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Town of Barnstable *Permit it rres 6 months from issue date Regulatory Services` feeBARNMBLE /� y Richard V.Scali,Director d® ®0 0 9. 4 �OrEn `" Building Division ' Paul Roma,Building Commissioner `auk 1 200 Main Street,Hyannis,MAQl�� o www.town.barnstable.ma.us ;� . Office: 508-862-4038 r��� � :.508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL 0� Not Valid without Red X-Press Imprint Map/parcel Number Property Address / //�YTY� I/� l KdMar Residential Value of Work$ 'Y��jS Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ���/////�'S t,�-- Contractor's Name '—/ }�' ` C • Telephone Number 776 o"Ile,-; Home Improvement Contractor License#(if applicable) �����/�� Email: �/� �� Cons tion Supervisor's License#(if applicable) /e9a�/./ Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑JA&the Homeowner I have Worker's Compensation Insurance Insurance Company Name j, � � /�1t'S, Cam Workman's Comp.Policy# / !yc 'yOfP-7b7-�� Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ (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) �s 57�0-4 ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *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: . _. QAWPFILES\FORNIMbuilding permit forms\EXPRESS.doC 01/25/17. Depardffaf offmhuftid AcdZgdts Office of1m.wagattons iwmmmamgopldia arimrs' Ca mpensadima 7nsm-ance davit BuilderslCaatractorsMecfiacians/Phunbers Amlivmt Infcn=tinn Please Print Le�y Nameea� Addres / e6 Cify/S to ig (� s�c� 7 76 31/ -,3 Are}emu an employer? 6�Checkthek appropriate bow ' Type of project(reg�eed}: l am:a employes with /we . 4. ❑I am a general canfrsctor and I 6. ❑New eansftuctios employees(fun anfor par"=e)* Piave hirediffte sub-cones 2.D I am a sole propEietor orparluef Tisted cathe attached sheet.. 7. ❑Remodel These sub-contractors have shFp and�e na employees 9.,❑Demolition la rvaridng forte fn any capacity. � yms �and: $hace wormers' 9: ❑Building ad3ifioa . INN�,.a&Oecs' camp.iacu•=e comp.iM • 5. ❑ We are a coaporaffou and its M El Electrical repairs or adds 3111 am.a bomeavmer doing all work officers have exercised their 1L❑P - grepasss or additions. self o w�' _ � of a fiaa per MGL �r s==e retained j T c.152,§1(4.andwe have no Eoaf employees.[gowodoess' a other ce camp.ms= required ❑_) •dayappficra aLstebe�sbosfflmnstaIsaffio tLesecHoabeTew ntdagfbeirvrnzicedcompevsatinupoycpiafanmsaoa Iffameovraea;wh sub=&ff s mokz agtdeyamdak.-RUwakauAt6mhimauhadeco�ftRc�. — snhmitanewaMda$tiadi�nasnrT+ fcaansctnsfdsstd,eaii,i boxmustw=rh anadditi—I sines shonsagtlnen=eoflmesab-cater mxmdsfdPwhetherarm&ftseeaitieshwe employees.if they�stgmsidetheir amrkexs'caatP•Pa Fabet I arrt err errrpTvgar fTttrt isgrauirTfrcg urorkets'con rtsrdiart iasriranca�vr arc}*emlvlo}�es Below it tha pa cy andiah site infonnaiiom Insmance Company.-Marne: Policy or elf i I;c. &piratibaDafe: !' Job TifeAddress: `9( '/�✓ �/ CstylS#afEf�ip: ,'� 1/��-S �J 0,2�� Af#ch a.copy of the workers'compensxtieapolicy-declaration page(showing the poficp number and ezpiration date). Failwe to secme coverage as requiredundes Section 25A of MGL c.152 can lead to the f reposition of criminal penalties of a fine up to$1,54a OU asd+'or one-gearimpdso—f as we11 as civil p—,, es in the form of a STOP WORK ORDER and a fee of up to$250-00 a clay a aiast the violafcr. Be adsised that a copy of this statement ffiag be f zwnded to the Office of Inestigations ofthe DIAL for iasurranca coverage yedficatkm Ida hereby certify cruder the pins and poems of Fa xp ffiatffra informationproiMed a-b7at�e is trrrs mid arrrect / Date- /0 —/ Phone iF ���— 76 OjEdid use wiTj. Do not wrke in tidy area,fa be cmnpfdad by rdtp artorn m,Oreiat City or Town: Pe-rmibUce se;9 Issuing$lnther€t)r(dde one): L Board of$•eaIfh BwTding Depm m.•ent 3.f*drown Clerk 4.Electrical Rmpectar S.Plumbing rmspecter 6.Other Contact Person: Phoontr#: - - 6 Er o Fd ro ' p b w acp o 0 El tg o " „, � � �,Er Qom, Et AEr Er Er rti O ° ram ° . A El b ArpEl10 s. b �"• p'r G H 4 I � � � rpl Vwl � � •l � � � I � � �1 � � W� `rD-1 CCn "Od q j � `� ° (�{�• V R 8 . q 11 1 �i p� � �` tr, ,• �i' � , O �,� CD � 7�WY � �y Fresh O `Q Id �t4 fp o n p �. , 40o I A • Y .'1 CP r a Town of Barnstable sl Regulatory Services of Richard V.Scali,Director Building Division t Paul Roma,Building Commissioner 639. ��m� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- 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 Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,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 procedures and requirements. , Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFII.ES\FORMS\building permit forms\E)TRESS.doe 06/20/16 �I Town of Barnstable E Regulatory Services AM * Richard V.Scab,Diregtor. Building Division. Paul Roma,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, jJ u A. Orb q- , as Owner of the subject property hereby authorize to d� SJ ��C. to act on my behalf in all matters relative to work authorized by this building permit application for. j f Aaw wl l Ave 4hl l'S, M a. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. 6� Signature of Owner Signature of Applicant A. Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOIoS f Massachusetts De • '� Board of Building Regulations of Public Safety and Standards License: CS-100111 Construction Supervisor STEPHEN L OR13E - 140 PLEASANT LAKE AVENUE HARWICH MA 02645 Commissioner Expiration: 01/31/201a lie � nz.rreo•n•cuealtic of-� /t c(wacfiiraeltj Office of Consumer Affairs&Business Regulations r HOME IMPROVEMENT CONTRACTOR I hype: Corporation .