Loading...
HomeMy WebLinkAbout0554 OLD STRAWBERRY HILL ROAD SSy Olcf S f `fay -a(-P� '- Town of Barnstable *Permit# F� Expires 6 months from issue e Regulatory Services Fee snuvseABIZ MASS,1639. $ Richard V.Scali,Director HIED��A Building Division , Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS ERMIT APPLICATION - RESIDENTIAL ONLY /3 /d Not Valid without Red X-Press Imprint Map/parcel Number / Properly Address ss b �� s7�� b 4 [Residential Value of Work$ 73 Ub Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Sfi�� .bar C7�l Contractor's Name f/G b C�7 CcZy�� ,��/� Telephone Number Home Improvement Contractor License#(if applicable) / ® � Email: eoo�4 2 C4:Zcl 7 Construction Supervisor's License#(if applicable) / ❑Workman's Compensation Insurance ,�� Check one: 1177]] Il ❑ I am a sole proprietor ❑ I am the Homeowner AU',; 12 204 I have Worker's Compensation Inns�urance Insurance Company Name e✓ ncw 7 BLE Workman's Comp.Policy# G Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) P;,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 (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILESTORMS\building permit fo s\EXPRESS.doc Revised 061313 y� ��t7Yt�TtI'GtliffFEYi�t�fib'�assr�e��s . eparft ent 6f, hf1 Y I-4ctcidentS 600 Kwhington Street Bf)s1oq,y MA 02H- Www 7titdss govdia 'workers' CompensatiiDitInsm-any davit:Builders] ntraE#ors/EletfriciansMumbers AppHca-ut Inforwatian ` r Please Print .b Na={Busi lO�ganiz ian viduai}: tG `4d �G�cf l �i✓s Are you.=employer: Check the appropriate bfl� T . a# o'ect r 4. I am a cornfractor wad I p I (���- L® I am a ennployer with t 6_ New oaosiroc#foa employees{full andlor p;nt-#ime}* have l the su iors. 2_❑ I a so re proprietor or partner- liste-d on the attached sheet; 7- ❑Remodeling sh tp and have no employees Iltese.sub-contractors have g- ❑Demolitioa wc fvr—in anY c employees and have workers' ctr 9_ Building addition �o•V�o±-�LPSS' comp.-rsicsiranre. comp-IflS11r8ITi�� 5_❑ We are a corporationand its 10-0 Electrical repairs or additions officers hati�exercised their 3_❑ I t rn.a home�3 nsa doing all uto� I1_.0 Plumbing repayrs or additicns ssrysel£ Poo wcsl-M'oamg_ right of eiempfionper MGL I�❑Hof in utan.ce c_ 152,§1(4} and we hale no• re fined] employees_[No wmk-s' 1S_.❑Other s ' �` comp_insurance r-g6Xed6I * ayappdzzaitt`natchecksboaW1IDns#slsofilloutthesectionbelowsh iv their woffce=sTEompeassfiauPORCY1U!M- 9 Rxneowue s who sub=IIIt his affidsvu i &LYWrg they sse axing RR rtac ai then hire omtu&coutracmrs— submit a new 2EiaTm m da�stin Mrh- R(txitiscinrs thst rTix7 this bmc rxi=st suerhe d sir:a3itionsI sheet shaming;he nxiva of fhe saij-ems mid ststs vrhethet ornnt fiflse Sim 1 -eMPI¢yers_ lftk� employees,thV mast pinIde t1�=r wark�s'comp.polio nmaber lam are a n� rizctt isgrox idirz�ttroriers'canzpsrisrliutt ansrtrru€cs jar r�z�errrltl��c� Be�atF is fft�go7ic}artrl}:ob ssl� irz�fatmafzo:�z . Instance Cornpamy Name-. eJ4 4- Polk 4 cr Self ins_Uc-:k 0�6 " �G e?G�0 / 6 Expiration Date: l/ / Al Job Sit Address: � Y� of ` f�itk r✓,© Ai(l City,Stat 2Hp- a Attach a copy of dire-workers'comp egsation policy declaration page(shovving the policy number and elation date). Failure to see co-vtrage as nNjuired uader Sectiosa 25A of MGL c. 152 can lead to the imposition ofr-imiml penalties of a fine up to S 1,50D_(ff}andlor one-year impHVMM ut,asjwelt as civil penalties m the.form of a STOP WORK OBDFFCand a fine- of up.to$250_00. a.day against the violator_ Be advised that a czpy of this stdemzat maybe forwarded to the Office of Iuvegligations of the DIA for inst am a coverage verfcation_ Itfri�er-e�t en.rft�y rt. tTrs �xs�rnr�psncce�`e`ss a�' �tr�if±rzttlts irr,�forrr�ation prairzc�d,�j�ts is rfrua nrf caFXse� Simature: Bate: G I/ , �3,f�zciaL v-se cmt}. Da nat mite in tli&area,tv ba compre-ted by city or town O ffic&L City-or Towa: _PerruitUceuse# Essu g Authority{circle one—. I.Sward of 3ealth 2.BmTding Department 1 Cit-O'Eax n Clerk 4.Electrical Inspector fi.Plumbing impector 6.Other CasLact Person: Phone fir: 6 Information and Instructions ` IV Massachusetts general Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 Iegal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." If MGL chapter 152, §25C(6)also struts that"every state or local Licensing agency shaII withhold the issuance or renewal of a license or permit to operate'a business or to construct buildings in the commonwealth;or alay applicant who has not produced acceptable evidence of compliance with the insurance.coverage requir ed." Additionally,MGL chapter 152, §25C(7)sues"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the peiiormance of public work until acceptable evidence of compliance vrith the insurance requirements of this chapter have been presented to the contracting authority-" Applicants — Please fill out the workers' compensation affidavit completely,by checkir..g the boxes that apply to your situation and,i.f necessary,supply sub-contractor(s)naine(s), address(es)and phone nzumbe,:(s) along with then certrncate( ) of insurance. Limited Liability'Companies(LLC) or Limited Liability Par tnel,l ps(L.LP)veit no employes other than tine members or partners,are not requixtd to carry workers' compensation iam ante_ If an LLC or LLP does have- employees, a policy is requu-ed. De advised that this affidavit may be-,bmi«ed to the Department of indust ial Accident for confirmation of i= -ance coverage. Also be sure to sign and date the affida� t '11ie affidavit shoi-11d be returned to the city or town that the application for the permit or license is being requ(-sted,not the Depa-r'ment of Industrial Accidents. Should you have any questions regarding the 1avv or if you are required to obta.u-1 a workers' compensation policy,please ca11lfh Depaftanent at he number listed below. Self-insured companies shm-ild enter their self-insurance license number on the appropriate line. City or Town. OfFacials Please be sure that the afffii davit is complete and printed legibly. The Department has proFdded a space at the bottom of the affidavit for you to fill out m i ae event the Office ofInvestigaioas has to contact you regarding the applicant Please be sure to fill in the pto: it/hcense number which will be used as a reference number. in add-6om an appL cant that must submit multiple perm-ti icense applications in-anygiven year,need.only submit one affidavit indicating current policy informatics(if necessary) and under"Job Site Address"the applicant should write"all Iocaiivis ua city or town)."A copy of the affidavit that has been officially stamped or marked by he city or town may be provided to the applicant as proof that a valid affidz-vit is on file for future permits or licenses. A new affidavit m,--t be filled out each year,Where a home owner or citizen is obtia i g a license or permit not related to any business or commercial venture (i.e,a dog license or permit to burn leaves etc.)said person is NOT required to complete tb s afhd3 t. 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,)s a call. -he Department's address,telephone aad fax number: Thc? Comiamvmean of Massachusfits Depart meat of InAu. trial Accidents - Offim of kyestigatians 600 Washisa9tou Stet Boston.IMA 02111 Ttl, 617 7274 QO w 4-06 or 1- 77 4SSAF Revised 4-24-07 Fax#617-727 Ic9 p zoorccrea o/t cullac�� vxi�ce of C c,nS�� er Affa�ro&Busir3gss R�gutc License or re ash at on;vand g. ('1-6- 111dul us toed y ^.?,N-P.Ar TOR before the ex iration date C b P . - r return to:. �r egistrati n 163607 " i'yN�' 4 oince of Consumer'Affairs i siness Regulati'. xpiration _8/2015 Individual' �`'. 10 Park Plaza-Suite 5170 i > =�•`0 Y RICHARD P CAZEAJLT L�R i 3 :J 6.Boston,MA 02116 ta RICHARD5. CAZEAULT r 198 FIVE CORNERS RD Iwo t` 1;a . CENTERVILLE, MA 0263 --.1 r a Undersecretary /i _,) J t valid wi•hout sjgnature. ,f Massachusetts -Department of Public Safety_ of Building Regulations and Standards Construction Supervisortrt License: CS-1.00393 RICHARD P CAZ�tAULT`' 198 Five Corners goa , Centerville MA 0$632 �J�6G . .,� tti� " Expiration Commissioner 02/03%2016..