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Home My WebLink About0049 KELLEY ROAD i • p . Town of Barnstable BUILDING DEFT T"E' ti Regulatory Services MAY 0 g 1017 o" Richard V.Scali,Director Building Division TOWN OFBARNMABLE 163g6 ,m 'Drfo ,1► Paul Roma,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# _ — I •t 3_.__�__"__7 FEE. $ _ .O.0 e w (YL 0— SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less Location of shed(address) Villa de Property owner's name, Telephone number Size of Shed Map/Parcel# Si a Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? You must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00 9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MIDST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:06/20/16 gal ( . via I �2 k V0(if � . ECTIOSP �x ------ - . Location: ` — __ -- -- YLIS .49 ao cp v I awellai 46 . I _ shed � AQ zte roc tot , y ref :. 2 � ------- — �� I►ut, -- 310od panes �D _ o T: 9herebu cerrifr that the mu i acl�Ih� 1 _._ }lo��d2one., C R .1 � �Ss! pectron wa��.pry aced.for --- suit [Gle awe,, E:`g z �� I p �a� ' 11 il , _ „Or, V; with an e ffecti e date o� fall in a special 7.�:.M:,�1.,flood zono S - and the lot�tion o fthe dwellih 9 _conformer t; ; 9 ? the lucai zonrn by laws !n effectat the trnne of con- ' ctron:with rF,pEC°`.ro horizontal din�tensionral;setL?ctck regr�rremen{s n- s exempt from Ilrc�laG.:�n enforcemPntartron Glneder vtb Scale 1"=` -- pleusethe,tru�r�re�tiy,,wrr i7.this vrrort a e rn� ection grey he�v?£ din sett ,3ile, lo. 42. _ rer rrdr?F a prerrr e l,catiorr r��<tr,�c tUAvC and rn g g p I �repu:'�n deed dt�Cri y r�pruxrv.,ate on! .fln rnstrur►�lehturrvey is necEssar to pedrt lines.`ihismartypyclnc e,tronratir;tno beu_5ed forrecordin ur n r y I r,e�m�r r;ron e�v5 0 ;u m� rt°+ u f ►variahce orbu,lding ,artment purposes.lVerr 9p p eso rf yule de t, c,-n uratron can on!j be accomplished by an accurarE rntrun�ent, crneu which may r urrrrutrnn than what,ti tiyownrrereon. Ni�TE: THIS IS NOT A BOt1P1DARY;St 3R�fE� AND t5 FAR Mcation_ vfhurlcli -e locations;prep... _ y eftectdifferent.rn LQNIA:L. — -- _ ORTGAGE PURPOSES ONLY �-A1�D SL�R�'E r°lNG ---- 26gHANOVERSTREET `F!Ar�1VLR M: PHI��IE:�87-t126-71f4(; _-. Fav �o, .,COMPANY, =-- --- INC. rf � s I l 4 .,ir r I r` 't � '`'n � �•L ,/ f � - .._ ..__ r '�Y. :. 1.' ,l "Datasheet HP Laierht Pro .M20.3,dW-P' 'rinte�r-- ,,-,,..,. '- to :Get more pages, t , tw�: -- ` n •" performance and protection, =-- -- from a wireless HP LaserJet i 1._• ' A, 1 Pro powered by © - Jetlntelligence Toner cartridges. 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'l., • Print over 2x more pages than standard cartridges,using optional Original HP high-yield toner cartridges.,, ee, ;"`� • Get more pages than ever before,,and track remaining pages to help ensure you get what you paid for.12 ' mopriCT r� .f t Based on ISO/IEC 19752 cartridge Nerds for HP 30A Black Original LaserJet Toner Cartridges compared with HP 83A Stack Original LaserJet Toner Cartridges,and HP 30X High CERTIFIED Yield Black Original LaserJet Toner Cartridges compared with HP 83X High Yield Black,Original LaserJet Toner Cartridges.Learn more at http://www.hp.comtgOAearnabOutswDlies Mobile device must have iOS v7.0 or higher.Learn more at hitpJ/www.hp.com/go/mobi6printing'Mobile device needs to be connected doectly to the signal of a Wi-Fi Direct° i .{ supported MFP or printer prior to printing Depending on mobile device,an app or driver may also be required.For details,see http://w".hp.com/golmobileprinting.Wi-f i Direct 1 t 't tw'L�s is a registered trademark of Wi-Fi Allianceo.4 Requires Google Cloud Print'"registration and Google account.Learn more at http://www.hp.conJgo/mobileprinting5 Measured hsing_ISO/IEC 17629.Exact speed varies depending on the system configuration,software application,driver,and document complexity.Learn more at,y lnr P ° 1 A http:/Avww.hp.conJgo/printerctaims 6 HP Auto-WAuto-Off Technology capabilities are subiect to printer and settings.I App or;oftware and HP ePrint account registration may also be required.Some featines requbedhaz pure of an optional accessory.Learn more a't http://www.hp.com/gohnobileprinOng a Printer requires ePrint account registration.App, or software may be required.Learn more at http://www-hp.comkAftoNleprinting I Not all HP Web Jetadmin features arc supported on the HP LaserJet Pro 14203.HP Web ` -• Jetadmin is available for download at no additional charge at httpJ/wwwJyp.com/go/webietadmuc to Based on HP internal research on competitor offerings(Device Security Comparison 12015)and solutions Report on HP JetAdvantage Security Manager 2.1 from Buyers Lab.2/2015.Requires separate purchase.for details,see hap://www.hp.com/go/securitymanager t t Comparison based on ISO 24711 ortridge yields for HP 30X High Yield Black Original LaserJet Toner Cartridges compared with HP 30A Black Original LaserJet Toner Cartridges.Learn more at httpl/www.hp.conVgo/learnatroutsLq)pbes.'2 As compared with cartridge gauges for HP predecessor products. �: f r Qeea Dp Solarb'04fty December 16, 2015 Town of Barnstable ATTENTION. BOLDING DEPARTMENT 200 Main Street Hyannis, MA 02601 RE: 49 Kelley Road, Hyannis Permit No.: 201408854 Our Job No.: JB-026702 NOTICE OF CANCELLATION This letter is to certify our proposal to install Solar(PV)at the above-referenced property has been moved into a cancellation status. SolarCity Corporation and John Guay will not be moving forward with the proposed installation at this time. We would greatly appreciate reimbursement for the permitting fees paid,but understand that the town will not refund any fees. If you have any questions or concerns,please don't hesitate to contact me. Thank you for your attention to this matter. Sincerely, Cheryl Gruenstern Cheryl Gruenstern Permit Coordinator SolarCity Corporation cgruenstern@solarcity.com Telephone: (508)640-5397 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2 02 Parcel 7 Application # cX 4��y Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee _ Date Definitive Plan Approved by Planning Board Historic - OKH 0 _ Preservation/ Hyannis Project Street Address 7 9 e e V Ok Village nt Owner Address y9 �e// /[�!• Telephone vay Permit Request//7 aS eG%//G OaIZ& D a V0 / Gvl e n� Q c cv 3. 1-7 Square feet: 1 st floor: existing pr000sed 2nd floor: existi r osed Total new Zoning District - Flood Plain -� Grou water Ov rlay —~ Project Valuation Construction Type�12U� SO /fin e .Lot Size Grandfathered: •tdo If y s, attach supporting documentation. Dwelling Type: Single Family W Two Family ❑ Multi- ily (# units) Age of Existing Structure /5• Historic H ❑Yes o On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Wall ❑ er Basement Finished Area (sq.ft.) ement Unfinished Area (sq.ft) Number of Baths: Full: existing ne Half: existing new Number of Bedrooms: `�� existing ew ' Total Room Count (not including b hs): existing new _ First Floors m Count~ CD Heat Type and Fuel: _Q Gas/7'� it ❑ Elect ❑Other �- Central Air: ❑Yes -a No 4� laces: Ex' ing New Existing woo /coal stove: CPPes ❑ No Detached garage: ❑-eistingf�tl n ize Pool: ❑ existing ❑ new size _ Barn: existing=❑ ng size_ Attached garage: ❑.existing n0 new- size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use /tPS/O�C � Proposed Use /70 c`ia4ge APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Cam! l S S6A6rl Telephone Number Address/0 6fWM1cr� ��': �ay4 License # �a7663 Home Improvement Contractor# l�v�J�7o2 Email Obldot9l,61 Worker's Compensation #(A14g7- aroD-a6626$=oay ALL CONSTRUCTION DEBRIS ESULTING FROM THIS PROJECT WILL BETAKEN TO 30 `C —� �h•� SIGNATURE DATE AZ /7 add -w FOR OFFICIAL USE ONLY APPLICATION# 'DATE ISSUED MAP-/PARCEL NO. ADDRESS VILLAGE 't OWNER �. DATE OF INSPECTION: FOUNDATION F FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL. PLUMBING: ROUGH FINAL ._ GAS: ROUGH FINAL t FINAL BUILDING 4 'f DATER.CLOSED,OUTS _ _ . - ,. ASSOEIATION,PLAN NO. r 1 = ;;SolarCity. OWNER AUTHORIZATION Job Z C 7e 2--0 Property Address: �1 l�:rG G r�/ 17�, 1 �i�/y/1 MA I v v `7 / as Owner of the subject property hereby authorize SOLARCITY CORPORATION to act on my behalf, in all matters relative to work authorized by this building permit application. C011"re of Owner: Date: SOLARCITY.COM 8 AZ kLC 211771tACC 2s5A5CYPCC277a98.CALZ*W8 104,GO ECIw, NS CT-29170 MA NC IS&S;TIMA EL 1:k,dR t:O Par�1C 17 Y.8, .. '61,th4fi1CM/3V1iU616Q600.':3Ar'�3Q17527U3,CRt879C1A3S'C$fi?`f�31-"O.PAN:C;'P+�)77y137ri TEGl2�U08.W15C9.APC9tGJv'SOI.ARC'SSP.OZQ?d SCY�RC!T`'CX}nl'CKL+.TIO"t Ak.4 R,Ck?t3 AESERJE�. Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 8-15-14 Town of Barnstable Thomas Perry CBO Building Commissioner ' 200 Main St. Hyannis,MA 02601 ` s t C) RE: Building Permits l <1 Dear Mr. Perry, 1 This affidavit is to certify that all work completed for 49 Kelley Rd,Hyannis has been inspected by a certified Building Performance Institute (BPI)Inspector. Ceiling: R-11 cellulose Walls: R-13 dense pack cellulose Basement: 2"Thermax on crawl walls All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a`141 Parcel 6 Application # Health Division Date Issued' Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Presentation / Hyannis Project Street Address 4 d. t Village_ Bann tS Owner o Address S 0.rn 6 Telephone Permit Request &A - t - 3 d Square feet: 1 st 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 suppo ing documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) c O Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Hj` way: C]bes 89% Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ OtherJbb 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 ?fNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) r r�-Name W 1 , kLlc��rwk.�,, 5 v Telephone Number 0,318 Address D �6 n t License # if 1'0 �So X4 �kmoloh _ MA Home Improvement Contractor# 3 gtI Email Worker's Compensation # w WC3 0 8N3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 0 1 n FOR OFFICIAL USE ONLY AOPLICATION# DATE ISSUED- MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION. FOUNDATION FRAME INSULATION FIREPLACE k k ELECTRICAL: ROUGH FINAL R PLUMBING: ROUGH FINAL OAS: ROUGH FINAL FINAL BUILDING E DATE CLOSED OUT ASS OM 61 ION PLAN NO. r Housing ®' Assi stance Corporation Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: PLEASE FILL OUT AND. SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. I N N hereby consent to and agree that weatherization wCleecCorporation may be done by the Weatherization Program of Housing Assist ( herein after referred as "Agency" )on '�e prope ated at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping & caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and Possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give / my consent. ^ ' (/ Home Owner: (Signature) Date: f Agent: (signature) Date: r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations k ,t! 1 Congress Street, suite 100 Boston,.MA 02114-2017 - www.mass,govfdia ' ilders/Contractors/Electricians/Plumbers Workers' Compensation Insurance Affidavit: Su Applicant Information Please Print LegiblAf Name(Busincss/Organization/l.ndividual). Cape save Inc. Address: 7D Huntington Ave ' City/State/Zip: South Yarmouth.MA 02664 Phone#: 508-398-0398.__ Are you an employer?Check the appropriate box: Type of project(required): 1.Q✓ 1 am a employer with _ 4. Q 1 am a.general contractor and 1 6. Q New construction employees(;full and/or part-time): have hired the sub-contractors 2.0 1 am a sole proprietor or partner- listed on the:attached sheet. Z. Remodeling These sub-contractors have ship and have no employees 8. ❑Demolition workingfor me in an ca aci employees and have:workers' y p ty 9. Building addition [No workers'comp.insurance. comp.insurance.+ requited.] 5. Q We are a corporation and its 10.Q.Electrical repairs or additions 3.❑ I am a homeowner doing all work, officers have exercised their 1 LQ`Plumbing repairs or additions myself. o workers' com right of exemption.per MGL y [N p 121-1 Roof repairs insurance required.]t c. 152;§1(4).and we have no emptoyees. [No workers' 11M.0ther Insulation comp.insurance required] *Any applicant that checks box#l must also Fill out die section below showing their workers'compensation policy information.. t Homeowners who submit this aff idavit indicating they are doing all work,and then hire outside contractors must submit a new of idavit.ndicating Such, 9'Contractors_that check this boxinust attached an-additional'sheet shorting the naive of the sub-contiiacwrs and slate wvheiher or not those entities have employees. if the sub contractors have employees,They must provide their workers'comp:policy number. I ant anemployer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Wesco Insurance Company _. Policy#or"Self-ins Ltc.# . WWC3085633 _. Expiration Date: 04/09/2015 7 1 Job Site Address-_ . ._ C City/State/Zip: , Ct 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.Section 25A of MGL c.1.52 can lead to the imposition of`criminalpenalties 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$250.00 a day against the violator. Be.advised that.a copy of this statement may be forwarded to the Office of. Investigations of the DIA for insurance coverage ication. I do hereby eerd under the ains and":enalties of er` that the information provided above is.true and correct.• Sienature: Date t Phone#: 50$=399-039$ Official use only. Do not write in.this area,to be completed bj=city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.-Plumbing Inspector 6.Other Contact Person: Phone#'. DATE(MMIDDJYYYV) AcoRn CERTIFICATE OF LIABILITY INSURANCE 4/14/2614 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 Jleu of such endorsements.. . PRODUCER NAME:NTACT Colleen Crowley Risk Strategies COSttpany PHOBE (7$1)986-4400 FAX(AIC No:(701)96a-4420 15 Pacella Park Drive ADDRESS.ccrowley@risk-strategies.com Suite 240 INSURERS AFFORDING".COVERAGE NAICt Randolph Mh 02368 INSURERA Selective 1.Ins. ,1 .oF America INSURED iNsuRgRa.:Safety Insurance Company 3618 Cape Save, Inc INSURERC 346SCCI Insurance Company 7 D Huntington Ave INSURERD: INSURER:E: South Yarmouth. M 02664 INSURER:F: COVERAGES CERTIFICATE NUMBER:CL1441475243' REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT.WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED.OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY E P LTR 'TYPE OF INSURANCE Zama POLICY NUMBER 'MMIDO MMIDD LIMITS GENERAL:LIABILITY EACH OCCURRENCE -$ 1,000,000 X COMMERCIAL GENERAL LIABILITY .PREMISES Es occurrence $- 100,000 A CLAIMS-MADE a OCCUR S199448.0 0/16/2013 0/16/2014 MED EXP IAny one person) $ 10,000 -PERSONAL&ADV INJURY $ 1,D'00,000 GENERAL AGGREGATE $ 2,000,000 GENI AGGREGATE LIMIT APPL18S'PER' PRODUCTS-COMPIOPAGG $ 2,000,000 ........ .. POLICY X. PRO- X LOG AUTOMOBILE LIABILITY (Ea accident).I L LIMIT1,000,000 ANYAUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 6208200 1/6/2013 1/6./2014 AUTOS X AUTOS,: - BODILY INJURY(Per aocident) $ NON-OWJED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Peraecident $ X UMBRELLA LIAB IN _. . OCCUR EACH OCCURRENCE $ 1,000,O00 A EXCESS LIAB CLAIMS MADE` AGGREGATE $ 1,000,000 OW RETENTION ex 1994480 0/16/2013 0/16/2014 C. WORKERS.COMPENSATION Officers Included For X,-.VvC SLATU- OTH- --- AND EMPLOYERS`LIABILITY Y!N TRYWil ANY PROPRIETOR/PARTNER/EXECUTIVE overage OFFICERJMEMBERE)O-LUDEL» N❑ NIA E.L.EACH ACCIDENT $ 500000 (Mandatory In NH) RM30856133 /9/2014 /9/2015 E,L.DISEASE-EA EMPLOYE $ .500. 000 If yes describe under - - DESNIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT '$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS!_VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space.isrequired) Issued as evdence :of insurance. Issued as evidence of insurance. Thielsch Engineering., Inc.. is listed as additional insured as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION m.song@c.ipelightcompact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Margaret song _ .PO BOX 427/SCH AUTHORIZED REPRESENTATIVE 310.5 Main Street Barnstable, M. 02630 ehael Christian/CLC ACORD 25(2010105) 01988-2010 ACORD CORPORATION: All rights reserved. INS025(201005)_01 The ACORD.name and logo are registered marks of ACORD 10/ Office of Consumer Affairs and Business Regulation 10 Park Plaza _Suite 5170 Boston Massachusetts 02116 . .s .-Home Improvement Contractor-Registration Registration: 171380 Type: Corporation } Expiration: -3/14/2016 T,r# 249649 CAPE SAVE INC. WILLIAM MCCLUSKEY � 7-D HUNTINGTON AVENUE SOUTH YARMOUTH,,MA 02664 g't � 'Update Address:and return card:Mark reason for change.. Address E Renewal Employment Lost Card SCA 1 €a 2010-0511 Y V 1Le�O�i77/i720it[IJP.CCGCiL a�U!/GCIJJfcC�+LG3��iS,€ �-' -. ` Office of Consumer Affairs&Business Regulation ", License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR Az before the expiration date..If found return to: j egistration171380 Type Office of Consumer Affairs and Business Regulation Expiration WAU6616: Corporation i Jo Park Plaza—Suite 5170 , l-� Boston,MA 02116 CAPE SAVE INC. ' a ti. ti �4 WILLIAM Mcc LUSKEY w 7-D HUNTINGTON AVENUE SOUTH YARMOUTH' MA 02664 �— Undersecretary Not vali ithout Signature Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen�isor Specialty License: CSSL-102776 WILLIAM J MC C`�U 37 NAT. ROAD West Yarmouth MA 02 7 c-' 5_ lN J.,�,, Jy Expiration commissioner 06/28/2615 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION (� � 6� Cow Map arcel Applica ion # Health Division Date Issued S _Zo-/y Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis (Project Street Address pillage----�'� !