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3512 MAIN ST./RTE 6A(BARN.) (7)
Ltn 1 - ' o d e universal® www.myuniversalop-com phone: 1-866-756-4676 UNV12305 MADE IN CHINA TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Maps Parcel ® � Application # Q6 1 S OG _S b Health Division Date Issued 2=2-7-iS Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address l440 S� ITV-2-- Village pot Owner_4 41U_S*ILJ 6�d /u�y� fZ- Address ),S le, Telephone .a D�V "ilo&*- TO 7 Z Permit Request Aftl,i&A 4, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new .Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No ;Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name WA Telephone Number Address i4plklo_P-1 6�p-,e License # o Home Improvement Contractor# 1 7t3 Zy� Email Worker's Compensation # UW(;79 06-&3 9V ALL CONSTRUCTION DEBRIS RESULTING FROM THISAP�RO'JAEC WILL BE TAKEN TO r SIGNATURE T DATE IS FOR OFFICIAL USE ONLY AOPLICATION# _ ` - DATE ISSUED l MAP/PARCEL N0. ' ADDRESS VILLAGE - OWNER cyw x DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH S' .'FINAL . PLUMBING: ROUGH FINAL a GAS: ROUGH FINAL FINAL BUILDING t DATE-,CLOSED OUT ASS©C, 1ON PLAN NO. Rvenewa� 1�+��q7�� y��7 '�j' ��y� 7U.T3Atos�FhR7'3 y {{,�,', JL�NIEY AK D•3 'rf 11�J ERS Lkctt�ermC69<5*5 "J l'I 26 Asian Road ' t:ncoin BL6266a *12i7 twd:ecaa wtilevn•,nnraac eeue m.WenmGt� � . yb m 866*.2935 Faxd0)-6, 6602 rGdd;al Lmc l+3#i6 OE[SriE C! Soritta ro 1!awlaeglaeil +Aa d! /v, CU$ 'M WINDOW Dooit 1l nioDl3l�rG AGREEMENT, t . 44 A.ara93tam.tnmkar y` }hherrebyjoinllyatad,ie+ r$lY.a tc�parcE+�xet9re�rodnc+��x9Porsecvies+�FSwu .cm;t�wEnglarlNuedrrAs,CJddbAa& el by And n of S4adtcrtd.New Wn Lnd TdmnmcW!ji in acr6adamce vrth die®errns,and r.defz�Ye�6�ed�oz a fit wed,the re-, of treio a irececn2 u;bd an dw attae8,vd t' c+aia chvvt[E)(xdl+cpA yg>h�s ' ❑"MU"' ❑11(tN? zaeel}obAmaumr. 7 6,c y CAD Eairee emc 9CM& UCwh 0M2nL1 Dep Sit ftecee;ed(I3Nc y' Grelft vve aaoi�red farapmt ordr-rt�mum I d1 d tRe Isatanea ac sra�r of jab(My ' `i ffstm ad GmcFlat�� •P!A1Qse a f,�e�ssr�C"'Cwd F"tem.Ftmq 3p Simi ft d- - Ft�eeaatetet_�aa.acknn-o!wl�d'�v#n#.�v 6sleteev srt3faat of Jah Brad ttin S�lu�rm on S&.aoa�ds9'- -} ? n[a sisal f:aanpf�'gn GF Jai WRpi dta i�.dY by .it Caeip'lal�aa cf jo6{S3'Y�jc 4 h a:r8 and Git r�da Gy per"soeal tlwak,�rtle tls�'�ar' .' litay r(s)a&rcs a.ad understand 'Agminne'ag cons$ifakeaAc.a#", • ets# d: ihveea f�c. iaulice,wort Ibat dkcre are ap vihbl'Rod cho M*g UDY of&C stains 9.f t$is Ag_ cot.R'(s)a;bM0_l45_* t Rapers} (11,lienirdiedttela Agresmc>otK t+ . ' ehe tee olf d13 Fecnne>nR,awd.. a g> sdi Signed,anud'd "d Y Ina - twa Natieeis of Caaesllntiipn�oo tlntc>1rmt+Fria>SeaaLavo ad� }was aralfy iafar edt of 8ii a l o 4' Do NOT��COM RAM'r» .u:E A,NYBIAN1ii SPA(ML ta&fshmd Sakai C!*if l�iotieato ayQr.(1)DO Oat dgmthis.ABree�eataf as i f thm'ipacea moiuded Cnrthe a Cr. to tltagwhl,�#oK tli-M hL:nlc_(2)Yen.are a=filled ko copy at't"Aar••�•••t at the time�sa9°! ak,�3�Xvo:ao>y yt 7 ti.ne.p'Y off. _ fign iiutryid hainure dnp.unde r piuy m soda $oo vany be"eptiiled to i+ezace a pallid sehate of thcfdn ' d;and iria�chim-9m:(4}�fde serer_ rsa> to anlairfullg pmria°pspui O eannmit'any bveacb of the peatcd .":repaesees goods pu"aaed�de,'r t8aa. e 7r4oi 9 ce�ntel trig Agrtem$et ie ik Gas rink 6aett eigXred at ffie o>1�ice ci rt larama4 altoe Q��LLue seder► '. . .• e4 Y° :mAt#[�#hr'St9et' tBl9 cix 8 ma efsee "I"" affae i&G%vA in the .eat frY'r +l :as ee�Red�mlp. clti e�ll0ye�4ste��tte�ter minas m�tlal�t ii tAe tbsed¢olexddar dip ajez tbc" wR gr6iafi't&e btryee the'@lgrt �clsd#ag smdap aad e y ka>idaip as wisie>� rimed.dteiiee8ita�nrat• _ See ttis ocsomwp�g3n�;�dac cdF emdr ibrffi€�oa�anat�➢uao�buyer3e , e mo G�pI'a� 1Gvedt[-LsythE { P3 "ctc IFR ffii'tloa.Baud_- f rr"1F mlt� RE!de%VA.by d Soot 1ti Awreamd DOpo-a} ... _ ... 1'18�hagee •. r.•r „ +,.:•- _, : ," t y Ss;�Qb2ri�@,". ]?Fete[ka"=', Pmduct Phi.�Taimc ' fiat6+Tsri3"e 1HE H1JYFdt(sar IDl1Y TEQB r1tA1VE+1G"J Il1i1�T A�AlliY P TO OUT, 1IB':.TM-LITUM ll>mfiMm D"AikftR THE DAfI'8(bF T1�6 rR SA4�11ON,$BB;°I I�A ITl! YYSTT��s�l�CAST TTQAi FOILA�IS FiJlt!`YiP oF'rl#9416H'C" Y -- ' - - - ,:ION •"` st 11a#�atTratuacki8n Yore nW craftel D*ft Ili• an Yov i1Lij1 eanew tihis te'at9�EtfA11,wllhOut,any at dhlig3t On.,Wltldfl`_ tf1�' 'wltttorlt any: a�figxt�onr vretlwn :tax ee b i®ess.da1►s,frvtre tha ab' 'da3a:lFlrae.eaerwl�crap;-!' thrvee tidtsliiess f lis the adoee&s-lf jMU a alroAl,a11tp profrer�ip.kTided in,ar�p'pomerrts edep yap, uYrdeo`tli® I ►tY tr�Id argr, !rrade bry you•uns�ir tht �ntract of Bala,sltd.�iy'„ a InstrwridDst�acutsd i �nntaact a'. e,end a ne mstruntdxil eadec- byj puu wild b+i iak twal'vn�Min _.f WA ress da.'iollvvrrng o; hY Srou'w4 be: medS;tvitie Lefi hus s6 d;< ;4o11�rYvielg reaedledt tilrr:fhe SCIfCC of ya�ur e111 •.p itlan'•nod6N!and any i 66fpt by a Se1Je�of lydeur caddeallation noti�gry a:td aiag s ilty Intemst'•arW:mg,aeut $fi a (transaction m11 6■ a se�n�a herb F euls�r S..out;s4 thc.taran�atdoei vrlt} �1e t®ncelvit If m canc[!t, must 4n toe araffable to tlh®SeJ canlceled IE 10: el,}tore musl.rnalav available♦b?'LM. er pou. !1:1 r rasq�arrca.In substldi lhi' good'condCtlon'as when,1 at p°!a?m'den ' in tsn't9alhr guod'cdint oti as rvi i e eei+►ed:?urP guvda'ab.lorwt>d Ca.ye:'ceder ehes Centraet du`I '110M d;aft de�Yered'tb,yuu rm er: k ti5tiitk or Salmi arlrou ifyo11.W1sh;. tfi®has0iV1 1811a-of 1 •:Sa*`4w.You irVojrWh 4omplg whh the t aincti6ro of the;Sellar d�6ga (ng the rot""S. ent of tlwgdodsak the: th*-*-ler the retuarn shipment afthe good&at the Se31er';e.�nse aefd nsk If y'air<do tfir dull tivailaMe Sslk i11t slsl�. AuAv naaloe tfaa Ep :Axaa`I e 60the. ew,and tile.5pirsir dam, p�ck> up lw C h ` t�a't Se er - d tbe'se©rr doca not,pitk tl�em up.t iie tyt"stags of the dace of Zeta rnel[reilem t t: twe'►�jr: # eRatTon.pads eti ratatlx.al" die del the goers iNitliout aay► (far u6( bdi If poll l: dlspils®of't ds w[tou a+rf der o&L"gatiot�If jrou fall rltalae Quoits itVallolr9 v 5nller,or!f'"M.eves,q-fail Cra'nlaloC _ gomQ9 00. i h[e to th®Sd[[ar,v r tt jro,+epee to retrden:the 'ads[o thc.gttlei" �fefl to do soli then,you � tdf,return ifio g to I&ei Seiler�ud'fafl;to d*'so;#w y,u rentalfsa liabCe fOr peeforteiapw 9f- tl obl@4ions'imdasr 1 I, ratrrin liati#a# pC:f ::nsneq olf s#l.oblbgatlo udddee the �"ontract o canmll tM9 4rei 9a tro anvil r tlClhMef A.Slgned Gadr au.�o I t trans ih d�rra31 or dsltwer a. set .A'11Q d 2 .