� 9 1/23/2014 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 - NAMEACT Berkley Assigned Risk Services McShea Insurance A')C.No.EM: 800634-4589 �ac.No.): 866 215-8118 1550 Falmouth Rd RT 28 Ste 2 . ADDRESS: PolicySeNces@berkleyrisk.00m Centerville, MA' 02632 INSURERS AFFORDING COVERAGE NAIC# INSURER A . INSURED - INSURER B: Richard Cazeault Jr INSURER C: 198 Five Corners Road INSURER D: Centerville, MA 02632 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY.THE POLICIES•DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN':REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICYNUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MMIDDIYYY (MM/DD/YYYY) GENERAL LIABILITY - - AUTOMOBILE LIABILITY - - $ - WORKERS COMPENSATION - _ WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS �ER ANY PROP RIETOR/PARTN E RIEXEC UTIVE EY] E.L EACH..ACCIDENT s 500,000 NIA WC-20-20-003093-02 02/04/2014 A OFFICE/MEMBER EXCLUDED? 02/04/2015 (Mandatory in NH) ❑ - E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under - - - .500,000 - DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Coverage Election Category Elect. Status Name State(s) All Entities/Locations Sole Proprietor Exclude Richard Cazeault Jr MA Cazeault Jr 198 Five Corners Road Centerville, MA 02632 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I N ACCORDANCE WITHTHE POLICY PROVISIONS. - AUTHORIZED REPRESENTATIVE 401 Signature. ACCIRD 25(2010/05) BRAC 3139 It CAZEAULT\ ROOFING REPAIRS. . PROPOSAL Proposal No. 13-793 October 8,2013 To: Dennis Marehant Work to be performed at $54 Old Strawberry Hill Hyannis MA . We hereby propose to furnish the materials and perform the labor necessary for the completion of: ROOF REPLACEMENT 1. Remove existing shingle roof 2. Secure and replace damaged plywood as necessary 3. Install new aluminum drip edge 4. Ice&Water barrier first 2ft,all skylights valleys and penetrations 5. Cover roof with.15 lb..felt 6. Re-roof with 30 yr architectural shingle 7. Flash all pipes and penetrations 8. Remove all rubbish from project Labor and Materials $4,300 All material is guaranteed to be as specified,.and the above work.to be performed in accordance with the specifications and completed in a substantial workmanlike manner for the sum of Four Thousand and Three Hundred Dollars$4,300 with payment as follows: Two Thousand One Hundred and Fifty Dollars$2,150 due with acceptance of proposal and Two Thousand One Hundred and Fifty Dollars$2,150 due upon Completion Respectfully f 1, Richard P. azeault,fr. RIC# 168607 CSL#100393 198 Five Comers Road Workman Comp and Liability with Centerville.MA 02632 Mcshea Ins Ost Acceptance of proposal#13-792 The above prices, specifications and conditions are satisfactory and are accepted. Yo are autho ' jend'todof the w,.Prk as specified. Pa - ` nt is outlined above. Z�tj--- Signature. Date i lC=> x. 3 a 3 y U ls.P.P. •q ' U�l< 1� Goo G � I� `• 115 . ig — t 't>kSPOoSAL P►T V;E 1, c cc L ti y SI VC_iA/AL.L AV-6A = IS o F . ISO -G.F . X 2 . b Lo N ENOT'TOM A2EA O }4 rP, Lill �• Q t O .'(' la, IQ fNp }ka1 flu PrP...�CaoL. 7(C>" i c. t•1 u 2 14UW oQ LEAS. `I 1 , ._. , , .Vl ., �. _1....... .fit.?.Q 3 d • •�� r ell, ••^^•�may ! } 4� 4 ! 1! �5T i or F4to • Ioo ..q.��'�''�j WWI 000 • 4 g - �P4 wV sue. 4 DtSt ceruu c3atw. 7,17 • ' 55.3 taot� d. tuv. GAL. 9� 4 `1G. Z L. r r9EfjrJM LEAS V Shtt*i WIT" T'Li A , � � ►�E STD&4 66 if C�T' I F I E T� ZaL.oT' PL A aa. `.UO ed�.i 101.3 !••r'�1 ��-!tit ±i,! �- Sc�t� r.ic �� TtirK SGL�L� I�N•50• F; -7 e � t CWLICTIF`f T;4AT Ta-I� V 0 NA L F 0 t� Stdouc/t.J pL d 1�1 21E.sr E2�tJG� ' I-�F Q_e(>►-.I GOM p�.�{S W t T" _r"E. ;a tit=t a.t t=. L. O T to Aw l> eI='T'BACtt' TLfaQoi Z�mE"-rS OF 'rwr_- Tb et/wi O F L�.2 Ti�•�' �.. �'�•`!� � L . G • 3 Z � 4 9 A 7-9 k'5T-6-= ue LA,�n T641S PLswi 14 UOT ' $ASED O U. AU l►_1-'r:: ,,:-:; OSTEZvt t MaCIS. SUS./ f_,, TO 6 OFFSETS 5"OULD i5 L To DEC Efi!it�t aJ E L.o T L l u-`'-ri. APPLIG A w1'T" C h £ °d'; c +� r 4. __ r• �•"" TOWN OF BARNSTABLE �y a Permit No. _?0L1n1___—,qoh 1 _; Building Inspector. cash $356.00 i Capewide o r Developrc nt; 011OCCUPANCY PERMIT Bond' "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied.until a certificate of occupancy has been issued by the Building Inspector." Issued to Hyannis Hills Realty Trust Address Lot 10 544 Old Straw►ber ry Hit? Road, Rvanni-P Wiring Inspector Inspection date �.f.