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Home My WebLink About0019 HARVARD STREET /9 lsst sor's Office.(lst floor) Map Lot / Permit# • Conservation Office(4th floor) Y Date Issue Board of Health(3rd floor)(8:30-9:30/1:00-2:00) Fee. d Engineering Dept.(3rd floor) House#1 / Planning Dept.(1st floor/School Admin.Bldg.) BARNSTABLE. • _ Definitive Plan Approved by Planning Board 19 a �� QED 6AId A TOWN OYBARNSTABLE Building Permit Application Project Street Address WAR—�n/G 2 ` l Village _S Owner Address W_19�e &9q ect Telephone —w Permit Request � ,e 2o 12 f G /Z Total 1 Story Area(include 1 story garages&decks) square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ 0 o Zoning District Flood Plain Water Protection Lot Size Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use Proposed UseU Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure �5� � S Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths /'L No. of Bedrooms Total Room Count(not including baths) y First Floor Heat Type and Fuel P #A_�oCentral Air Fireplaces / Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Bu' er Information Name - Telephone Number 7 7 7 Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) r' FOR OFFICIAL USE ONLY - PERMIT NO. - .4864 . DATE ISSUED June 9, 1995 MAP/PARCEL NO. 307. 146 - ADDRESS 15 Harvard Street r 'l VILLAGE Hyannis, MA 02601 r OWNER Francis X. & Laura Frost Dohdrty. 4 DATE OF INSPECTION: FOUNDATIONJi j. FRAME - INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH .FINAL - GAS: - ROUGH FINAL ' FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ° 11 02/94 17:02 $817727 7122 DEPT IND ACCID Q00: � /L o� II r ..=rT. COt)unonitlea �a��rzcl/useM Veto! �JaPartirtenE o��n�friaL�cc 600 !/Va LVIon S'hr l I - James J.Campbell &ton, cwac"fi 02 f f f Commissioner Workers' Compensation Insurance Affidavit 1, (iAadtseclpamitrce) with a principal place of business at: ,lo hereby certify under the pains and penalties of perjury, that: () I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number () I am a sole proprietor and have no one working for me in any capacity. I am a sole proprietor, general contractor o homeowner circle one) and have hired the N, contractors listed below who have the following wo ers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number I am a homeowner performing all the work myself. 1 ende-surd teat z copy of dais s:ztemenc will be fow:zrded to the Office of invesdrations of the DiA for coverage verification and that failure to secure cove-age zs rec:i;ed under Section 25A of MGL 152 can lead to the imposition of criminal penalties eonsisan¢of a fine of up to s 1,500.00 and/or cr.- yea-s' impraon,rnent:u well as civil penalties in a for cf a STOP WORK O ER and a fine of S 100.00 a day against me. Signed this day of I9 A�— Li ensee7Permitte Building Department Licensing Board Selectmees Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 11fl nT7VMTT :i i i c n i TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE cif/A/e— JOB. LOCATION Number Street address Sec ion of town "HOMEOWNER" �p Name c Home phone Work phone PRESENT MAILING ADDRESSAIVA ` Ci y town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Officia on a form acgeptable to the Building Official, that he/she shall be responsibl for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the Sta Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said proced=. nd/�Oequi ements. HOMEOWNER'S SIGNATURIA APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. TOWN 61�BARNSTABLE BUILDING PERMIT APPLICATION-!, Map- ParcelI Application # n�lf Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee &5 ''00 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village -4�n}.. Owner �.,,,,��r Address Telephone -�53- Permit Request r,fl.cC-.zCV,..r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1 yam. — Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 1k Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's H,ighway-0 Yet,- ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces; Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mi!re M _ acti"ini _ Telephone Number Address PO Box 52 License # Cell (508) 280-6964 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ATE FOR'OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. ' ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT r A 2 ASSOCIATION PLAN NO. • Town of Barnstable • g Regulatory Services Richard V. Scali,Director Building Division _ Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www barnstablema.ns Office: 508-862-4038 pax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, L46 l Q WY ,as Owner of the subject properry, hezeby authorize to act an my behalf, Cin au matters relative to work aathonl by this building permit application for: la �aryaYol Skr��atn�i M� b2(a01 (Address of Job) "Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilired before fence is installed and all final inspections are performed and accepted. 1,512.1 C-O elr Susan Comer(Apr 10,2015) Signature of Owner Signature of Applicant Print Name Print Name Date Q"$Ms:owNE"WtMISszoriPOQIS . r Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction SupervisorWL License: CS-058633 MICHAEL J MCC�R PO BOX 52 s W DENIMS MA 0267 Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation ` 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration ? Registration: 169393 r x 7r Type: Individual d+ .. G` Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY �r MICHAEL MCCARTHY 'i h P.O. BOX 52 , WEST DENNIS, MA 02670 Update Address and return card.Mark reason for change. 20M-05/11 l Address Renewal L] Employment j�] Lost Card 1 The Commonwealth ofMasrachuselts Department oflntlustrialAccitlents I Congress Street,Sitite 100 Boston,MA 02114-2017 www.mass.gov/d a Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pltimbers. TO 13E FILED FYITII THE PERMITTING AUTHORITY. Anulicant Information ar.a M rthy CGM%truetiolli9lease Print Le ibly Name(Business/Organization/Individual): PO BOX 552 Address: Nest Dennis, AIA 0267 - 8 210-6964 City/State/Zip: CSL- � V: HIC-169393 Are yot an employer?Check the appropriate box: Type of project(required): I.7m a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.0 1 am a homeowner doing all work myself.i14o workers'comp.insurance required.]t �• El Demolition 4. 1 am a homeowner and will be hiring contractors to conduct all work on m 1.0❑Building addition ❑ g y property. 1 will ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs Or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. These subcontractors have employees and have workers'comp.insurance.) 13.❑Roof repairs 6-❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.90ther 152,§1(4),and we have no employees.[No workers'comp:insurance required.] •Any applicant that checks box#I 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. tContractors that check this box must attached 9n 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 Are policy and job site Information. p� Insurance Company Name A / t MAJO —InT. o.•�p�nv Policy#or Self-ins.Lie.