�C fiaif Li11s; mlwil •'e nOtIce,or-any oihol"I..` a<lti' dt64 ca of-this caniellibM n-natke #1"' other t4Yltbf► i9ce;orsendateMpBFa'n; r#cecenra0blr3fjndprsendrf .t: wd Gl tloB6t; rscndot6efe 4floltett byrA�of Sautherii Wew'En d d426A®iio R 6 5,:1 southern Flow glincl a t-2 Albioar'Road,Lincoln,RI UMS, F#OT LATIMTHAKMIDNIGHT F KEPT LATER'7'FIAM-141lyN1G1•T OP. 9gate .1 EseB7 C�l.TtfISTRAN >hl;.- I, •IH:EI[EBfYCAA CH TFUTMINISAGTiba#. •,gy��; � ' 1 , . '{�� -:Suy¢rsf '.•' iirl�rloAm' ' - 7)atie -. AblyGopgriVhire- our- Y,91— B CoprrPink` I Southern New England Windows d.b.a oil Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor f " tw€tense;GS-095707 -Y .,a':T i'e is x•r� BRIAN D DEINMSON 7 LAMBS POND tfiIIt Charlton MA 01507 4 's J,.f:,.•�� �a'}"A Expiration Commissioner._ 0910812016 W Office of Consumer Affairs g d Business Regulation 40 10 Parr Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9119/2016 SOUTHERN NEW ENGLAND WINDOWS LL DENNISON BRIAN 26 ALBION RD — LINCOLN, RI 02865 Update Address and return.card.Mark reason for.change. scnl 0 20,14-05111 Address f—I Renewal [—I Employment ` Lost Card £ _ trice of Consumer Affairs&Business Regulation License or registration valid for individul use only f before the expiration date. If found return to: PROVE CONTRACTOR P r Office of Consumer Affairs and Business Regulation Registration: 173245 Type 10 Park Plaza Suite 5170 Expiration., .g/19/2016 Supplement-Lard Boston,iVIA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC: RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD --y9 _- LINCOLN,RI 02865 Undersecretary Not va ithout signature AC a® CERTIFICATE DATE`,.� CATE ®F LIABILITY INSURANCE (M;U THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.iTHIS ' 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER., IMPORTANT: If the tert flcate holder Is an ADDITIONAL INSURED,the poll the terms and conditions of the li P des)must be endorsed. If SUBROGATION IS WAIVED,subject to Ao cy,certain Policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen(s. PROOUCERNillis of Now der BeY. Inc. C/o 26 Century Blvd PHONE Y.O. Hos 305191 1-877-945- 378 FAX A/C No i-888-467-2378 NaehMlle, TN 372305191 D8A ADD L :certiticatssariilie.com INS) S AFFORDING COVERAGE NAIC 0 INSURED INSURERA:8electi— Eaeuraace of Be 39926 Southern Nev Ragland Windows LLC INSURERS:The an :on Yutnel Iasuraaca D/B/A Reaeral by Andersen 24017 26 Albion Road INSURER t maurance 19801 Lincoln, RI 02865 INSURER D INSURER E COVERAGES INsuRER F CERTIFICATE NUMBER:N52916o 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 DESCRIBtB7 HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN THE BY S D CLAIMS. 1LNSR TYPE OF INSURANCE ADD POLICY E7(P POLICY NUNBER EFF PO X COMMERCIAL GENERAL LU18fUiY Lam EACH CLAIMSMADE OCCURG OCCURRENCE $ 1,000,000 A PREMISES Eaaccurrence $ 200,000 MEDE(P(Any one person) $ 20,000 GEML AGGREGATE LIMIT APPLIES PER S 2029459 08/10/2014 08/10/2015 PERSONAL&ADV INJURY S 2,000,000 POLICY Q JECT ®LOC GENERALAGGREGATE $ 31000,000 OTHER:* PRODUCTS-COMP/OP AGG $ 3,000,000 AUTOMOBILE LIABILTrY S COMBINED SINGLE LMrr X ANYAUTO 'deep $ 1,000,000 A ALL SCHEDULEDWNED � R1� 1 $UTD AUTOS 8 2029459 08/10/2014 08/10/2015 SDILYINJUR1HIREDAUTOS X �ED ' $ A PRO cd DAMAGE E A X UMBRELLA LUIB X OUR $ EXCESS LAB 8 2029459 08/10/a014 EACH OCCURRENCE $ 5,000,000 CLNMS MADE 08/20/201.5 AGGREGATE DED -1 RETENTIONS $ 5,000,000 woRNERsCONPENSATION $ B AND EMPLOYERS'LIABBJTY YIN X P ER OFRCEPUM ANYPROPRIETO�ARTND CUTIVE N/A 0000068028 EL EACH ACCIDENT $ 1,000,000 (Mandatory I0 NH) 08/21/2014 08/21/2015 er B_�yes desTIONOcdbe O E.L.DISEASE-EAEMPLOVE $ 1,000,000 DESCRIPTION OF OPERATIONS below C ork Camp/EL Covg: EL.DISFASE tatutory Limits - NC -POLICY LIMIT $ 1,000,000 MC927938352394 08/22/2024 08/21/2025 .L Be. accident - $1,000,000 R.L. Disease Policy Lint - $1,000,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(ACORD 101,Adt0ftnal Rwnadm Sahed L Dieaaas Ea. employee - $1,000,000 ute,men be aaeehad If mare space to►squlnd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ANY DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Southern HE LLC AUTHORIZED REPRESENTATIVE 26 Albion Rose cola, RZ 02865-0000 ACORD 25( )2014101 ©1988 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 8R ID;6629625 RATCRtBatch #: 79627 YiiL V�d+Era�FL-S+S rrZ�.i��P/�a�l� Office Of Investig ns I Con.%=st-884 s4keI00 wwwWorke&Compensation insurances ada a qd a -- A.n�lt �o� ioaeerxa�als Please _J&gLb1v Name(Puskess/oram ization&di : SOUTHERN NEW ENGLAND WNDOWS LLC .address: 26 AL BIt, N ROAD Ciiyf8tatt pp: I_INCOU t-v, R!02865 Phone: 441?28-9800 Are you an employer?Cheek the appt-opy ate Aso= I- I am a employer whir 20 _ 4 I apt a general contrmtor and I Type of.Proteet( d_ )' employees(full aadlor part times* have hired the sub-contractors 6 Q Nevi constri melon 2.❑ I am a sole proprietor orpartuer- listed on the attached sheet 7- Remodeling ship and have.no employ= These sub-coot:acwrs-have 8- [1 Demolition working for me in any capacity employees and have workers' [Noorlcers'comp.insurance COMP-insurance. g• ❑Btnlding addition amrequ tLj. 5. Q We I are a corporation and its 10.E]Electrical repairs or addition 3_Q am a hoTneowner doing all work Ofcers have exercised their II. Plumb" mctself. [No workers'comp. right of exemption per MOL -- airs or additions fimuatice regwred.I' c_ 151 sI(4),and we have no I2-0 Roof repairs employees. N- o tvorkers' 13.1!Other""N°O"" C"E" comp-iasumce regtiiratL� 140-- mere hosuecItbax=lmustalsoflU tgtindcalin thOMticabeloushow-ittgiheirworkmts compensationpolicyinfarmatioa_ Homeosimers who submit-this aFndat�it indicating thet.ate damQ t =a l work and��hire inside contractorsmusrsubmitane�c�affidavitmdic�anng mwiL =Contractorsthat cfiecL-this bo�mustattached an additional sheet shoe the-Remo of the sub-contmaors and statewhetiierornotthoseen"ashave employees. Iftltesub-contractorshaveempiayees_tbegmustprovidetheir tivo&cWcomg p��,a eT I 70J�M pZqjrerthatispr©viditraa�orkers'come # orin �tion, f m 10yees. Blow is thep& anal job su-e Insurance Comparq Name: ARGONAUT INSURANCE CbMPANY Policy r Or Self-ins.Lic-4-- W0927938352394 ExpirdtioIl Date: 4812�I2015 Job Site Address: Attach a f , #/ copy of theoa'kers' m - _City/StaYe/Zip �— Lozl Endure to set y o co peRsatioA policy declaration Page(showing the policy number andeVirafion date. W as required under Secfion 25A of MGL C. 152 can lead to the imposition of criratinal penalties of a line up to of up to tit)0-00.00 and/or one-yew in fisonme�as w=ell as civil penalties in the fomn of a STOP WORK ORDER and a fine .00 a day against the violator. Be advised that a cop,,of this statement may be forwarded to the Office of Investigations of the DIA for tmance coverage v,,icatioa r a hereby L uL erenp L.e-lify under ftte p�and pond es of pe rry tltattlze ' g formatiouprovided¢bove if andcwrem Serrature: Date- a Phone g: 401-228-9800 O feud use only. ,13o rootWr&W m this Meg to be completed by c&y or town a&W, City or Town: Permit/Licenselssu # g Auftrity(arcle MO.