�)' Plumbing Ibspe for Inspection date e ` r Gas Inspector Inspection date Engineering Department .�'� � �;� r r/ Inspection date ��-7f 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. -27 _......... , 19 ..................... ......Building�Inspector v /00 Assessox`s--map and lot'number `� ��.''. Awusx � Sewage Permit number ...... �11I><6� �R`1�O E H: STATE l�tlnA AND `����tia i �0,*TNEro�♦ TOWN OF j3A tF �,S h��� E i BARNSTABLE, i /1 "6 9 GUILDIN.fG INSPECTOR. APPLICATION FOR PERMIT TO ........................'................................................................................................... TYPEOF.CONSTRUCTION .......... ... .................................................. ...............................``......... + ./ ...... ..................19".. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for aQpeerrmit according to the following information: Location ...�Lo S� v�� ���C C � ..: ProposedUse ...�.....l C..................................................................................................... ................................... ZoningDistrict ........................................................................Fire District .............................................................................. Nameof Owner ......................... ..........................................Address ........................ ...... ................................................ It Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .........../.........../...................,......................................... Number of Rooms ............ .....................................:........Foundation ....C /Y.. :.................................................. Exterior ........ .� 'J�.. .........................................................Roofing .........�J,.!..!1„C4-/•�.............................................. Floors .Interior 7G� ........................................ .............. o�� r.✓ -.................. .. ................................................... Heating �../...�.......................................................Plumbing .............� ............................................................ . ......... ....... .. Fireplace .............W--- .................................................Approximate Cost .. J..�U........................ .. .............. Definitive Plan Approved by Planning Board ________________________________10________. Area AV....:..................... Diagram of Lot and Building with Dimensions Fee .....a11-� Q ........................................ SUBJECT TO APPROVAL OF BOARD OF HEALTHS^(v �0'Q GC jr 77, d e6 - �111 7r Y I .hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the a ove construction. L_ ........... ..... ...'e4.............................................. CXAfpeo id�§x # �3t3�2GAc Hyannis. Hilla, Realty Trust a" 20103 m one story No ..........:...... Permit for .,.................................. ; " single' .family dwelling .a.. ......................................................................... Location .......554...Old Straw....Hial.. Rd. Hyannis s ..................... ........................................v nHxjjlij�Realty 'rust '- Owner ........ .............................:............ Type of Construction frame ............... ................................................................................ Plot ............................ Lot ................1............ i Permit Granted Ap.ril...14...19 78 ` Date of Inspection ....................................19 Date Completed y. � . ......19 4 PERMIT REFUSED ... . .................................................: . ... 