�J `ner oak/ Address / S Telephorie= Z319q A21 -41-18Z4 All y' Permit Rem. �G i TV a X A, a Flo Square feet: 1 st floor: existing,66 proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValGa—Zn�?N, 666 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 et o Basement Type: Mull ❑ Crawl, ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Y Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths : existing 15; new First Floor Room Count Heat Type and Fuel: ❑ Gas Oil ❑ Electric ❑ Other�� Central Air: ❑Yes �o Fireplaces: Existing New Existing wood/coal stoveL Y ❑ No o,....; c Detached garage: existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: OWe,"isting C4-new Size_ w iw Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: -� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ZZ NO Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION t t /! (BUILDER OR HOMEOWNER) Name `'�J C :> Telephone Number Address �� a License# 3 Home Improvement Contractor# Email �G�� Q� (�`� 1�;�Ue?/--Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING F OM THIS PROJECT WILL BE TAKEN TO Ad) l� y SIGNATURE DATE �� FOR OFFICIAL USE.ONLY APPLICATION# DATEIISSUED MAP/PARCEL NO. ADDRESS VILLAGE 4 OWNER DATE OF INSPECTION: FOUNDATION ' r FRAME .j INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i F GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. net Canzinanwea&a,f MYsaclrrrseh Diviarhumt o,f li s 'Acc alems - lag �'fcenturrs 60 Washbigton,Feet I#vstory M4 02111 wwnt masxgviVdia Workers' Compensation Insurance davit:R iers/ ntractDr&fElect icians Plumbers Applicant Information Please Print Le,,TLbly AT 1ya=(Burin�1117 onUd- n o' J °�-��if Of 1�� / Address: Q/X al City/Stat&Zig: ll i Phone 9 �L/� z� Are you an employer?Ct"heel'`the appropriate-box: Type project r• �. am a eneral.contractor and I JIB of p �ect� ezlnirer�: 1.El I am a employer with ❑ I g 6_ ❑New won employees(full an&or part.-time).* have hired the sub-contmcton 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I ❑Remodeling ship and have,no employees 'these sub-contractors have $. ❑Demolitism working for me in any capacity. employees and have workers' 9. ❑Budding addition [No workers' comp.insurance comp-insutrance.1 d.] 5. ❑ We are a corporation and its 10_.❑Electrical repairs or additions 3_ am a homeoi;mer doing all wort£ officers have exercised their 11_Q Plumbiag repairs or additions 1, myself [NO workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] r c.152,§1(4X and-we have no employees.[No workers' 13-❑other comp_insurance required-] !AzEy auglicsnt d at checks box-1 most also fill oot the section below sbowingih&woakeie compeasar9o-g policy info€madiam i Someoanaem who submit this affidavu indicating they axe doing all wa k am d then bare aatside contactors mast submit a new affidavit indicating such Mors that check this box must attached au additional sheet showing the name of the sub-CCWWArs and stsM whew oraot those eatitks lie employees.If the sub-con actors have employees,they m=pnnade their workers'ramp.policy numbez I am art ernpLa ki er that is proiiding it■urkers'comperrsa on insrrratace for my enrpLoy ees Below is five policy raid job ske. information. Insurance Company Nance: Policy 9 or Self-ins-Lic.9: Expiration Date_ Jab Site Address: City/stateMP: Attach a copy of the workers'compensation.policy declaration page(shoring 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 brie up to,$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STEP WORK ORDER and a fine of to S250-00 a day against the violator- Be advised that a copy of this statement maybe forwarded to the Office of Isrvestigations of the DIA for insurance coverage verification_ Ida hereby cgrisfjr wider the pains anti penalties q f per,uty.that the information pros deed above is trite and correct. ' ' Matt': Phone#: Offinal use only. Da not write in this area,io be completed by city or town ofjidd City or To-%u: PermitUcense Lssuing Authority(circle one): 1.Board of Health 2.Building Department 3.C iVrown Clerk 4.Electrical Inspector a.Plumbing Inspector 6.Other Contact Person: Phone o: Town of Barnstable Regulatory Services Richard V.Scali, Director Building Division * mom . t Tom Perry,Building Commissioner MASS $ i659. 200 Main Street, Hyannis,MA 02601 QED www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: /511 z / JOB LOCATION: / '1��/ L-�JVI /CS_ number street village "HOMEOWNER": U C/ / ll name / ho/me phone# / work phone# CURRENT MAILING ADDRESS: `7 pffy/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 buildingpgrmit. (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. Si 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 of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. * BAMSrAsis • 16 9. Town of Barnstable rFD MA't� Regulatory Services Richard Scali,Director Building.Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us. Office: 508-862-4038 Fax: 508-790-6230 Property O er Must Complete and S' n This Section - If Usin A Builder I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized this building permit ap cation for: (Ad ess of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPHLESTORMS\building permit fonns\smokecarbondetectors.doc. Revised 050412 r.t xrf f`tr L. oe 0 5z 201/1 6MY d 3 pill 3: 4 CMUST BE NSTAI�LED PE ALARMS I }j 4,;a j o MASSACHUSETfS BUILDING CODE SMQK E DET TORS REVIEWED BARNSTABLEBUILDIN DEPT. J( � / DATE A FIR E DEPARTMENT BDTH.S► DATE -- WTURESAREREQUIREDFORPERti//T/NR I 1 C;)d 1 0 C, 0a �pFIKE Teti Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee BARNRMBLE = 9� 16 9 Thomas F.Geiler,Director ArED FAA't A @� BuUffing Division E it Tom Perry,CBO, Building CommissionFE13 200 Main Street,Hyannis,M 2�10 www.town.barnstable.ma.us "®� Office: 508-862-4038 508-790-6230 - EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint Map/parcel Number Property Address r�' �N '' �!�✓ f V �`t!'V [Residential Value of Work 75 'mum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name U 5 mJ..jPe.S Telephone Number Home Improvement Contractor License#(if applicable) /�iJ / (� t / / 7 Construction Supervisor's License#(if applicable) 3/workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ am the Homeowner have Worker's,Compensation Insurance Insurance Company Name Workman's Comp.Policy# �ti5 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ 771�Replacernent #of doors Windows/doors/sliders.U-Value S (maximum.44)#of windows *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 Ovvner.Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q MPFILESTORMSUilding permit formsT)TRESS.doc Revised 090809 The Commonwealth of Massachusetts Department of Industrial Accidents Of, ceofInvestigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApOcant Information aA Please Print Ledbly Name(Business/Organization/IndividualY Address: ✓ 1 City/State/Zip: � 0 Phone#: Are you an employer?theck the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I _employees(full and/or part-time).' have hired the sub-contractors 6 ❑Nf�t'construction 2.[� I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9. Boil addition [No workers'comp. insurance comp.insurance.t ❑Building required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑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#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 contractor must submit anew affidavit indicating such. tContrctor that check this box moot attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subtonbutor 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 po&7 and fob site information. Insurance Company Name: j Policy#or Self-ins. LicC. Expiration Date: 7J Job Site Address: / e City/State/Zip:1/ N" 0--o Attach a copy of the workers'compensation policy declaration page(showing the policy uumber 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 S 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 eertl u der he pains nd penalties of perjury that the information provided above Is true and correct Simalure: Date: Phone#: — Of e a use only. Do not write in this area,to be comp etc y city or town ofj?cla[ City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 1.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone N: Information and-lustructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as ...every person in the service of another under any contract of hire, ` express or implied,oral or written." hi association,corporation or other legal entity,or any two or more An employer is defined as"an individual,partnership, of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or this receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not mole than three apattments,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." g g MGL chapter 152,`§2SC(6)also sCifes.that"every staeo or-,local IiceneLi .a eutY shgH 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 not 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. Applicant 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 Accident. 