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HomeMy WebLinkAbout0345 OLD STRAWBERRY HILL ROAD 3`IS ODD SiRAtiI "I� HILL' 94- Ai (_ i f �I �lfJ Application number................................................ Date I ssued............ttvv, .k. . .......................... IIAR-'VSTABM MAM $ i6g9. �FOMA' L Building Inspectors cneslp...e..c..�ors�Initials .._.ls.....�.I......J 4i .....I........�........................................ TOWN 0BA1NSg . TOWN OF BARNSTABLE I I� EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: s �O1 �( o f wl S NUMBER ST ET VILLAGE Owner's Name:, �,w FA75E---12Phone Number 60 8--7 Email Address: Cell Phone Number Project cost$gal Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: -,k S e p A-- a JNa 0cP,4c&4 Date: TYPE OF WORK 0 Siding Cl Windows head ge)# Insulation/Weatherization Doors (no header chan e)# Z Commercial Doors require an inspector's review J Roof(not applying more er'of shingles) Construction Debris will be going to Lcl CONTRACTOR'S INFORMATION Contractor's name f�c�un �e nn,so✓� - So,,k���n Akli Fry 1C14 i'11 cow s Home Improvement Contractors Registration(if applicable)# 17 3 Z-L[5 (attach copy) Construction Supervisor's License# ()J S 7 07 (attach copy) Email of Contractor P ti ee- 9 q S@ 61-W i I- C b M Phone number qo l- Z 2-9 -J g oo ALL PROPERTIES THAT HAVE STRUCTURE516VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER ..................•• *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNERIS LICENSE EXENTTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction p Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures;specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date F- PLICANT'S SIGNATURE Date Signature All permit applications are subject to a building official's approval prior to issuance. ,' Renewal Agreement Document and Payment Terms b Andersen• dba:kenewal B Andersen of Southern New England y ,A gl Susan Patev Legal Name.Southern New England Windows,LLC 345 DId Strawberry Hill Rd RI#36079,MA#173245,CT#0634555, Lead Firm#1237 Hyannis,MA 02601 WINDOW NE IACEMENT- 10 Reservoir RdI Smithfield-,RI 02917 - - - H:(508)771-4027 - ' - Phone:866-563-2235 1 Fax:401-633-6602 1 sales@renewalsne.com Buyer(s) Name: Susan Patev. Contract Date: 0.1/03/19 Buyer(s)Street Address: 345 Old Strawberry Hill Rd. Hyannis, MA 02601 Primary Telephone:Number: (508)771-4027 Secondary Telephone Number: . Primary Email: seahagsueQgmail.COm Secondary Email: Buyer(s)hereby jointly:and severally agrees to,purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any.documents listed in the Table of Contents,and any other document attached to.this Agreement Document, the terms.of which are all agreed to b the parties and incorporated herein by reference(collectively,this"Agreement"): Buyers)hereby agrees to sign a corripletion certificate after Contractor has completed all work under.this Agreement. Total Job Amount: $9,111 By signing this Agreement;you acknowledge that:the Balance Due;and the Amount Financed must be in by personal check;bank check,credit card,or cash. Deposit Received: $40556 Balance Due: $4,555 Estimated Start•. Estimated Completion: Amount Financed: 8-10 weeks 8A0 weeks $9,111 Method of Payment: Financing We schedule installations based on the date,of the signed contract and secondarily on the date in which:we complete the technical measurements:The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weatherare the most common causes for delay Notes: 50% paid by GS,; 50% paid by GS at compl,;Taxes paid in Barnstable Buyers)agrees and understands that this Agreement.constitutes the entire understandings between the parties and that are no verbal understandings changing.or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1) has.read this Agreement, understands the terms of this Agreement;and has received a completed,signed,and dated copy of this Agreement,including the.two attached Notices of Cancellation,on