19 ....................................... .a. ................................... .................................................................. .......... ............................................................................... , ' •` /,f i a ................................................................. ......... .................... ................................................... ' .................... ......................................................... r Assessor's map and lot number .. ?� Sewage Permit number .......................................................... �OFTMEr��y TOWN OF BARNSTABLE ii i BAUST"LE. i q "6 9. BUILDING INSPECTOR ,Je— APPLICATION FOR PERMIT TO �� � ` i ........AP..................................... ... l .......................................................... TYPE OF CONSTRUCTION y. ..... 7. .1.1/............................19! ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location /1CO S7XAj e� Y...... �� (....../(V...:........................:................................................... ........................ oProposed Use ...4e,s ld ewr 2:........................................................................................................................................... ZoningDistrict .........�.../.............................................................Fire District .............................................................................. Name of Owner (" ................... ..............................(,) �� ' ..... Address C)Via........ .................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... /J r Numberof Rooms ..................................................................Foundation �/.�.....................................,............. ............ p 'Q ( � Ce Exterior ........ /1 .� ......................................................Roofing ......... ✓...... ...��.............................................. Floors e .Interior 1�� ,af�/ �-- ........................................................... Heating ......!..................................................................Plumbing .............vC............................................................. Fireplace ..............!.?!................................................................Approximate Cost . ....�....�...........�................ ..A............. Definitive Plan Approved by Planning Board -------------------_-----------19________. Area (� ................................ Diagram of Lot and Building with Dimensions Fee .....C�,/'60 ........................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH 36-6 'QV �d G Gt '01 J 77, � co eb/,Vo A �11i 7 > s I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name.. �' ::.." � .............................................. Ca ewid p e Dev. A- r 20103 permit for orYe Story No ........... ......... ...... Sin le famil dwelli g.....................Y.................. �........... Locationt 554 Old Str w H annis y........................ .................... ! Owner ............ ap.ewide D;v.�..................... Type of Construction .Z�:ame..................... ............................... ....................................... { Plot ............................ Lot .... .... ............ Permit Granted 78 Date of Inspection ............. ..............19 i } Date Completed ......................................19 G y PERMIT REFUSED ........................... ........................ 19 { .........�. .....,, ............ ......... ... *1.... .i. ...... ' /...f�........ .... ................... .......... . ... ........ .... ' ........ y.. ........... ! .. ......... x rApproved ................................................ 19 .............................................. S ............................................................................... f I Town of Barnstable -Permit# I6,q - O,� Expires 6nwntlrafronr issue date •: r Regulatory Services Fee s � 9 R .a��$ Richard V.Scali,Interim Dii �r IvAI ;T _ BuildingDivision Ion �< - Tom Perry,CBO,Build' Commis*), r 200 Main Street,Hy i 599 www.town.bamstable.ma Office: 508-862-4038 16"'�� Fax: 508-790-6230 - EXPRESS PERMIT APPLICATION RESIDENNL� Map/parcel Number o2 7j Not valid without Red X,Press Imprint Property'`Address ySt/ c,/ err , AResidential Value of Work S �_ Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address. 