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 a ro Ovate 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 affidavi t for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. of the please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license 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,c. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. telephone and fax number: The Department's address, The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 , 1-22-06 Revised 1 Www.masS.gOV/dia The Commonwealth of iiWassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02III www.mass.go v1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El please Print m rs i A licanY Information y� Name(Business/organization/Individual) : Address: v U Gs, Cc>i'e-i City/State/Zip:_r___1"�G��' Phone #:_ Are u an employer?Check the a ropriate box: Type of project(required): 4. 1 am a general contractor and I 6 Ne onstruction I . I am a employer witly� * have hired the sub-contractors employees(full and/or part-time). listed on the attached sheet. 7. Remodeling ❑ I am a sole partner-proprietor or- - - These sub-contractors haveDemolition ship and have no employees em to ees and have workers' working forme in any capacity. p y 9. ❑Building addition [No workers' comp. insurance comp. insurance. 10.❑Electrical repairs or additions 5. (� We are a corporation and its required.] officers have exercised their 11. Plumbing repairs or additions 3. 1 am a homeowner doing all work right of exemption per MGL 12.0 Roof repairs myself.[No workers' comp. c. 152, §1(4),and we have no insurance required.]t 13.❑Other . employees. [No workers' comp.insurance required.] fill icy *Any applicant that checks box 1 must italso mdicatingtthey the are doiction nglall work and then hire outside ow showing their workers'compensation s mulst submitfanew affidavit indicating such. t Homeowners who submit this tContractors that check this box must attached an additional sheet showing the name c the sub-contractorsand state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy icy number. ensation insurance for my employees. Below is the policy and job site I am an employer that is providing workers'comp information. - �zo PuJ � s S Insurance Company Name: as- V 22 C� Expiration Date:Policy#or Self-ins.Lic.#: 7 ` Cih' p/state/zi : Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). d to the imposition of criminal penalties of a Failure to secure coverage as required under Section 25 bf aMGL c. 152can lea in the form of.a STOP WORK ORDER and a fine fine up to$1,500.00 and/or one-year imprisonment,as penalties 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 ilre pains and penalties o jury that the information provided above is true and correct. '�-----'� Date: _ Signatur72 Phone#: � official use 1.Board of Health 2. Building Departme only. Do not write in this area, to be completed by city or town official. # City or Town: Issuing Authority(circle one): nt 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: l --------------- I r ,tar Board o ui �1 ii �i� s `68 n Yglta�0 lei s (n "GTLM y 1�r HOME IMPROVEMENT C T O Registration* 153140 S trExpiration: 10/31/2010 7'r# 273191 +q•...1A Ay I. B Type. NU-VISION IS L 32 OVAL DRIVE ��... EST YARMOUTHw MA 02673 Administrator F L,iceuse or registration valid for indivi ul use only before the expiration date. 1f found return to: Board of Building Regulations and Standards- One Ashburton Place Rm 1301 Boston, Ma. 02108 Not.valid without signature Licensee Details rage i of i The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints (\) License Type Home Improvement Contractor" (U(;/ License N 153140 Restriction Company Nu vision Installations 1 Name Stephen Restaino \ 32 Oval Drive ` �� te- Address City,State,Zip West Yarmouth,MA,02673 Expiration Date 10/31/2010 Status Current No complaints found for this Licensee. 3zck To_Sea_ch Board of Bull.din g e—s'"-4� r �S^ ,+�. Y3.✓ F�.✓ s �.Upervl r •.Deck L... License: CS SL 99560 r Restricted to:_ WS 4 Ki STEPHEN RESTAIN4 32 OVAL DRIVE ' -� - i GS WEST YARMOUTK) MA 02673 c--�- -- :----� EXp ration: 1122/2012 t "I,�►i>>>i��ilt�ji t' �� d� Tr' 99560 v51Gv r DATE(MMIDD/YYYY) CORD CERTIFICATE OF LIABILITY INSURANCE STEP 07 15 09 RODUCEri THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION tide Cape Cod Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE (artha Findlay HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 96 Winter Street [yannis Mh 02 601 NAIC 4 ?hone: 508-171-3300 Fax:508-715-3821 INSURERS AFFORDING COVERAGE 39454 Isuaeo INSURER Safe insurance Co INSURER B: 3 e hen M R®staino INSURERc DBA Nu-Bision Installations INSURERD: 3 val Drive West Yarmouth MA 02673 INSURER :OVERAGES THE POLICIES OF NSURAN09 LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AID CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, bK ROD, POLICY NUMBER DATE MWDDIYV DATE TR NSR TYPE OF INSURANCE MMWM YYEACH OCCURRENCE $500000 GENERA.LIABILITY 9 100000 A COMMERCIAL GENERAL LIABILITY BP00004763 07/13/09 07/13/10 PRENIISEs EeOu�enC6 CLAIMS MADE OCCUR MED EXP(Any ens PS=n) IS10000 w PERSONAL&ADVINJURY S 500000 X Business Owners GENERAL AGGREGATE $1000000 PRODUCTS-COWIOPAGG $500006 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY JPFR LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per pereon) SCHEDULED AUTOS HIREDAUTOS BODILY INJURY S (Per ecddent) NON-OWNEO AUTOS PROPERTY DAMAGE S (Per accident) AUTO ONLY-EA ACCIDENT 6 GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO S EACH OCCURRENCE $ EJ(CFSSIUMBRELLA LIABILITY AGGREGATE OCCUR CLAIMS MADE S e $ DEDUCTIBLE S RETENTION $ . C 51ATV. 101H_ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDEjLO7 $ ANY F ROPRICT ER EXCLUDED? ECUTIVE E,L.DISEASE-EA Ifyym,dwerlbe under - - EL DISEASE-PO LI Z6 6PECIAL PROVISIONS below DINER PROPERTY 3510 )EScffl" N OP OPERATIONS i LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY EN55RSIEErtENT I SPECIAL PROVISIONS Certificate Holder is an Additional Insured ti .. ;ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED PQLICIES BE CI(1NCELLEO B j RE T PIRATION gig DATE THEREOF,THE ISSUING INSURER WILL ONDEAVOWTO MAL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO$0 SHALL The At-Home Services, Inc DBA IMPOSE NO OBLIGATION OR LIAS&M Of ANY KIND UPON THE INSURER,ITS AGENTS OR The Home Depot at the Service REPRMENTATIVES. 2690 Cumberland Parkway AUTOO Atlanta GA 30339 m ACORD CORPORATION 198E X(:ORD 25120011081 !a �.`:.rr.n_•ra..�';%y .� 1 f..i:rl,..w..*fir, e _ Board of Building Regulations and Standards ' HOME IMPROVEMENT CONTRACTOR Registration: 126393 '= Expiration: W&2010 Type: Supplement Card The Nome Depot At-Home Service DARREN DEMERS 3200 COBB GALLERIA PKWY#20 ATLANTA. GA 30339 ' .-administrator License or registration valid for individul use only "before the expiration date. If found return Board .to: of Building Regulations and Standards P One Ashburton Place Rm 1301 Boston,:via.02108 a Not valid without signature ATE ACOR®rM CERTIFICATE OF LIABILITY INSURANCE D 02/202/20/DDIYYYY) /09 -PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION - Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certrequest@marsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 948-0902 IINSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Steadfast.Ins Co 26387 THD At-Home Services, Inc. INSURERB:Zurich American Ins Co 16535 2690 Cumberland Parkway INSURER C:NATIONAL ANION FIRE INS CO OF PITTS 19445 Suite 300 Atlanta , GA 30339 INSURERD:New Hampshire Ins Co 23841 INSURER E:Illinois Natl Ins Co 23817 COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AODT - POLICYEFFECTIVE POLICY EXPIRATION LTR N RD TYPE OF INSURANCE POLICY NUMBER DAT MM DD DATE MM/DD LIMITS A GENERAL LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE $4,000,000 DAMAG TO RENTED X LIMITS OF POLICY ARE EXCESS PREMIES(Ea .ce 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurence $ CLAIMS MADE OCCUR "OF SIR: $1,000,000- PER CC" MED EXP(Any one person) $EXCLUDED PERSONAL SADVINJURY $4,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - - - PRODUCTS-COMP/OP AGG $4.,000,000 X1 POLICY PRO- JECT LOC B AUTOMOBILE LIABILITY BAP 2938863-06 03/01/09 03/01/10 COMBINED SINGLE LIMIT $110001000 - X ANY AUTO (Ea accident) ALLOWNEDAUTOS BODILYINJURY $ SCHEDULEDAUTOS (Perperson) HIREDAUTOS - - - BODILY INJURY $ NON-OWNEDAUTOS (Per accident) X SELF INSURED AUTO PHYSICAL DAMAGE (Per accidentROPEdent) AGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO - OTHERTHAN EAACC $ AUTO ONLY:H_ -AGG $ A EXCESS/UMBRELLA LIABILITY IPR 3757 ,608-02 03/01/09 03/01/10 EACH OCCURRENCE $5,000,000 X OCCUR CLAIMS MADE - AGGREGATE $5,000,000 $ DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION AND 3566916 ('CA) 03/01/09 03/01/10 X T RY LA IT ER D EMPLOYERS'LIABIUTY 3566915(AOS) 03/01/09 03/01/10 E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E OFFICER/MEMBEREXCLUDED? 