#: V W(/ l00—601 '7(S6—--d)`( Y Expiration Date:_ Job Site Address:_ ' its Q 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER-and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerfify un t! al s and lli aes rjuiy flint tlie:informatlon provided abov is trite and correct. .Signature: Date: S )t Phone#: Official use only. Do not tvrlte 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• milk -J WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMA'flWPAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 26158 POLICY NO. I VWC-100-6017656-2014B PRIOR NO. VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P O Box 52 FEIN:""-"`3862 West Dennis, MA 02670 Legal Entity Type: Corporation Other workplaces not shown above: See Location. 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m. standard time at the insured's mailing address. 3. 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 3.A. The limits of 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.Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by'our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual 'Of Annual Remuneration Remuneration Premium INTRA 0712979 INTER SEE CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV I GOV Deposit Premium $7,748 STATE CLASS MA 5479 State Assessments/Surcharges $28,601.00 x 5.8000% $1,659 This policy, including all endorsements is hereby countersigned b � P 9 � Y 9 Y 12/15/2014 Authorized Signature Date Service Office: Bryden &Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 1 Burlington MA 01803 So Dennis, MA 02660 / WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. Parcel Detail Page 1 of 4 TAR w a Logged In As: Parcel Detail Monday, May 11 2015 Parcel Lookup Parcel Info Developer Parcel ID '307-146 Lot LOTS 15& 16 Location 19 HARVARD STREET I Pri Frontage 100 I Sec��" _ Sec Road I Frontage t Village HYANNIS �� Fire District yHYYANNIS Town sewer exists at this address}Yes I Road Index 0670 I Interactive . Map �� Owner Info Owner[DOHERTY, LAURA FROST- Co-Owner jr%COMER, SUSAN I Streetl IT39 MORGAN ROAD Street2 City CANTON State FCT Zip�06019 Country J Land Info Acres r0.19 � Use Single Fam MDL-01 Zoning RB mm Nghbd�0106 Topography Level I Road Paved Utilities Public Water,Gas,Septic Location Construction Info Building 1 of 1 Year Roof`�---- Ext ".. Built F935 struct Gable/Hip wall F od Shingle Living Roof —.. AC - p 2667� � Cover Asph/F GIs/Cmp one Type Area Style t Bed IColonial ) wall Plastered Rooms R4 Bedrooms ) w Model lResidential Int Carpet Bath[2 Full-1 Half s4. ` Floor Rooms Grade Average Plus Neat Hot Water Total 8 RoomsType �u " Stories,2 ories Heat Gas FoundRooms'ConC. Block �1 ` ° M', Fuel a ion z Gross 4204 Area Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=24691 5/11/2015 ` -' Town of Barnstable (` y Post This Card So That it.is Visible From the Street-Approved Plans Must-be Retained on Job and this Card Must be Kept , f Posted Until Final Inspection Has Been Made. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit Permit No, B-17-4125 Applicant Name: Approvals Date Issued: 11/30/2017 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 05/30/2018 Foundation: Location: 19 HARVARD STREET, HYANNIS Map/Lot: 307-146 Zoning District: RB Sheathing: Owner on Record: COMER,SUSAN EACOTT TR Contractor Name: Framing: 1 Address: 139 MORGAN ROAD Contractor License: 2 CANTON, CT 06019 Est. Project Cost: $22,408.00 Chimney: Description: Replacement Windows(36) U-Value .29 Permit Fee: $ 114.28 r Insulation: - Fee Paid: $ 114.28 Project Review Req: Date: 11/30/2017 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. . All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7. Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable *Perms o Q.O Expires 6 mond ro srre d Regulatory Services Fee aaaMA13M v azass. $ Richard V.Scali,Director 'OrFn nita't� BI)<ildldlg Division Tom Perry,CBO,Building Commissioner 100 Main Street,Hyannis,MA 02601 www.town.bamstable-ma.us Office: 508-862-41038 Fax: 508-790-6230 EXPRESS PERMIT APPOCATION - RESIDENTIAL ®NL`�' // NotValid tvirho►rt Red,Y-Press Imprint Number_ 3o 7 � � b Property Address /q � (�/✓�tra/ S-f Wla.,-,- � residential Value of Work S 1 Z. y0 Minimum fee of$35.00 for work under$6000.00 0,amer's Name&Address SU.sa,-\ Cp&l e r /9 ��,.k�� S� ,.5 0 Contractor's Name W DtJ WOttA 1,)F-FF S /F.FU-� Telephone Number 7 ¢c3Z of 3�r'D� Home Improvement Contractor License''-:(if applicable) /&6 OZj Email: Construction Supervisor's License#(if applicable) 87 2-'7 7 2-- - YVorkman's Compensation Insurance AN Check one: ❑ I am a sole proprietor ❑ I am the Homeowner NOV 3® 2017 I have Worker's Compensation Insurance r z �m NN O�BARNS ABLE R Insurance Company Name 'gt� ` PZ;� �V-Qt( Aa Workman's Comp. Policy# ZZ W j�,C- --T 26 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ side �placemenf Windows/doors/sliders;U-Value .29 (maximum.32),#of windows 36 #of doors: I _ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic.Conservation.etc. "*Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE- C:\Users\Decol r mdo vs\Temporary inf6met Filcs\Cbntent.Outlook\)PPIOI DFIR\EXPRESS.doc Revised 0402I; Window World of Boston,LLC MA HIC Registration Offices&.Showrooms Number. G y Q 15A Cummings Park 0 295 Old Oak Street Feder1 a I Wobum,MA 01001 Pembroke,MA0659 daIlD5 'Simply Best lot Less" (781)932.4805 (781)826-6281 ' wvJvV ii owfNoildofBoston.com Customer. Phone Install Address: Phone Q j�yt7 City. State:MA`ZipP�� Email WINDOW WORLD GLASS OPTIONS 1000 Series,Single•hung AgWeld $189 SolarZone Ellie _2000 Series DH MechiWelded Sash $215 _Triple Glazed TG2t $195 �400DSer'tesDHAII•Weld $225 (`Se/ios6006Only) 6000 series o14A11-Weld $260 . WINDOW OPTIONS _2 Lite Slider $364 _LG4assBreakage Warranty $75jNC1UDE0 _3l.ite Slider pi3,ip,tlq pt+,'usvq $545 �t—/ '1/ /2 Screens $91NClUDED —Picture/Fixed Lite $354 oam Insulation on Jambs ard.Head $11 INCLUDED _Awning $280 /Double Strength Glass $16 INCLUDED Casement $310 _� Double Locks(>26') $51N(LUDED 2 Lite Casement $ _Full Screens $22 _31.iteCasement riAlAuat tw4omire $880 Cotoniat Grids(Cdntoured/Flat) $48= Basement Hopper $334 —Prairie Grids $51 Diamond Grids $69 —Say Window-Soffit Mount/INS Seat$2660 —Simulated Divided Cite $182 _Bow Window-Softit.Mount/INS,Seat$2785 —Tempered DHSash(BSO)'(TSO). $65 _Garden Window, $2040 Obscure Glass(BSO)(T30) $35 ^Specialty Windmi $ _Oriel Style(40/6(F.or 60/40) $30 nefge/Mmorid $40- _Faam Enhanced Frame $35 _woad Grain interior(Sei es 4000/600:onW$100. PRE 197E BUILT HOMES(EPA LEAD SAFE RENOVADON) (Ughr Oak/Dark Oak/Cherry/Fax Wood :'Lead Safe Prances Required $30 fL Itahmopre) MY HOME WAS BUILT IN THE YEAR ` d3 Initial Brawn Exterior(Arch.Bronze/American Tena)$1013 Des narColor rfor t75 MISCELLANEOUS i9 $ J�Custom Exterior Aluminum Cladding Wiridax Color ,/ 157 O.Textured$ASR.M."MMAP0 rmforo - oulwa:- Facing ColorNON CU$TOM.o00RSMetal Window $50 Vintd Rolling Patio Door So..atOIL Sim _NowConstNe6on Vinyl Removal $175 ' _j_Varyl Rolling Patio Door 8R Sim _LSpectalty Window Exterior Trim $ Add to base pricelm GUstorn fto fu g Pal 0 floor$1250 Mug to Form Multi Unit $30 French ftu Sildlng Patio door fit ocsit. $1395install Interior/Ekterior Stops $50 _French Rod 31d'arg Patio Door tat._ $1495 -install Interior Casing Starts At$95 _French Rail Slid ng Paso coor9fi. $15M Minsulate Weight Boxes $20Z� _Custom Exteder 0adtGng $1363 _Rool for Bay/Bow Windows $500 _L6olerZone Elbe or kTC Glass ' $205 ZQ5 Existing NewConst.Ext.Retro Fit $150 (olds Patio Ooor $tag _Removal of Existing Bay/Bow $250 _:NlacdgrainintertoisRepair Sill,Jarnb.or replace-Miff nosing $50 _Exterior Designer Color-.; $a9$ Full Sub-Sill(Single)replacement $160 IrdettorCasing 2,r? S�� •_�L Mullion Removal $30 _Handloset options: 5 _Bay(Bow Conversion ExL Retro Fit. $350 Siding Will Not Match) rS DoorCotor _1 r , ' . Z a / owsda :. t ti I WN a i 0 r1 LNiA, . Customer declines exterior wrap-arid understands-painting and/or repair may be required initial Customer declines grids on wlndows/doors Initlat DISCLAIM1111rCuslarner Is responsible for the fullehing twasnoadion with ibis comtt Kipting,Staining,Alarm SystemdscannecVrerromed StA tgPermlihosin exoessaF9no0,Hdmeavner and arCendoA sWatlonAppraval,HistoricOlstnatAppmratCiyof Boston padarg&sidewelklutmt fees InconneeBanwMinstalatton:. NiD EXTRA WORK IF NOT1N WRiTINGI Customer agrees to the term of payment as f0 ows: Exha tabor&Materials $ O/9 Site Setup; elm f Disposal&Delivery Fees$ $389.00 73 - h TlT. KS Total Amount$ ZZ4rW-.r " r- Custom Order Deposit 60% $ /Z Ck# . 9ZO Balance Paid to Installer upon Completion 9117CAl Amount Financed;$. window Viand of Boston anticipates starting this work on andOenpsohstaittlalycompletedrays:Securitylntemstyes No Anydep�ilrequkedinadvanceetltestaztafdleworkSHALLt 6'"033U37althetwalcometpttceortheactialcostofshyMateialoregmpment0oa special aberor custom made nature<tidtitdl must ba ordered in advarrce dtlre Stan of tl�a waUctoe59ure that tAe project vAll pmce�onsrmedut&Notmatpayrdent shall t8 demand¢d ar@7 the contract L5raempieled tothe.9ag5faCliell of hoBh patties.. All home Improvement coolmolars and subcontractors shelf be registered and that any inqtires ahout a comet.orsubcciftaetor vela ng to a fe0istiaCan should be dtrecled m:0flice al Coniumer ARatrs aed 0miress Regufadoi%Tea Part fthaz,%Suite 51T0 Bastoo,MA 8271B.Pbene:(617)973.8700 No viom drat begin pdor,to theslgning of the cindaicl and transmittal to the owner of a copy of such cordtael. Window Ykrhf of Boston under provision of Chapter 142A of the,general laws 19 repaired to appiytorand obtaiii'all eonstruciio"iated purink Window World of Boston shall riot be deemed responsible for delays In the work described in Oft agreement Caused by regulatarf pmmt gran6n9 agencies;auttroddes at bdulduais. Notice:lithe PURCHASER(S)abtaics bls awncoushuollan related patinas far the woik dotartked under this agreement or deals with urvegisferedcontractolk the PURCHASER(S)Is hereby advised that In the event at a dispute;iedgemant and eonpaymonl,the PURCHASIR(S)Wm not be entitled to make a Nelm er cbne Wan kom the BuarandyNitd established hydiafter 142A;16.GA. You the buyer may cancel this Iransacttonat any lime prior 10 midnight of the third business iday after the data of ibis tranimaon Notice of cancellation most be In writing postmarked no later than midnight of the folfewing Herd business day. RESALE! r. This Window Almlds Franclase isindepenileaffy owned and operated by!Z=of Boston;LLC,ua nice Ytldaw wad Ie. O Z vner.Do.riot also otaare arty blank epaeea, � e /7 .t Shceamarr.Do notainn tith any iblink,spaces. date V owner:Do not Stan,ll.tho are any blank i paaee Date. .. rmnaaii .. wwaa Ccpy.�0tigir1w Yeilowoepy-no Pink.Copy•Customer nmesvnnaeeesmiti4e; Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-072772 Const uct%on Sa:oerr,iso. JEFF C STEELE - 24 SHERWOOD AVE _ a DANVERS MA 01923 ..�.� '✓`�- Expiration: -ommissioner 04/07/2018 4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 166025 Type: �--- Expiration: 411212018 LLC ram_ - WINDOW WORLD OF BOSTON,LLC. JEFF STEELE 24 CUMMINGS PARK SUITE 15-A WOBURN,MA 01801 Undersecretary License or registration valid for individual use only before the expiration date. If found return to:office of Consumer Affairs and Business Regulation 10 park Plaza-Suite 5170 Boston,MA 02116 7/ .,Not valid without signature c. The Commonwealth of Massachusetts = d Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 s� www.mass.gov/dia lVorkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lezibly Name (Business/Organization/Individual): ,,Izndri u/ "rld -tr- f LG C Address: /.SOH Cu/>,.