--Aeaistration Expiration WE =_ ��546 10/11/201 S Earth Safe,Inc;:! Stephen Orbe 140 Pleasant Labe��u I Harwich,MA 02fi45--. - Undersecretary �I Construction Supervii6-- Restricted to: i'Unrestncted-:Buildings of any,use group which contain's less than 35,00. d cubic feet(99T cubic meters)of enclosed space. s . { i i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS,Licensing information visit: WWW.MASS.GOV/DPS Registration valid for individual use only f before the expiration date. if found return to: j Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 .e�Sif Not valid without signature 1 " WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE *].M Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803:0970 (800) 876-2765 NCCI NO 26158 POLICY NO. AWC-400-7020258-2016A PRIOR NO. AWC-400-7026258-2015A ITEM I. The Insured: Earth Safe Inc - DBA: Mailing address: 140 Pleasant Lake Avenue FEIN:**-***1977 Harwich, MA 02645 Legal Entity Type: Corporation Other workplaces not.shown above: 2. The policy period is from 11/05/2016 to 11/05/2017 12:01 a.m.standard time a#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 a-pplies`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 INTEA 153035 INTER SEE CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $6,178 GOV GOV Deposit Premium STATE CLASS MA 5146 State Assessments/Surcharges $5,749.00 x 5.6000% $322 This policy, includin all endorsements is hereby countersigned b 1 14 2 1 p Y� 9 . � Y 9 Y 0/ / 06 Authorized Signature Date Service Office: Frank L Horgan Insurance Agency Inc 54 Third Avenue P O Box 250 Burlington MA 01803 Hyannis, MA 02601 WC 00 00 01 A(7-11) Includes copyrighted.material of the National Council on Compensation Insurance, used with its permission. Town of Barnstable *Permit � Expires 6 months from issue dare Regulatory Services Fee BAMSTABM �039. `0� Richard V.Scali,Director BuRding Divisiong-PRANS Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis, MA 02601 SEP 14 201li www.town.barnstable.rn Office: 508-862-4038 's�fl,fl` 9 bft O� 8ARIVSTAKT08-790-6230 EXPRESS PENT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 3 2—?j Q j} Property Address �j A ti/4 p�S A 66C V41/1/I I S YResidential Value of Work$ )L\, 7 3 7 — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address a+ct Vl U S (/rb-e_ c1—:1la/or C�r h e— Contractor's Name g nJvt Js / /I t So/l Telephone Number N 01, R�Q D Home Improvement Contractor License#(if applicable) / 73 2 L/ s Email: Construction Supervisor's License#(if applicable) 04q 7 t7 7 12<orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ m the Homeowner I have Worker's Compensation Insurance Insurance Company Name `Z.17110�OL I 41e�5 P/rl 1/tt S �fZ Workman's Comp. Policy# (d6f 6 315620 f I 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) Je-sideReplacement Windows/doors/sliders. U-Value y (maximum.32)#of windows Z #of doors: ❑ 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. t ***Note: Property kOwner must sign Property Owner Letter of Permission. A copy cK the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: Ln� C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 I > 1 Agireenlient Document -and Payment Terms FU:936079j.MA 4173249i ,lM M% Le4d'.Firm#123F r�rann4 MIN 026Qa v■a� 'za Abcor lincedr0.i-tlz®65 'C5IX Y7 5 5s4E 'Pt+tidiE: r 22 5 M F3d.:aG1 fi3 € 1 sa reni=r;alsna.c :k aG 3'19•8759 i sy`i�aurie;Octayia us 0101be and Manorr,Wbe xiate1.cr C3 r,m 4 i irs�a i 3 ,4tt[ce'}i,d�l qq 1 awes Ave, Hysn'"K,� LA.0'26,01 1'iaeustTdj511faL Lvienp be a- : . o©Ct e: �IB� � II IJIS18i1L:t ' 'y! Odom . . �E70(9¢191�B�°i�Jl��;l: buyt&j hereby,jar.nel..V andismuflyagve, oea pu mhasc d t pre ucis andlo.r stevaues ,die .er1. {ICn� 3:' 0 uneL s, L3:t :dlt a ®v :�!klw$trsd:lil rt� aivalita� Il l'S'S'.Ea4 In wecotd ur,�+e'widbi Ait ievi u9 mb d conddidow its. 'bed dlais.t vgtll Dxummx. I'azrraem TI'6nxs�Nodce of Cahn haun.km-hed Ordirr k.oMpi,.Tam aired +nd.�i�nilr±$oF ,,SNE CC_Aurh Fo:rag;POF 8speff pd,5sles Cmi,Saw tri :F' bra rri d�+CS1.'.}¢L IHWm'(�C:r&L",Irnpaetl nr Praj i I nfomudwa d any r rheea dm.uii so sQaasdrad mis x Bern i; th`toms of�e aA mill igutid�lair chs partiiM and iiuewrponred y:Acme(ad6cxiuAl. ah �a crtir'�-'6u ree s 'he ;arrczs u sign.a:off® iam�errifa®ttc a f*tta C�uaeaa or h7s enpleted all*rs A vndu dt.is reeni st_ ` 11ah! iiisdrisiyk: $20737 By$19pj"ins WOUMeK You zt k a' h'° Fhtari rrla�5i llrr rd,i; �m 1 dwk b it che* iC ,dyr,cwh_ 14 .1�i SI; S2S Estefivaftl&inr k.,eei i fed d rran pk tlrAfibia: kkn 'of,pd iit.:iit: Chit Card ' f let "ursraDl runs e, gat d>cdart�f rlle'si ±al .nur ae' ldl.seu imilla�il�r mn the dlaEc 6 W.tidh Ve oe►reifslpt�-alpIMI.ueie mpremeeuts-IbE.instal6t6a 6te t6m.. . N62M1 paid.by,CC Z.8 pold are pro�-adlrnZ ae eh is tiratc is only;an cwmstc. '4 �arill v�a�mu nirarr n t�h$ci�l'd4�1Ge ups ilartl€aamotatio i. avid anent at a 116[ee,dam I Atrand ir. is wcudt iey ate dtt ifrioit rtafranjon Cad s f(je Taxes;pald'lei I�l �irtiis dlel }c .Ba_W"W saxes and undeua dw-i mJats Agmewnd. nx-hures the em'dme U:nsll r izkgp keaweem ehe panim end dur,&re,are n•�%xiW ueUdca*=dlat9 Auaul8ln-OF 15IM1fCC�un�iitq of tlat a�tum crf this.;�(�n iikul_No atl Dumlam io oe deviaAms!6m 6is Aputive-tit MU be 4d mddw im Ae sipg 9,wri,rredm caa na cif borhi r,he ��r, c�md Cencmrrrlr B t, (s)ll n*,a�lc-im+�le �rl3aq:l� sr(a) L'�leas t�k l ibis,' eei ar;,unJ-:rRan&dltc i10 ias Olaf irks�4;pmlinkm and has Fecci l a co6Flp�ae�, I�U�,.�IOf�ti=1 COPY 016h Ageement,iG16lt'iJifl,FI thr to m zincked Mast mn 9'r-a toe-Uaiaan,or.the dare firm*iis'lmm ANW4 Mrad 21 WM Oi2[1),infii¢WMd of liUTWIL:FOT as d amda!this, ,F�i�;ceeyn�srut.. l`���161C�''0_,'f�:�1� �.k:}d::IGD� �4�t:tltiix ahPiie!td,e:e:att'@i�ilt."��u�i�ki9eiel�G d���k�l"�uf i:l;,c air®ea:udYe pit rite auia� ,ci.:��ii. i Y YOU,THE BUYER,,kNWCANCELTHIS TRANSA TON AT ANYTIMENOT LAUM THAN vRDN GL r~' 1201 4i"lQ`lfi T H IRDI BlJifi l l 5. i},r?lt 4 T ,I }; T�[i TRj # 'm , lax r' I VrEIL SEE .rHt XTIFACHIE-11)NOTTU OF NCELLAMON>�RM. FOR AN aa►c R.Mc-A kti.Angle q ic�+�.pY,,�14nsa �nGlarid, nuts b'1. Esc d5 L ilLS L' tswea 1 rutir l'�cfart 1'rai5t 14;.i iaie Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts Deoartment of Pub is Safety --card of Su'liding Regulations and Standards encase. C.S-095707 Q+21;r �z r BRIAN D DENNISON 7 LAMBS POND CIR CHARLTON MA 01 0 Expira-rion'. i o rn M 1 S S n er 09/081'2018 Office of Consumer Affairs find Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL E-Virstion: 9119M016 DENNISON BRIAN 26 ALBION RD LINCOLN,RI 02865 Update Address and rdum card.Mark reason for changL -------[3-Addres;-0 Renewal--o-MOloynient-0 Mikrara &On.of C;aammer Agairs&Rasisess Peguistio. License or regiarbration valid for ibdividul an only E RAPROVEMENT CONTRACTOR before the expiration date. Iffound return to. Office of Consumer Affairs and Business Regulation INIZINU012: 173245 Type 10 Park Plan-Sake 5170 EXPIM110n: 9A9=16 Supplemerd---aro Boston,KA 02116 SOLM4ERN NEW ENGAANDWINIDOWS LLC- RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD LINCOLN.R1 028W Not valid without signature I - The Common wealth ofMassachrtsetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,AM 02114-2017 N VIV,Mass.JovIdra Workers'Compensation Insurance Affida-6t:Builds rs/ContractorslElcctricians/Plumbers. TO BE FILED«7TH THE PERMITTING AUTHORITY. Applicant Information Please Print Lem"biv Name(Businesst'Organization,Indiaidual): (,{, O EaGklh (O-5 nddress:_ -ar✓p 1�6t� ~— _ City/State/Zip: o Phone�: t Are you an employer'.Check the aPppropriate box: Type of project(required): 1 X i am a employer with 20 r etnplovees(full and/or pan-Lime)' 7_ New construction 2.1'1 am a sak proprietor or parmtrship and have no employees working forme in h. Remodeling any capacity.