3566917 (FL). 03/01/09 03/01/10 E.L.DISEASE-EA EMPLOYEE $1,000,000 - If yes,describe under - SPECIALPROVISIONSbelow E.L.DISEASE-POLICY LIMIT $1,000,000. OTHER D Workers Compensation 3566918 (ICY, MO, NY, WI, ) 03/01/09 03/01/10 F TX Employers Excess TNSC45694422 ,(TX) 03/01/09 03/01/10occurrence/SIR 25M/2M C Workers Compensation 4801323(QSI) 03/01/09 03/01/10 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS RE: EVIDENCE OF INSURANCE CERTIFICATE HOLDER _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THD AT-HOME SERVICES, I11C. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 2690 CUMBERLAND PARKWAY - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR SUITE 300 REPRESENTATIVES. ATLANTA, GA 30339 AUTH ORIZED REPRESENTATIVE - USA ACORD 25(2001/08)ckomraus_hd ACORD CORPORATION 1988 11172180 FE2-01-2010 12:51 HOME DEPOT HYANNIS P.00i HOM b.'I M PRO V IUNIJEINT CONTRACT PLEASE READ THIS Sold,Furnished afid 1as ed by. X1+D-At-Homc Services,luc. Branch NAine. e d/b/h..The homef)-pot At-Homc Smvicc%%: .345A(3rccbwooZStrect;LTnit2,i.Wo-rceAerMA 01607- Branch rlumbcL:.3L:: L�.(508)756- 823 Toll Free(900) F- Fcdcml.ED#.,75,26984W.MELic,04COO-439;IUCont-Lic#16427 - CT f-I oinC julpiO�Tincit 611t=ai Regtt 126893 H Installation Address- ) :� \� —�^ 11-- . . - I.. 4K_el slam.:; lp Purchase h Cell-Phone: Werk;rlion c P on*.-- Rome Address, ........ (1fdifferent from_Installation-Adckc State ,E-mail 7.Address'(to- - m tcj')_�Mjcct'_ ❑T DO any marketing email:s�rom-The Homc-Mapor-- _ Projectoixineis'o' tfie`properc l ocatd"c ab ovi mita), litibn addiess,agrees to buy, and THD At-Homc-Services,Inc.(wrhc Rome Depot"ya& :t6;fu7iiish, installation('Installation")-6f a]I-materials-desadbed-�qn-.,;hc,,bcJow,and,:on:,the,-referenced,,Sp.ec,,ShPet(s),all-of.which:arc-incorpoxated,into this Contract by this; refcr=cc;,,alon-.wjth..an ��yuu�rq,§umma attached hereto..and.say 0�. ' colli:ctiveLy., _y.:a t!4e SUV'31�_Mcut and ry pplicablerS Job Pr bducts. r Sec Sheets —ofoo. fing Siding Windows Gutters/Covers' E, Vs CJ: o, Roofing'; S7diiag Ll Windows..LJ.I=Iatiol Qc :LjSidLng';L, floors RoofingPgiding-E]ViindowS. Iwulution' 1 C6:v 015;1ty Total Co ntract'Amo Maine Purchasers may not deposit more than one-third of the Cnntmetkmount Cus.toiq,q.4&n�es,.Eh4- e tcjy..upon-.cop (one fj defined bAn'yjadivid40 Spec S 'cct)an, PaY,xv _ance due -.As app 6 'ca Xi�stouier under this Contract agrees toejbiritl�..an 'Sey- "d ejaily0 bfigatcdiiid liable he're"i m' der. � The liomeDcpovrcse.vcsLd"e2jZhtwisme,a:Chng.c,OrdcT-or,-tcaTijimte this Conuwt4Dr=y..individdatPodckct(s)irfOudedherein,at its discretion,if The Homc Depot or its authorized ser�,ico provider deter-mines.thattit-camot:pciforiii,itiplilig7ttiol)s.due-.to a strucWral problem,with the-home, -uyiro=�,ntW..bazards such,,as;mold,:,asbcstos or.lcad.painL.qthei:,sgety concerns,pricing errors oz,because wort cgruredto ;thc job was not 1iicudcd.jn the_ ontract total Sunmary'ff .iacW&d-fs�spA1t of.-thm Commet.,sets,forth the Payment S6mniarv. The Pa Prodila' cab L 'b ��t coutract amount andpa�mcni<-ircquircd for-the;deposits an Pkvm by, (as*P�h le) • NOTICE TO CUSTOMER a ompl-, opyo th-_ ontract�a.,t�th"e��e*yo'u',,,s,ign',-'D.o'nqt'$'px*a completely if,* 'Cc Contract,," i ru#lctloii'*Certificate*(.�iie-. Prod�W4er c re 'onthatl there is one.Completion-Certificate for each listed kdfvjdjjlS�jALk,.qjW6 >mauct is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Rome Depot or Authorized Service Provider through the date of termination,phis any other amounts set forth in this Agreement or allowed under ippileable law. THE HOT101 DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM T14E DEPOSIT PAYMENT OR OTHER PAYMENTS NLILDE, WITHOUT LIMITING THE HOMF,DEPOT'S OTHER REMEDIES FOR RECOVERY or SUCK AMOUNTS- Acceptance and Authorization- C"tomcr agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products,and Installation services and supersedes all prior discussions and agreement,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Rome Depot Customer acknowledges and,agrees thatCu.;.ton1cT-has-read;understands,voluntarily accepts the temps of and has received a copy.of this.Agrcc==L ...... Sub by: At An i 's Siate I . -- 1441 .ner Sales oi tantli;Palac ate U a (-o'0 Telephone o.-3 Sales Gusto l"IeDAipature Date Sales Consultant License No. CANCELLA CUSTOMER MAY CANCEL TUTS (as applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING NMTTTFN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING TIUS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF * ONE IS SPECIFICALLY PRESCRIBED BY LAW 'Pi CUSTOMER'S STATE. NOTICE:ADOMONAL TERMS AND CONDITIONS ARE STATED-ONIM REVERSE SWE AND ARE PART OF'nnS CONTRACT 74"o C-SCCustomers Piiik-S�albD C66sultadt'-' s John Guay 49 Kelley Rd. Hyannis,MA, July 11,2008 Mr.T.Perry 367 Main Street n Hyannis,MA. Dear Mr. Perry, I John Guay part owner of 49 Kelley Rd. Hyannis. Submitted a permit through our j electrician to repair and add 220 volt to the existing metered service. O p The reason we are asking for the addition of a single 220 volt service is because my compressor requires this voltage and is useless without it. I do not want to use the shed commercially, but would like to have power so I may Work on personal and home projects, because the house and burn are 120 feet apart. Running an extension cord is not an option. We would appreciate your approval so that our election can proceed with the work. Any questions please e-mail me at nalteg@comcast.net Thank You, N o �7 m - .. ♦ •. .v.. a („� .e4...> eGua a% rn 1 i N uF BARNSTABLE 2008 JUL 14 PM 3: 33 - oEvlsi�H 7/12/2008 Mr.T.Perry 367 Main Street Hyannis, MA. Dear Mr. Perry, I Linda Getlan the owner of 49 Kelley rd.' Hyannis, MA.026011 asked you fora 220 volt for my Shed. I understand your reasons.Can I please invite you to come and take a look at what's insulted Now.The shed had power years ago,and I just want to start it up again. I will not have a company:, The shed and the house are 120 feet apart from each other. Please e-mail me if you have any questigps at nalteg123@comcast.net Th o 1 Linda Getla .,'i.,+. ,:! ya3 s-s '" 'x-r9 ,J..- .a ss>p •_. ... �J -- r File Edit Tools Help Application ZQl€t 2893 + Applicant, EC-ELECTRICALCONTRACTOR Status ACTIVE __. - O�,rer" 2ZZ� Departmerd 6300-BUILDING`DEPARTMENT GETLAN,LINDAJ Prqje Descd i ti y REWORK-ELECTRIC E:R SOCKET NO PANEL COMPRESSOR Contractor - — SOR AND PLUG IN Business ECPT Descriptlon;Z' R r Prope€ /Use Non-Codorming I Dates�t�tisc Permits Type _ Status ass+ ed ° - _,. esYrtn Ccar iac�or Fee Total - Unpaitd Arrt Total fees 34}. ',° Ti#al unpaid _ - ,v d �3 x� Prere ui ies H d Restr, .^ Names - lar nds Spa Udrs T a m P�€c€ i ca . Ir€ ectrons I r�iati€�r eviei�s .rl L�Pen t +` r't2a�rrarn s, Fi6o P?elated __ ----_.--_ Z'Own1 of Barnstable .__ _ ._.__.... _..*Pernvt# �?0Q7,4-u c;?o 5� • Expires 6 months;rom issue date • Regulatory Services Fee 01 . 0 ®PRESS PERMIT Thomas F.Geiler,Director Building Division . MAY 2 4 2007 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLE www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION .- RESIDENTIAL ONLY -*� Not Valid without Red X Press Imprint [ap/parcel Number f roperty Address ! A V Ja 6L1fnt?4 NX Q o24Q l ]Residential Value of Work aC 7 d Minimum fee of$25.00 for work under$6000.00 iwner's Name&Address .ontractor's Name Telephone Number Op [ome Improvement Contractor License#(if applicable)_ orkman's Compensation Insurance Check one: - ❑ I am a sole proprietor FJ;Am the Homeowner Er I have Worker's Compensation Insurance isurance Company Name_f�L°fLe-r S Vorkman's Comp.Policy# �iU d o a 39 lopy of Insurance Compliance Certificate must be on file. -emut Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-si Replacement Windows/doors/sliders. U-Value �3 (maximum.44) "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, Ycopy of the Home Improvement Contractors License is required. AJA AtAl, IGNATURE: i:Fomis:expmtrg xvise061306 Office Order Copy Pella Windows & Doors Westerly RI, Centerville MA, Wakefield RI Seekonk MA, Dartmouth MA, Plymouth MA Serving Massachusetts & Rhode Island Phone: Fax: r:. :a .t:(:.: :.............................: freri ..Quer..............................................................