* L Board of Health 2.3$uRding Department 3.�CityNown Clerk 4.Rieet�'iM juspec�r S. ?331 �- 6 Other Contact Person: � ,� a,fn.n 2 a. t _m:. _ T i• i as$eic rr Nwa�nb�rcim I doors } cab i r wi Le Alit-I Yet' 11 ' • r r,, If�f�.,GS9CtGl i • I r1 1 .I-- ' Irlis loft i . r t i ft win, ` �i 1, I Windswept Farms Homeowners Association 3512 Main Street Barnstable, MA 02630 February 25, 2015 To Whom it May Concern, This is to inform parties of interest that Susan Rhilinger, resident of unit 12, Windswept Farms Trust, has been elected to the position of Trustee of the Windswept Farms Homeowners Association. Susan's duties as Trustee began upon the resignation of Stanley Smith, January 31, 2015. A copy of the homeowners annual meeting, January 10, 2015 is attached. Respectfully, iwv . Bruce A. Childs, Trustee Windswept Farms Homeowners Association 3512 Main Street Unit 11 Barnstable, MA 02630 505-797-2060 Town of Barnstable � J!s11" 1 Regulatory Services Thomas F.Geiler,Director • Building Division -2 MANK g Tom Perry,Building Commissioner 1639. TED MpI 0. 200 Main Street, Hyannis,MA 02601 t 4 c 23 i'.f f t 9 Wf www.town.barnstable.ma.us Office: 508-862-4038 -Fax: 508-790-6230 Agproved� , Fee: S'e d-O Permit#: �0 I b HOME OCCUPATION REGISTRATION Date:_/a / 13 h/ Name: nr., / v Phone#: SOP 776 Vbl Address: * 2 Village::C 3q rhl•t4 Ple Name of Business: o ti � /�i tv C r- C�h s 7i' 1 / o h s�o'vi'C e S' Type of Business: r,0 tip'q C 7�i!-i c, Map/Lot: q 17 n q 1 o() INTENT: It is the intent of this section to allow the residents of the Tomi of Barnstable to operate a home occupation ,mthin single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dNvelling: there shall be no increase in noise or odor;no usual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the follom'ng conditions: • Tlne activity is carried on by the permanent resident of a single family residential dwelling unit,located'viithin that dwelling unit. • Such use occupies no more than 400 square feet of space. • Tlnere are no external alterations to the dwelling which are not customary in residential buildings,aid there is no outside evidence of such use. • No traffic will be generated un excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,un excess of normal household quaitities. • Any need for parking generated by such use sln<all be met on the same lot contauninng the Customary Home Occupation,and not Avithin the required front yard. •. There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed onie ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed un the Customary Home Occupation rvho is not a permanent resident of the dwelling unit. I, the undersigned,have read-ann'dagree with the above restrictions for my home occupation I an registering. Applicant Qi� / Date:—) / / Homeoc.doc Rev.01/3/08 YOU WISH TO OPEN A BUSINESS? _�' For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures 6 on this form at 200 Main St., Hyannis..Take-the completed form to the Town Clerk's Office, 15' FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Fill in please: Date: z APPLICANT'S NAME: Rc I ilek- YOUR HOME ADDRESS: 151 �2 /Vln.i� 5� ry q� /O A s BUSINESS TELEPHONE # db' '77L- b q� HOME TELELPHONE #: EIN OR NAME OF CORPORATION: FID # NAME OF NEW BUSINESS PAY T I iJ�r �.o��ir:,�^�'►!�ri Seryir'O TYPE OF BUSINESS rr Vi r-�}i . IS THIS A HOME OCCUPATION? YES � NO ADDRESS OF BUSINESS 3S12 OVla►r; St.,I # Ili 0a636 MAP/PARCEL NUMBER (Assessing), When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in town. 1. BUILDING COM ISS NER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individ al a ern i r e of ny permit requirements that pertain to this type of b AND REGULATIONS. FAILURE TO Y MAY RESULT IN FINES. Au. . rized Sjcgn re** C MMENTS 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Mapi3l-1 Parcel.0gli Application #_Zonlo YO t 10,020 HealtW:Division Date Issued j 7 Conservation Division Application Fee �J Planning Dept. Permit Fee Date Definitive Plan Appr Planning Board Historic.- OKH Preservation/Hyannis Project Street Address (3b l L M,G1,6{O 5t Un a+ Village Owner,-J�m Ctl�n cl7 Address Telephone Permit Request To w (A)" (per/ nfav)+ 10rad-el-2-S- ro a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation d10 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new a �; Total Room Count (not including baths): existing new First Floor Roorl Count, Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/eo al stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑e ing ❑new size_ a: Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Boar7esr peals Authorization ❑ Appeal # Recorded ❑ Commercial ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 'Wo — }( trnD Telephone Number Address LOIq 1�M45-UOV— 1 oad License# 031 S 7 L CIXIrNt--) MCLO-3-igoi Home Improvement Contractor# Worker's Compensation # 'OUcI a(436 aoO ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4M)ah DATE SIGNATURE 5� 5 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED - MAP/PARCEL NO. ADDRESS VILLAGE OWNER, i 'p DATE OF INSPECTION: k S t FOUNDATION ' E FRAME ti INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ° f GAS: ROUGH FINAL r FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information --�— Please Print Legibly Name(Business/Organization/Individual):_&ynue— &us - Address: 191 -bCV05A&J0[ Poaa City/State/Zip:RuCtnnl�:s `mCA Phone.#: Ar tarm an employer?Check the appropriate box: Type of project(required): a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2:❑ I am a§ole proprietor or partner listed on the attached sheet. 7. .❑Remodeling ship and have no employees These sub-contractors have g.'❑Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'comp.•insurance comp.insurance$ required.] 5. (].We are a corporation and its 10.