[No teorkcr>'comp,insurance required.i 3.Q I am a homcoamer doing aif tinrk rmsel`(\o tcorke`rs camp.insurnce re�uird.); 9- ❑Demolition 10 Building addition l.❑1 am a homeowner and will be hiring contractors to conduct all trexl on my propxt}. 1 hill ensure that ail contractors either have workers'compensation insurance or are sole I I_Q Electrical repairs or additions proprietor with no employees. 12.❑Plumbing repairs or additions 5.❑f am-,senerai contractor and i havc hired the sub-contractors listed on the attached sheet 13.0 Roof repairs Tftesz sue-contractors rave employees and have tvor';crs comp.insurance.* �-�/ 6.❑We are a corporation and its officers have exercised lheirrigbi of exemption per%-ML c. 14. `1�Other i>l,;1(4),and the have no employees.[No workers comp.insurance required.l -IF =Any applicant that checks box€t MUSE also fill out the section belor:•showing their workers'compensation policy information. +Hninemmers 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 atached an additional sliest showing the name of--the sub-contractors and state whether or not those entities have employees. If the sub-cu tiractors have employers,they must provide their workers comp,policy n mrbe, I mar an employer that is providing workers I compensation insurancefor rnj.,employees Belolr is the policy and job site* rnformatiolr. Insurance Company Name: wj a yk eS%�1Z6U � S . a Policy=or Self-ins.Lic.n: �A 313&Q 8,1 Expiration Date: / �7_ , Job Site Address:_ ) -0a L,)eS A,,(e_ City/State/Zip: 0 y 4 ,1/1 ,'TV`�✓'i :attach a copy of the workers'compensation policy declaration page{showing the policy nu�and esptratton date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to 51,500.00 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 DLA for insurance coverage verification. I do hereby cei ' under t/le pr-is and penalties of peijiny Mal the information pr ovided above is Prue and correct 3 Signature: Date: Phone Official«se only. Do not suite in this area,to be completed by city or town official. City or Town: PermittLicense Issuing Authority(circle one): I_Board of Health 2.Building Department 3.City/Town Clerk 1.Electrical Inspector a.Plumbing Inspector 6.Other Contact Person Phone : i • -. �.� SOUTNEW-01 UOLLINGER CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD1YrM 6129/2016 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 CONTACT .NAME: CoBiz Insurance,Inc.-CO °HONE 303 988.0446 FAx (303)988-0804 821 17th St -MI.No Eat:( AI No Denver,CO 80202 D ESS:CoB!zlngumnce@cobizinsurance.com INSURER( AFFORDING COVERAGE NAIC# INSURER A:COntinental Western Insurance Company 10804 INSURED INSURER B: Southern New England Windows LLC WSURERC: D/BIA Renewal by Andersen 26 Albion Road MSURER D Lincoln,RI 02865 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 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. -mrS SHOWN MAY HAVE BEEN REDUCED'BY PAID CLAIMS: INSR TYPE OF INSURANCE EFF -POLICYLIMITS LTR INSD .WVD POLICY NUMBER D MMID A I X COMMERCIAL GENERAL LIABILITY 1,000,00q EACH OCCURRENCE $ CLAIM"ADE OCCUR I CPA3136080 07/01/2016 07/01/2017 PREMISES Eaoxunenee $ 10000 MED EXP(Arty ore person) $ 10,00 PERSONAL&ADV INJURY $ 1,000900 �GENI_AGGREGATE LIMIT APPLIES PER: GENERAL AGGATE $ 2,000,000 PRO- PRODUCTS-COMP/OP AGG $ 2,000,00POLICY aJECT 17 LOC OTHER: EMPLOYEE BENEFI I$ 2,000,000 OMBINED INGLE LIMIT $ 1,000,600 AUTOMOBILE LIABILITY I Ee,cadent A X gp1Y gUTp �CPA3131080 ' 07101/2016 07/01/2017.,BODILY INJURY(Per person) $_ ALL OWNED i SCHEDULED i BODILY INJURY(Per accident) $ AUTOS NON-0NMED I AUTOS PROPERTY DAMAGE $ j HIRED AUTOS AUTOS Per-aecideM $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 A EXCESS LIAB CLAIMS-MADE CPA3136080 07/01/2016 07/0112017 AGGREGATE $ pEp X RETENTION$ 0 Aggregate $ 5,000,000 WORKERS COMPENSATION STATUTE OE TR H AND EMPLOYERS'LIABILITY YIN CA3136081 07/01/2016 07/01/2017 I,000,000 A ANY.PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA A E.L.EACH.ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 (ManddMln.NH) Byes describe-under E.L.DISEASE-POLICY LIMB $ 1,000,000 DESCRIPTION OF OPERATIONS below F DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addidonal Remarks Schedule,may.beattached irmore apace Is.raquired) 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. AUTHORED REPRESENTATIVE :.._._. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CAPE COD INSULATION 11l DATTf J ourTI JJ IN GY FOAM JUJOf NOLO Bltt! OU ITIYf INJUl1ilOH CJIIINOJ 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St _ Hyannis, MA 02601 ; ' = " Z" Date: n Dear Building Inspector - 4 Please accept this Affidavit as documentation that Cape Cod Insulation, �c. perfemeC completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village Y Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ) ( ) ( ) ) Floors ( ) ( ) ( ) ( ) Walls ( ) (Y— (13 ) (X) ( ) • r�,�2 ckw",7 Sincerely H ry E ssi r, President pe C Ins anon, Inc. r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application _ ©t w c� Health Division Date Issued OZ 11 71 , PIC- Conservation Division Application Fee ry ` Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic- OKH Preservation / Hyannis Project Street Address 2l 1 �l(9 Village mm - Owner W bpi Address Telephone Permit Request Lti D ✓lo I' Sl 0 6b` Uk Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District )Flood Plain Groundwater Overlay Project Valuation 5(rJf�O ' " `'Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting do cum tation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway::: Yew ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other n 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 Ao If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) _ Name ( � Telephone Number 57 774 ZI/ Address l ��(/ ,01? ��t '� License # B U Home Improvement Contractor# �b Email Worker's Compensation # WCC ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO UiW&MW dW SIGNATURE DATE 'V i FOR OFFICIAL USE ONLY APPLICATION # Is DATE ISSUED MAP/PARCEL NO. r , F r ADDRESS VILLAGE 4 OWNER ,s t •E DATE OF INSPECTION: FOUNDATION k FRAME INSULATION .� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i Massachusetts Department of Public Saf6ty ' Board of Building Regulations and Standards License: CS-100988 Construction Supervisor , � .; 3i HENRY E CASSIDY f 8 SHED ROW ' d WEST YARMOUTH MA 052673 ` f Expiration: • I�., Commissioner " 11/11/2017 r tt Office of Consumer"Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 .'Home Improvement Cdr>,,tra'ctor Registration ' Registration; 153567 ' r.r Y Type; Private Corpolion= i, Expiration; 12/15/2016 Irk; 25918.8 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 ' Update Address and return card, Mark I'ason for h1 Address Q Renewal Employ mna �� Los SCA I Ci 20M'05/11 Y ....... .. ... — — ..... " V/ie cpoa�r��Lovuverr�C�aa�C�/�t/«JJrrc�ccJeG�J �i License or registration valid for Individul use only �\ Of(lce of Consumer Affelrs& Eiilslness Regulation g y � ,• { OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to; eglstratlon; 1'53567 Type, Office of Consumer Affairs and Business Regulation : j xplratlon 12115/20/6 -Private Corporation IQ Park Plaza••Suite 5170 } -Boston,MA 02116 §.fr CAPE COD INSULATION, INC' HENRY CASSIDY s 18 REARDON CIRCLE'. SO. YARMOUTH, MA 02664 Undersecretary qNyid wi ut sign e t# F iS' C f' t j �i" The Cormnonwealth of Massachusetts Department of Industrial Accidents j Office of Investigations r . 600 Washington Street Boston; MA 02111 z J ww}v,mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers A pplicant Information Please Print Le ibl Marne (Business/organizatiorvindividual): Address: J City/State/Zip. /L �'Aft a Phone #: � Are you an employer? Check th appropriate box; l.�_employees l am a employer with "7� / 4. ❑ I am a general contractor and 1TYPe of project (required): (full and/or part-time),'` have hired the sub-contractors 6, ❑:New construction Ip 2,❑ 1 am a sole proprietor or partner- listed on the attached sheet, 7, EJ Remodeling ship and have no employees These sub-contractors.have g. Demolition working for me in any capacity, employees and have workers' comp. insurance,# 9. ❑ Building.�ddition (No workers' comp, insurance P� required.) 5, 7 We are a corporation and its 10.❑ Electrical repairs or additions 3,❑ I am a homeowner doing all work officers have exercised their i l,❑ 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, Other ' comp. insurance required,] *Any applicant that checks box 91 must also fill out the section below showing their workers' compensation policy information. r 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 attag..hed an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers' compensatlon insurance for my employees, Below is the policy and job situ,=. ,xnfo.rmation, - Insurance Company Name; G ,7 $li ChLO /'` �' ���z� /y, , ' Policy # or Self-ins, Lic. #: r �i l0�✓ Expiration Date: acy� Job Site Address: City/State/Zip; Attach a copy of the workers' cofpensation policy declaration page (showing the policy numbe 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 .Kriprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator, Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insuran4 coverage verification, I do hereby certify d the pal an penalties ofperjury that the information providedNOiVes true and correct. aSi nature; Date; Phone#: Official use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/License# Issuing Authority (circle one); 1, Board of Health 2, Building Department 3. City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector 6. Other (--tart parcnn, D1, CAPECOO-27 BDELAWRENCE �acoizo° CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 6/30/230/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE,POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Rogers&Gray Insurance Agency,Inc, PHONE ac No;(877)816.2156 434 Rte 134 E-MAIL South Dennis,MA 02660 ADDRESS; INSURER($)AFFORDING COVERAGE NAIC p INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURER B:ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation,Inc, INSURER C; 18 Reardon Circle INSURER 0: South Yarmouth,MA 02664 INSURERE: 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 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. ADDLSUBR ILT R TYPE OF INSURANCE - POLICY NUMBER MM/DDY� MMIDD�YY LIMITS LT A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEU_ CLAIMS-MADE M OCCUR CBP8263063 04101/2016 04101/2016 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO-JECT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY IT COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accidenq $ PaOaHNON-OWNED IREDAUTO r DAMAGE cden $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY B ANY PROPRIETORIPARTNER/EXECUTIVE Y� NIA WCE00431901 06/3012015 06130/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLVDEO' (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addltional Remarks Schedule,may be attached It more space Is required) Workers Compensation includes Officers or Proprietors, Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod insulation,Inc" THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS, 18 Reardon Circle South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION, All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Town of -a mstable deg _*tP ry 0 ces MA.4R• 'D�y.