1'1 a-F f i`P,-J — e r io r Old StraLOW ; I( (2c� C �Pr✓;��e Mr} oZ- 5'3 2 Contractor's Name /SOA) Telephone Number f0/-L2? Q06 Home Improvement Contractor License#(if applicable) /73 Z S Email: Construction Supervisor's License#(if applicable) B Q5-?Q7 kworkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name AL AJ . Workman's Comp.'Policy# C 3 f�lP 6 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. G❑Re-side ona over existing layers of roof) ZF [� eplacement i Windows/doors/sliders.U Value • so (maximum.35)#of wind ws #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. k Separate Electrical&Fire Permits required. *1tfieie required: Issuance of this permit does,not exempt compliance with other town department regulations,Le.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requir d. SIGNATURE: Q:1WPFlLESlF0RMSibuilding permit formslEXPRESS.doc Revised 061313 Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Matthew&Amy Jenner ���� Legal Name:Southern New England Windows,LLC 554 Old Strawberry Hill Rd ���i RI#36079, MA#173245,CT#0634555, Lead Firm#1237 Centerville,Ma 02532 WINDOW RE LACEMENT 26 Albion Rd I Lincoln,RI 02865 H:(508)280-2920 Phone:866-563-2235 1 Fax:401-633-6602 1 sales@renewalsne.com Buyer(s)Name: Matthew&Amy Jenner Contract Date: 03/06/17 Buyer(s)Street Address: 554 Old Strawberry Hill Rd, Centerville, Ma 02532 Primary Telephone Number: (508)280-2920 Secondary Telephone Number: Primary Email: matthewsjenner@yahoo.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 by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $9,650 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $4,825 Balance Due: $4,825 Estimated Start: Estimated Completion: Amount Financed: $9,650 7-9 weeks 7-9 weeks 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 weather are the most common causes for delay. Notes: 50%deposit by bank. Balance on completion by bank Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there 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 and 2)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 03/09/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal Andersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature Paul Sandrey Matthew Jenner Amy Jenner Print Name of Sales Person Print Name Print Name - UPDATED: 03/06/17 ,Page 2 / 11 Massachusetts Department of Public Safety �IBoard of Building Regulations and Standards License: CS-095707 Construction Supervisor k`'"` �,... BRIAN D DENNISON _ 7 LAMBS POND CIRCLE-', ;".. ;. CHARLTON MA 01507:: .' . _-. t'-I- UZ CA__ Expiration: Commissioner 09108/2018-, Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration -- ==- - Registration: 179245 , Type: Supplement Card ' Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS LL - - BRIAN DENNISON 26 ALBION RD LINCOLN,RI 02865 = _ Update Address and return card.Mark reason for change. sc :: zacccvn ❑Address ❑Renewal ( j Employment LostCard y='Ofice of Consumer Affairs 8 Basiaess Regulation Registration valid for individual use only before the =?mac: 140ME IMPROVEMENT CONTRACTOR expiration date.If found return to: r`._. - Office of Consumer Affairs and Business Regulation z r Rotstiation:;1mm: Type: 10 Park Plum-Suite 5170 ` =' Explra00i`:,g/18/2 ill.: Supplement Card -Boston.MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON:-" BRIAN DENNISON' -_= 26 ALBION RD � . L NCOLN.R102865 l l)irde Not valid without signature i The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia IYorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers— TO BE FILED RTIH THE PERMITTDIG AUTHORITY. Applicant Information o C Please Print Leidbly G' Name (Business/Organization/Individual): so ul��ll A/F c1J nr,Ian A L )i n J Z>t ti/ Address: g2& o✓A City/State/Zip: Lail /1 I Phone#: (40) Z 29- 9 8()O Are you an employer?Cbeck the appropriate box: Type of project(required): 1- am a employer with 1-O employees(full and/or part-time).