PERMIT TO .........................................................r�........................ .................... ...... TYPE OF CONSTRUCTION ........." :. d ......... ..................................... ............................... - ..... G,r .........7......:......,99Y TO THE INSPECTOR OF BUILDINGS: The, undersi ned hereby applies for a,permit according Ita the following f .information:p, l Location .........�... ... ..::.��.C.,l,'�Dr�.�...5.............:......n.,...�.v��!.e...)..L�..�...................................................... Proposed Use ... ffl%�/]/�./e..:.. .1/{/�..........:.......... ......... .. ... Zoningev Ile District ? �4. ..Fire District / ..r f>r. . .fie. ............• Address r "PSG` 1 1�P� �14 f � Nameof Owner .. . .........:.. i�:............. ..................__'.. .....................�......................................... ... ` Name of Builder ... (Vi.. . ................Address ......:.............................................................................. \ Name of'Architect ........ Address t co tol CR Number_ of Rooms .............`... ou o.... ................... .... ... any l� � .. r _ ...... Exterior .. ... .../1:��^...� ..:.. ............ ...... .........................Roofing . .. ..�............ .... .... .. .................. Caine 0'� .7`.:. C.0 Floors Interior (' Heating ✓..'.... ...... .. ..........:'.:...........:...........::...........rPlumbing ' .9:........... ��TnS .............. Fireplace '....... .^. .. � ��Cc ........:1 .........Approximate Cost ............ .. . :...l...... Definitive Plan Approved by Planning*Board_'__-------_------------------_---19________: A'rea' / .� .a .......i... . Diagram of Lot and Building with Dimensions Fee C..�JGI ..........'i. SUBJECT TO APPROVAL OF.-.,BOARD OF HEALTH M e OCCUPANCY PERMITS REQUIRED"FOR NEW DWELLINGS _ a I hereby agree to,conform to all the Rules and Regulations of the To of Barnstable regarding the above construction: Name ........ . v :........... .......... ' { t Construction Supervisor's LicensA§)a. ....... ...... `) .CC LIDGE HOMES Nlo 2566.�... Permit for One...Story........... Single Fami.ly Dwelling _ ;, �rw4' ` location Lot l0 r 55 Victoria Street '� •' Centerville..... .........:.....' �'.` ���r- -.�—' .�;• - - ................. t Owner ..CQo11 S........................... Type of Construction .,Frame,....•,,,,...:,•........,• !". ~ ` .,e. ............ ....................................... ....... aPlot ......................... Lot ... ......... ......... w ; f ,Permit"Granted ,,,. October 19t, 19 83 k r "` j� Date of Inspection ..................................... 19 F Date Co pleted ........�-J�..*.... ...19�' �1 f i -,�- � � � ..�-..y €1 ,. .• � gyp;i s� r/' f �, - .,. ... - .,.