❑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 12.0 Roof repairs insurance required.]t C. 152,§1(4),and we have no employees. [No workers' 13. Other comp.insurance required] info&ef75 •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 subcontractors and state whether or not those entities have employces. If the subcontractors have�employecs,they must provide their workers'corrtp.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.#: t Lf 501 sW(29 Expiration Date: ( t Q Job Site Address:�c�I Z: lli?) Uh& Iy city/State/zip: Dw17 c�tavjc JVVWa ' 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 tip to$1,500.00'and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d th a' s d penalties of perjury that the information provided above is true and correct: Si ature: Date: � _ Phone# Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OEM ��I�I: 3�[: �►�t�TiH�t771�'I7:71►I:1�s:U101MINNN T T o.Lf- #y13/31/2008 14:18 Bryden & Sullivan Insurance Donna Seviour-*Margo 1/2 ACORy. CERTIFICATE OF LIABILITY INSURANCE OP -1 1 /31 oaTE(2/31 SPRIN 0 /08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 62601 11 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER Associated Industries Of HA INSURER D: Spprinkle Home Improvement Inc. INSURER C: 199 Barnstable Rd INSURER D: Hyannis MA 02601 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMlOD/YY D/DATE(MM/OYY) LIMITS OF,NERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PRENOSES Eabccurence S CLAIMS MADE ❑OCCUR MEO EXP(Any one person) S- PERSONAL&ADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S POUCY PRD-JEC LOC AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $ ANY AUTO (Ea abeltlenT) ALL OWNED ALTOS BODILY INJURY S SCHEDULED AUTOS (Per person) . HIRED AUTOS ' BODILY INJURY S NON-OWNED AUTOS (Per acdtlent) PROPERTYDAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTOONLY. AGO S - EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE S 1 OCCUR D CLAIMS MADE AGGREGATE S S DEDUCTIBLE $ RETENTION $ S WC ST TLL OTH- WORKERSCOMPENSATIONAND T ORY LIMITS ER A EMPLOYERS'LIABILITY AWC7004943012009 01/01/09 01/01/10 E.L.EACHACGDENT s 500000 ANY PROOPMETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S 500000 0 yes,describe under SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT S 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVI610146 CERTIFICATE HOLDER CANCELLATION SPRNKHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Sprinkle Home improvement, Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Fax #508-775-1350 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Margo Mack 199 '$'arnstable Rd. REPRESENTATIVES. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE lKelley A.Sullivan ACORD 25(2001108) 0 ACORD CORPORATION 1988 �i7 '%t➢A Uf.'•CC I !(Iif : 1 i:9 rt':•.. . �._� lea ii d of Builduig Regal itions an'd Stsrxlau ds Construction Sup:erviso"r License License: CS 6643 Expiration: 10/8/2009 Tr# 94'7 t, R@strction: 00. BRAD K SPRINKLE 19010THROPS LANE W BARNSTABLE,MA-02'668 Commissioner 00 3�,Q0;0 cf enclosedspac:e } 1A-Masonry only Ui 1G- 1 .2 hamil CTomes + i y ii ,4 Failure to possess a current edition.o,ftht massad usetts State Building Code i is cause for revocation of'#++his license. i 1 ��1!:' � '![ ,.•!, reGfl.(F.4:'- ill %(:C� Board:of Building Regulations and=Standards i� k < HOME IMPROVEMENT CONTRACTOR t lu. Registration: 103757 Expiration: 7 kOl0 Tr# 271033 Type:: Private Corporation SPRINKLE HOME IMPROVEMENT, INC. Brad Sprinkle 199 Barnstable Rd Hyannis, MA-02601 Admin"istr.ator -- __.. License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,.Ma.02108 Not valid wit out sig tare , IWrti Town of Barnstable Regulatory Services sAxw "BI'E Thomas F.Geiler,Director '°rEnrwaY"' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA:02601 www.town.barnstable.mg.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Secti n If Using A Builder I, rycm Gyp , as Owner of the subject.property hereby authorize '�I 6 to act on my behalf, in all matters relative to work authorized by this building permit application for. l Z. VVV-"rX st—Un ct t Z. z'��t; 1 (Address of Job) v n5 fab u� f /Yl- V (/ TtUA o Dwner ate O 4 eil Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RM S:O W NERP ERM IS S ION z� Town of Barnstable �oF T°�ti Regulatory Services BARNsr.,BEY- : Thomas F.Geiler,Director mess �p 1639. A�0 Building Division lED µA'l Tom Perry,Building Commissioner 200 Main.Streat, Hyannis,MA_02601. vrww.to wn.b arnstabl e.ma.us Office: 509-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street vsllaga "HOMEOWNER": name %j home phone# work phone# CURRENT MAILING ADDRESS: cityhown state zip code The current exemption for"homeowners"was extended t include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire o does not possess a license,provided that the owner acts as supervisor. DEFINTTI N OF HOMEOWi\'ER Person(s)who owns a parcel of land on which he/s a resides or intends to reside,on which there is,or is intended to- be, a one or two-family dwelling, attached or de ched structures accessory to such use and/or farm structures. A person who constructs more than one home in two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building O eial on a form acceptable to the Building Official,that he/she shall be responsible for all such work erformed er the building permit. (Section 109.1.1) The undersigned"homeowner"assume responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and re lions. The undersigned"homeowner"ce es that.be/she understands the Town of Barnstable Building Departrnent minimum inspection procedures d requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Offici Note: Thre -family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Co Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code testes that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section.