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Home My WebLink About0030 MAIN STREET (HYANNIS) 3O �ooq�---oaP e�� ,�2�- 1 Town of Barnstable it# Expires 6 months m issue date Regulatory Services Fee s MASS. Richard V.Scali,Interim Director 659• IY� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number a-1 10 6 m ee Property Address o i J Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&AddressD50CI BicbeMn rrum a Udif M Contractor's Name Telephone Number ®o_7®11-1 3 F Home Improvement Contractor License#(if applicable) ZR 6 9'13 Email: Construction Supervisor's License#(if applicable) 0 7 00 7 7 0 �Workman's Compensation Insurance _ Check one: OCT 2 3 2014 ❑ I am a sole proprietor ❑ I am the Homeowner TOWN OF BARNSTABLE RI have Worker's�Compensation Insurance co Insurance Company Name #drip SH-/pr- // ` Workman's Comp.Policy# �' ® 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) Re-side Replacement Windows/doors/sliders.U-Value r �� (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Dire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner M s sign Property Owner Letter of Permission. A copy of H e Improvement.Contractors License&Construction Supervisors License is required. SIGNATURE: T:IKEVIN_D\Building Changes\EXP S XPRESS.doc Revised 061313 f The Commonwealth of Massachusetts Department of IndustrialAccidents13 . O eo)1c f Investigations 1 Congress Street,Suite 100 Boston,MA 02114 2017 wwwmassgovldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LEgibly Name (Business/organization/Individual): HOME DEPOT AT HOME SERVICES Address:2455 PACES FERRY ROAD City/State/Zip:ATLANTA, GA 30339 Phone#:774-265-2139 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 20 4. ❑ I am a general contractor and I employees(full and/or part-time).* .. have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers'[No workers' comp, insurance comp. insurance.$ 9 ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no WINDOW REPLACEMENT employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Con tractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:NEW HAMPSHIRE INS. CO. Policy#or Self-ins. Lic. #:WC049101882 Expiration Date:3/1/2015 Job Site Address: �//l�J �/�r�f m 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 agains;Pce ' lator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under,t a e the information provided above is a and correct. Signature: Phone#. 401-714-6399ij 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 S.Plumbing Inspector 6.Other Contact Person: Phone#-. r - The Commonwealth of Massachusetts Department of Industrial Accidents 4` Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 �44=- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address:_ Is- ��5� b 0i City/State/Zip: ! LOfvo �23yd Phone #: 7?'7- 74"213 2-5- Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I — 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 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 LE] Plumbing repairs or additions exemption myself. [No workers right of tion per MGL comp. g p p 12.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13. Other WIN O�.c� comp. insurance required.] 'lp I *Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy info ation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. . $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurancie Company Name: U ax;f� Policy#or Self-.ins.Lic.-#: Expiration Date: Job Site Address: 1 yprr Pk City/State/Zip: 5_y__�'►IT 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. ^K I do hereby certify nder the paips and en ies of erjury that the information provided ab ve is tr a and correct. S i afore.E ._ 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#: _ a d Office of Con sumer Affairs and Business Regulation - - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 126893 Type: Supplement Card THD AT HOME SERVICES, INC. - Expiration: sr3/2o1s ANDREW SWEET -- 2690 CUMBERLAND PARKWAY SUITE300 .; ATLANTA, GA 30339 - _ — --- Update Address and return card.Mark reason for change. SCA i - 20 MAW11 J Address J-] Renewal is-; Employment F Lost Card -r� O Al ffice of Consumer Affairs&e Business Regulation License or registration valid for individul use only t? g i, t HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 12ggg3 Type: Office of Consumer Affairs and Business Regulation _ ; 10 Park Plaza-Suite 5170 Expiration: 602016 Supplement Card [Boston,NIA 02116 Tun AT unne_e CCOL/I/�CCIpiv! r\ THE HOME DEPOT AT HOME SERVICES ANDREW SWEET / • 2690 CUMBERLAND PARKWAYS HOME IMPROVEMENT CONTRACT PLEASE READ THIS _ n9u t, Sold,Furnished and-Installed by: Branch Name:Boston North&South Dater/30, _` THD At-Home Services,Inc. d/Wa The Home Depot At-Home Services Branch Number.31 and 33 909 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903-3768 . Federal 11)#75.2698460.ME lie#C 02439;R1 COnt.Litt!1642'7 CT Lie#HiC.0565522;MA Homc Lnprovcmcnt&tractor Rej.