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0093 SEABROOK ROAD
3 i, I l`�\ �� Town of Barnstable Building ' ' x -A raueP.lansMust be;Retaine one oband th�szCard MastberKe A Post:This Cardf So That it.is Visible From the Street pp; �,. q p M" Posted�Until Final Inspection Has Been Made x � ' 1639. .�', :` :, ;-a,•.. 5,�. '; yam * , R °of.©ccu anc' i Re aired such„Bultlin' shall Not be.Occu �etl,un#il,a Finahl.ns ectionjhas:been made, . -„ ei iljll Where a Certificate p y xq Permit NO. B-18-2567 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals Date Issued: 08/13/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/13/2019 Foundation: Location: 93 SEABROOK ROAD,HYANNIS Map/Lot 307-035 Zoning District: RB Sheathing:. Al Owner on Record: PENA,JOHN ContractorNarne SOUTHERN NEW ENGLAND Framing: 1 �WINDOWSiLC. Address: 93 SEABROOK RD ° 3t 2 -Contractor License 173245 HYANNIS, MA 02601 Chimney: Description: replacement window(1) �, E�stProJect Cost: $6,535.00 ( Permtute°e: $35.00 Insulation: Project Review Req: �. -r Fee Paid#: $35.00 Final: x ate-", 8/13/2018 Plumbing/Gas r k Rough Plumbing: Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authoniedby this permit is commenced within six months after issuance. Rough Gas: �; All work authorized by this permit shall conform to the approved appl ca 11,naand the approved construction documents:for�T" , this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zonirigTy laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open foripubI c"inspection for the entire duration of the At X work until the completion of the same. w Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the,6uildmgand Fire Officials are,provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or Footing Rough: 2.Sheathing Inspection ._ ._ 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final' Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department -KV1,Z Building plans are to be available on site Final: t All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ' c ��4 y Application numbe .,�, , Date Issued..............y� e aAR.WsrABr�e, ....../................................... Building Inspectors Initials.... ..........AUG 0 8 201 ............ I � Map/Parcel...:..: o: ......n. 5 TO�1�� .................... � OF, N� TOWN OF A ST LE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: ] oo . AA NUMBER.- STREET Vn LAGE Owner's Name:_fit-i,,� r Qn�. Phone Number 77q - Y,?7- -/o Z S Email Address: o LUG;c S ,� Cell Phone Number`- - 77/ S 0`t' 2- Project cost$ (o S3 s _ Check one Residential Commercial • OWNER'S AUTHORIZATION HORIZATION As owner of the above property I hereby authorize s to make application for a building permit in accordance with 780 CMR Owner Signature: Sep .44"t-'a C��+.-(Y�-� Date: TYPE OF WOE 0 Siding 2/'Windows e no header char - 0 ( g )# • 1 Insulatton/Weathenzatton17 _ Doors (no header change)# Commercial Doors require an inspector Isreview c0_l Roof(not applying more,than 1 layei of shingles). Construction Debris will be going to crI r she�/�'1�iJa q P�'/P - ��%'�co/�► /� L CONTRACTOR'S cif• CTOR'S YlV FOS\LV'J ATIOlV Contractor's name t�an ��n��so� - Soe�n �2�J �rS(cv�cs? 4A'nc�owS Home Improvement Contractors Registration(if applicable)# 17 3 LK 5' (attach copy) Construction Supervisor's License# E'7 O' (attach copy) Email of Contractor Phone number q01- z 2 R ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS tiv 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 pin-4.30pnL 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 H01M EOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number. Cell or Work number I understand nay responsibilities under the rules and regulations for Licensed Construction 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 Bar stable. Signature Date �. g L1CAN 11 9 S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document and Payment Terms by,Andersen. dba:Renewal By Andersen of Southern New England John Pena Legal Name:Southern New England Windows,LLC 93 Seabrook Rd. RI #36079,MA#173245,CT#0634555,Lead Firm#1237 : Hyannis,MA02601 winnow nE LACEMEBT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)771-5092 . Phone:866-563-2235 1 Fax:401-633-6602 1 sales@renewalsne.com C:.(774)487-4025 Buyer(s)Name: John Pena Contract Date: 07/29/18 Buyer(s)Street Address: 93 Seabrook Rd., Hyannis, MA 02601 Primary Telephone Number:.(508)771-5092 Secondary Telephone Number: (774)487-4025 Primary Email: moronies@gmail.colYl 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"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed.all work under this Agreement. . Total Job Amount: $61535 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: $3268 Balance Due: $3,267 .Estimated Start: Estimated Completion: Amount Financed: 8 to 10 weeks 8 to 10 weeks $6,535 Method of Payment: Financing We schedule installations based on the date of the sighed 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: Taxes paid in Barnstable,Ma 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 08/01/2018 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:Rene% By Andersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature Gino Montesi John Pena Print Name of Sales Person Print Name Print Name UPDATED: 07/29/18 Page 2 / 11 ti Of,¢i%e of Consumer Affairs and Business Reg.flation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2018 BRIAN DENNISON 26 ALBION RD L+NCOLN, RI 02865 Update Address and return card.Mark reason for change. Address Renewal 7. Employment Lost Card --office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 72245 Type: 10 Park Plaza-Suite 5Il70 Expiration: 9119/2018 Supplement Card Boston.MA 02116 IUTHERN NEW ENGLAND WINDOWS LLC. :NEWAL BY ANDERSON IIAN DENNISON ALBION RD JCOLN, RI 02865 �-Undersecreiary Not valid without signature \ V fi wi - f �sl1i � and V t dG vS �i -095707 BRIMNN D DENNISON L MSS PONE CIRCLE C EARL T ON V1A 016CAT - r-rn m r. J� I ' The Commonwealth of Massachusetts Department of IndushialAccidents 1 Congress street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensatibn Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Please Print Legibly Name (Business/Organizat3on/Individual): ` e - aw� Address 1& AL�IDL City/State/Zip: Phone#.- Are you an employer?Check the appropriate bog Type of project(required): I. am a employer with Z�femployees.(fuil and/orpart-time).' i. ❑New construction 2.D I am a sole proprietor or partnership and have no employees working for in any capacity.[No workers'comp.insurance required.] ` 8- F1 Remodeling 3.Q I am a homeowner doing all work myself[Na workers'comp.insurance required.i; 9. ❑Demolition 4.❑I am a homeowner and wt71 be hiring contractors to conduct all work on prop 1 []Building addition , m?P P�1 I wili ensure that a1 contractors either have workers'compensation insurance or are sole 1 L[]Electrical repairs or additions proprietors with no employees 5.