(Sec an 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 homeowner:who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fu1ly 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:forms:homeexempt u: tg �� March 4t", 2009 ��rt t Town of Barnstable Barnstable Mass To Whom It May Concern , y, As a trustee of Windswept Farms Condominiums located at 3512 Main Street, in Barnstable, I authorize Sprinkle Home Improvement to install vinyl trim.wrap on the rear of the building and paint the brackets in the rear. k3, } 4 lQ �. aiixcerely, es A. Crown,Tnistee oc. Sprinkle Home Jiupiovemerrt/Atln: Elise l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION SMap ���� —' '/ Parce — Application# lJ� � l 'Health Division Conservation Division Permit# Tax Collector Date Issued — Treasurer Application � Planning Dept. ermit Fee Date Definitive Plan Approved by Planning Board �110P g Historic-OKH Preservation/Hyannis / n Project Street Address - l Village Owner Address zne-�,a Telephone 50,F — 3 7 S" 9Y Permit Request � rw YV P m Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes,attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)_ Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size, Attached existin -"garage: g ❑new size � Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# s y Current Use Proposed Use �,i4-j11 BUILDER INFORMATION Name Telephone Number Address_10?2 / n S� License# ©2CD 3 Z� e r A-- G2_ro� S� Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER s i DATE OF INSPECTION: i FOUNDATION FRAME INSULATION i FIREPLACE + ELECTRICAL: ROUGH FINAL + PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ! FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations UV 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmization/individual): PQ,1) C Address: JO 3i M(I i� — City/State/Zip: O SI'C t`�1 i(� rn Fl �(�5 Phone#: 50 zS 11 Are you an employer?Check the appropriate box: 1. I am a employer with 1�- 4• ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.$ 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp, right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no 12:M Roof repairs 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 roust 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--\f CAee Y-<, Qs Policy#or Self-ins.Lic.#: v d Op y c Expiration Date=91D O 6 Job Site Address: `� Q 1^1�1 '� Z a „ \ MA O'D(o 0 City/State/Zip: �� 1�(-� 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 ee under the pa' and penalties o e Fury that the information provided above ' true and corre Si a e: Z-7 0 Date: Phone#: Official use only. Do not write in this area,to be completed by city or town offrciaL 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#- 1 Property.Owner Must Complete & Sign This Form If Using a Roofer / Builder. I (print) �, ` " Owner / Agent of the subject property hereby authorizes Paul J. C t & Sons Roofin_n Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job Signature of Owner Mailing Address of Owner 3-�7 a. L-Ii . d4 Telephone# Date; (Please return this form to Cazeault roofing along with your signed contract; it is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you)fax#508-420-4555 } a r 4T1 M Proposal ' ti. R i 1 Y� l P 1031 Main Street Ostervmt,,....02655 _ { s S Tel:(508)428-1177<-Fax:(508)420-4555 ti s www.eazeault.com _ Wyk f Windswept Farm Condo Trust DATE ESTIMATE NO. Mr. Jim Cronin j Y 3 512 Main St., Unit#12 J� � 1/24/2008 4114 tarnstable,NIA 02360 _...__•� t 1, Phone# Estimated by: }�4, 508-375-9394 Mike .fir 5.c. 1 Total Description of work to be perfromed h Small addition on right side of building only. 4 Remove existing shingle roof.(wood shingles) is Re-nail any loose boarding. Install .032 aluminum heavy drip edge. Install WeatherWatch or Stormguard,ice&water shield on bottom edge, in valleys, around penetrations, Install Shinglemate underlayment felt. Install GAF brand shingles. All shingles to be storm nailed. Vent pipes to receive new flashing. Cut open and install Cobra. ridge vent. All roofing related rubbish to be removed from premise. Provide GAF System Plus Warranty (covers both labor&material)see brochure. I I I � 4 I � Tj SQUARES/FLAT SQUARES/SHINGLES ------------- ,. _and fees i;. ` TOmer fails . THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA l j/ P MPOsal IV 6 1031 Main Street Osterville, MA 02655 www.cazeault.com 22 Giddiah Hill Road Orleans, MA 02653 Windswept Farm Condo Trust Mr. Jim Cronin j' 3512 Main St., Unit#12 Barnstable DATE ESTIMATE NO., MA 02360 2/22/2008 4164 r Phone# Estimated by: Ei08-375-9394 rt Mike Description of work to be peromed Total rthe rental of the 60'ft lift he shingle roof and removal of old sky lights. ts and installing ice&water shield, shingle back in 9p t i _7 -- _-- ` � t x _ P T/n Board of Building Regulati ns and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 103714 Type: Private Corporation i Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS, INC.: Paul Cazeault 1031 MAIN ST -- - OSTERVILLE, MA 02658 Update Address and return card. Mark reason for char•"c. Address Renewal I j Employment Lust Card j DPS-CA1 is 5CM-05/06-PPCO490/� /te "llJomv�staotuM,auia o�✓��iudel.�6 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:;_103714 Board of Building Regulations and Standards Expiration: 7/9/2008 One rton Place Rm 1301 Type: Private Corporation Bo on,M .02108 PAUL J.CAZEAULT 8 SONS INC: .:. Paul .Cazeault s J• 1031.MAIN ST OST RVILLE,MA 02658' Deputy Administrator Not vali witho ignature t i Boar o ge ui m ulat�ons�an gWan6rds�� One Ashburton Place - Room 1301 i Boston. Massachusetts 02108 - Construction Supervisor License I q M fr License CS: 26325 r Restriction: 00 Birthdate: 10/20/1959 i Expiration: 10/20/2009 Tr# 6311 PAUL J CAZEAULT +„f 1031 MAIN ST ---- OSTERVILLE, MA 02655 Y 'T Update Address and return card.Mark reason for change. a ❑ Address ❑ Renewal [].Lost Card I DPS-CA1 ;a SOM-07/07-PC8490 ——--_---- ✓/LQ -l%04IUYIZOOLU/P,Qya ✓�2lJQr1Q�I2CLdY.L1/Y ( u Board of Building Regulation§and Standards z 'Construction Supervisor License Ei I License; CS 26325 Bi04d49'10/20/1959 E 0/2009 Tr# 6311 I , ?' Restrtctton PAUL.J CAZEAULT% - - �% - . _ — Board of Building Regulati6ns and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation PAUL J. CAZEAULT & SONS, INC. Expiration: 7/9/2008 Paul Cazeault -- 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return c:n•d. reason for c1moge. 'S-CA1 it SOM-05/06-PCO490 I_..I Address I..._� Renewal I ; Gmploymcnt Lost Card Board of Building Regulations and Standards icense or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR b fore the expiration(late. if found relt"111-11 to: Registration: 103714 Bard of Building Regulations an Standards Expiration: 7/9/2008 Or a Ashburton Place 11n1 1301 lug Type: Private Corporation Bo s on,Ma.02108 'AUL J.CAZEAULT•B.SONS,:INC. 'aul Cazeault ; 1031 MAIN ST JSTERVILLE, MA 02658 Deputy Administrator t alid without signature x , Boar o ui 1 egulat'on an tan ards One Ash rton Place - Ro 1301 Bos n, Massachusetts 02 8 Co truction Supervisor Lice License CS: 26325 - Restriction: 00 Birthdale: 10/20/1959 Expiration: 10/20/2009 Tr# 6311 PAUL J CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 Update Address and return card.Mark reason for change. DPS-CA1 t'i 50M-07/07.PC8490 C � Address I� Renewal [ Lost Card fie ('ommomu�ea �..i1i<raacu�uraella '.Board of wilding Regulation and Standards „Construction Supervisor License .r License; CS 26325 B i rthdate:"`.10/2011959 Ex01W..4 m 10/20/2009 Tr# 6311 Restriction:".:.00, PAUL.J CAZEAULT:':`- 1031 MAIN ST OSTERVILLE,MA 02655 Commissioner .j . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma ( G p Parcel Application # Health Division Date Issued Conservation iDivision Application Fe' Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address a� m (� +-(�� Village + �. Owner Jame-s &onIt% Address MP4n 5ffWt Telephone ) Permit Request �fat�Y1 �J� Q } Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater OverlayVA Project Valuation out) Construction Type f_ C Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup orting &cur ntation. _. rn Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals horization ❑ Appeal # Recorded ❑ Commercia _ es ❑ No \ If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 4--30(InVA& Telephone Number _ ''9a'T75--018 Address bmn!4a. 10le- �QjqdLicense # &4�) (I .S VIA o"I Home Improvement Contractor# WYE-? Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY . APPLICATION# t DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ; FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL k GAS: ROUGH FINAL s FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. { of Bu Idmg Regt 1Miion St,`qnd St1u 1141d � F C,onstruction Supsennsor Lrcense_ $? - r License CS 6643 Ae x <V + Expiration 10/$I2009 ,Tr# -9427 �i �� Resinciton 00: � � ~ r BRAd K SPRINKLE }Yi 190 LOT'HRORS LANE WIBARNSTABLE MA02668- Commissioner � a k� O.Os-3"�;000>.cf�enclosedspace' Ctt' IA. Mas0 Arpy.50nly ry 1G 1 2 EFam�ly FIomes , Failure to possess a currentedrttonsofttie ' 1V.I`assacltusetts State Buildiag,Coile is cause for:revocat�orr-of�this license: f. • -� I I �- ✓� l/?L7I2/I72d{2(((CLGLiL (p�'J✓(,Q�1(X.fiZllb�d�4 t Board of Bolding Re9Ulations and Standards ;HOME IMPROVEMENT GONTRgCTOR. `� � `P`. Registatwn Y03757, Expiration 7/9/2010 . Tr# 27.1033 r 5 Type Pnuste Corporation SPRINKLE HOME IMPxROVEMENT INC. Brad Spnnklp. " 199 Barn-80bl'e4Rd 4 t Hyannis MAxO2601" • Ad,minstrator '` License or registration valid for individul use only 1 before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 C" Boston,Ma.02108 k I Not valid wit out sig tore :,,,:,> ,r� �.. ..,- rc..tx +:xts;raµ*.�: .��5:€�.:-✓.:T.3:�hC'+>�A7.. Nnt'�'.�}t,,,,,,+�.-^F vfPl'/$aSti.cr°"�. '?'r,«k u�a:�aFS,'�3,5,w;`�' i�1i°'.?i.2�`4;y::..;^`...r .., Avower CERTIFICATE OF LIABILITY INSURANCE OP ID DS GAT6(MM/OO/YYYY) SPRIN-1 05 09 OS rltoouoeR THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden s Sullivan Ins Agency HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURER Associated Industries of MA INSURER S. Sprinkle Home Improvement Inc. INSURER C. 199 Barnstable Rd INSURER D: Hyannis MA 02601 ISURER'c: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAMS. iNSK POLICY NUMB6R ICY L3FEC71V6 PCUCY EXPIRATION LTR NERD TYPE Of INBURARCf DATE(MNYDOKY DATE(MM/ODFY LIMITS GENFRALLIABILITY I EACH OCCURRENCE $ CDMMERCLAL GENERAL LIABILITY ' PREMSE (Ea(Any o e pan e) ;r-WL CLAAAS AIP.DE OCCURAtEO E�(Dryone penPERSONAL&ADV INJURY $ GENERAL AGGREGATE $ REOATE LIMIT APPLIES PER'. PRODUCTS-COMP/CP AGG gCY PRO CT LOC AJTOMOBIIE LUIBLLITY COMSINEO SINGLE UNIT $ iANY AUTO I (Ea accmeN) — I. I ALLNEOAUTD5 BODILY IN.AIRY �$ iSCHEDUOWLED AUTOS (Perperson) HIPEC AUTOS I BOOILY INDJRY M$NON-OVVNED AUTOS i (Per accident) PROPERTY DAMAGE I$ (Per accweni) GARAGE LIABILITY I I I AUTO ONLY-EAACCIDENT ; ANY AUTO OTHER TWIN EAACC ; AUTO ONLY: AGO $ EXCE66.NMBREUA LIASIUTY EACH OCCURRENCE 4 OCCUR CAAIMS MADE .AGGREGATE g 1 �$—GEDU(:TBLE 4 REjENT10N $ - - 1S - WORKERS CCMPuiATION AND A 'a EMPLOYERS,LIABILITY TOPV LIMITS ER A ANYPROPRIETOR/PARTNER/EXECUTNE AWC7004943012008 01/Ol 08 01/01/09 .L.EACHACCIDENT $500000 OPFlCER(NENSER IXLUJDFD7 EL.DISEASE-EA EMPLOYEE I$500000 If YES,tle9tflbe Vleef SPECIAL PROVISIONS below E.L.CISEASE-POLICY LIMIT I$ 5500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SpgNKHO SIIOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL -0 DAYS WRITTEN Sprinkle Horse Improvement, Ina NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 90 SHALL Fax 75-1350 Margoo Mack Maok IMPOSE NO OBLIGATION OR!LIAB ILITY Of ANY KIND UPON THE INSURER as AGENTS OR 199 Barnstable Rd. REPRESENTATIVES. Hyannis MA 02601 AUTHORIZEDREPRESENTATIVE " Kelle A.Sullivan ACORD 25(2DO1108) ©ACORD CORPORATION 1989 The Commonwealth of Massachusetts Department of Industrial Accidents 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 Leaffil Name(Business/Organization/Individual):11Y�lL4 Ci1M11_ Qcy1 _ & --E Address: �e- City/State/Zip: l Out Phone.#: Are y an employer?Check the appropriate box: Type of project(required): 1.' a employer with 4. ❑ I am a general contractor and I * have hired the sub.-contractors 6. El New construction employees(full and/or part-time). Remodeling 2.❑ I am a sole proprietor or partner- listed on the:attached sheet. 7• g ship and have no employees These sub-contractors have g. Demolition working.for me in any capacity. employees and have workers' 9 Building addition [No workers'comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions 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. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new,affidavit indicating such. ,onk.ictors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have ployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an`employer that is providing workers'compensation insurance for my employees Below is the policy and job site formation. _ tsurance Company Name: DAS 1 olicy.#or Self-.ins.Lic.