the date first written above and2)was orally informed of Buyer's right to cancel this Agreement: NOTICE TO BUYER;Do:not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,.MAY CANCEL THIS TRANSACTION AT ANY TIME NOT.LATER THAN MIDNIGHT OF 01/67/2019.OR THE THIRD BUSINESS.DAYAFTER.THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal NamerSouthern New England Windows,LLC dba:Renewal sen of thern New England Buyer(s) Signature of Sales Person Signature. Signature Kevin Desmarais Susan Patev Print Name of Sales Person Print Name Print Name UPDATED; 01/03/19 Page 2 /_12 r J , f�C��%2/�ZC�f7CG�PCGG/ C� U. � CCG�7LG1� f� Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 .Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS,LL Registration: 173245 G- Expiration: 09/18/202U 10 RESERVOIR ROAD SMITHFIELD, RI 02917 Update Address and Return Card. SCA 1 G 20M-05i17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 173245- 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS.LLC Boston,MA 0211 1 � BRIAN DENNISON 10 RESERVOIR ROAD u SMITHFIELD,RI 02917 Undersecretary 1 a—t na. Without signature Y Commonwealth of Nl assachusetts Division of Professional Licensure- Beard of Building Regulations and Standards Construction St.�p�r�isOr CS-095707 _ _ - E p i res : 09/08/2020 RIAN ® DENNISON �_5 8 BLACKWELL�®RIME CHARLTON mA.,..01607 Commissioner CIL f The Commonwealth of Massachusetts Department of Indusftd Accidents I Congress Stree4 Suite 100 Boston,MA 07114--2017 www.mass gov/dia Workers'Compensation Insurance Affidavit.Builders/Contractors/Electricians/Plumbers. TO BE EILED WITH THE PERINU TLYG AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organizationllndividual): y(�"t h e f A, be o fnj2 I t tjad U.)16 dixils Address-_U S uDl it FA City/State/Zip:S M t-HIA e-l�,ham- / 0z9 /7 Phone k YDl—Z?/g-- n 0 v Are you an employer'Check the appropriate box: Type of project(required): �. _ 1.01 am&employer with TL employees(full and/or part-time).* 7. ❑New construction 2E]I am a sole proprietor or partnership and have no employees working forme in 8: ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.[]l am a homeowner doing all work myself.[No workers'comp.insurance required.]* 9. ❑Demolition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation imur nce or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 3.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp,insurance.: 13.❑Roof rekairs 6. We are a corporation and its officers have exercised their right Other �- ❑ gtnt of exemption per MG[,c. 14. 152,§I(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation licyinfiqfination. 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 came 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. 1 ant an employer that is providin;workers'compensation insurance for my employees Below is the policy and job site infornadon. Insurance Company Name:_ rM MS ;,S UK AY— (,O • pF VIP; b.a . Policy#or Self-ins.Lic.#:—yt/C R �� S S 7 2 8 L Expiration Date: /' — D LO Job Site Address: City/Sb&Aip d)7 S Attach a copy of the workers'c mpensation policy eclara 'on page(showing the policy nu her and eApiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a ftne up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi underthe p ' S iatu penalties of perjury that the information provided above is true and correct • / ` Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# l 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#: aRa� CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 12/28/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: CoBiz Insurance, Inc.