�tA,® �111�1�1D�;�1'i7I51E/a Tomperry,Bnil iie�gtouddsdmia 20O Mam S*k Ry=ni%U buo1 :ww�vtbwa.'i►ans�le.ma:as Prc>p.Er�y x plete:as �d ;TMs:�Seq o zf..using AB hez�bp�ut�onxe. �� COS /n�5t2�pGV 1�aa au uiybc�.. . in all:matters:rela veto woik.authoazed by: us . ` h pe .rapplimtion'far I olves 1-�Vt"7ty 11/7-1- IS ivq 'y'' 'ool;f is s and-maims ane. mspoh l 7,6' e-ap ins tio)ps arp.peafo rned:dad aece� eC, �� tu�eo. er- Si�asa:eofApplieant Pzut wine. :Pt Nance Date- t�:Foxrxs:o�i►rt�essiar�.00is. .. �� Town of Barnstable *Permit# ' � Regulatory Services Mumma 3MR,, Rivard v scah,Interim Director xv - RESS PERMIT Building Division Tom Perry,CBO,Building Commissioner JUL 10 2014 200 Main Stream Hyannis,MA 02601 ,. www.town.barnstable ma us Office: 508-862-4038 TO 6TA13LE EXPRESS PERWrA" RESEDENTIAL PPLI �� Property Address Avc- Residential value of work$ CJ y76 1 — Minimum fee of SA00 fakwork ceder S6moo t?wner's Nary&Address � lJ(i m uo alT B. �1 /fA ps ' vP ems,4A (AlU tJGS��✓ Tel NumberQDt-2Z� Contractor's Name A bpa ,r A Lt�l�aCln�s �O1e -r Home Improvement Contractor License#(if applicable) l 7!3 5' Email— construction Supervisor's License#(if applicable) 0��7 /�-7 ggYv 'aCompensation Insumme Check one. ❑ 1 am a sole ptopr ew I am the Ironer I have worker's Compensation Insurance Insurance Company Name Workmen's Comp.Policy# Copy of Insurance&nar ace,Certificate must accompany eaeh perm#. Permit Request(check box) . ❑ Re roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Rsroof(hurricane nailed)(not stripping. Going over existing layers of rod) ❑ Re-sic �RepbKmeM Windows/doors/sliders.U-value�---3-0 ( .35)#of windows #of doors: ❑ SmokeCubon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Deediaat&v%m Permits required. ,.,,,,1,,t,.,�� •Wh= lous of fts t�t does not exempt COL1Q�with odd tmm dVaUI At rOgAldmk$.Le.t;18ft*C,W=M00a,d. 0 **•Note: Property Owner must sign Property Owea Letter'of Permission. A of the Hsu Improvement Contractors License&Coosimelien Supervisors License is r SIGNATURE: T.433VIN_DM1> n8 CbM**8MDa%M PE,RIAMMIRES&doe Revised 061313 1 ,I NMI P;J'il , _ JT to Mill-it TR —117 `.1 a' ' � Of � ` 1 � ! La 11 IF ro 41 f i _: - — 1� All I i : 41 ri ME ;Il ' �� IfF gll� �' '. ; 7!1 r '1L e' e� C6 _ — 1� kill i 11 ib Southern New England Windows d.b:a Renewal by Andersen of SINE Massachusetts -Department of Public Safety Board of Building Regulations and Standards C(In'truction Super%isor License: .707.CS-098 .i BRIAN D.DENNVON - ,'- 7 LAMBS POND EIRC Charlton MA 0117 ` I� Expiration Comrrussioner 0910812014 IFNI � na,�jf���.o: ,,���1'�a�.lcu�`frc�u-<Office orConsumer'Arri lrs dBusmessRegulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registww- 173245 r Type; St[ppkttlettl Gaud SOUTHERN NEW ENGLAND WINDOWS LL Enpiratiore PJJ9. 414 DENNISON BRIAN —__..._,.. _.___....... _...... 1137 PARK EAST DRIVE ..._...----- WOONSOCKET,RI02895 __._........_...._..___ . .... ._.— Update Address and rnteva card Marl mama ter ebsage. o .,, Address Renewal Employment �.�Lost Card 'r^_Offin of Carom—,A141n!Bodo—Rtaalatiw Ikeew or so`6tntbo valid/6r indWMal of only -11 E 1MpRowlmtr CONTRACTOR before like expiration date.Itfaund nun to: A Office ofCensuaw Affairs and Busiow Regulation �4[ e"''""w.173M 7yPe: 10 Park-Flan-Sane$178 EaplraSon:9V7912014 Supplement:lard Boston,MA 02116 SOUTHERN NEW ENGtAND WINDOWS U.C. RENEWAL BY ANDERSON DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET.RIW89S ._.,._ _-.-..'�_—_._..____. Under—",y Not valid witbom atum The Commonwealth of Massachusetts Department of IHdrtstrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www-mass.govl a 'Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Apoficant Information Please Print Leaibl Name(BusinesslOrganLadion/Individual): s [L� Address: A (2p p e City/State/Zip: -lIl/CDI Phone#: YD/ m?a $" ?YDO Are you an employer?Check the appropriate boa: Type of project(required): 1.1 I am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time)-* have hued the SUb-dontractors 6. ❑New construction 2.❑ I am a sole proprietor of meter-, listed on the attached sheet. 7. p Remodeling ship and have no employees Thy sub-contractors have 8. []Demolition working for me in any capacity. employees and have workers' q n [No workers'comp.insurance comp.insurance# ❑Building addition required.] S. We are a corporation and its 10.0 Electrical repairs or additions -3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself,[No workers'comp_ right of exemption per MGL 12_[]hoof repairs insurance required.]t c.15 2'§1(4)'and we have no 13. 0$ter � Gt) employees.[No workers' comp.insurance required.] 'Airy 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 mustsubmit a new affidavit indicating.suc. tcontiactors that creek this box must attached art additional sheet showing the name of the sand state whether or not dim entities have employees. If the sub-cmMumn have etnployM,they must provide their workers'comp.policy number. I am an employer that Is provulrng workers'coo pensadon insurance for my enrployee� Below is the policy and job site information. Insurance Company Name: am 44V Policy#orSelf ins.Lic #: � � �� � ExpirationDate: c't Job Site Address:_ 3( CitylStatelTap: „S //?k Attach a copy of the workers'compensation policy declaration page(showing the policy num r 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 coveraee verification I do Hereby ce under the pains and penalties of perjury that the information prnvided abo77- ,hone#: ' and correct c Si ature: Date: `7 O,f)`l we only. Do not wrde in this ama,to be conrlet. by-city or town offlcial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2...Building Department 3.CiVrown Clerk 4.Electrical Inspector S.Plambinglospeetor 6.Other- Contact Person: Phone#• Client#:30124 SOUTNEW ACORD. CERTIFICATE OF LIABILITY INSURANCE DAT1E(MM1DDIYYYY) 8/06/2013 THIS CERTIFICATE 18 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(In)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 NAME; Anita Little Willis of New Jersey,Inc. PNONE :856 9144M No; 856-914-1881 1015 Briggs Road,PO Box 5005 EMAII. , antte.11tUe@willis.com PO Box 5005 Mount Laurel,NJ OB054 INSU AFFORDMCOVERAGE NAIC L INSURER A.