�►,'y1� S �r_ K City/State/Zip: Gw6 n p Phone#: ti 3 z - t-(8 o 5- Are you an employer?Check the appropriate box: Type of project(required): l.ffl ama employer with, 0 mployees(full and/or part-time).* 7. New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.FJ I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.7 Electrical repairs or additions proprietors with no employees. j 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other_W I d O or 152,§1(4),and we have no employees.(No workers'comp.insurance required.) f-,P A(e,,7q,ei--�`5 *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: Fi re Tn s,)Af11JC E cep . Policy#or Self-ins.Lic.#:p Z�2— VVr C L_ ,)� S Expiration Date: �� 2- — Job Site Address: /7 f tCt/'t/G ,,/ T/ City/State/Zip: 6444 f'S Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this s tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi tion. I do hereby cer ' under a pain erjury that the information provided above is true and correct. Si an ature: Date: Phone#: - .3 L- 9 0 Offr a use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �"1 - WINDO-2 OP ID: HI ACG?2D DATE(MMIDDTYYYY) CERTIFICATE OF LIABILITY INSURANCE 05/0412017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS j 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 l 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). I PRODUCER CONTACT Agency GSO NAME: Carli Witcher CISR,CBIA, CIC Marsh 6 McLennan A g Y' PHONE 336-272-7161 FAX No, 336-346-1397 3625 N.Elm St Arc No Ext: Greensboro,NC 27455 EADDARESS:Carli.Wtcher@marshmma.com I C.Timothy Ward,CPCU,CIC INSURERS AFFORDING COVERAGE NAIC S INSURER A:Hanover Massachusetts Bay 22306 i INSURED Window World of Boston, LLC INSURER B:Allmerica Financial Benefit 118 Shaver Street North Wilkesboro, NC 28659 INSURERc:Hartford Fire Insurance Co. 19682 INSURER D: INSURER E_ ! INSURER F: 1 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. �TEXP F I L TYPE OF INSURANCE I IN SD,WVD I POLICY EFF POLICY POLICY NUMBER L1MI7T (MMIDD/YYW)�(MMIDDN.YYYYY) A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE S 1'wC,000: CLAIMSMADE X OCCUF. 'OD6790252708 04101/2017 0410112018 UR 1 sES c Re-=%nce) 50G.000 iMED EXP(AOv one person) c 5.000 1 PERSONAL E ADV INJURY F 1,000.000 GEI_%AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000.000; PRO- POLIO`' JECT LOC PRODUCTS-COMP/OF AGG £ 2.000,000; OTHER'. S AUTOMOBILE LIABILITY COMBINEC SINGLE LIMI? 1,00G.000; (Ea accident) B X ANY AUTO AW68757615 061612016 0616/2017 BODILY INJURY(Per person'.. OWNED SCHEDULED _ AUTOS AUTOS BODILY INJURY(Per accident) j NON-OWNEC PROPERTY DAMAGE HIRED AUTOS AUTOS (PeraccmenU - i iAX UMBRELLA LIAR X OCCUR - EACH OCCURRENCE 5 L.000.0001 EXCESS LIAB CLAIMS-MADE ,OD6790252708 04101I2D17 04/01/2018 I AGGREGATE c DEC, RETENTION S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER I i C *ANY PROPRIETORIPARTNERIEXECUTIVE 7i,N A j22WECLJ2635 0112712017 01/27/2016 EL.EACH ACCIDENT S 5010,000; OFFICERIMEMBER EXCLUDED- (mandatory In NH) E.L.DISEASE-EA EMPLOYEE 5 5UL.000; I`ves describe under ' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB 5 506.000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.mat,be attached P.more space is required) j I i i i' i i I I CERTIFICATE HOLDER CANCELLATION i I i SHOULC ANY OF THE ABOVE DESCRIBED POLICIES BE GANCEiiEC BEFORE 1 l THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH,THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE f r� C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and Iogc are registered marks of ACORD