-CO PHONE 303-988 0446 a Ne:303-988-0804 1401 Lawrence St.,Ste. 1200 E-MAIL Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC. dba Renewal by Andersen of Souther New England INSURER c:Homeland Insurance Company Df New York 34452 10 ReserviorRd INSURER0: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:787175890 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER . POLICY EFF LICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DDJYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/112019 111/2020 EACH OCCURRENCE $I'DIXI 000 CLAIMS-MADE a OCCUR DAMAGE TO RENTE5-PREMISES occurrence) $300,000 MED EXP(Any one parson) $10,000 PERSONAL&ADV INJURY $1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,0W,0W X POLICY❑PRO- El LOC PRODUCTS-COMP/OP AGG $2,000,MD OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 CO acl.ntSINGLE LIMIT $ 000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident $ A X UMBRELLA LIAB X OCCUR OPA3158728 1112019 1/1/2020 EACH OCCURRENCE $15.000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $15,00D,0W DEO I X I RETENTION $ B WORKERS COMPENSATION VVCA315872924 1/1/2019 1/1/2020 X S R_ ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,0MAW OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000.000 C Pollution Liability 7930073340OW 1/1/2019 1/112020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000,D00 Retroactive Date 061202013 Deductible $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached B more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 3 --7 ---t TOWN OF BAR STABI.F INSULATION �� 7013 MAR -6 R�_: '12: 4 5 Ed /IYIR OlAS> SIAMt1'aa ...IOAYI 30P9X40 \AILS YY111Yf IXSYIAIIOX LIIIIXOf 1-800-696-6611 DIII Vown. of Barnstable Regulatory Services Building Division 200 Main St 1-tyannlis, NIA 02601 r Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property, Address Vile ayw/ is Insulation Installed: Fiberglass Cellulose R-Value Restricted Urwestricted Ceilings ( } ( ) (30) ( ) (x) Slopes ( ) ( ) ( ) ( ) ( ) Floors RCTt�i a1v Sincerely He y E C� sidy J , President Cape Cod nsulation, Inc. Dlc S i raG�)bar r i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o?S1 Parcel J ` Application #QO l ® ( 3 Health Division Date Issued 4 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village 6014 Owner Address TTh, Telephone � 1-Ti- Permit Request WtZyRt �/ (i`7ij1� G•t� id�4(/L' kAV"i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation If ®�9d Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —now 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 sto4: ❑ems ❑ No C Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn:0 xisting tn ne size Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other,- ' Al Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes i/No If yes, site plan review # ' Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ��i' � !! / �s�� ?���� Telephone Number /�- Address` a7iLicense # Home Improvement Contractor# Worker's Compensation # ��}®®,�o�c7,�r�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE l Z { FOR OFFICIAL USE ONLY t r APPLICATION# DATE ISSUED MAP/PARCEL NO. i i ADDRESS VILLAGE t OWNER t DATE OF INSPECTION: a FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL I PLUMBING: ROUGH FINAL l GAS: ROUGH FINAL FINAL BUILDING l 6 r DATE CLOSED OUT ASSOCIATION PLAN NO. i Massachusetts - Department of Public S.tret� Board of Buil-(lin�­ Regulations and Stan(lards Qonstru•>ction Supervisor License Licen .:�CS 100988 �4 HENRY CASSIDY 8 SHED ROW ' WEST I ARMOUTH, MA 02673 Expiration: 11/11/2013 ('uumiissiouer Tr#: 7620 Office of Consumer Affairs and Business Regulation -- - 10 Park Plaza - Suite 5170 may. Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2b14 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE -- --- - ---- . ..- - - S0. YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. CA 1 0 20M-05/11' Address Renewal n Employment I_� Lost Card S l.'f��K l�'OI1l.YIGO/Ll(.K�lClN[�/��I[XdJC[C/LUdC-.