�........:.........p.......................................,.................................................................................................................................................................................... Getlan,Linda GETLAN Order No. 738IDIZ73 Order Date 05/16/2007 49 KELLEY RD 49 KELLEY RD Customer No. GETLIN Need Date 06/28/2007 Tax Code MA Sales Rep.Code IJD4702 HYANNIS,MA 02601 HYANNIS,MA 02601 Taxable no Sales Rep.Name Dobbs, Ian J. BARNSTABLE BARNST Tax Exempt No. Window Store 000001 Terms Code Wells Fargo Financing Territory Lie.No.: P.O.No.: Customer Type H Ship To County BARNST MDR Code SP Prepared By Lucy Glen Owner: LINDA AND JOHN Overall Discnt. 18.403 % Architect Name Bus.Phone: (508)221-8300 Bus. Phone:(508)221-8300 Comm.Split IJD4702: 100.% Dist.Order No. Bus. Fax:( ) - Home Phone: (508)534-9559 Cellular:( ) - Home Phone:(508)534-9559 Delivery Instructions: Comments: Install Notes: Need to cut back shiplap board to apply ext casing t ::: t :::::::::::::: I t :::::::::::::::::::::::::::::::::::::::_::::::::::::::_::::::::::::::::::::::: :::::Vu�t:Pr. Extended::: C3u........Y�e�....I.em:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.........: .....................................P......................................_..................................................................:...:.:._.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:...:.:.:.:.:........................................... Item#10 Qty: 1 6068(6 0 x 6 8 )Vent/Fixed XO Sliding Patio Door,Frame:71-1/2 X 2,720.68 2,720.68 Location: 79-1/2: Pella Impervia,Alternative Material,Model I , White, V InsulShld (500.69) (500.69) R.O: 6'0" X 6'8" Temp IG Glazing, Sliding Screen,White Hardware,4-3/4"block,3 1/2" fin, 2,219.99 2,219.99 WallCond: 4-3/4"block,3 1/2"fin Block Frame w/Std Fin 18.403 % Value Added Items: Install Entry/Sliding Doors/French-2 panel-Qty I Disposal fee per wdo/door-Qty 2 Notes Item# 15 Qty: I Provided by Pella Ix12 primed pine 1/8' 0.00 0.00 Location: 0.0 0 0.00 0.00 0.00 18.403 % Notes: Office Order Copy-Page 1 of 2 1 t for Customer Project: GETLAN Order Fw R0, Outside View Item No. OLL . ummary Description Unit Price Extended Eric Item# 10 Qty: 1 6068(6'0" x 61811)Vent/Fixed XO Sliding Patio Door,Frame:71- 2,219.99 2,219.99 Location: 1/2 X 79-1/2:Pella Impervia,Alternative Material,Model 1 ,White, R.O: 6 0" X 6 8" 1"InsulShld Temp IG Glazing, Sliding Screen,White Hardware, Block Frame w/Std Fin Value Added Items: Install Entry/Sliding Doors/French-2 panel-Qty 1 Notes: Thank You For Purchasing Pella Products Taxable Subtotal $ 1,281.63 Customer ig ture Pell ales R resenta ive Signature Sales Tax at 5.0000% 64.08. i Non-taxable Subtotal - 938:37F b / Tt Total $2,284.08 , 1 I'lute € (,l� Date De ositReceived $ ,000 y rP ay p ;I -"ACKNOWLEDGEMENT: OF C.S.R.REVIEW WITH CUSTOMER(Customer initials): k1 .. 4 l ►t)t Gnd 4onditions: This order is made especially for you,the customer.No cancellations are possible after 3 business days of the signing of this order.This agcoemtsnt ,., t °` ° 4,� 1►z 'tiil�(ildlog contract only upon review and acceptance by authorized Pella Windows and Doors corporate representative in Fall River,MA. All promises of slt_ipnl ill�ii #tom ir ruts our best efforts are used in every case to ship within the time promised,but there is no guarantee to do so. Seller shall not be liable for any dircCt;`h�ditt' (tli161 d�tltllt► C c aused by delay in shipment.For non-installed orders the customer represents that the window/door sizes and specifications shown on'thllAl S i'4(j�j iirding the finishing, ,I uc maintenance,.service and warranty for all Pella products, visit the Pelf }�V I ,4 4T..s e F �y 4 -ti E) i:11 i€a k E e 1 !^C < R + ✓ �"e� a ! {t, Printed 05/10107 t�1. 1181*)`ti + ; k �' � I€I'itsl ,e`t1�'• '� �.;�#at fs't. ;.f' i tt;.:i.,i. f 'i,. rye`5:r'!i ...'f: ,��. _ I. q`(ff I ,I IItV r�}':t. FtE„4j Sbltl.. ,l l:k�F4!•; p., .F, Pi 1 1 l _ .. . .... , _.. _.. . .. ._ �._ ....�. . ILICI�I� it€�I��IG��ill.�� , , ... .. r. .w. . . i , • , ".. .,. , _; . , . � _ �.�.�, �.��.��1 €l►��{�. . � € F •� � I , Department of Industrial Accidents - -- Office of Investigations. 600 Washington Street Boston,MA 02111 k _• www.mass.gov/dia ' Workers' Compensation hasurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le `bl Name(Business/Organization/Individual): . &A /"' Yos Address: /v- /'��• City/State/Zip: / t'10 &A iv,720 Phone t 1.0v 6 "l0 8'2-0 Are you-sa employer? Check the appropriate box: -Type of project(required):_ . 1. I am a employer with 4. ❑ I am a general contractor and I employees (fall and/or part-time).* have hired the sub-contractors6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the'aitached sheet. 7. ❑Remodeling These sub-contractors have ship and have no employees 8. ❑Demolition working for me in any capacity. employees and have workers' 9...❑Building addition [No workers' comp.insurance comp.insurance.$' required_] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions '3.❑ I am a homeowner doing.all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑R repairs insurance required.]t c. 152, §1(4),and we have no , employees. [No workers' . 13. Other C !J s 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. tcontractors that check this box must attached m additional sheet showing the name of the'sub-contractors and state whether ornot those entities have employees: If the sub-canttactors bane employees,they must provide their workers'comp.polidynumber. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name:_ �pll'ess DVS. Policy#'or Self-ins.Lic.#. 4 Expiration Date: lob Site Address: `7'� �� !� City/State/Zip: Attach a'copy of the workers' compensation policy declaration page•(showing the polity nuAber and Expiration date). Failure.to secure coverage as required tinder Secton 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 maybe forwarded to the Off ce of Investigations of the IDIA for insurance coverage verification. Ida hereby certi u der the ains nd penaIties of perjury that the information provided above is true and.correct. Si afore: Date: a Phone#: Official use only.. Do not write in this area,to be completed by city or town offrciaL City or Town: Permit/License# I. issuing Authority(circle one): :i.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ContactPerson: Phone#: Inf®rm ati®n and Instructions y : Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other Legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer, or the tier nr trLctee-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." MC-rL 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•acedptable 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 comp&:dee with the insurannee 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-contiactor(s)name(s),address(es)and phone number(s)along with their certificates)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. Re 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 Aecidents,:Should you have any questions regarding the law.or•if you are required to obtain a workers.'- compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Town Officials Please.be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact'you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license 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 brim leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike to thank you in advance for your cooperation and should you have anyquestions,! please do not hesitate to give us a can. The Department's address,telephone-and fax number; .Com ouwealth of Massaebusotts Department of IndusWal Aoc.dints Office of ations o 600 Washington Street Boston,MA 0.2111 TeL#617-727-49-00 ext 406 or 1-a77 MASSAFB Revised 11-22-06 Fax-4 617-727-7749, www.mas.5.gov/6a Town of Barnstable. ti Regulatory Services h t • 9$MASS, '� Thomas F.Geiler,Director Alf 659. Building Division Tom Perry, 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, ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to.work authorized bythis building permit application for: . (Address of Job) 4N C.O,?J#ae'�— LeikC44Z6 Signature of Owner Date Print Name I Q:FORMS:O WNERPERMISSION Board of Building Regulations and Standards License or registration valid for inlividul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: R �tstea�t�n: 9840 g g ''' Board of Building Regulations and Standards r. _ # :__,t3/2008 One Ashburton Place Rm 1301 f_- -- ' = Boston Ma.02108 cJ LiabilityCorporation sr !3; PELLA WINDOW - r ! STEPHEN DICKIV.Sv_ 1325 AIRPORT ROAD` =� FALL RIVER,MA 02720 Administrator Not valid without signature � - - fie 1ilamx�zzonuiea.�+/;�z o��.oa�ui6seF'J�i 1 y40100 • � i Naytt�}��{� C.S t�3"Ir84t3 Tr_no. 1737 .y T x -! 1 r. / j . U:J/ UJ/LUU f L J0 J000 f o00LJ f GLLH WlIVLUWJ rHllC UG/UL From:Jeanne Pansey At The Pre5tDn Agency FaxID: To:Tracy Simagftna Date:613=07 01;27 PM Page;2 of 2 ACORD CERTIFICATE 4F LIABILITY INSURANCE LOp L& z DAT05/oDI/0 FELLA-1 OS 03/07 PROOUOER THIS CERTIFICATE.IS ISSUED AS A MATTER OF INFORMATION The Preston Ardency, Iric. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303 HOLIER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Sox 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Greenwich RT 02818-0810 Phone:401-ORG-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE MAX# MauR» INSURERA: Peerless Insurance Company 24198 PFR Ac ilsition, LLC dba: Pella Windows & Doors INSURER0. 1325 Airport Road Acquisition LLC INSURER C: 1325 4irport Rd INSURER0: Fall River MA 02720 INSURER E: COVERAGES THE POLICIES OF IN61)RANGE 1,19TI10 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PoLIcY PER(OO INOICATBb,NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT,WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE I65UED OR MAY PERTAIN,THE INSURANCE AFFORrAV AY THE POLICIES DMCRIOCD HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS alOWN MAY HAVE OCCN REDUCED DY OAiD CLAIMS. LTR FOUL 9 TYPE OF INSURANCE POLICYNUMBER DATE(EFFE I DATE(MMIOGIYY) LDRTB GENERALLIAIILFY EACH OCCURRENCE $1,000,000 A X COMMERCINL GENERAL LIADILITY CBP8022572 OS/01/07 05/01/08 PREMISES (Ea oaauranoo $300,000 f'IAIMS MADE O OCCUR MED EXP(Any nna pnrson) $to,000 X EBL _ PFR60NAy R ADV INJURY $i,000,000 GIRNWIAL AGGREGATE $2,00 0,000 OWL ASGRFGATELIMITAPPLIESOFR: PROD(IM-COUPIOPAGG $2,000,000 POLICY ACT LOC Entp 8®a. 11000,000 AVTOMOB(LE LIABILITY A ANY AUTO EM022972 05/01/07 05/01/09 (EOmdderf)ED SINGLE LIMIT $1,000,006 ALL OWNED ALTOS BODILY INJURY $ X SCHEDULED AUTOS (Perpereonl X HIRED AUTOS BODILY INJURY S X NON-OWNEDAUTOS (Ptvaddw) PROPERTY DAMAGE S (Pa errJwi) WAGE UASILMY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS&NORELLA UAfLnY EACH OCCURRENCE S 10,000,000 A X OCCUR CLAIMS MADE Cue140390 OS/01/07 OS/01/08 AGGRFGATF s io,000,0o0 s pEOLCTIBLE $ — X RETENTION $10,000 $ WORKERS COMPENSATION AND X I TTJRY LIMITS ER A ANY,PR ERB'61ABILITr WC8023972 05/01/07 05/01/08 Ea-EACHACCIDENT $1 000 000 ANY PROFRIETORfPARRvERfEXFCUnVF r , OppICER/MEMBEPEXOLUDEDT E.L DIS[nSE-GA EMPLOYEE $1,000,000 gas,dm lEo undu CIAL PROVISIONR Wow E.L.DISEASE-POLICY LIMIT t 1,00 0,000 OTHER DEBGR(FTION OF OPERATIONS I LOCATIONS I VEHICLES I EXVLMQN$ADDEO BY ENWR$EMEW I SPEOIAI PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED IEFORE THE EXPIRATION DATE TNEREOP,TW ISSUING INSURER WILL ENDEAVOR TO MAIL _DAYS WRn7EN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,OUT FAILURE TO 00 SO SHALL PROOF OE 2NSURANCE ONLY WOVE NO OBLIOATION OR LIABUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENITATWES. AUTHQ�jZ6DR@_FR FS NTATN@_ ACORD 25{2001M) 1�'l�SY��Qr��7�'y__'_'.�p�_f_ 0 ACORD CORPORATION T986 -- - - Pella Windows & Doors 1325 AIRPORT ROAD FALL RIVER,MA 02720 TEL. 508-676-6820 FAX 508-676-6823 June 19, 2006 To: Whom It May Concern RE: Contractor and HIC License I hereby give permission for Steve Correia to use my Contractor Supervisor's License #CS081843 and my HIC Registration #149840 to pull permits in the State of Massachusetts for all projects related to work performed for Pella Windows & Doors, Inc. Steve Dickinson Operations Manager Pella Windows & Doors, Inc Windows, Do( & Skylig y�FTHE T TOWN OF BAR.NSTABLE • 88HBSTADLS, i _ 9� O 39.Ar � BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... ................ 1,....,.1� U . ........... ............................................................. TYPE OF CONSTRUCTION .1. ..� � � ` �\ ..........� ............... . ..... ......... ... ................. ......................... \...... ..........19...:e. TO THE INSPECTOR OF BUILDINGS: The undersigned her (appplies �car-ci—nermit' accordi .g to the following information: Location ...�...\.......... `\.... 1\d C�� 1\"�1\� ProposedUse .... . ...` .... .. .. ....................................................................................................................... Zoning District .....��.. S. �, . ...o Fire District�`Name of Owner��....`....�. ..U.S `.`.............Address Name of Builder . .�..— ...............................`.............Address ......... . . . 1z. _...................................... Nameof Architect ........... .................................................Address ........................................ .......................................... Number of Rooms ......................................................Foundation ..� 1 3 � . ................. Exierior ` ..........................................................Roofing .... \ . .... Floors �N...�.�....`. ...................................................Interior ........6.C�:�...�� ;; Heating(�"i .............Plumbing ...... .A....................................................................... b \ ` Fireplace .............................Approximate Cost . ` Difinitive Plan Approved by Planning Board --------------------------------19--------. 1, �✓✓ Diagram of Lot and Building with Dimensions 4 I. i� C� THE PROPOSED METHOD OF PROVIDING FOR SANITARY WAT'FR SUPPLY, SEWAGE DISPOSAL AND DRAINAGE iS FiEREBY AK RUV`ED TOWN OF BARNSTABLE, BOARD OF HEALTH A. LICENSED INSTALLER MUST 'OBTAIN SEWAGE --"�" E' A, D Ii"dS T ALL SYSTEM. - I hereby agree to conform to all the Rules and Regulations ofZtThe 'wn of Barnstable regarding the above construction. Name ...... .. McClusky, Edward No ....12 Permit for ...add...tq s i ng1.e fam i1 zJ..dwe11 i ng............................ ........... .... Location ..........4-9..Ke,11,y„Road G✓r1� ; H nz a . ns y........... ...................................... Edward McClusky Owner .................................................................. t f Type of Construction .................rame ................... ............................................................ Plot ............................ Lot .J.1q ..................... Permit Granted .....ecember 18.......19 69 , Date of Inspection ...�...:.47..............19 ;70 I { Date Completed ......................................19 GC51 n' PERMIT REFUSED: _..-------- �+ r ...................................... 19 ............................................................................... ►. i .. ................................................................................ u -r. ............................................................................... , ............................................................................... i - v Approved v ............................................................................... ............................................................................... �OFfHE Tpk� Town of Barnstable *Permit# 9; G0 �? Expires 6 monthrfrom issue date BMWSrABLF4 Regulatory Services Fee i6 9.� Thomas F.Geiler,Director plED MA't A` . Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Off - lce: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY n Not Valid without Red X-Press Imprint J6 Map/parcel Number oC /1 6 6`7 ��ff Property Address Ea F kd ` . (S 11 4 6 6 d DI esidential Value of Work s� — �• Owner's Name&Address !� i=14 N a 7-# l/ 4 FE 14 -72t f-i xa L 7- � Contractor's Name dz., p a')k &VI e% Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) r-- A - RESS PE MIT ❑Workman's Compensation Insurance Check one: S E P 0 6 200 ❑ I am a sole proprietor [!rI am the Homeowner :TOWN OF BARNSTA ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) 2-1ke-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature �t Q:Forms:expmtrg Revised121901 O 6' The Town of Barnstable— _ Permit#� 7,3 Massachusetts Wr WABIX Date SOLID FUEL STOVE PERMIT Fee .n O d This constitutes an official stove permit after inspection and approval by the building inspector. . a Owner EN fli e /N E,Q' u 7- Telephone no. 7 7�— 9 6 7 y� Address of Property EU F Village Location and Stove Type t,��opl� V ^N G a645 ij t_ Date: 2 B g Inspector The solid fuel burning stove at the above location passed: ` failed: inspection. Assessor's offioe (1st floor): OF THE To 29 6 7 Assessor's map avid lot number ............. .................... ... ` Mya• ��y� f Health (3rd floor): IST Board STALLED 6N �� ewag Permit number ............ .... ...i�.......�� .`� r{� ,;� B�SIIn9eTABLE. LE. • tiE�ngineering Department (3rd floor):'� _ House number ..9...m..�.� � 3r �i .oti� i3� � <w '�� oyp�a�e�° APPLICATIONS .PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M..only TOWN REGULATIONS TOWN 'OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......�L?.L.CD GA-,e f�E _ ......................................................................................................... TYPE OF CONSTRUCTION ..............:�� 4 ......................................................................................................... .....................o�.......---..............19�.4._ TO THE INSPECTOR OF BUILDINGS: The undersignedd hereby applies for a permit``)according to the following information: Location ...... ...1......!.��.4 ..y......�� I�'.y..F1.f�1V.ts. .r........................................................................... �. . Proposed Use ..C`l4.`Z.i ... ... To.R:R�. ........................................................................... ......... Zoning District .........P118........................................................Fire District ........ Name of Owner 4S S Y.... .=..WA.R .........................Address ..4r1.... 5, .... 1 -.f.fFN4 1 .................. Name of Builder ...5 .. ..A6......6.S.U�'!y ..............Address .............:...................................................................... Nameof Architect ..................................................................Address .................................................................................... 4 Number.,of Rooms ...........+....�Oi1. ).................................Foundation ..!CC�NCIZ > ................................................ Exterior qq7 .............Roofing ...�� ...'.�............k� . :!"�. ......................... Floors .....Cv1'?.C.PTP ....Interior ' 9 Heating .......... .......................................................Plumbing ......../..`.:D!1��..................................................... l f� ...... Fireplace .........�0.!t3> ........................................................Approximate Cost ...... ........................................... Definitive Plan Approved by Planning Board ________________________________19________ . Area, .. ......-.•'.�.-.�........�......... Diagram of Lot and Building with Dimensions Fe SUBJECT TO APPROVAL OF BOARD OF HEALTH ! � —' 4%11 P � of I ' � I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. c It Name ..... ........... .. .................. .. .. Construction Supervisor's License .................................... } HARVEY, RICKEY L. No 32 .... Permit for ...Build Garage Single Family Dwelling .......................1 .. 4 9 �„ I—�-�-� Road........................... w Location •� � ...................................... , ..................HXanni s........................................... w =' Owner .....Rickey...I!-...Harvey................... _ Type of Construction .....Frame r" Plot ............................ Lot ................................ Permit Granted .......Auus:t 10, 19 8 Date of-Inspection .....................................19 t.v w Date Completed ....... 19 f r lit ! J se s offioe (1st floor): 'THE s " '6 Assessor's s0 map and lot�number .... ,,_Boare-,No Health-(3rd floor): . mber ..............0.,jewage Permit ,nu SAWS'TABLE. NAS& ngineering Department (3rd floor): 1639- House number .................................. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00:-P.M-..only 41 TOWN `OF- BARNSTABLE B U IL D I H,_G HAS P E C T,:O R _ r APPLICATIONFOR'PERMIT TO .. ....................4............................. .................. ......................................................... TYPE OF CONSTRUCTION ........... ....................................................... ............................ ......... ...................1 9n. .... ... .... TO THE INSPECTOR OF BUILDINGS: 'The undersigned hereby applies for a permit according -to the following information: ... Location ......KF,�.%f...... ........*. ... .... ....... .......................................................................... 4, ProposedUse ................................................................................................... -i�-ONtrict Zoning:, Distract /"7 f. .......................................... . . ......... .............................. Name of Owher R.s :AgvjU. ..............Address ........ .....K!f .6................... 's 4 ty?JE ��-%...............Address ..................... Name of Builder ...........................5.......6 ............................................................... Name of Architect ...................................................................A a d r e's�s NE' Number of Rooms ......... ......(9 . ....................... ....... . ........Fouridation ...QPN!;.Kf5T.E................................................ woo Exjerio. ................................ n1g .......R-1-r ...... ............... Floors ..... P.0!1?.............................................. ......................Interior. ......—..................................................................... Heating ..........MP&).F............................. /J Z)A-).,C- ...........................F�Ilu m ........................ .......................................................... . Fireplace ...L,...../\)0 A.........)E............................................................Approximate Cost .......45� . 9........ Definitive Plan Approved by Planning Board ------- 19-------- - -------------- Are. • ......... ... Diagram of Lot and Building with Dim6nsions'T fee� SUBJECT TO APPROVAL OF BOARD OF HEALTH t 415 A A _71b OCCUPANCY PERMITS REQUIRED FOR NEW DWELL I NGSA---.-kz -T I hereby agree to conform to 'all the Rules; and Rigu�lafions of the Town of Barnstable regarding the above construction. oul� U..-i.................................. ......... -;-,,.C6nsi?6ctibn Sup e�ryisor' 'License ................................ HARVEY;' RICKEY L. A=292-067 ` 3�159 Build Gara e No ..Y:..":........ Permit for ..................................... Single Family Dwell-i ... . ..... �.�.� !T.g......... Location :.49 .di �ad.. .................................... ......................Hyann i s............... Owner ......Ricke ..L.-...Harvey................. Type of Construction Fr.ame.................. • E ......................................................... Plot ............................ Lot ................................ Permit Granted ........A,Ugu.st...10........19 88 Date of Inspection ....................................19 i Date Completed ......................................19 Pn) 1 � ` s , ^J b�Py�FTHE tp� n TOWN OF BARNSTABLE i BARNS TABLE. i "AM i63q. BUILDING INSPECTOR pp `00 •fp V a' s APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION .... .. . ............................................................................................................ ......................�.0... .r......19..t� TO THE INSPECTOR,OF BUILDINGS:.!— The undersigned hereby applies for a permit according to the following information: p Location ..........�..r�....... .L.4�.............d�..................... �...................................................................................... ProposedUse ......... ................................................................................................................................................. ZoningDistrict .............!.k../........../.......................................Fire District .............................................................................. Name of Owner ..rD. l ...0...°!�.... LV, ,I� ..Address ..C/.(��..... ..�r.. c. .... ............................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms Foundation �� Exterior W'�C� .� �6�°4+.�..�-..........Roofing ..............! .S l' ............................................ Floors ..................... ...............................................................Interior .................................................................................... Heating ............... ...............................................Plumbing ...............tt ............................................... Fireplace .................................................................................Approximate ��...Cost ........� .rAp..�.�°.. A Difinitive Plan Approved by Planning Board ________________________________19________. Diagram of Lot and Building with Dimensions rr r� 4 / U I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... ........ . ............................. ....... McClusky' Edward J. e 0712, i I 3..... Permit for tool No ...1...... shed..................... r ............................................................................... i Location 49 Kelly Road .... .................!.. �....................... ........ ........... r zds. ; 4 Owner .................................................dward J. McClus ............. Type of Construction .............frame 'h 4 ................................................................................ �a Plot ' ....October ..21............19 70 W�` � J dlin Permit Granted _ Z � � Date of Inspection .f.1............3.............19-76 Date Completed. ....... ....... ............. PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ Approved ................................................. 19 } 1 ..................... ......................................................... i