❑i am a genera contractor and I have hired the sub-contractnrs listed an the attached sheet 12-EJPlumbing repairs or additions These sub-contractors have employees and have worker.'comp.insurance., 13_� f repairs 1 6.D We are a corporation and its officers.officers.have exercised their right o;exemption,per MGL c 4. Otber . � 15_§1(4),and we have no employees.[No workers'comp.insurance required-] 7 Any applicant that checks box F1 must also fill out the section below showing thec workers-compensation,policy information Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new a5d2vit indicating such. !Contractors that check this box musi attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Lrthe sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers inffoormation. 'compensation insurance for my employees. Below is the policy mind job site Insurance Company Name: 1-re MIF A$ flis. Q m Policy 3�or Self-ins.Lic.;�: c�����7 Z q _ 2-t� E�Xpimtior�Date: �1 / 1 Job Site Address: 3 sea boo K iZ10 City/State/Zip: q�n� /-� Attach a copy of the workers'compensation policy declaration page(showing the policy num er and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violatioz plin.ishable by a fine up to S1,500.00 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 ofthe DIA for insurance coverage verification- 1 do Hereby certify under 1h liras and penalties ofperjury that the information provided above is true and correct Signature: e Dale: Phone*: 9 Official use only. Do not write in this area,to be completed by chy,or sown of cial City or Town: Permit/License Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/To"Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone#: i CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD""") 12/29Jz017 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 certificate holder in lieu of such endorsement(s). the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the 'RODUCER CONTACT COB¢Insurance, Inc.-CO NAME: 1401 Lawrence St, Ste. 1200 PHONE 303 988-0446 Denver CO 80202 EMAIL ac No:303-98&0804 DDRE : COMail �cobjnurance.comINSFFORDING COVERAGE NAIC r nasURER A:Acadia i Com an 31325 NSURED ESLERCO-01 Southern New England Windows, LLC. INSURER B:Firemens Insurance ompany of WA,D.C. 21784 Jba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F :OVERAGES CERTIFICATE NUMBER:1252851165 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. ISR AODL SUBR POLICY.EFF POLICY \ TR TYPE OF INSURANCE POLICY NUMBER MM/DD EXP MM/DD A X COiEMERCIAL GENERAL LIABILITY LIMBS CPA3155728 111201E 1/11201C EACH OCCURRENCE S 1,ODD.000 CLAIMS-MADE OCCUR - PR MSES Me occurrence S3DD,DOD MED EXP JAny one person s 10,DDD PERSONAL&ADv INJURY S 1,000,ODD GEITL AGGREGATE LIMIT APPLIES PER: I I GENERAL AGGREGATE X POLICY E LOC S 2.ODD,ODD PRODUCTS-COMPIOP AGG $2.ODD.00D OTHER: $ A AUTOMOBILE LIABILITY N CPA3158728 I 111201E 1/1201S COMBINED SINGLE LIMIT X Ea ace-dent S•ODO DOG ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) S � I AUTOS AUTOS BODILY INJURY(Per—accident) s HIRED AUTOS X NON-OWNEDPROPERTY DAMAGE AUTOS Per accident S A X UMBRELLA LIAB X CPA315872E s OCCUR 1/12016 1/1201..c EACH OCCURRENCE S 1D.ODD,01m EXCESS I" CLAIMS-MADE AGGREGATE s 1D,00D.00o DED X RETENTIONS S B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN WCA3158725-20 i 111201E 1M2ois X T O H- ANY PROPRIETOR/PARTNERIEXECUTIVE ff 1.000,000 OFFICER/MFUMBER EXCLUDED? ❑NIA E.L.EACH ACCIDENT (Mandatory in and EL DISEASE-EA EMPLOY s 1,000,000 IF yes describe under DESCRIPTION OF OPERATIONS belm, EL DISEASE-POLICY UMIT s 1,00D.000 C PtaPollution Liability Po 79300733400D0 111201E 1112018 Each Occurrence s i,000.000 ClaimsMatle Policy Reltoactive Date 06202013 ABBrectiblegate 51,0DO,000 Dedu 810,OD0 IESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD.101.Additional.Remada Schedule,may be attached if more space Is required) :ERTIFICATE 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 AUTHORED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. kCORD 25.(2014101) The ACORD name and logo are registered marks of ACORD F top Commonwealth of Massachusetts Sheet Metal Permit Date: Permit#SSA Estimated Job Cost: $� PERMIT Permit Fee: $ Plans Submitted: YES NO q p R,2 3 2014 Plans Reviewed: YES NO Business License# / ADDlicant License# (�/� TOWN OF BARNSTABLE ' J Business Information: Property Owner/Job Location Information: Name: . v-\ Name: \ 0 Street y 194 Street City/Town: � e� 4 \ 1 City/Town: Telephone:C - C "L) 02� Teleph V Photo I.D. required/Copy of Photo I.D. attached: YES- on NO start Initial J-1 /M-1-unrestricted license J-2 M-2- stricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing-�— Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: INSURANCE COVERAGE: I have a current liabi lity insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes o❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIV :I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only - Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the'permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By M ster Title ❑Master-Restricted >0 City/Town ❑Joumeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.gov/dpl Inspector Signature of Permit Approval ne.Commonwealth of Massachusetts Department of IndustfialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information l Please Print Lep-ibly Name(Business/Organization/Individual): Address: , City/State/Zip: OCA(Ve( O- 'SP Phone q Qo-�, A;Tu an employer?Check the appropriate box: Type of project(required): 1. am a employer with�0 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. aRemodeling ship and have no employees These sub-contractors have -g• ❑Demolition working for me in any capacity. employees and have workers' Com msurance# 9. ❑Building addition [No workers Comp.insurance p• required.] 5. 0 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 1 P C 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 hue outside contractors must submit a new affidavit indicating such. tContractors 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: A )O Ao—wi(CL / Policy#or Self-ins.Lic.#: W�/�/ �� ��{ Expiration Date: 31 Job Site Address: `'l� S�q Llt l t t�G'1(11 City/State/Zip: �OAAI,Snv)-AU-01, 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 maybe forwarded to the Office of Investigations of the D?A for insurance coverage venficatior, Cj 1 ry r I do hereby certify under the pains and allies of perjury that the information provided above is h u`e and correc µ �— Signature: Date: e -v Phone#: S b :iv Official use only. Do not write in this area;to be completed by city or town official c� City or Town: Permit/License# r'r+ 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#: Information ;and Instructions Massachusetts General Laws chapter 152 requires all employers to.provide workers'compensation for their employees. . f 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"au imdividual,partnership,association,corporation or other legal entity,or,;any two or more of the foregoing engaged m a Joint enterpnse,and including the Iegal representatives,of a*eased employer;,or. p p, receiver or trustee of an individ' ai4nershi �association or otherlegal entity,employing employees::However tfie` owner of a,dwc1 ing house having not more than three'apartments and who resides therein,orrthe.occupant_of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall:not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that.."every state or local licensing agency shall withhold the issuance-or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance -- requirements.of this.chapter_have-been presented to tlie..contractingauthority APPIicarits ' Please fill out the workers compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)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 maybe submitted to the Department of Industrial Accidents for-confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city`or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to'obtain a workers' compensation policy,please call:the Department at the number listed.below Self insured.companies should enter their. self insurance license.number on ttie`appropriate line.'— rr. 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 th affidavit th4t 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 homeowner or citizen is_obtaining a license or permit not m related to any business or comercial venture (Le.a dog license•or:permit.to bum leaves etc.)said p ur son is NOT.required to complete this affidavit. The Office of Investigations would 111�e to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts 4 Department of Industrial Accidents office of Investigations 600°W4shington Street r . i Boston,lklA 02111 Tel # 1 �- 2•=4 e 406 r 1- -MA r,7 0 xt o 7 SAFE � ? 7 9� �7 S .... Fax#61.7-727-7749. i. Revised 4-24-07 vwv.mass.govldia Majic Air, Inc. Phone: (508) 465-0739 Heating & Air Conditioning Licensed&Insured Fax: (508) 465-0738 36 North Main Street Carver, Mass. 02330 Proposal Submitted To: - - Date , . , Proposal# 5 Richard Avery > 2/25/14 1934 Address: Phone: e-mail 93 Seabrook Road S08-9S8-7373 rtaven}IAxinaiLcom City,State, Zip Code: Job Name: Hyannis,Mass 02601 Same Contact: Job Location: Peter Piikington peter(maiicair.coin We hereby submit s eci cations and-estimates or Central Air Conditionin . Furnish and install: • One Trane XB13 series outdoor condenser(Model#4TTB3036E1)located on a pre-cast pad(location field determined) • One Trane multi speed air handler(Model#GAFAO836H21)located in the basement • All required supply and return duct work • All ductwork to be duct sealed and insulated(per code) • Register location to be ok by the owner prior to the installation • All refrigeration and condensate piping • Provide a digital thermostat(for the a/c only) • Start up and test system / ! • Cost for the above S 7,500.06 accept w decline �✓ _ OPTION 1. • Add.a Aprilaire air filter Model 121� d i ional cost S 450.00 Accept ✓Decline Additional P — _ 2. Add a Beacon Morris kick toe heunder the kitche binet Additional cost S 550.00 Accept_Decline_ NOTES: • Temperatures will vary room to room • All Power and control wiring by others PAYMENT TYPE:CHECKNISA/MASTERCARD/AMERICAN.EXPRESS CODE EXP. APP.# CREDIT CARD NO: PAYMENT TERMS:1/2 upon acceptance,$ fo balance upon completion$ All material is guaranteed to be as specified.All work to Ife completed in a i Authorizid - work like manner according to standard practices.Any alteration or deviation .Sig at [ from above specifications involving extra costs over and above the estimate will become an extra charge and be billed according.All work is warrantied for one year on parts and labor.Trane a 10 year manufactures warranty on the all per. Note this proposal may be Withdrawn by us if not accepted within 3 ys. Acceptance of Proposal-The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as Signature specified.Payment will be made as outlined above.The Party agrees that any amounts not paid in(30)thirty days of the date of Invoice shall bear interest at a Signature raie of 1.5%per month,which is an annual percentage rate of 181/6.The Party also agrees that if it becomes necessary for Majic Air,Inc.to engage Legal counsel to Date of collect the debt,Then you will,in addition to the amount of debt plus interest,Pay , / P t' Majic Air,Inc.for all of their Attorneys Fees and cost.incurred in.attemptitigto acceptance I collect said debt. ® + DATE(MM/DDIYYYY) ,4 U : CERTIFICATE OF LIABILITY INSURANCE 4/4f2014 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: 8017ri t011 Insurance Boynton Insurance Agency - PHIC No'Exti,ONE (781)449-6786 VC No:(7S7)449=4269 72 River Park StreetADDRESS: •MAIL ADp E 5: PRODUCERCUSTOMER IDN00006701 Needham MA 02494 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Harle .Sville Preferred Ins. Co..- 35696 i INSURERB:Travelers Casualty & Surety IL 19046 Majic Air, Inca INSURER c:Barle sville Worcester Ins Co. 26182 36 North Main Street INSURER D Amtrust American. Ins Co. INSURER E: Carver MA 02330 INSURER F i COVERAGES CERTIFICATE.NUMBER:CL1131101403 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 AFL R POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER. MMID MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,-000 X' COMMERCIAL GENERAL LIABILITY PD SES Me occurrence) $ 300,.000 A CLAIMS-MADE OCCUR y Y PP00000080362M 03/11/2014 03/11/2015 MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $. 2,000,000. ^ dEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG "$ 2400,000 PRO- POLICY X- LOC-._. _.... _ _ $. A,- AUTOMOBILE`UAMOTY'' '` z 00000059886S 02/01/201402/01/2015 COMBINED SINGLE LIMIT 1,000 000 ANY,AUTO, ' � - s BODILY'INJURY(Per person) ;ALL OWNED AUTOS. Y Y.; t°�" i , BODILY INJURY(Per accident) $ x; SCHEDULED AUTOS ^r t ::::' PROPERTY DAMAGE $ X .HIRED AUTOS (Per accident). X NON-OWNED AUTOS C X UMBRELLA LIAR X OCCUR Y Y CMB60600094257Q 05/16/2013 05/16/2014 EACH OCCURREICE $" 5;600,;-000 EXCESS LIAB CLAIMS-MADE AGGREGATE'r,4 i $= 5 O,000 +. — DEDUCTIBLE $ Tas] RETENTION $ $ 3 D WORKERS COMPENSATION Y C3085208, 03/15/2014 03/15/2015 X WC STATU- OTH- _0 AND EMPLOYERS'LIABILITY - -4r a e" YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1 Q QQQ OFFICER/MEMBER EXCLUDED? N N/A , (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1 0100 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-PO ICY LIMIT $ 1,15 000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Joseph Papasodero. is covered by-Workers' Compensation policy, 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. Verification of coverage AUTHORIZED REPRESENTATIVE William-Rohr/WRR " ACORD 25(2009/09) _ ©1988-2009 ACORD.GORPORATION. All rights reserved: INS025 poosog) The ACORD name and logo are registered marks of ACORD E . . . . . . . . . . . _ .: � ..; OOMMONWEA `HAM v Y LT `OFF �ISACHUSE a :COMMONWEALTH OF MASSACHUSETTS. OMMONW LTHxOFM THUS � S I _ naaF Aga 0 � I a. R ,, , ;. PSLUMBEF S D G F a TT R SHEET E'I AL V�0R .LICENSED AS A MASTER GA ,� �rr .,<� : , �.: � � :- .. .;. j SFITTERa :. ::::. , „ _., t s ; � : i;SjSUES T E Fa 0{�LQW?�I3NG ,L: DiI� tSE��AS A, . 4. �S iSS4UE..S Tk E FQLL:QWI.I+IG:.: Lea tENTSE .. r rt - �;: , . ISSUES THE ABOVE LICENSE TO: i �y,#` `:. d w ,I � a NT� A Sg'E JOSEPH A PAPASODER0 0.5{OS M � 'N � PARASQDERO 4�; c� ;JEI�IA PKA PAOD�E{0 MW ��77 OPAL INS`, ` AVE 77 OPALIn _?AVjEW" , rL �W MIDDLEBORO MA 0234b-3057 �c x � p`LED'QR �w ','.MIDtILEB0R0UGH MA 02' 46 0 ;6, ��� a. . 38:64 05/01/14 1,458-0U. .._ �3 x& .: � x11 COMMONWEALTH OF MASSACHUSETTS Commonwealth of Massachusetts .�b � , • .t� � � t!J Department of Public Safety SRN LICENSED JOURNEYMAN GASFITTERH r RetYi;eration Technician • . 5 � WI 3ElSE t E SSUES A License. R 4 .:' z I THBOVE LICENSE TO, T-01309 , } -.� '_ � `,�- /., +�,� ��� � ��� ��AS Ax 11S, 'N�ESS-��� ,a►-sr>� ., � . J U S E P H A 'PAPAS 0 D E:R 0 € JOSEPH PAPASODERO '; 5 77 OPAL AVE r, :JQSp;At ppERry(1n 77 OPAL AVE r MMDLEBOROMA F§ lry MiDDLEB0R0 MA .02346-3"057 •, \� `` 111 4�„* �'' MioSEBo$Ro ` 4:046. 05%01/14 1457.99 Expiration: Commissioner 10/07/20142/� • •. - _ ` OMMO.NWEiaCLTH OF M S CHUSE �, COMMONWEALTH OF MASSACHUSETTS • •10 ILGIA-111112n, • x. Commonwealth of Massachusetts .• . . De P1:, MBE SSA. TTIr#t� P artment of Public Safet y SHEET METALWORKERS k k Oil Burner Technician Certificate A5' AN INSTRUCTOR 1 SSUES VTH � QLLr VJ l L I CE -SE :. a ` License: BU-031979 ISSUES THE ABOVE LICENSE TO: t ��REx1STtIB _ R e a JOSEPHPAPASODE O A 'PAPASODE. 0 UQSI:PMPAOASQDO ' r JOSEPH 77 OPAL AVE 't MAJI C AIR" NG " MIDDLEBOR -6 I OA A 77 OPAL , VE MrDDLEBOR0 MAC, s� s NI3[i�I�LE:BORO � M}Ai 0,2�346 3o 7<k J,•�.... �11 ...�i Iti% Ex iration: 7 � 02346 305 c ; a xy • e�5r � c' p } 1 �� U � � 20g3 Commissioner 10/07/2015 13617 10/28/14 256353 �`` ' ��. . 6 . . , ;. !' t r �; o ary�� � � , s. � ©y �� ,.� .� d ��' � �r ':� � �. �A � � � �, �* �t �� --f. t �; � ", `�" '. a . - '..�. .MJ� .. � ��� �` � � � - .i Jam, f r r \ . F TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7© ', Parcel Application #Loor Health Division '►] 0 r- + I` U- Date Issued Conservation Division Application Fee Planning Dept. Permit Fee ri V1 Id a Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address 1 3 5 E A a'Zd O g Ao Village. H L/ �11J T Owner -TO 111.) E&A Address �C— Telephone U 9.6 8 2-11 0 � b Permit Request I C—l,-•l D n 1 I- , K TG -4- r--� 7 i C4-0FA FKfpr-p-7 GX I T( r-Ae S`-F n1 F=,orL 7 Square feet: 1 st floor: existing 16 roposed e, 2nd floor: existing proposed Total new Zoning District Flood Plain N D Groundwater Overlay U Project Valuatior O COO Construction Type T��.gt Q evA eir Lot Size_ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 6r-- Two Family ❑ Multi-Family (# units) Age of Existing Structure ` mil �o Historic House: ❑Yes Qlo On Old King's Highway: ❑Yes .l-J-Mo Basement Type: VLFull ❑ Crawl ❑Walkout ❑ Other B O L.K R — !r,-/G f ST-1 t4 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) t � 8q Number of Baths: Full: existing_ new Half: existing I new Number of Bedrooms: -3 existing 1--n-ew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ( 'Gas ❑ Oil ❑ Electric ❑ Other Central Air: Oyes ❑ No Fireplaces: Existing New / Existing wood/coal stove: ❑Yes �?(No Detached gara�g(e: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached gar. 'eg ?❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 41N0 If yes, site plan review# Current Use O ) 0 Proposed Use _)/O APPLICANT INFORMATION n / ,^ (BUILDER OR HOMEOWNER) Name d Telephone Number Address a 1 /' 1, �T��d� �i License # D "1 771 c� MA Home Improvement Contractor# Email �%f'� �NG� Worker's Compensation # N1/4— ALL CONSTRUCTIO DEBRIS ESULTING FROM THIS P OJECT WILL BE TAKEN TO Q_ C SIGNATURE DATE FOR OFFICIAL USE ONLY t APPLICATION# DATEISSUED MAP/PARCEL NO, ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL" GAS: ROUGH FINAL FINAL BUILDING i� - D4T-E CLOSED OUT ' AS O( KION PLAN NO. The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organiration/Individual)- AV : Address:. �- Fo)ff+0—, to City/State/Zip: ��; ?' �h' D �`C Phone#: J q e �3' Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. JE4.I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 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.in urance J required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LF]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 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. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby ce u =erthepandpen of perjury that the information provided abov is true d correct C Signature: 7 Date: -� �© Phone#: �� 7 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#: Information and Instructions 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 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." 11' MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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 (Le.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth°of Massachusetts Department of Industrial Accidents Office of Tuvestigations 600 Washington Street. Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749_ WWW.mm.gov/dia �...� BAERBR5 OP ID: PS LIABILITY INSURANCE D 10/22/201 YY) CERTIFICATE OF 1or2212o13 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 Phone:508-385-2454 NAME:CT Patricia Sanzo Edward J.McGrath Insurance Fax:508-385-5991 PHONE o E,d:508-385-2454 __ FAX No): P.O.Box 1003 - Dennis,MA 02638 ADDRE-MAESS: E.J.McGrath Insurance Agency INSURER(S)AFFORDING COVERAGE I NAIC# _ INSURER A:Liberty Mutual Insurance Group INSURED Brian Baer INSURER B: _-- 93 South Orleans Rd INSURER C: Brewster,M 02631 - INSURER D: 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 I TYPE OF INSURANCE �ADDL�SUBR i POLICY EFF I POLICY EXP LIMITS LTR I POLICY NUMBER i MM/DDIYYYY i MtAIDD/YYYY GENERAL LIABILITY I I 'EACH OCCURRENCE S _ j I I COMMERCIAL GENERAL LIABILITY l j i D PR REMISEEmisi TO(ERENTED i ! : S aoccurrencet_ S L J CLAIMS-MADE j_ OCCUR I MED EXP(Any one person) $ _ i PERSONAL 3 ADV INJURY I GENERAL AGGREGATE S rGE.'L AGGREGATE LIMIT APPLIES PER: I i PRODUCTS-COMP/OP AGG j s I S POLICY• 1 PRO- i LOC 1 I 'COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY f i Ea accident) -` ! i BODILY INJURY(Per person— ) S i ANY AUTO ! --- ALL OWNED SCHEDULED I ! i I BODILY INJURY(Per accident) S :AUTOS AUTOS ! i - NON-OWNED j ! I PROPERTY DAMAGE i$ ( - (Per acc ent id ) I HIRED AUTOS I _AUTOS I I IS - j I i UMBRELLA LIAR OCCUR I EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADEI i G AGGREGATE $ Is DED ' RETENTIONS I i WORKERS COMPENSATION ; ! TWO STA IT, ! OTH I X TORY LIMITS ER IAND EMPLOYERS'A ANY PROPRIETOR/PARTNERIEXECl1TIVE Y/N I i WC2315389108013 01/01/2013!0 1/0 11201 4 E.L.EACH ACCIDENT is— 100,000 ;N/A -- - - OFFICER/MEMBER EXCLUDED? ® EMPLOYEE!_ I i 100,000 (Mandatory in NH) E.L.DISEASE-EA OYE S If yes,describe under I ( I E.L.DISEASE-POLICY LIMIT is 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES;Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION CAPEREM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Cod Remodeling LLC ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2416 Mashpee,MA 02649 AUTHORIZED REPRESENTATIVE E.J.McGrath Insurance Agency ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD / 7 ® 72/14/14 IMM/DLYYYYY) � CERTIFICATE OF LIABILITY INSURANCE 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: R.L.Tennant Insurance Agency I PHONE FAX Al No: P.O. Box 600069 EMAIL Newton, MA 02460 ADDRESS: INSURE S AFFORDING COVERAGE NAIC# INSURER A: 1 INSURED INSURER B: Ederval Tristao DBA INsuRERc: 1 Tri Star Painting INSURERD:NGM Insurance Company/Treiber 34 Pitcher Avenue -INSURER E: Medford, MA 02155 INSURERF:NGM Insurance Company/Treiber 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. IN SR IAWL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE p) POLICY NUMBER M/DD/Y MM/DGYYYY LIMITS D GENERAL LIABILITY �MPB4168H I 6/19/13 6/19/14 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED �$ 500 QQQ i CLAIMS-MADE OCCUR MED EDP(Arty on-person) �$ 10,000 Ij 1 I ! I PERSONAL&ADVINJURY $ 1,000,000 ttt— I I i ji j I GENERAL AGGREGATE $ 2,000,000 h G--EN'L AGGREGATE L[MIT APP LIES PER ii 3 PRODUCTS-COMP/OPAGG I$ 2,000,000 POLICY JECOT- n LOC ( I I I I I$ AUTOMOBILE LIABILITY CO 6 NED SINGLE LIMIT I Ea accida !$ ANYAUTO I I I I BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS I I E BODILY INJURY(Per accident)I$ NON-OWNED I I PROPERTY DAMA GE $ � HIREDAUTOS _AUTOS 'i I Peracadent (S UMBRELLA LIAB OCCUR I EACH OCCURRENCE Is EXCESS LIAR CLAIMS-MADE I AGGREGATE $ DED RETENTION$ I I I i$ NA�RKERSCOMPENSATION I 6/19/13 6/19/14 WCSTATU- I OTH-I Ff ; ,WCB4168H X !! AND EMPLOYERS'LIABILITY YINANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT is 100,000 OFFICER/MEMBER EXCLUDED? N/A i (Mandatory in NH) f I I I I E.L.DISEASE-EA EMPLOYEEI$ 100,000 Ifyyes describeunder ! ' DESG�RIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 1 i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is regri red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE' DELIVERED IN Cape Cod Remodeling, LLC ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2416 Mashpee, MA 02649 AUTO T_Ayv� i Walter F. Tennant ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: �as 4 li r w r — x i R r \ t LL O, ^.a x � � L f X. ZD -f- - -E--f-� i oFmE ,ti Town of Barnstable �. Regulatory Services Thomas F.Geiler,Director ram' .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 1 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf in all matters relative to work.authorized by this building permit l spl A-b UL �YL— (Address of fob) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner' Signature of Applicant J PP Print Name.. Print Name 311C)LI Date QFORMS:OWNMERMSSIONPOOLS 6/2012 1p� 1 own of .Barnstable THE t t Regulatory Services Thomas F.Geiler,Director KAss. i619. �� Building Division. Tom Perry,Building Commissioner 200 Maim Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: !OB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: S city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she.shall be responsible for all such work performed under the building_permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner �. Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code.Section 127.0 Construction.Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section I09.1.1-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 cannotproceed 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. . Q:foi-ms•homeexempt I Cape Cod Remodeling, LLC Contract Cape Cod Remodeling LLC Home Improvement Contract Dated: 03/10/14 This contract is between the following parties: Contractor: Cape Cod Remodeling, LLC Richard Avery, HIC# 152049 29 Fountain St. (Mailing PO Box 2416) Mashpee, MA. 02649 Phone: 508 958 7373 Homeowner(s): John Pena and wife Chris 508 771 5092 (cell) 93 Seabrook Rd. - Hyannis, MA 02601 Location of work: Same as above 21 g CapeCod Rem odeling, elfing, LL C Cont ract A Warranty of Ownership and Assignment of responsibility for this Fork contract to Richard Avery: The Homeowner warrants to the Contractor that he has marketable ownership of the above, described real estate. Homeowner(s) agree to assign Contractor sole responsibility for and control over construction means, method, technique, sequence and procedures and for coordinating all portions of the work under this Contract, unless the Contract documents give specific instructions concerning the work contract. Approvals t rd Avery, Cape Cod Remodeling, LLC John Pena (Home Owner) 4 ua - = ._.t-_.. !_.-__--�-- { o- ` {w_.wi __.._.1 _/-1 - wig. _- '• �-- t - F__ - ...3.._._.__�__.j._�..=�-....+._..__{L-..�' - �__.- .-._,_....-,1.-.__.L_- _ 1 ..._-1__/�CL�r�.;' ��•_//�/�/��KJ�n1/may;/{ _ —'— _ ..... ...._ 1 91, FT 94 { 16 _,.4--, r `1 � i I l t t I , �- - � ` - _ -�- - - - - - - --� � .�_ �. � -r-•-•-fit----�---i-- - � - - - - - -- - -- �_ - � --� - I - [ 17 s - t a r f ,t ` ' ' v + �' ► y Alk tz . t t r- a !J ..Iv k y, f A Y i ` r :t a l f �j" 00 --__ �--_ � — / _- / -- �-- . —r-- � - — � - -;off - -. — -- --•�.�e5�'.as� - --+-- - - ........ — —. _� — ___a __ r— 7— R sMassachusetts - Department of Public Safety ADEL Board of Building Regulations and Standards Construction Supervisor License: CS-084771 RICHARD T AVERY PO BOX 2416 a Mashpee MA 02649 , Expiration Commissioner 01f15/2015 P�/re IG"C+)J24JfLRJfCLJC(C�U O��C-/7��CLdJCIC�IJ C�r' q �Q\, Office of Consumer Affairs&Busibess Regulation License or registration valid for individul use only h`l ibIOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: N Registration: 152049 Type: I Office of Consumer Affairs and Business Regulation ,Expiration: 7/26/2014: Ltd Liability Corp-: 10 Park Plaza-Suite 5170 5 // - Boston,MA 02116. CAPE COD HOMES&REMODEL LLC RICHARD AVERY ? 29 FOUNTAIN ST L� MASHPEE,MA 02649 a Undersecretary Not valid without signature T. . BAERBR5 OP ID.- PS DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 01/10/2014 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; E.J. McGrath Insurance Agency Edward J.McGrath Insurance PHONE FAX P.O.Box 1003 WC, /c No Ext:508-385-2454 AIC No): 508-385-5991 Dennis,MA 02638 E-MAIL E.J.McGrath Insurance Agency ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC/I INSURER A:Liberty Mutual Insurance Group INSURED Brian Baer INSURER B:. 93 South Orleans Rd INSURER C: Brewster,M 02631 INSURER D 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 ADDLPOLICY EFF SUB POLICY NUMBER MMIDD/YYYY MM DD/YYYY ( LIMITS POLICY EXP LTRWVD i GENERAL LIABILITY EACH OCCURRENCE I$ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence HI$ CLAIMS-MADE1-1 OCCUR MED EXP(Any one person) I S PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: l PRODUCTS-COMP/OP AGG $ POLICY I (JECTPRO LOC I I$ AUTOMOBILE LIABILITY I Ea aBCINEDI SINGLE LIMIT $ ANY AUTO I BODILY INJURY(Per person) $ ALL OWNED �SCHEDULED BODILY INJURY(Per accident) $ AUTOS I AUTOS NON-OWNED I PROPERTY DAMAGE $ HIRED AUTOS AUTOS PER ACCIDENT I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ I EXCESS LIAB CLAIMS-MADE jj AGGREGATE $ ' DEO I RETENTION$ I ( $ WORKERS COMPENSATION 4 ) X TORY LIMITS I OER AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WC231S389108014 01/01/2014 01/01120151 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 100,000 If yes,describe under I`DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 j I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Brian Baer, sole proprietor, is exempt from