�1 Office or Consumer Affairs& Business Regulation License or registration valid for individul use only IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 163567 Type: Office of Consumer Affairs and Business Regulation xpiration: 12/1'512014 Private Corporation 10 Park Plaza-.Suite 5170 Nis Boston,MA 02116 CAPE COD INSULATIiON;;INC:. HENRY CASSIDY 18 REARDON CIRCLE. S0.YARMOUTH, MA 02664 Undersecretary Aotvalr' witho t nat re i. GlleiiW:4597 CCINSUL AC®RD. CERTIFICATE OF LIABILITY INSURANCE UAl'llhlhlllllltYll'Y( THI,,CERIIrICaI1.15 IS iuE. MATTER _ 07L0212 2 IOA�A01. O _ - F INFORtYIA`1IJN UNLY AND CONFERS NO RIGHTS UPON TIiC CERTIh-1CATE HOLDER,T111S C'LUVV CATS DOES NUT AHFIRMATIVL"EY OR NEGATIVELY AMI-ND,EXTEND OR ALTER Tilt COV12RACL AFFORDED UY TI-II3 POLICIES k1k LUW."rI11ti CL RI'IFICATE OF INSURANCE DOES NOT CONS 111 U rE A GONTRACT BETWEEN THE I',,$UjNG INSURF;R(5),AUTIIL)IIIL.LLI REPRE$E:NrAI'IVE OR F'140DL)CIER, AND T'HF CERTIFICATE IICiLUCIt. Vtv IvRT :If tho cartlfl[Flu FlulUr�r ie an At1Oil ONAL,INSUNk u.Ihn polit y(ies)nita�t De t nclul�e(1.II`SUdRUGATICIN IS WAIVED,sub)u,:t ro -- ulc Icl nlu rand cuncllllan�of the Noll y,cnitaln poll I"nlay r,,,,,:,,,un arldaranntanL A ntutanlent On thly oerlifi(ulp(Inca rlul CLIIH'cr tlUlu':IL�j lU IIIc Lhltlllc,�ltf Iloltl,.r in III:U c1I;UCIT on Oul"jIltJIl1(x), NS al lLftt Y UL J II & Cat:Iy 1118. -Su. LlMruus AME M aJ4lluuld 134 IAC,No Exi:508-760.4602 ;"Itll Hurtnlr MA )') E-hlAll_ W t1111 i 1511 JU7f,1`.)Li-/JQl) NfUlthN(G)AFFCIRQINUCPVLIimlL - d IJAIi �raul<Ia, IN'"URERA:Peerless IllsLlydnCu 18333 Cape LOCI (wiWat(on Inc INSURERB:EVamiloll 111suranca C011Lt),Iny il'js Yarmnutll F:ua(1 INsul:eac.AtIrinNc ChBltar InsurluTCa r (IyLuuliti, IVIA O;:uU'I m9ukF.'ko: Otlllll(:fG01116Uril11CC C�O111).11lly 341u�1 IrtsuRER r:: -- - t'uvt-Iwt,1:;; _ ----- INerJrt�Ivr: 4thlIF1GAIL NUMBER. _ __ __ RL.VI ION NIJIVIElLlf1: 1 Tu c'L:hll11 Ill ll', IapLlt lr OF wS1)t2hNCE LI;1 !? uu rY iIAVEDEENISSl1ED l0 1HE INSURGO IJAh11=DAllOYE ^� rPllll„tlkL� Nu1W111-I,ilANDINU ttNY Wt1U(REIvIENT, ll`-RM OR CJi' ,;i 110Pi0F ANY CONTRACTOR OTHER DOCUMENT WITH RESI'Licl, *10 1,N I POLICYGH Iluti a:Nllit;AlL. MAY BI-' 19SUED OR MAY PERTAIN, THE INSURANCE Arrl]RDEp BY THE POLICIES DESCRIBED HERE-IN IS SULI.IFCF "I"O AL.I. 'IHE jLkNIii, i-Al,L.USIONS ANO CONDI IIONSi OF SUCH POLICIES. LIMITS.SI-ICj p: p;"T NAV9 BEEN `"I", k` __-----_'----_�- N RGQUCED dl' PAID CLAIMS. ApOLSUBR -_._. 1'Y Nk OF IN,4UNAN(;E - POLICY EFF Pl7LICY e)iF --'----------------------- _...__...__� T y f•ul.lc r rltn„��n jMhI10nIYYYYI hlMrnlllWYY LIAIJ U.' }1 iiLN ORAL LIAlfILIrY ---------- t- -_._L._-..-_..__._. P82630i1:' 4101/20.12 04/0'1j201•' EACr1oCCLlrtrtENCE &'I,OU000U X CtlMhlLtviaAL GENkrdAL LIAEtILIIY — -- enreo F��k�lst �<� y,1 uIl uuu .�CLAIA1ti-MADE ( ,Xl OCCUR hltip EAF tAl1Y OOU PUNtllll ✓•�,t)l)0 &AUV INJURY 1-1 000 000 • .........-__'-.------__._-._...----•-'---- (dkNl°JiALAOCIdGCiATf; �z,uuil,oull ._^..___......-_---•- p ,} NRonucTs-cOMI'ror'nu[i $2 OU()IJIIN 12MMBCK_Vrv;h. 41U1/2012 04101/ U1; Ea�I ljv Q itvcLci:itriii-- .I� UUU _._..._ ,,Air AU It.) 000,, ..___._ .._._._._. AL I_UVVNtU SCIOILY INJURN'(P.. Au1US X SCrIL't)UL6G _'.--T_'-_-"__._-- _._..._....._... AUTOS' BO&-LV INJURY IP. anc-Uonl) R .. . -. X r(itLO AU IDS X N0N-OYVNEI) ._--.._-.___....... .._�. _-,- AUTOS PROPERh'I]AblAflk Tf X UMKkILA UAN �_- _-_,��_. _.�...__ OCCUR _ XONJ453S1 4/U'll2U'12 U4)01I2U1 cACN nccul:ltt Ncta 41 000 000 .. tNC L'St UA.0 -. ._ t.LAIMS�MAOE AccrmcAlc :p1 UUU UUU vvuRKctc{;I:omrtrvnArlGN --___ AND thIPLQYERB'LIABIUrY rrry CA00925Jo_ 613UI201? 0G/3012U'I' X wG s7tY 1,111 1 l nr:r Ptn1 wI i1 LP,AH' rl/ �h JuTIVK LYC�-�n� h �R NIA C.L.CAcI I AccIC11"Nt' NI 1 UUl1 UUU_ (hlundutory d, •Q --'------•.--•-----•_•_..:t,--t---..L___ .....--- Ir y� au�t:nn�,Indo, E.L.p1sCASE_,A Ch1PLnve6 $'IL U(IQLOOp ,FUIiSCNiP LION OF QI'Ltl�ATIONS�_1, -,--loluw ..----'----- .-.-.. _ C.L.01i:LAa6-POLICY LIMIT y'I OdU tIUU i 711'1tt)11(SUt1�1'1ptRA I IONy I LOCAIIONS 1 VLNICLES(Atla4h ACORIJ 101,AdJl,i.,:�,1n1li Irlforinutloiterri ur Proprlaturs Ncale I Iu1Jmr iLi IIIQILIdvd wi an additional insuract undue i;linnial Liaoility w116n roqulrod by Wrlttoll cuntract or a�reamant, CERTIFICATE HOLuL=rt ------- .._-.