* 7. New construction In I am a sole proprietor or partnership and have no employees working for me in $• E]Remodeling any capacity.(No workers'comp.insurance required) 9. El Demolition 3Q I am a homeowner doing all work myself(No workers'comp.insurance required)t 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property- I will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees- 12.❑Plumbing repairs or additions 5.❑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-insurancei 13.QROof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c 14.[ ther UJ/��?�cJ 152,§1(4),and we have no employees.[No workers'comp.insurance required.) I`v��a c ems,G,•�"5 *Any applicant that checks box#1 must also fill out the section below showing their workers compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: Ins. Co — Policy#or Self-ins-Lic.#: W C- ri 113 i n e I r Expiration Date: Job Site Address- t s14 old S'f-ra w (5w rt'y City/State/Zip: �iffP�'✓:Ile M A Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thep andpenalties ofperjury that the information provided above is true and correct Si ature: r Date: 3 Phone#- (LID I L 2. $ — i g o o 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#: SOUTNEW-01 UOLLINGER 14� ®' CERTIFICATE OF LIABILITY INSURANCE DA6129101 129126 96 THIS CERTii-ICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THiS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEidD, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF iNSURANCE DOES NOT CON6TI7UTE A CONTRACT BETWEEN THE ISSUING iNSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT: If the certificate holder is an ADDITIONALINSURED,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 COBiz Insurance,Inc.-CO PRONE FAX 821 17th St Arc No Ezt:(303)988.0446 Ar No;(303)988=0804 Denver,CO 80202 DREss:CoSizinsur-ance@_r-obizinsurance.com INSURER( AFFORDING COVERAGE I NAIL# INsuRER a-Continental Westem Insurance Company 110804 INSURED I INSURER B: j Southern New England Windows LLC INSURFRC: DIBIA Renewal by Andersen , 26 Albion Road INSURERD' j 1 Lincoln,R102865 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCHPOLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AEI WTSRRI TYPEOFiNSURANCE IINSD,VVIiD POLICY NUMBER POLICYEFF I MPVYEXP- 1 Lffirs A X COMMERCIAL GENERAL LIABILITY ! 11000,000 i t EACH OCCURRENCE iS J CLAIMS-MADE ,n OCCUR ': CPA3136080 j 071011201610710112017 1 PREMISES(Ea ccamence i s 100,00 j MED EXP(An one person) S 10,000 II �i PERSONAL&ADVINJURY I S 1,ODO,000 GEN'LAGGREGGA-T�E LIMIT APPUESPER. ; i !GENERAL AGGREGATE IS 2,000,000 j X POLICY 1` j j� LOC. j PRODUCTS-COMPIOPAGG;S 2,000,000 I OTI- r ' EMPLOYEE BENEFI is 2,000,000 I AUTOMOBILE LIABILITY !CO,MNED SINGLE LIMIT S 1 D00,000 acadBIErd] . A ;�ANY AUTO CPA3136080 071011201161071011201 7 i BODILY INJURY(Per pe—)_I S. I ALL OWNED !AUTOS AUTOS SCHEDULED I 1 I 1BODILY INJURY(Per a¢idsnt)j S ` I NON-OWNED i ! I HiRED AUTOS AUTOS !PROP RTY DAMAGE :5 PeOPERTYo i i5 I X UMBRELLA LIAR j X I OCCUR 1 II I i i EACH OCCURRENCE is 5,000000 A EXCESS UAB CLAIMS MADE} ? ICPA3136080 07101120161 07/01/2017'AGGREGATE is DED I X I RETENTIONS 01 jAggregate is 5;000,000 i WORKERS COMPENSATION i i PER OTr+ AND EMPLOYERS'LIABILITY Y l N 1 I STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE N I A j IWCA31360B1 ;0710112016 1 07/01/2017 EL EACH ACCIDENT is 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandetary In NH) i I EL DISEASE-EA EMPLOY 5 1,000,000 It yS desc+lbe wder DESCRIPTION OF OPERATIONS below I i ! .EL.DISEASE-POLICY UMrr I s 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Raman'schedule,maybe attached A more wca Is requhmd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE'SCRIBED THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE VYRN THE POLICY PROVISIONS. AUTHORIZED REPRESEITAME. _. .. ©1986-2094 ACORD CORPORATION. Ail rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD