HomeMy WebLinkAbout0336 TURTLEBACK ROAD
f '
I
0?6 a6w�8
Town of Barnstable *Permit
Fapir nt ue date
ESS PERMIegulatory Services Fee
* •narvsrears,
;�� JAN -3 2013 Thomas F. Geiler,Director
p�fD MA't e '
Building Division
rry,CBO, Building Commissioner
TOWN ®F BARNST air Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY,
Not Valid without Red X-Press Imprint
Map/parcel Number
Property.Address 3 3 (O Tu rt t k 13 A-CA 9 0, /M AAa'VNI P 11411,ci
Residential Value of Work W 0790 o 0 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address IK a rT
Contractor's Name D- Telephone Number (�bod— b 3�
Home Improvement Contractor License#(if applicable) , 1 r/!7 6, LO
Construction Supervisor's License#(if applicable) d y 6/ SS
❑Workman's Compensation Insurance
Check one:
D- amain a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name /17-L ?a-rT'C_-
Workman's Comp.Policy# WCV00 7,56,A6
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 lJ-
❑Re-roof(hurricane nailed)(not stripping': Going over existing layers.of roof)
❑ Re-side
#of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
❑ 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 departm6nt regulations,i.e.Historic,Conservation,etc.
***Note: .property Owner must sign Property Owner Letter of Permission. .
A copy of the Home Improvement Contractors License&Construction Supervisors License is
. required.
SIGNATURE:
Q:IWPFIL.ESWORIAMbuilding permit formAEXPRESS.doc
I
• Office Ifff�on'�um� airsu mess egu a on License or registration valid for individul use only
before the expiration date. If found return to:
HOME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation
I Registration: A.19766 1 10 Park Plaza-Suite 5170
DBA.
Expiration: 8`L28/2013 Boston,MA 02116
CRAFT DESIGN= '•'7�
25 MEADOW VIEW%pR:_���:--. �:.- g�•�-x��
� a /% i
EAST FALMOLIT IVIA;,0 53� °% Undersecretary Not valid without signature
Massachusetts -Department of Public Safety
.Board of Building Regulations and Staridards
-Consfruction Supervisor
License: CS-046189
DAVIDH WEBB
24 MEADOW VIEW D
E FA LMOUTH NIA
Expiration
Commissioner 10/29/2014
I
WORKERS` COMPENSATION 4ND:EMPLOYERS LI ,81LJ 'Y IRISURANCE POLICY
Information.::Pagewc'00 00 01.
Atlantic Charter Insurance Company VDAC
NCCI Co. No.:29211 Policy Number: WCV00730206
i. INSURED: Prior Policy Number: WCV00730205
Tyndall Roofing, LLC
Producer:
80 Brigantine Avenue Fredericks Insurance Agency,
Osterville, MA 02655 Federal ID Number:204616445 Inc.
Risk ID Number: PO Box 427
Osterville, MA 02655
Business Type: Limited Liability
SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS
Other Named Insured: Other Work Places:
2. POLICY PERIOD: The Policy Period Is From: 7/11/2012 To 7/11/2013 12:01 A.M. Standard Time
at The Insured Mailing Address
3. COVERAGES:
A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed
here: MA
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our
liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 100,000 each employee
C. Other States Insured: Part Three of the policy applies to the states, if any, listed here:
COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A
D. This policy includes these endorsements and schedules:
See WCE105
4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates &
Rating Plans. All information required below is subject to verification and change by audit.
Code Premium Basis Total Rate Per Estimated
Classifications No Estimated Annual $100 of Annual
Remuneration Remuneration Premium
See WC 00 00 01
Minimum Premium: Deposit Premium.-
$500 $500
Interim Adjustment: Annually
Servicing Office: Estimated Premium (Minimum Premium) $500
25 New Chardon Street
Boston, MA 02114-4721
14
Issue Date 06/14/2012 Countersigned By: DateUN 201?