-__—_..._.._-_-.------'--' CANCELLATION C„pu Cod lilt;ulahol1,lnc SHOULD ANY OF THEAEOV6 OEMCRIOE❑PDLIC:lES OE 4ANCkI..Ll;11 WhI(NL• THE EXPIRATION DATE THEREOF, NOTICE WILL BC- DFLIVt kEU IN ACCORDANCE WITH THE POLICY PROVIOION3. AU MOR120)RENRES EN I ATIVE O 1t10 -2010 ACOITD GURPQHA1ION,All rl9hl J ra�arvutl. At oum ('V10/US) I Ctf'I The ACORD Rapla and 1090 cutl rnUi;lerult Nlark6 of ACORD If�83d4UlMa3U411 My The Commonwealth of Massachusetts Print Form Department of Industrial Accidents `` Office of Investigations l 1 Congress Street, Suite 100 Boston, MA 02114-2017 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): yte7u la a Address: l06 &Vdtlw City/State/Gip: UI/t� {MA' Phone #: -r200- 7 ' IZ l Are you an employer? Check t e appropriate box: Type of project(required): I. I am a employer with 20 4. ❑ 1 am a general contractor and I employees (full and/or--part-time).* have hired the sub-contractors 6. ❑ New construction 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. required.] 5. ❑ We are a corporation and its 10.[:1 Electrical repairs or additions 3.❑ t am a homeowner doing all work officers have exercised their I LE] .Plumbing repairs or additions myself. [No workers' com right of exemption per MGL p� 12.❑ Roof rep a'rs insurance required.] f c. 152, §1(4), and we have no j ����Q t � employees. [No workers' 13.�] Other ( �L l;{/ comp. insurance required.] / *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i_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 acid state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. f,, Insurance Company Name: ao� (', ouvhv 10%vao 6—& Policy #or Self-ins. Lic. #: WG� QQZ52 01 Expiration Date: �O" �fC-?- Job Site Addres • �/`� `'' � s• Crty/State/Zip: . Attach a copy of the workers' compensation policy d claration page(showing the policy numb `•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 tine 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 tine 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. 1 do hereby cer f 'ntler the painsgad penalties o ejury that the information provided aby ve is true and correct. Si mature: Z 7--7 Date: L I� 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#: I t7 k. . _ PARE&PARG CONTRACTOR .+ n PERMIT AUTHORIZATION FORM { owner of the property located at: (Owner's Name,printed) (Property Street Address) (City/Town) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: eg'ea= Participating Contractor Date At Rev.12132011 i .S �o TOWN OF BARNSTABLE Permit No- --__z . L I � IASI- ; �-��-��,�,�Building Inspector - ■ a Cash .. - - �o 39. - -OCCUPANCY PERMIT Bond --- --- Issued to 6�pricorn Realty Trust Address ,/Ltot 67 345 Old Strawk�rry Hill Road, Hyannis g j � Cr W Wirin Inspector J Inspection date Plumbing Inspect - Inspection date y Gas Inspector r � r) { ` Inspection date �u A I Engineering Departxn`ent Inspection date Board of Health �-` 4 - Inspection date ` THIS PERMIT'WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON• SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ............ .. ..........._........ ,........./...................................................... ..._......._ .._.._. .. j/ Building Inspector r� w 4. bl • r � 4' i I •x v 14" [ Vy in E 3./ 'e Rc- CERTIFIED PLOT PLAN 3 �S-Utz M�N tN Of ROBERT _ Jz EWUCE /' 4 �� I N �tzF N Ho 77 svgST j SCALES /./_3 a DATE �i¢ ..,. CD OGE ENG/NEE /NG C0./ F?f`^'�� I CERTIFY THAT THE G.LLENT _,. SHOWN ON THIS PLAN IS LOCATED E9ISTEREO� ftl�®ISTERED ids-NO.-�_ ON THE GROUND AS INDICATED AND Assessor's map and lot number ..... ............................ 'THE Sewage Permit number ........ ....3....-1�12.......... t./,,Z, Pao ......... .... .. . mu STABLE. House number . . ................................ ................ IC 5151r 0 t"r, 1639- L D C MA-i TOWN OF . BARNS .4L CODE rr 1016 BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..C.onstru6t Single Family Dwelling ................................................................................................................. TYPE OF CONSTRUCTION .......Wood.....F........ram.e............ ....................................................................................... .. .. .. .. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies,for a permit according to the following information: 67 Old Strawberry Hill Rd ........... 7' 7�.. .................. ......y.. . ...7/. ....... Location ................... ........................................................ .......... ProposedUse .................................................................................................. ................................................ ......................... Zoning District ......R.....B...........................................................Fire District ......Hyannis...................................................... Name of Owner Capricorn R!��.y..... .... .. ..... ... t��rus ............ ..........Address ..76 ..Falmouth ...)�y ....................... ........... ............. CoHyannis Name of Buildepran.co Real...Estate. . rev. .*Address .1�5.. ........................... Nameof Architect ... ..............................................................Address ............ ....................................................................... Number of Rooms ..S.ix............. .................Foundation ....P....C................................................................ Exterior ..Clapboard and/or shinQ;A�!�. ...............Roofing ... Asphalt shingles . ...................nae.s.............................................................................. Floors .................Caret ...............Interior ....Sheetroqk........................................................ ..................... Gas F.W.A. Two_ 7-w- Copper Heating ....................................................................................Plumbing .................................................................... .................. Fireplace ........None........................................................... ...Approximate-cost ....�4.O,000.00. . . ..... ................................ ....... Definitive Plan Approved by Planning Board -------------------------------19--------- Area .::T:q77P...: .q......ft............ 2. Diagram of Lot and Building with Dimensions Fee ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of t e Town of Bar le regarding the above construction. Name . .. . .............. . ....................... 000989 CAPRITtORN REALTY TRUST "24951 One Story �?No ................. Permit for .................................... 'J' Single Family Dwelling ............................................................................... Lot #67 345 Old Strawberry Hill Rd. Location ................................................................ Hyannis ............................................................................... Capricorn Realty Trust Owner ................................................................... Type of Construction ......F.....ra...m.e......................... .. ti ................................................................................ Plot ............................ Lot ................................ Permit Granted ...4Pr;...il.......1.3... ...... .......19 83 Date of Inspectio 1.1.�..V 190-1-1 Date Completed .... ............19 JOS Town of Barnstable *Permit# Expires 6 months from issue daate) i ILARM„BIX : Regulatory Services Fee C, MAM v 1 �� Thomas F.Geiler,Director Building Division Elbert C Ulshoeffer,Jr. Building Commissioner Office: 508-862-4038 367 Main Street, Hyannis,MA 02601w `SUN 99 Fax: 508-790-6230 roWAIop- 2001 EXPRESS P ahoMI RT APPut Red LICATION LI Imprint Valid Not A�ttVe�R�STge `v LF Map/parcel Number Jr Property Address ❑�sidential OR ❑Commercial Value of Work 4 7Q<n , 5 U Owner's Name&Address nt n WG ,A z c���.