Workers Comp coverage. CERTIFICATE HOLDER CANCELLATION CCREMOD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Cod Remodeling ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2416 Z-T Fr>vD,j 1���•15T, Mashpee,MA 02649 AUTHORIZED REPRESENTATIVE 7-3 E.J. McGrath Insurance Agency I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD �1K t Town of Barnstable *Permit# G Expires 6 months from issue dote Regulatory Services Fee 3 * BMWSUBLE i ® Fes, r „�,;, �® "^ a� 9a Mass. �' Richard V.Scali,Interim Director +" �� �3e i639' �� �``. Building Division MAR 17 2014 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barmtable.ma.us TOWN OF 13ARNSTA �E Office: 508-862-4038 Fax: 508-790-6 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 3,o 7 Cv 3 S- —1 Property Address J k/1.0 o FC O 4 [/]Residential. Value of Work$ 3 0 0 0 Minimum fee of$35.00 for wo k under$6000.00 Owner's Name&Address Contractor's Name All . Telephone Number S o S te{Sa 7 3 7 3 Home Improvement Contractor License#(if applicable) f O Email: RT-i (Lj H(@� Co�JlCf�t TiN�� Construction Supervisor's License#(if applicable) i�� �(��77z Vorkman's Compensation Insurance Chec one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 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) P�'Re-side 2-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 requi ed. SIGNATURE: Q:IWPFILES\FORMS\building permit forms\02RESS.doc ,r The Caasrwomueah*ofMassachmef& Depart of liuksftialAccidentg Offwe�r,f firvex;r i�rrrs IF 600 Wmhrrtgton Mreet Boston,MA0211 F wnw namgosMi a Workers' CompensatiauInsua-ance Affidavit.Builders/Coia ractorsMecEricians/Plumbers A t.Infarmatl6II Pleas`Prole Legibly Name(�i3sme�73�6E�d111TdhQl�DdfJ7iC�73�- Cityfstat-z : �s I�l�• Phone,�: Are you an employer"Check the a :ropriat'e box: Type of project , 4_�arr.a contractor and �'o I �r'���- I.El I am a employer with I �6- New canstruc� employees(full audlor part-f e).* have hired the sub-contractors 2= listed on the attached sheet 7-.❑Remodeling El I am a sole proprietor orpasfner- ship and have no employees These sub-contractors have S- ❑Demolition w for mein an capacity. employees and have workers' working Y � tY• 9_ El Building addition [No workus,comp.insurance Comp.insumm, reTrtired-1 5. ❑ are area corporation and its 14..0 Electrical repairs or additions 3_❑ I am a homeowner doing all wod- officers hnT exercised their 11-0 Plumbing repairs or additions myself[No worker$'comp- right of e2mmpPion per MGL 120 Roof repairs insurance required-]T c-152,§1(4} and we havens employees [No workers' 13_❑Other comp-insuranm regdred>f * YaPP mtthatchecksboa9lmastalso511outt�sectionbeloeashowing&eirwodims'compensmd npo&TinRmnx flm_ �I3ameowners vrho submit this off davit indicating they are doing alluaodt sad then hue oa=&coatxactars— submit a near alfdwit indicating.sarh- =Contacmrs that dheck this bar,must attached an additional sheet dwwiag the name of ffie snb-cauftxton and sutE whether ornot those,mdfks have en playees If the naVcontiaam bate employees,they mast pwvide their waders'comp.police number. lam an empZcrytw that is pragd&g workers'congwnsai{on irrssr=ca for my anq fvyeat Beloit.is the paucy and job site informadam Insurance CompanyName: Policy 4 or.self=ius_Ii(-- Fxpintion Date: Job Site Address Cit?lstatelzip: Attach a copy of the workers'compensation policy declaration Page(showing the policy number and expatdau date). Failure to secure coverage as requisedunder Section.25A of MGrL c. 152 can lead to the imposition arcriminal penalties of a fine up to S1,500.Oa andlar one yearimpr sonment,as well as civil penalties in the fbm of a STOP WORK ORDERand a fine ofup to P50_00 a day against the violator- Be advised that a cry of this statement may be forwarded to the Office of Iuvestigations of the DIA for insum a coverage verification- . . . .. . . .. ... . .. ..... .. ...._ _ .__.._. ....-- • -•-- ---•-- - - . ._ .. .., .. ...._- ----- - --. .... .. I do hereby ccrti wider poi nnrlgena& .1FF�l�l'thattfieinformatianpravidedab&Vets and correct ' siPnaturt: Date: t�l Pam : -5�9 �. s 73 73 11U&*I use anTy. Der not write in fh&area,to be camplstesd by cify or town oficfaL City or Town: Pert w1ke>ose If Issuing At fiar4(circle one): Information and Instructions 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 legal representatives of a deceased employer,-or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or.repair work on such dwelling house or on the grounds or building'appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(e7 also states that"every state or Iocal Licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their ceri..ficaie(s) of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance_ If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance Coverage: Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the lave 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 are 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/licease 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 submif 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 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 The Department's address,telephone and fax number. The Commonwealth of Massachust~tks Depaiiment Qf 1iidnstLial Accidents Office Of RLveadgatians 600 Washington St=t Boston,MA 02111 Ta#617,727-4 900 W 406 or 1-8 MAS E r oFmEr Town of Barnstable Regulatory Services y��IEg` Thomas F. Geiler,Director fo;9,.cA 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 4J T, t?,46 0— ,as Owner of the subject property hereby authorize / qo-b to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections a erformed and accepted. X Signature of Owner Signature of Applicant •Print Name Print Name Date it of1HE.'�s. Town of Barnstable Regulatory Services �BARNSTABIX,$ Thomas F.Geiler,Director o;�,{►.`$ 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILINGADDRESS: city/town state• zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner'assumes responsibility for compliance with the,State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official. Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any.homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&ReguIations�for LicensnagConstruction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the lomeowner 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. C:\Users\decollilc\AppDatalL.oca1\IvficrosoftlWindows\Temporary Intemet FileslContentOutlook\QRE6ZUBN\02RFSS.doc '6s s Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction SuperN isor License: CS-084771 RICHARD T AVERY ° PO BOX 2416 Mashpee MA 02649 Expiration Commissioner 01/15/2015 l . avr�rnaiacue«�l/n�C� License or registration valid for individul use only. ulation ulation _Office of Consumer Affairs&Business Reg before the expiration date. If found return to: Office of Consu Suite S170 and Business Reg SOME IMPROVEMENT CONTRACTOR Type• 10 park plaza- -- �$tegIstration: 152049 __ , Ltd Liability CC") Boston,i\'IA 02116 ((E x p i ration: 7/2612014: CAPE COD HOMES&REMODEL LLC RICHARD AVERY _ gam` Not valid without signature 29 FOUNTAIN ST Undersecretary MASHPEE,MA 02649 A CERTIFICATE OF LIABILITY INSURANCE DATE(MM )2i14/14 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: R.L.Tennant Insurance Agency I PHONE FAA/X No. P.O. BOX 600069 EMAIL ADDRESS: Newton, MA 02460 INSURE S AFFORDING COVERAGE NAIC# I NSU RER A: INSURED INSURER B: Ederval Tristao DBA INSURERC: Tri Star Painting INSURERD:NGM Insurance Company/Treiber 34 Pitcher Avenue INSURERE: Medford, MA 02155 INSURER F:NGM Insurance Company/Treiber 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 IADDL SUBRF POLICY EFF POLICY EXP LTR TYPE OF INSURANCE DI POLICY NUMBER MM/MfY MMIDDIYYYY LIMITS D GENERALLIABILITY I IMPB4168H 6/19/131 6/19/14 I I EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY i rDAMAGE TORENTED I$ 500,000 S �c c CLAIMS MIADE EX].OCCUR ; i ME EXP(Anyone person) Is 10,000 1 ! PERSONAL&ADV INJURY I$ 1,000,000 GENERAL AGGREGATE $ 2,000,000 II GGEN'LAGGREGATELIMITAPPLIESPER I I PRODUCTS- COMP/OPAGG Is 2,000,000 X i'POLICY F PR I O- LOG I I j I$ JECTAUTOMOBILE LIABILITY I COMBINED SINGLELIMIT i - l+ j !S Ea accident— ANYAUTO j BODILY INJURY(Per person) I$ — ALLOWNED SCHEDULED I I AUTOS AUTOS I I I i BODILY INJURY(Per accident)!$ HIREDAUTOS NON-OWNED AUTOS PROPERTY DAMAGE AUTOS I I I I Per accident $ i I I$ UMBRELLA LIAB OCCUR i I EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE !$ DED RETENTION$ F I WORKERS COMPENSATION i WCB4168H 5/19/13i 6f 19/14 X WC STATU- I OTH- I AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE YIN j E.L.EACHACGDENi $ 100,000 OFFICERIMEMBER EXCLIAED? N/A' (Mandatory in NH) ! E.L.DISEASE-EA EMPLOYEE $ 100,000 If yyes describe under ( ! DESL`RIPTION OF OPERATIONS below I 1 I E.L.DISEASE-POLICY LIMIT $ 500,000 ! I I i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If 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 Cape Cod Remodeling, LLC ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2416 Mashpee, MA 02649 AUTH D E T_A�vFi I Walter F. Tennant ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: _ ineering Dept. (3rd floor) Map. Parcel �JJ /0"—Permit# �G V573 House# � ate-Issued Board of Health(3rd floor)(8:15 -9130/1:00-4:30) Fee D-D Conservation Office(4th�floor)(8:36- 9:30/ 1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) - oFTHE, De ' five P n Approved by Planning Board 19 ; -- � RARNSTABLE, ` MASS 16 RFD MPS�`� TOWN OF BARNSTABLE Buildinpg�� Permit Application Project Street Address S� 5Qaa- 6A_ � P-0 Village r1 t Owner J dl1I,J. kew\*:� Address Telephone Permit Request l Q First Floor squar feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning,District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name 1 __G/tit Telephone Number Address %(A_1t e4 wA Q r/l License# ��rr Co,�� 441g Home Improvement Contractor# &P 3 6 Worker's Compensation# _4,� ��'3 e,9/6 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE -7�8/ BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY j PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS 1 VILLAGEf OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL , FINAL BUILDING DATE CLOSED OUT i 1 t ASSOCIATION PLAN NO. f. , �"E The Town of Barnstable NAM Department of Health Safety and Environmental Services 1639. Is Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations;renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est.Cost Address of Work: �'3 ��cL 64--C4 t lc7 Owner's Name Date of Permit Application: —7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT ,OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: DaT Contractor Name Registration No. OR Date Owner's Name The Ct1»rnrutrl1-calllt of.4fassacbuscttt t •�;il i•�:- Dcptirtnutrt njladirstricl Accideurts •�\�_;�' �i�:�' 6011 !i'ux/rirr�rurrStreet • •�:•���'`i a- ��' Bustu,r..11tt>is: (12111 Workers' Compensation Insurance Affidavit al�nlic tot informatirn PGse PRINT TedyilyF- r name, Fl?C4/✓1 �✓l C.�>�-Q/1, Inc ttinn "71 city On`I—Cu-1C � nhnnc I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity am an emplover providing workers' compensation for my employees working on this job. rnrnn/nc• name* lddrt•cc 7er /1C,C City- (��y-C�c,c� nhnnc f!• . InC11r1nrC Cn r� Lt t'X�/C- t ��✓ T[��i�'' nolic�•� r,�C'i 3/S rsa 36 3 o i6 ( am a sole proprietor. general contractor. or homeowner(circle atre) and have hired the contractors listed below who hz%-e the following workers' compensation polices: CmmMInr nitnc• 1tltlrrcc• nhnnc 0. in-mrinrr rn nniier H cnm .inv mine- :lddrecc- rite nhnnc Of' incurnnre co noiicv d Attach additional sheet ifneeeisarv,- •r .'_.' "^�i!.:�' r....y�.._ .::'��•=�-_ � �' �' :...r.��....�...- - .Ziv�_�� yam._.. ....w.w..... Failure to secure ctiveratle as required under section 3A of I%IGL in can lead to the imposition of criminal penalties of a lineup to 51.500.00 andiur uric cars' imprisonment:1. .ell:Is civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement ma} lie forwarded to the Olfce of lnvestileations of the D1A for coverage verification. 1 do herchr cc '_ our c t/ and p•ttaltics of perjury that the information provided above is true and correct. Date 7 Print name (�_ �� � Phone ..'•nlfcial use only da not write in this area to be completed by city ortoH•n official '•� permitilicense IY r•tlluiiding Department city or town• C311censing!Board � I] check if immediate response is required C35eleetmen's U11icr ► C311calth Department c phone#: ri0ther ontact person: s �. :wt'a6� °'>•'N'7k< xF;�S..J!�' '�� �,..r.M� �4�1'K% R�hE '� 3 � ,�k'x`. 1.sd}r, -r'j+.i z n.',:. q t. :.:'S � yYr. i! 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"x .: ,yY- �., ... 1 ♦' n5 45'. *'J.r � ,yv Y Mass achessetts , � M C.� �S} �,,} ;; d ,HOME','UMPROWEMENTr CONTRAC:TOR�� � : .� a, '" k, R�r=`F .,t �� � ,.fiyk k- �• k< .e. F2eg'istra•tlorr112536 ion W,04/,0 a>� a -,�,.c .mot, OE3 -Ut`..•sa ,t` �*'' .'P � F:,{ lPat�,,q. r 4 ";+a4 4,y.��i:Y•J t y �" Fy' i r M $ d r ra 'l M1" 4z '�f �9. '+•. i ...... ;� ��;'E �r 4✓ }. �"•~-.+. CF T �AM@ � � :�%'� T�:-..f�. g b •, `' `° IMPROVEMENT"CONTRACTOR `.- .a^i4o-y# { d° rt, s {: :� f3. ,.���s,r r ..^t,'.�,,.'�-ip •Y. ,.'�v, .•,.+ .a,�' '` t� F�+p�?f' M. .P r'�e�a 44'>�,,,� ,�it••s'�' j,� +.erx _,.;v' 'o` „_� ��� � ..:���jY� �-, ,� � r•. ��> r� �. 4 ��,/4..e, ,,;. .�,><�,,,3� �' '� t�,�. t `RegtstraEon4�'111536 :�-, y. :, �^^V .� �A' yS{ ".: ,} :.`T� y*�4 .'T£ 'vf 'n- w`:tf`•'A�$. i• Y:,Ww �5m is ij a F �:.r"" y r� > .. p': =Y`•,r x��: { t ERASER CONS1'RUCTIOIV f . .z t; • E,:K x. � `� m;Y •vim �i t t to i:�'ar � k .. '�""{" �i. J_-q• tt;-' 2+�:. d,j k �� a ;•DEAN r.C ;::FRASER y .. Yi _ _.6Yti:y kr!,4,x��„��i"Y`,¢"`t;'t'Cy,°,...'�,i��t'k'Gv+.`s��_�r+.-s�a.,.✓v��.•.�__n«.5--'4 r 4'pF�,:R`<tt�F��*.�#^,.5,:,.$:C7:sy.;�,:,�;$,?a:rtv.*<`.d,�:.��t{j."�a 1,kr,.s-srg�,'F,�_.,-��i,,y{'u'iSa{a:z�r�":,v'�'vk.M,&�Y S c�"r't'�h^':•'l..�.4R"'�.ya.:a.a.rE#�q.'�..q'"i'2�,�3i'ti..,..tin7`�il.a.?�.r,,,,g�``no�Y.f''*a#r.*_4�3`;y.�N�5'�a}y,4a,«"c<x-rc:�r�rY:�SxY S#�.''�.+!,'�e-i.tu S,c•$��'.••,tl�.�1.�r..�fi�`.d�,.>�i,:y�,•.g vs�.�t�,�7�•�s�P;,4T.'S�.•,�.*F..�^4:„ay''>'yrP:_,rA tf'�c�'7�-'„€cfit.r,.,:n 0.2•.4,:+�ztia:�p.'.:.��,�Ts',P..�•ta,.„i5 1:s-r``a�i?r;6>•;?_�;.,,>'�..z��rFt''Z'a#.t,^F's�'r dv-v.,r`�4`'L 44'..y�''•:.�''�fiid<'�,vf'sa';'.�.Y.'.=.a"a'''y�.�8 w..J'..w,q�yi.�/".i.),:g-°';#�k��,q.`.`�Lt°�`E2.EP' `C$t - R � p yy� S,'E•R0 4 rvI;.c;-3 S 'TARRAGON 4 � �.`,sr 35 �OTULT MA,CO26 vq FRASER .CONSTRUCTIO0:�N UL i Q.O 6 I 99sv F ,.v�RpJ.,•. .�a .F<•.,,',,yt� ,l ,.,i;s .; x � � ,, .y�s3r ti . nonnPw R�, 1TARRA60N CIR ..q {ti r ,,. 0,e 4 _ .� $TRATO, ..%:• t: z �,py.:..G-5 .';:a: i.,:4f..�';...>i,r;C .a<.�^'`t,�Y-,F w '?t a..a{ Jt.yk Y q ..�,� •5.}, �. tk t !:: x �.5.: ;;�,�S ,}',s 2,,, P eKt a: S.t a# )+f;}..:, :' 2+J 1• ...,.n`, u y. t: f;rn -✓,i a Via,.• •.;'� z.t .r:' 7{ i t fit:-�i- i. : k;.r, .•.'✓a i i.,.,..�, 4 5 ;`i ;�'w,�•. s£MA . 35?f+.i�a COTUIT ,? , t 026 j��,1 } Assessor's map and lot number -- ....... ..3... ....1.,.... Sewage Permit number .. . .... `� ......... ........ I ,., . � . .. .... .. �FTHET� TOWN OF BARNSTABLE i 89SBSTADLE 'i "6 9ae�� DUILDING INSPECTOR 7-APPLICATION FOR PERMIT TO .�'�-D ... s E ......i j. S TYPE OF CONSTRUCTION ....... U.-I-):.............................................................................................................. ..............19.7�` . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 7 S,U/tr/1? ' S ( �..A/1/F y�-NN 5 ..................7........ ................... .... .............................. ......................................................................... c-- -P Y �' ProposedUse ........................................... ............................................................................................................................ ii ZoningDistrict ..........�..............................................................Fire District .............,....... .r' ..................................... Name of Owner ..........Address ... ...,5 ./1l�/YJF�r�s.1 �c ........ .t`N ...................... Name of Builder ..�.:..r i4aN.!..................................Address F-D��� 5 T, GZ7, y A2NtoU T...... ........................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............Foundation .....w G Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. "" o o Fireplace ..................................................................................Approximate Cost ....�........... ..vo .............................................. Definitive Plan Approved by Planning Board ________________________________19________. Area 11—� ... ................... 7 Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH f 3 Eck let � ja l�FuvS.� L � r ,I hereby agree-fo conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . .... ./.............................................. /J. R. Dpe ����� / ' 17241 No ��� -------z a�_z g� �� Location _ .. J!aoe___ --------------------------' Owner ...... .. ............................... � Wood _ Typo of Construction -------------- ----~^--------------------'' � Plot ..... Lot ................................ � July 29 75 Permit Granted ........................................lP Date of Inspection ------------lP Date Completed ...................................... � . , PERMIT REFUSED .----'_--------------.. lV ` ^-------'------------------' --^---------------------'--' —'----^---------------'—^'--- , ' ----~----'----'—^'—`---'-----^ Approved ................................................ 19 ---------------^—'---------' -----------------------^^~^' ! .�,-r_...--.. � - .. _ __���w,,_r-�-•...--�._.,...�,,.�+"�ti-�-.-..�--�+-. `._`'^•..+..... ram,..--..--Y��...�_._.�,_......�._. ..b--- '-� Assessor's map and lot number Y" TIC SYSTEM DUST BE 9 INSTA1:9 Eta 13� Cd , �.+:".'�'� E !/f d�'•� � Sewage Permit number ... ! .:..... .............:....:...:.... WITH ARTeti!C E FT - t SANITARY CODS AN©TOWN 0*TNEo�o TOWN* OF BAN"TABLE Rio � �,_ ,: �� _ . � • � �. i B ,ARXSTADLE,"� M6 BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..�.�.':b7?.... C TO S 1 p E .a HQ S F TYPE OF CONSTRUCTION ......:Y:Q.5 11..............:..:. ..............19.77 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 7 SvMw1 ,e,s l � 9., F N �1 NN?.5.................................................:...... ....................................... ............... ................... ProposedUse ...............1�.'e.0.Y POe� ! �1R............................................................................................................................ P ZoningDistrict ............�.... .....................................................Fire District ............. .. ... .. .......:.................................. Name of Owner .. (JC !1!F .............Address .. ... ( !f?/l'1E S.1. 1. .......Le..A4 .............. Name of Builder .. ..... f} f��N ....Address ..FD.....� STD (,f9e yA2-NLoUT1� ....................................... Nameof Architect ..................................................................Address ................................. Number of Rooms ........................................Foundation ..... ..�.LI/1l G ........................ ......................................................... Exierior ...........Roofing ............................................................................................ .................................................................. Floors ..................................................................Interior .............................................................................. .......................... Heating ........... ............................................................Plumbing .................................................................................. Fireplace ................................Approximate Cost ....7Q.. . —8a d Definitive Plan Approved by Planning Board -----------_______-----------19________. Area l?.... ................. Diagram of Lot and Building with Dimensions Fee .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH o- (y� /4-o u 5 6 --]J Sol V I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name � Cctc r .............................................. No 17241 ..•.............. Permit for to..ho e ...................... Location .... � .� . �... ane••••••••Hy-anuLs ............................................................................... , Owner ...... UQe"_a,v..............................._,...,� Type of Construction Wood .......................................... VW e'`k :............................................................................ 1 Plot .....Aq.�7....g,,.q5. Lot ...........:.................... � Permit Granted ......JUXY....,29.................19 75 Date of Inspection ...... .............................19 Date Completed ..c1 .a?. .. ... � k PERMIT REFUSED • f .............. •......... ................. 19 4 •.•......... ..•........................• •.............................•... i1. �.t�••..........• •................................................• •....• •..........................................•......................• • ^� r ' ..... .............+....w ............................ ................. k Approved ................................................. 19 ,