-SeleCtilre lbsuraftm Co Of the S 39926 SOURED INSURER B:Argonaut Insurance Co. 19801 Southern New England Windows LLC INSURER C:Beacon Mutual Irks.Co. 24017 DB/A Renewal by Andersen INSURER D: 26 Albion Road Lincoln,RI 02865 INSURER E. INSURER'F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER- THIS IS TO CERTIFY T HAT`THE POLICIES OF"INSURANCE LISTED BELOW HAVEBEEN 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. LTR TYPE OF INSURANCE INSR U6 POLICY NUMBER POLICY EFF EXP LIMITS A GENE whelurY 5202945900 8/10/2013 08110/2014 EACH OCCURRENCE S11,000,000 N MERCIAL GENERAL LIABILITY a 100 000 CLAIMS-MADE OCCUR MED EXP/Any.c a person), $10 0OO PERSONAL&ADV INJURY $1 000 000 GENERALAGGREGATE s3 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s3,000,000 POLICY JECTPRO LOC $ ,A AUTONIOBILE LIABILITY S202945900 0811=013 08/1012014 COMA BINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDUI I D BODILY INJURY(Per accident) $ AUTOS AUTOS X HIREDAUIOS. X AUTOS PO TY "GE S S A X UMBRELLA LIAB OCCUR S202945900 8/10/2013 0811012011 EACH OCCURRENCE $5 000 000 EXCESS I" CLAMS-MADE AGGREGATE E5 000 000 DO RETENTIONS s C ►ORKERS COMPENSATION 0 8028-RI 8/21/2013 08/21/201 X t+VC STATIJ OTH AND EMPLOYERS!UAWLRY T � B ANY PROPRfETOiLPARTN13LlEXECUTIVE� AIC927818352394 /2t/2013 08M/201 E.L.EACH ACCIDENT $1 000.000 OFFICERMMEMBEREXCLUDER N MIA ( undw ybes�,+coy in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 DESCRIPTION"Coo OF OPERATKNIS below E.L.DISEASE-POLICY LIMB $1 000,000 DESCRIPTION OF C QERA?TL'Y.S;LOCATIONS.'Yam:C.S E:(ASa't+ACORD IOS;A SaeceFRectaeks Sehed ts,9 mots ePme Is se4u3rad) CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. uncoln,RI 02865 AUTHORIZED REPRESENTATIVE � 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S215109/M215088 AXL W �— � �o t V ' ra The Town of Barnstable Barnstable Office of Town Manager ►ui-amedcacKy * BARNSTABLE, MASS. 367 Main Street, Hyannis MA 02601 �A 1639. rFor s www.town.barnstable.ma.us Office: 508-862-4610 2007 Fax: 508-790-6226 Email: John.klimm@t6wn.bamstab1e.ma.us John C. Klimm, Town Manager INTEROFFICE MEMORANDUM TO: David Anthony- Procurement FR: John C. Klimm DT: October 23,2009 RE: Notice of Cancellation of Street Opening Bond=Octavius A. Orbe Please see enclosed for your review, information and records. Thank you, John 00 Enclosure JCK:jp ;2 C:) rn r �d ., The rOkk )1� F^ ; W. an®verInsurance Group° V/ r OCT15 p3 -20 BOND DEPARTMENT + s� THE MASSACHUSETTS�BAY INSURANCE COMPANY NOTICE OF CANCELLATION Town of Barnstable Office of Town Manager 367 Main Street Hyannis,MA 02601. Bond No.BLN-1755281 WHEREAS,on or about the 6"' day of November ,2006 THE MASSACHUSETTS BAY INSURANCE COMPANY,as Surety,executed its bond in the penalty of Five Thousand Dollars and 00/100------------------------------------($5 000.00) on behalf of Octavius A. Orbe of 743 West Saddle River Road:Ho-Ho-Kus:NJ 07423 as Principal,in favor of Town of Barnstable, as Obligee (Nature of Risk Street Opening Bond ), and WHEREAS,said bond,by its terms,provides that the said Surety shall have the right to terminate its surety ship there under by serving notice of its election so to do upon the said Obligee,and WHEREAS,said Surety desires to take advantage of the terms of said bond and does hereby elect to terminate its liability in accordance with the provisions thereof. NOW,THEREFORE,be it knovm that TF—P MASSACHUSETTS BAY INSURANCE COMPANY shall at the expiration of 10 days after receipt of this notice be released from all liability by reason of any default committed thereafter by the said Principal. Signed and sealed this 7'h day of October ,2009. T" S T BAY CE, :ANY BY: Mary�"nAedy,Atto ey-in-fact Reason: per Agent Request;PROPERTY SOLD cc: Octavius A. Orbe cc: Marshall K.Lovelette Insurance Agency,Inc;West Yarmouth,MA (32-5267) 440 Lincoln Street ■ Worcester,MA 01653 P h o n e 1800-343-6044 F a 1 1 508-855-3073 w w w . H a n o v e r c o m 271-5866NS(1/06) r. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 4 D Parcel 00 Application# Q60 6e 4S3 Health Division. Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board o Historic-OKH Preservation/Hyannis P Project Street Address Village � / Nh Owner ©�// . / - ®��'�- Address � � dc��' 114211�� JAJ ' Telephone Permit Requester Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑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 0 No r 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-0 Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name / S - � Telephone Numbe 77 S Address 1?/ / /A-V /�Vc�_ License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 13 FOR OFFICIAL USE ONLY A n PERMIT NO. DATE ISSUED MAP/PARCEL NO. f ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ' FRAME 1 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL . l PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL i FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ' i ne t ommunweacrn vJ lnussa.unuyecca Department of Industrial Accidents Office of Investigations Y ' d 600 Washington Street Boston, ND4 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 3l7✓ 15 /�7/ City/State/Zip: ' �l-S Odf Phone #: � Are you an employer? Check the appropriate bo 'Type of project(required): 1.❑ I am a employer with 4. 21 am a general contractor and I 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. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Ro airs insurance required.] t . employees. [No workers' 13.ET&er 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 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: 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 certify under th ai an a al es f per' that the information provided above is true and correct Si azure: Date: `7 Z/, 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 Person: Phone#: 3 Information and Instructions .. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. "...every person in the service of another under an contract of hire Pursuant to this statute, an employee�defined as every p y , 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-contractors)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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicens a 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 burn 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tell- _617-727-4900 ent 406 or 1-877-MASSAFE F ax # 617-727-7749 Revised 5-26-05 u-w-w.mass.goviaia Town of Barnstable Regulatory Services Sg Thomas F.Geiler,Director Building Division.' Tom Perry, Building Commissioner 200 Main Street; Ijymnis,MA'02601 www.town.b arnstabl e.m a.us office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and sign TWs Section, -If Using ABuilder I, -/ ' ' ,as,Owner of the subject property hereby authorize CUB to act on my behalf, in all matters relative to work authorized bythis building permit application for. v` 31 fY// -J!S I�V,- rli/AI/S /rim (Address of Job) /e� Signa of Owner Date Print Name Q:FORMS:0WNWEP1,Iss10N DOCUMENT n-ch-'Ati� e (awe 'Flame - 'Q �;tse ISSUED BY Date of ShiP'm N1 S_E R ent EVANSVILLE, INDIANA 47725 Tent Idenfifica t iall MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN -,erbfy that the materials described have been flame-retardant treated ire inherently noninflammable) and were supplied to: 254_'()0 PARTY CAPE COD 60-0 MACARTHUR BLVD POCASSET MA 025592230 --Jhot-, is hereby made that- .ff°!CI les described on this Certificate have been treated with a flame-retardant approved -a' and that the application of said chemical was done in conformance with California Code. All fabric has been tested and passes NFPA 701-99. CPAI 84,......... ULC log. ----------- Flam,e Retardant Process Used Will Not Be Removed Washing And Is Effective For The Life Of The !Fabri c Signet!: S PEC'AL EVENTS G1,'j0t4.AK'HOR INDUSTRIES Please take this certificate of Flame Resistance to your local building department to attain a permit for the tent installation. Massachusetts State code requires a permit for all tent installations. Please he advised that a Dig Safe inspection is also required for all tent installations. In preparation for the inspection Dig Safe requires all sites to stake the tent area with white markings. Party Cape Cod will call vou the week of your function to advise you of your inspection date. To Y t 3m Date (� . Time f (WHILE YOU WEFT OUT M �T of Phone c;20/ Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message Operator AMPAD 23-021-200 SETS EFFICIENCY® 23-421-.400SETS CARBONLESS /Z -3 - 9b Eleanor Orbe 743 West Saddle River Rd. Ho Ho Kus, New Jersey 07423 �?y-r s7�ble 0)' 9 --- LF.Q1`� a n10 � o,�r ,&Z�?A p .s lf-�,C) r vv Gay'' V e- h 67 Y� ea use a7 �E �r;�--gin 4;C ° � � v 5 � h b)e haile 4 0 t)Y'S ��Yr Lf --fit- ---,-- - The Town of Barnstable .nRr,erns�. • ' � ' Department of Health Safety and Environmental Services 9- Building Division 367 Main Street,Hyannis NIA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner ,I October 25, 1996 Octavius Orbe .-r - - 39 Hawes Avenue Hyannis,MA 0'2601 Re: 39 Hawes Avenue,Hyannis, MA Nl lap!parcei 3231003 Dear Property Owner: A review of our records, including the permitting history of 39 Hawes Avenue,as well as the Zoning Board of Appeals records indicates that the use of that addres.z as anything other than a single family home is illegal. You are hereby ordered to discontinue the use of the above referenced proper;as it is now being used and restore it to a single f'amils home. You are to accU-,;plish this vyork and notify this offli ce to inspect within 14 days of your receipt of this letter. A building.permit musi be applied for to redesign the la your to accommodate the conversion. You must do this before you make any changes. You have the right to appeal this decision. if you so choose_ %e v ill be more than happy to help you. if we do not hear front you within the 14 days, at e�,�ill be forcee W se_ek criminal action, against vou. t Very truly yours. Gloria M.Urenas Zoning En,OTCenient Officer . i GMU,'kni CERTIFI.ED MAIL P 229 805 345 R..R.R. i i I Q960712B — - — 7 LdC1,0`039 HAWES -AVENUE CTY] 07 TDS] 400 HY KEY] 235436 -�-A ING—A-BDRES ==`-PCA] 1011 PCS] 00 YR] 00 PARENT] 0 ORBE, .00TAVIUS A & ELEANOR MAP] AREA170WC JV1312815 MTG10000 743 WEST SADDLE RIVER RD SP1] SP21 SP31 UT11 UT21 . 55 SQ FT] 2202 HO HO KUS NJ 07423 AYB] 1930 EYB] 1970 OBS] CONST] 0000 LAND 232700 IMP 153500 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 386200 REA CLASSIFIED #LAND 1 232, 700 ASD LND 232700 ASD IMP 153500 ASD OTH ##BLDG (S) -CARD-1 1 153 , 500 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 31 HAWES AVE HY TAX EXEMPT #RR 0675 0120 1825 0200 RESIDENT'L 386200 386200 386200 #SR WHIDDEN AVENUE OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE] 00/00 PRICE] ORB] C58009 AFD] LAST ACTIVITY] 07/14/95 PCR] Y ft323 003 . A P P R A I S A L D A T A KEY 235436 ORB°E, OCTAVIUS A & ELEANOR LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 232 , 700 153, 500 1 A-COST 386 , 200 B-MKT 356, 400 BY 00/ BY /00 C-INCOME PCA=1011 PCS=00 SIZE= 2202 JUST-VAL 386, 200 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 70WC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 70WC HYANNIS PARCEL CONTROL AREA TREND STANDARD 151 15 LAND-TYPE 2327001 LAND-MEAN +Oo 3862001 218620 IMPROVED-MEAN -300-. 2501 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 100°61 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR] AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] a --A323 003 . P E R M I T [PMT] ACTION [R] CARD [000] KEY 235436 000000001 PERMIT—NO MO YR TYPE VALUE CK—BY MO YR .CMP NEW/DEMO COMMENT lax y�y 1 'tit ' : .:::..:.........::::::. ......... US24 V9 L ::> WE guar• .:::. >> € x::;:HAWES AVE ON .::::::.::::::.:::.::::::.:.::::... ::::.:::.::::::::...::::::..::...:::::::..:. a a Nei� :::.»: :•: ........NEI HB R G O .......................................................................... ...........................:::.:::::.::::.::::::::::::: ILLEGAL.. G APT.:: >::�::»:::.: :.:D•••� RESEARCH--THEN MAKE U N.O 6 d � �L. ............ ............. ............ ............ .........:::. ............ .............. .::.:::............::.:::: r 9 'ROPERTY ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHD KEY NO. 0039 HAWES :AVENUE 07 RB 400.. 07HY, 07/09/95; 1011 00 70WC R323 . 003. 235436 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T gCRES/UNIT$. VALUE Description ORBSi-'-OCT'AVIUS�'A' 8' ELEANOR 'MAP— Lana By/Date size Dimension v -UNIT ADJ'D.UNIT / CD. FFDe I"Acres :MAP— LOC./YR. CLASS ADJ. COND. P PRICE PRICE #LAND ' .1 1 232:700 CARDS IN ACCOUNT — 15=1WATERFNT 1 - x< .5 =10 99� 141 29999 422499.95 .55 232700 #8LDG -.CS) CARD=1 1 " .:'.153.500. 