#i26893. Installation Address: 30 City State Zip Pu chaser(s): work Phone. Home Phone: Cell Phone: [ l [ l [ ] Home Address: . (lfdil'fercnt from Installation Address) City State Zip E-mail Address(to receive project communications and Home•Depot updates): El I DO NOT wish to receive any marketing emails from The Home Depot Proigg Information: Undersigned("Customer'%the owners of the property located atthc above installation address,agrees to buy, and THD At-Home Servio m Inc.C'The Home Depot-)agrees to'furnish,deliver and arrange for the installation(-hwi 11'ation")of all materials described on the below and on the referenced Spec Sheet(s), all of which are incorporated into this Contract.by,this. reference.-along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively; "Contrast"?: Job#: nowt Rd—,) P oducts: S Sheet(s)#: Pro'ect Amount Roaring Siding rpdtnvs Insulation �y $ �� ❑0uttem I Cover% ❑Entry Doom ❑ 7 �+ �7• Roofing OSiding U Windows 0 Insulation $ 00utters/Covers ❑Envy Dom ❑ Roofing Siding 0 Windows M insulation - E]Gutwrs/Covers ❑Entry Dom❑ $ Roofing OSiding 0 Windows 0 Insulation n ❑Guucrs/Covers ❑Entry Door, ❑ $ ,NLnimwn35%DepositefC obudAmoomtduenponemaartimoftbbeormract Total Contract Amount $ MainelNuchasers may"deposit more than onathudoftheCansdAmouM Customer,agrees that,.immediately,upon completion of the work for each Product,Customer will execute a Completion Certificate (one lur'cstch'Yroxluct as defined by an individual Spec Sheet)and pay any balance due_ As applicable.each Customer under this Conuaot agrees;to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual PrWuct(s)included herein,at ' its discretion,if The Home Dcput or its authorized service provider'determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbcstus or lead paint,other safety concerns,pricing errors or because work requirtxl to complete the job was not included in ContracL Payment Summary: The Payment Summary# 0 ` �_- includedas part of this Contract sets iiirih ttd total 73 Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER Yton are entitled to a completely tilled-in copy of the Contract at.the time you sign, Do not sign a Completion-C:erdficake(mite:' there is one CompletionCertificate for each listed Product as defined by individual Spec Sheets)before work tin that Proi!itttct is complete. In the event of termination of this Contract,Customer agrees to pay The home Depot the casts of materials,lahor,expenses and services provided by The Home Dq&or Authorized Service Provider through the date of terminatiou,plus any other amounts set forth in this Agreement or allowed under applicable law. THE:HOME DEPOT MAX WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WffIIOUT LIMITING TH E HOME DEPOT'S OTHER REMEDIES FOR RECOVERY Or SUCH AMOUNTS. Acc ace and Authorization: Customer agrees and undo-stands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installaticm services and supersedes all prior discussions and agreements,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 Home Depot.Customer acknowledges anTagrees that Customer has read,understands,voluntarily accepts the terms of and has rcccived a copy of this Agreement_ Sub 't ed b Cust(;mer's 95gliature Date Sales sultant's Srgnaturc Date g Telephone No. �� 61e G 1`D ' Customer's Signature Date Sales Consultant License No. CANCELLATIOIN CUSTOMER MAY CANCEL THIS osapplicable) / AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING VAtr 1'EN NOTICE TO THE HOME �•\'� DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDI' oNAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 03.07.14- While Branch File Yellow-Customer Td Wd6Z:S SZOZ LS 'a�'W 1LZZZ9£809: 'ON XUd Pe6mpr: ,. woaJ P e �f�r{ Fa� �,.•. � "�� n,ta 4n�� '� Warp�. ,,. f i .YS �' i� 'F.dm•� xy 2 'T • � W � �N A '"'• ��.— a, r 'f,��. .•tit �� t�ce•� �w_ F 3l�.AyF�yS � , �R��R•M1��f a �+:� 's` �� r:•r , �N x}.�',. �#e�y,,,�t�y�F ��,�_S A ��!bt,'°Ea.a az�[ut,+r � r v _ H _ �l Fi rst Property MA rJ A G E M E N T 10,16 Bain Street, Suite 11 Tel 508 420 0299•fax 508 420 0789 Osterville. Massachusetts 62655 www 1prmcapecod.corn August 26 2014 Janice Campbell At Home Services The Home Depot I Dear Janice, I Andy Witter, President of First Property Management approve the installation of 2 replacement �tzndows for Dena Rieherson at 30 Main Street,Unit MA,Hyannis MA. Home. Depot will install earth tone exterior, white interior, no grids,vinyl windows in the upstairs bedroom. They«6it-be energy star%rated,PRS 5}00 series,condo-approved for--the earth tone.cotor,to match the color already-them. Home Depot will pull the permit for the job and provide proof of insurance, which T will send under separate cover. AndmN,J. Witter,ARNI First Property Management 4. Y Y 9 fih e � . Generated by CaM' Sca Der