#: �y �'r 1�t�n �0 Expiration Date: �l 1 ►b Site Address:351 L V 1 \)qV-1 Ste• W+ ( , City/State/Zip: p k ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of.criminal penalties of a ie tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 'up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of - .vesti ations of the DIA for ins , vera a verification. to hereby certify er t e ai d penalties of perjury that the information provide�aboT�trueaaand correct~ re 1 Date: �VD lone#• Of use only. Do not write in this area, lb be completed by city or town offlclaL 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#: j WINDSWEPT FARMS CONDOMINIUM 3512 Main St, Barnstable, MA 02630 September 19,2007 Town of Barnstable ,Barnstable,MA As a trustee of Windswept Farm Condomium located at 351.2.main Street,Bermtable,I authorize SpdAkle Home improvement to install trim wmp on certain sections of the front of the building. Sincerely, es'X Cronin,Tnistee cc. Sprinkle Home Improvement/Attn: .E.lise agreements are contingent upon strikes, accidents, or delays beyond Contractor's control. Homeowner is to carry fire, and other necessary insurance. Contractor's workers are fully covered by Worker's Compensation Insurance. 8. Fencing, carpentry,painting,plumbing, electrical, dry wells, etc., and all other work necessary that is not contained in this contract, shall be the responsibility of the Homeowner. t` RIGHTS TO CANCEL. The Owner may cancel this Agreement if it has been signed by the Owner at a place other than the address of the Contractor, which may be his main office or branch thereof, provided that the Owner notifies the Contractor in writing at his main office, or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Agreement. WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in workmanship for a period of two (2)years following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship, or damage caused by the Contractor,his subcontractors, employees or agents, is discovered within two years after completion of any job, including clean-up,the Contractor shall, at his own expense, forthwith remedy, repair, correct,replace, or cause to be remedied,repaired, or replaced such damage or such defect in workmanship as long as the owner has paid their agreed contract in full. The foregoing warranties shall survive any inspection performed in connection with the agreed upon work. All warranties for product supplied by the Contractor under this Agreement shall be those given by the manufacturers of such product, which shall be and hereby passed directly to the Owner. Such manufacturer's warranties,the Owner may be required to register or mail in a warranty card or other evidence of ownership, and use of such product in order to activate such warranties. The Owner's failure to send in or register such documentation,which failure voids that manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such product. Note: Any changes in the contract during the duration of the project which results in additional monies due will be paid in full to the contractor at the time of the change. I authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be performed on this job (i.e. permits, applications etc.)if necessary. Ji r in Date Brad K. Sprinkle Date Celebrating 62 years in business!! a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ll oo AA Permit# �0 7 Health Division Date Issued Conservation Division Application Fee Tax Collector Permit Fee Treasurer Planning Dept. D Date Definitive Plan Approved by Planning Board 30 Historic-OKH Preservation/Hyannis Project Street Address -3 5( 2 q 1 o S Village Owner,:51 M �f Q 1 Address 25� �, S"t— Telephone 31� — �3� baY-Q5_4ftk AA:023(o Permit Request ram' C—M+' (Barn E) t.�� wcod ��. —72 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) 1 L Age of Existing Structure Historic House: XYes ❑No On Old King's Highway: Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _ Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing 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 s ve: ❑ s -0 No v '-Detached garage:❑existing ❑new size Pool:❑existing -❑new size Barn:❑e> ting ❑nip size., Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: A N Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ w Commercial ❑Yes ❑ No If yes, site plan review# p Current Use Proposed Use t BUILDER INFORMATION Name Telephone Number Address License# 02fs ss Home Improvement Contractor# 0-3-1 'A Worker's Compensation# ObcdTA66 to I AO�a ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �SAQrc(No\,� YAA� 1 SIGNATU DATE L i5 j FOR OFFICIAL USE ONLY PERMIT NO. + DATE ISSUED y MAP/PARCEL NO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME t '1 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL = PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r a ` DATE CLOSED OUT f ASSOCIATION PLAN NO. u o� E64"STABM _ 'Town of 1"arnstable M �Ep ,.�•� Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 ?x: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder wner of the subject property hereby authorize QAaA� 6ft)�Yn /,)C to act on my behalf, in all matters relative to work authorized by this building permit application for: 3512 1c ;n (Address of Job) J /4 -7 Signature of er Date � b LtH� ft9 L 4 Print Name Q`:Forms:e,xpmtrg Revise071405 The Commonwealth of Massachusetts Department of Industrial Accidents „1 , >Il. Office of Investigations l i , 600 Washington Street i Boston, MA 02111 v1, www.ntass.gov/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/E►cctriciaus/Plumbers Applicant Information —Please 11'rint l,c ilily Name (Business/organization/Individual): Q�� � (f AZ7 e A3LT &CQF + Address: 1()3\ �A a� ,C\ S lS City/State/Zip:_(��`� 2— ione#: So cs - -2- Are you an employer?Check the appropriate box: 1.� 1 am a employer with \Z 4. ❑ ! am a general contractor and 1 Type of project(required): employees full and/or * 6. ❑ New construction ( part-time). have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. z 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. [] Demolition working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9. ❑ Building addition required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself [No workers' comp. c..152, §1(4),and we have no ►2, oof repairs insurance required.]t employees. p`q ] [No workers' comp. insurance required.] 13.❑ Other Any applicant that checks box it l must also fill out the section below showing their workcrs'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 their workers'comp.policy information. fain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_.' of 1,Q ( S" <1 Policy#or Self-ins.Lic. It: Expiration Date:_2 Lc) p:7 Job Site Address:-3s12 City/State/Zip: *2(p --6A A—OO — _ 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 cer 'y under th pains and p allies of perjury that the information provided above is true and MI correct Si mature Date: ..Phone#: Official use only. Do not write in this area,to be completed by city or town offtciaL City or Town: Permit/License it Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6,Other it Contact Pcrson• Phone#- R 0 0 F I N 0 DATF .