Copyright 1987 National Council on Compensation Insurance Form: 100mv
f The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
i
Name(Business/Organization/Individual): D lA . w6J-0-6
Address:
City/State/Zip: Phone.#:
Are you an employer?Check the appropriate box: - Type of project(required):
1.El am a employer with 4. Lld'i�a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 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 I.El 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
j 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.
tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the subcontractors 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: ,��-/9Z✓/ lG-- �`
Policy#or Self-ins. Lic.#: W cl/y 6 7 3dc�a-(a Expiration Date:
Job Site Address:-k 3.3(P T"TLE AA-f*01 City/State/Zip.ftVrAS"-S 44,JUS MA4 01 Y t
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 cert' nder the pains and penal 'e of perjury that the information provided above is true and correct
Signature: r Date: 1- 3—
Phone#: s09— .56 6 _
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 Instructions4
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."
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
(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 Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Revised 11-22-06 Fax # 617-727-7749
www.mass.gov/dia
r
QpSHE r 'Town of Barnstable
ti
Regulatory Services
r a
a ♦ '
a saxMASS. E Thomas F. Geiler,Director
y MASS. ,
�pTFD:59. `�� 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
1, LLB At , as Owner of the subject property
hereby authorize D , '1�, to act on my behalf,
in all matters relative to work authorized by this building permit application for.
3 3 C,7 I u a7-Lrz- i5 li-c4< R o, lx^
(Address of Job)
Signature of er ate
All Al? L-u As
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
!1•R(1R tuf C•(1 WATFR PFR MT.CC7(lN
® 04/16/2005 10:53 7814611636 . MARTY LUNDY PAGE 01/01.
® Dec. 4,. 2008 3:39.PM rvo, viz I u r, i
f�'°;f g-Jown of Barnstable (0
", y, h' r� Permat
�� �Regulatory Services I I monlhof}om taruedare
08
Thomas F.Geiler,Director
.ems•A. Bp.RJVS7-, E3jT Buuilding Division
om Ye"Y,CaO, Building Commissioner O r
206 Main Stroat,Hyaruds,MA 62601
Www,town.batnstable'.=,u9
Officc: 508-862,4038 Pax: 508-790-6230
EXPIRESS PERMIT APPLICATION , RESIDiE]NTL41-Q1yLY
Not Va#d wdthout Red X Press Imprint
Map/paroel Number
Property Address P;
2 K.esidential Value of WorCj1..FS1 &0 b Minimum fee of$25,OU for rvoak under$6006.00
Ovmcr's Name&Addresss
Contractor's Name Telephone Number
Nome 1mpr0vemcnt Contractor License#(if applio,Pble) 1 (o
ow.
orkman's Compensation Insurance
Check one:
a a,Pole proprietor
I am,the Homeowner
Q I have Worker'a Compensation Inattrance
Insurance Company Name rt 4iU�r r rF A-p-r
Workmaws'Comp,Pokey# W�V 0 0_13 01C Z
Copy of Insurance Compliance Certificate rnusp 6e on t3dp,
Pcrmit ReeQUeeSt(check box)
Lfi Re-roof(stripping old shingles) All construction debriq aril]be taken Co r
Q Re-roof(not stripping, Going over____`existing layers of mot)
[] Re-side
Replacernent WindovNdoors/sliders,U-Value (maximum,44).
'Where roquired: Issuance of this Permirdoes not exempt Compliance with other town dtpsutmont regulations,i,e FGstoric,ConservAtfon,eoc,
•*Nate: I'ropofty Owner must sign Property Owner Letter of Permission.