01 of 01 A I #PL+39'1HAWES AVE. HY, BATHS 2 AL U x A= 100 14700.0 14700.0 1.00;'14700.a #RR 0675.0120. 1825 0200 ARKET ' 35.6400 FIREPLACE_ U '. X`: A= 100 4800.0 4800.00 '1.00 4800 3 #SR WHIDDEWAVENUE NCOME A SE D PPRAISED;VALUE ID 386.200 4 u ARCEL"SUMMARY" T S AND 232700 4 T LOGS A53500 IMPS E OTAL 386200 E -,CNST N DEED REFER ENC Type DATE Rti—ded R I OR`YEAR'V A L U E A T Book Page '^at' Mo. �,.D saleaP oa AND 232700 r S C58009 0/00 LDGS 153500 J OTAL 386200 3 ` BUILDING PERMIT Number LAND. LAND—ADJ ., INCIME SE. SP- S Date To, AmountBLDS '. FEATURES ' BLD-ADJSi +UNIT 232700; 19500, : Class Const. Total Base Rate Aoj.Rate B It Age Norm. Obsv. CND Loc 4e R.G Re pi Cost New qo Re`Value Storiee Nai ht Roortra Rms Bitha /fix. Pnrl N Fao. Units Unit- A 1� DBPr. C.b%. P I P 9 ywa 01A-. 000 :115.115 85.05 97.81 ' 30 70�24:74: 100.. 74 <;207494" 153500:2.0 . 8 , 4'_ 2.1-'10.0 Description Rate Square Feet Rep` Cost MKT.INDEX: 1.00. IMP.BY/DATE: / SCALE: 1 0O .A0 ELEMENTS CODE - CONSTRUCTION DETAIL AS:100 97.81 ? 1076 10 5244' r 820, 60 58.69 1076. 63150, *- -20--* TILE 05 OLONIAL!OLD 0.0 FMP+ 55 5.50., 320. 1760 16 *-14-* ETTGN ADJMT-.< -03 'S5 b1 /6DJUST-'j 0 J FSF? 90 88.03 50, 4402' FMP '.10, 10 XTE-R:W-A LS-- -06 LURIVMTL ---U:O FOP' 35 34.23 60, 2054:: *_-- EAT/AC-<TYPE 02 A�--------------- 0 r FFG . 30. 29.34, 388 11384 NTER.FINISH- `00 -- - ----- ---� 0 BASE NTERLATOUT -01:----- ------------U=O J 26 26' NTFR.DU7RTY-:' -02 AWE-AT ERTER:--U:O LOIVR-STRUCT-;' -00-------------------U:.O D W'. E LOO-R-CWER-- -00..-- ---- ----- ----0':O E Total Areas A,. 768'Basa_ 1126 -*-X=11 `* 36r----* ; OOF.7 TYPE---- -00 -- ------- ----II O T BUILDING DIMENSIONS 11:*T-10*. LE-CTRMAL 00.: U'.0 BAS=N26 .E21 ;`N10:E14:S10. E01 ' S26 A !FSF :6' OUITDATIVN--- -00; ----- 9v 9 A W36:.BAS .. FMP.M26 E01; N16 E20 *=+e-FOP*-* J. ---=---------- --- --=----- -- ----- --- S16:W20,WO1 :S26:Fi9P .. FSF ;E01 ; -----NEIGHBOR OD 17t7fiC-'HYANNTS------- L S05KE101N05•W10 W01 -- ' FOP' EW 16. LAND ' TOTAC' `MARKET S05=E10xS06_W10,N06 N051WOI ' FOP ; ":FFG PARCEL' 232.700 386200'. FFG.W06 .S1.i ,'E18 S02 E04:S16 *---22--T*; AREA '109310 .le W22' N18; FFG .N11 ;E06 VARIANCE +0'4 t253 STANDARD, ;2.5 .' 9;r +.a•j .S'.F..-... A hJ'v ::ice �"� _ t• s :n + { .. .x - i 3 - :.ys„i h s ae I. 9 . 1, v: :;: r} - ..;•:r:�� a ��� i..'._;• „r,t� at+..+.;a:r. .4r =.. .r, - I ','t.• ja •t E..-, r. x' + s r .-sY; ,;«.{s,,}. .a".: � -4;.a •.rs .}. 3Y ,i• p {4 ty.is l .1.i s Y `* � '1..'� �.: `v'�`G.'..s�� '+ k ,y•' . ...... ..;e.•- .:C;.� k• .•::.- .:.. -. .yy �.. a :6 k h. �.66 2 : 1� rx .� %:*�r -'h J5 .�$fL�:.k X;ri: rt�.x G`t^ >'? 'b•.%�a - a;sY .,e . ,Y i Y 1 5f V3 /hi. ie; +.its ` r c, .2 ,•c'� t �. 's ,:`,r.spy 'xt r y yy g � r:i� 4 '' .'1%^ { iiF '.: t 3h .. I .:� F ? f -.r.. vl "� b � '{�!•� .�.� >r�- �y ram., � ,. ��, �; � �: �RESIDENTIAL�k•PROPER x � "*'�'.��.Cst. �+ :';. d.�f:': ✓ ,r','•�� .b. t.a,�� F ��JT _x;,: '�. �i ,�sl 1? �F :1 Y r ^rr •. s �.- •:,...+mf2�.. r• .. 'FIRE.DISTRICT., 39 � r , Y�3 STREET1�I33W@S'`AVe.x"t;_ ` c Y'it.° Han . �yISUMMARYI4i 323: 3 j y -7 LAND .5- Hy --BLDGS.: I,'; c OWNER Z :TOTAL` 'sl LANDF. e 4 DIYY' RECORD OF TRANSFER pare erc Pc I.R.s: REMARKS: 2 wad D.L." 1 1 8 1: 1. ` .,BLDGS. lib TOTAL �7700' A4'r t v✓ LAND �B oov. BLDGS. At y a<. TOTAL -1 G LAND Orbe O'.dtAviUb A. '& 'Eleanor C. 3=16-73 tf. 009 �166/9 BLDGS. _ %N / vc ✓)r.'OGeryoo 1� /V,7",' 3-16-7 1823 235 8 00 consideration TOTAL _ 7 _ f, 67 y S`0 L.C. 14 4,B r: BLDGS. ` ,+,•� r TOTAL . -�::- , LAND S BLDGS. #'> TOTAL LAND BLDGS. # TOTAL { 'LAND. INTERIOR INSPECTED BLDGS. TOTAL b .r ,DATE '• .s2`(n ��: / / ✓ ��.:�'1r'�r�� > '`f `. .'t� '';�i r '�•y's�. LAND ACREAGE COMPUTATIONS a :r BLDGS. --i 3'v LANID"TYPE � - :.# OF ACRES - PRICE TOTAL- DEPR. - -,i: VALUE '_ TOTAL t.HOUSE`LOT' s s Y Z` O # LAND �" .2ov' a +{YN C{{CEARED"FRONT �. u i n , Ti aREAR BLDGS. E• •TOTAL'.. ., ,WOODS&SPROUT FRONT LAND €. f' REAR WASTE'FRONT BLDGS �r y 'RE I' I TOTAL: N REAR LAND BLDGS_, r' 'TOTAL: a` LAND., ,r S �OOU Ir7Jr BLDGS. LOT COMPUTATIONS LAND:FACTORS :.TOTAL {!FRONT + ', DEPTH STREET PRICE DEPTH % FRONT FT. PRICE TOTAL DEPR. COR. INF. VALUE 7' s HILLY TOWN SEWER �' •LAND a2.O ROUGH TOWN WATER, , ._BLDGS HIGH- GRAVEL RD. . TOTAL la LOW DIRT:RD.'SWAMPY NO RD. BLDGS:[TUND OTAL ac._Yiads .Fin. Bsmt.Area Bath Room Base . ^� - �C/f.C,� " �iz:.� u•°c Conc:';BIk Walli"' Bsmt:'Rec.'.Room St.'ShowerBath .' &• `7 _ . -BLDG' COST v " Bsmt.'r �.O '`PURCH. DATE one Slab 4 Bsmt Garage St. Shower Ext. Walls PURCH. PRICE Brack Walls Attic FI.&Stairs Toilet Room Roof RENT �� T z� Stone Walls Fin.Attic. Two Fixt. Bath Floors ].. �rers INTERIOR FINISH Lavatory Extra — 1, 9smt I N" 1' Sink _-1 Attic /U r/a r/:+ r/� Plaster Water Clo. Extra tEXTERIOR WALLS Knotty Pine Water Only louble Siding j Plywood No Plumbing Bsmt. Fin. Tingle Siding Plasterboard Int. Fin. Shingles TILING CEb. 0 Anc Blk G F P Bath Fl. Heat J ace Brk:On Int.Layout . Bath FI.&Wains. / Auto Ht. Unit 4 G �f"'.' •,Veneer .. Int.Cond. Bath FI. &Walls Fireplace 4- om Brk On HEATING Toilet Rm. FI. _ lumbing 4- L/3� -. Mid Com Brk. Hot Air Toilet Rm.FI.&Wains 'F�' �O Steam Toilet Rm.FI.&Walls Tiling + 1lanket lns + Hot Water A St. Shower - toof Ins_ Air Cond. Tub Area Total y C Floor Furn. -3 op71 W 'ROOFING COMPUTATIONS. �g 3�� kspW Shingle Pipeless Furn. /D 7G S.F. o? F�• Nood'Shingle: No Heat S. F. J/ s �� 3 4sbs Shingle y,, -, Oil Burner.C d Ai S.F. J O 3 Coal Stoker S.F. 02 file ":' ,+ !' .• Gas f' r!ROOF '.TYPE Electric 7 p S. F. o a 8� OUTBUILDINGS fable s `.Flat S.F. 1 2 3 4 5 6 7 8 91101 1 2 3 4 5 6 7 8 9 10 MEASURE[ S.F. Pier Found. Floor 5.". lip, fYlan38rd FIREPLACES 1a'mbrel Fireplace Stach Wall Found. 0.H.Door "z "fF..LO IRS Fireplace / LISTED Sgle.Sdg. Roll Roofing Drat .az LIGHTING' Dble.`$dg. Shingle Roof No Elect. - DATE Shingle Walls Plumbing iardwood ROOMS Cement Slk. Electric. s: "`��i ,+•7 Asph`Tile Bsmt. lst � TOTAL _ . „3,. Op Brick Int.Finish,. RInCED,' Singlet} 2nd 4 3rd " FACTOR' " �6 P REPLACEMENT reS p C•r`'a.�'"sIOCCUPANCY• CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACT.UAL.VAL. M 3S Sys Zf$, ��2�'isf •�-� - - s�,jrx V,9 �y -• - ---- --- — ;• i '�i c 5 _ .i`: :TOTAL% Y rkti y �sG IGY •-b e