� �5 fie�� �l bey �-�`I 1 e . C-tnlee V1 Contractor's Name Cam_/jZZ. NtYle-_ 5 0,,UP_MMI Telephone Number -/Xa F 151 O Home Improvement Contractor License#(if applicable) 100 7 1V d Opnstruction Supervisor's License#(if applicable) CS O_702 7 Z/ y orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Q.Yhave Worker's Compensation Insurance Insurance Company Name C 'd — li5WL '10 U Workman's Comp.Policy# Z U 4 l G 1 Y'f7Y1. r at Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roofl ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) Other(specify) a�U.✓9LL4 / tja&— =I (, a c J� *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature t��' i�.� G�� V /Eaj expmtrg Assessor's map and lot number ..... ,: � J Sewage Permit number ........:...... ...7.{�.........../fiyur....... r BJHB9TADLE. i House number ....................... ... .. ..................:.............. r000�MAS b ' SEC Mar M1� TOWN OF ' BARNSTABLE A r. x BUILDING INSPECTOR APPLICATION FOR PERMIT TO Construct Single Family Dwelling .. ... ......... .. ............ ..... TYPE OF CONSTRUCTION ......good Frame... ............................................................................................. ............................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: f r Location LO ...' .. �.... Old Strawberry Bill RdAw '�r f , . ?............................... ProposedUse ............................................................................................................................................................................. Zoning District .....H•B•.........................................................Fire District .....Hyannis Name of Owner apricarn..Realty Trust Address 1�5 Falmouth Road, Hyannis .. ......................................... .................................................................. Name of Builder'raneo Real Estate Dev. Co.Address . �?�..ralmouth Road. Hyannis ....... lO.I .................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms iX........................................................Foundation ...P.'.C.'.....................................................I............ Exterior Clapboard and/or shingles Roofing ...Asphalt shingles ............................................................. ...................................................................... Floors Carpet......................................................Interior ...5hee'trock ........................... .............................................................. wo Heating ...........................:.:.'..................................................Plumbing .................................................................................. Fireplace iOnE.................................................................Approximate Cost ..`p Q a OQ... QO 4".t-/ Definitive Plan Approved by Planning Board ________________________________19________. Area �05' sq. ft. ............. ............ ............... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH CJ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . `. .." .��:..: �. ...... .Eros. CAPRICORN REALTY TRUST A=251-191 24951 One Story No ................. Permit for .................................... Single Family Dwelling ............................................................................... Lot 67 345 Old Strawberry -Hill Rd. Location ................................................................ Hyannis ............................................................................... . Owner Ca.pricorn. . . ...Realty. . ....Trust. . . .......... ....... .... .. .. ....... .. .... ..... .. . .. Type of Construction Frame Plot ............................ Lot ................................ April 13, 83 Permit Granted ........................................19 Date of Inspection ..............................:.....19 Date Completed ......................................19 I, ��0-