� PHONE -- ESTIMATE DONE QY r::;CLEI: MIKE KEVIN -- — RUSSELL PAUL - I Ij I —- I --- ,I r — — —- — -- -01 , I � I , a — p t - SQUARES/SHINGLESSQUARES/FLAT \YYj l a ATE(M DD '. pRoouceR •T jS CfiRTIFlCATE !S ISS.UED,AS A n:ATTEE;:QF Itw-tFtircxw►u., DOWSING & O 1JEIL INS AGC ONLY AND CONFERS NO RIGHTS UPON THE' CERTIFICATE: 222. riEST'htAIIJ .STREET. HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND"'•OR ALTER THE COYERAGE AFFORDED flY THE POL1ClE�flEl flW_. HYANNIS' ttA 02601 `""' '" COMPANIES AFFORDING COVERAGE 22 LG E3' COV FA N'L A TR.AVELFSRS pR.nph.R.T'f Or nr� CASUALT'f COMPANY OF INSURED - COMPANY PAUL J CAZEAULT 6 SONS INC. fl 1031*MA.IN STREET 057ERVILLE MA•02655 COMPANY C. COMPANY D VE' S>=- ys�: vS... �"ef, ;THIS 1S'TO CERTIFY THAT THE POI IES �zc a¢7 s L CIE OF INSURANCE LI TED+BELOW"HAVE BEEN ISSUED TO'THEv'INSURED NAMED'A it INDICATED,NOTWITHSTANDING ANY REOUIREtdENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH nr PE CT O WHICHER(HOIU i>CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, "EXCLUSIONS AN--CNDITION3 OF SUCH POLICIES.LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS: ' LT TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER LIMITS ' DATE.(td.AOII\YY) OATS(MCSDU\YY).� - - GENERAL LIABILITY GCNCHALAGGIIflGAIC $ - CUMMEH(:fAL GrNtF7AL ilAflILIIY ' - -. 'PNUUUG CLAIMS MAOI;1-(;IjMN60 kid. MADE OCCUR. PFRSONAI,R ADV.INJURY S OYrri@fPS a GONTRA7)TiJH13 AHOY.• FACII OCCUnnGNCG q RRE DAMAGE(Any one tire) g ' AUTOMOBILE LIABILITY MED-EXPENSE.(Any ono person) s• ANY AUTO COMUINED SINGLE - S LIMIT ALL OWNED AUTOS SCHEDULED AUTOS BODILv INJURY (Per Person) i HIRED AUTOS NON-OWNED AUTOS 0004LY INJURY (Per Accident) 3 j,;' GARAGEUABILITY PROPERTY DAMAGE 3 ' 'AUTO'ONLY:EA ACCI ANY AUTO DENT' S OT)if R TIiAN AUTO ONLY', LA II ACCIDLNL EXCESS LIABILITY AGGIICGAIE j UN.ORC LLA FORId EACH OCCUNICNCE 3 FORM AGGIIEGAIE ; OTHER THAN UMBHELUI - WORKER'S COMPENSATION AND. p` EMPLO:YER:SUAwLiTY (UB-0095B69—A-06) OE3-10-06 OB-10-07 STATUTORYLIMITS 'THE PROPRIETOR/ EACH ACCIDENT PARTNERS/EXECUTIVE v INCL S OFFICERSARE: EXCL DISEASE-POLICY T., i DISEASF-FACII EMPLOYEE g 1S M L M k j IP L lT: TfII� REPLACES" ANY PRIOR CE'RTIFICATG IS3= TO THE CERTIFICATE HOLDER G.•�<::F.IGc r�': Ol R':3 s. s. AFFECTING WORKS CO MP COVERAGE. 77 '•' —'- SHOULD ANY OF THEyABOVE 0ESCRIBE0`POLICIES`OE'CANCELLED yBEFORE THE ' r Paul J,Cazeault&Sons EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Roofing,lnc, 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 1031 Mal T Street LIAWLRY OF ANY,KWa UPON THE C-AWWV,LTSA"141SOphgWFE6EWA`TIYGS.. Ostervillu, MA 02655 AUTHORIZED REPRESENTATIVE o�a.cniapnRaranrtta9 Am' Client#: 19989 2CAZEAU LTPA ACORD,M CERTIFICATE OF LIABILITY INSURANCE o5;9106*IY"'I) .PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insural-,:�e ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 222 West Main St PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western World Paul J.Cazeault&Sons Roofing,Inc. INSURER B: ' 1631 Main Street Oste,-viile,MA 02655 INSURER C: INSURER D: INSURER E: - COVERAGES THE POLICIES OF 1'•'SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMEN',TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE.. NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREC•,:TE LIMITS SHOWN MAY.HA4E BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LTR NSR Ty LI OF INSURANCE POCYNUMBER DATE MM/DD DATE MMIDD LIMITS A GENERAL: '31LITY NPP1012091 04/30/06 04/30/07 EACH OCCURRENCE $1000000 X CON'l CIAL GENERAL LIABILITY DAMAGE TO REES(Ea ED occurrence) $50 000 i_ :',.:AS MADE Q OCCUR MED EXP(Any one person) $2 500 X Blt' :.7ed:1,000 PERSONAL BADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 . GEN'L A(k;kLc m,,.fE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $1 60O 000 POLICY _PST LOC AUTOMOBILE LIABILITY . - COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ - SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS(UMBRELLA LIABILITY - EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE - $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If,yes,describe underE.L.DISEASE-EA EMPLOYEE $ SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate of insurance will be issued directly by the insurance carrier. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Informational purposes Only DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO Sb SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACOFi 25(2001/08)1 Of 2 #42866 LS1 0 ACORD CORPORATION 1988 Board of Building Regulati ns and Standards One Ashburton Place - Room 1.301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 103714 Type: Private Corporation Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS', INC. '�' Paul Cazeault 1031 MAIN ST ---" OSTERVILLE, MA 02658 Update Address and return card. Mark reason for change. Address .� Renewal ( Employment ! Lost Card DPS-CA1 0 50M-05/06-PCC88490p /ee C�ovsvr�zoouuea�� a�✓�aaacce�icrdeLl6 Board or Building Regulations and Standards License or registration valid for individul use only lug HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 103714 Board of Building Regulations and Standards + Expiration::'?/9/2008 One Ashburton Place Rm 1301 ,''" Boston,Ma.02108 ;r,Type Private Corporation PAUL J.CAZEAULT%&SONS,INC: 'I Paul Cazeault 1031 MAIN ST ,- ,,, •,,� �a .` . ..... ...... . .. OSTERVILLE,MA 0265i`: Deputy Administrator Not valid without signature Board of Building egulations One Ashburton Pace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE •, Birthda.te: 10/20/1959 Number: CS 026325 Expires: 10/20/2007._ • Restricted To: 00 PAULJ CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 - Tr.no: 7696.0 Keep top for receipt and change of address notification. DPS-CA1 0- 5OM-04105-PC869B � ✓!tC I/JO'I7L/l2012[OCLLGL{t O�✓//la06QC{LILdP.l�6 . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR 1s Number ,CS 026325 Birth ate10/20/1959 Expires,: 10/20/2007 Tr.no: 7696.0 Restricted-:. PAUL J CAZEAULT 1031 MAIN ST 2 ()CTI-(?1/II I F. All�, (1'irrr- / . S