A copy of the home Improvement Contractors License is required,
Q:%WPF7LF51F0PMStbu11din9 permit fbimSTYPR5ss'doe I
Revisc020108
04/14/2005 06:11 7814611636 MARTY LUNDY PAGE 03/04
No. 4 I tlU F. 4
. ' The Camrnomveahh of Massachuseets
Aeptartmetd of Industrial Accidents
Off ice of Invesdga ons-
600 Washington Street
Boston,MA 0,2111
www.mass goulWa
Workers' Compensation TiotsOrsl ice Affidavit: Builders/Contractors/Electricians/plumbers
AVD90at LaLomatiolkPlease P t L
Name WusincsS/Orpni=doMndIWUaf)'
Address:
City/Stateaip: Mom*
Are you an enaployer2 Check the appropriates bom
1.❑ I am a employez with 4. fK1 am a general contractor and 1 Type o f projbrt(re�tait eQ):
etrtployces(fu4 and/or pwx imn).- have hired the sub-contractors 6 ❑New constxteC r
..2: f am a We prpprietor or partner_ listed on the-attached sheet. 7. .0 New
!bop and have no employees These sub-contractors have g,•❑Dmowon
worldng for me in any capacity. employees and bravo workors'
[No wor cers'-comp.•itsttrancc. comp.wstaaneo.t 9. ❑Building addition
required.] 5. [] We are a corporation audits '10.❑'Electrical repairs or additions
3.❑ 1 am a h.omcowncr doing all work officers We exercised their 11.0 Plt ing repairs or additioos
myself.'[No workers'comp, right 6f exemption per MOL 12 a Roof repairs
instance required]1 c.152,¢1(4),and we have lac
employees-(No workers' 13.N Other
comp,insurance re j
`Argr 8MIi-1,(hd ehw6 box Ili mat eko fin Dort tree scathes below 9h tteeir we:rtleers'eo�on ensidon Poky
t flotitcaammeuy dho eubm,t efiig nViidavit mdi�mting they are doing ell work and then f lftc ouwde em cbm nnu subrrdt a new awavit mdiardng each
Vonavetors that obeok this box tm,,t ArtncW m addldooej shut CYTshoe i�g dee ewm of the aub'oengnansrs and stain u�tether ex e+et those entities bava 1 . if rice sub conoaotors baw eteployexs,tttt y must WWde their workers►camp.Pokey zahnbcr.
ram as emptoyea'that tis proviQing works'comp ensa don tnsurar red for my employees. R4ow is tie poI4 hard fob site tnforniurkon,
Insurauco Company Name'
Policy#or Sclt=-ins.Lie.#: Bxpindon Date: 7 q
SobSt •. --- f---'----
i+a Addrese,� .333 6
Attach a copy of We wortcers'compemRation policy doolaraEiots aQe she CWStaWZiP l'49STr7/�5��,�., 0.2(y qk
p , ( wipg the policy number and expiration date).
patltut:. seesttso coverage,as rcgttn•ed rider Section 25A ofMaL c. 152 can load to the.irr9ositim 6f erimitial penalties of a
�tip to 50.00 d and/or onost thg err imptisomnetiy as well as civil penalties in the ibrm ofa•STOP WORK ORDE1L and a find
of'AP to$250.00 a day agauust th4 violator. Bo advised that a copy of this gtatemeut may be forwarded to tale dike of
lrtve sh! •ens of the 11 r ce ra a ifictetion
I do Hereby ceHO under the p and penalty of perjury(had lie tnformatio►r provided above is there and correct
c use o►►y. Do rhof write in MEIN area,to be COAVAwry cuy or town oJJ7curl
City or Town: PeradvUeense#
Yssuittg At (circle one):
I.Roard of Health'Z.Building Depar6tr ent 3.City/Town Clerk 4.FJe�txtea!Zupeactor S.Pltrrta6ing Inspector
Contact Contact Peron;
•khone#:
04/14/2005 06:13 7814611636 MARTY LUNDY PAGE 02/02 c. cvv� iv-Anin IVO, 41tlU f', b
Town of Barnstable
= Regulatory Services
z
• Thomas F.Geiler'Mmetor
Building DiviAon '
Tom PaTy,Bs flft9 Commissioner
Mimi
mm-town.bargslablt»xne.ns
Office: 509-9624038 F'= 508-790-6230
�r0ta�eo�thv>�n 1.x�rsa> rYon1 .
Pkase 1'Aae
Aire: `/ 0 ,
JOB t ocnrlox, -'� 33 G 744r � 8K Q - es rau.S �R Al t
. Wombat stroll vitlagt'
n�nc htmsph�o� wor)tpAtuietM .
0Ab»MZ"= rtug,"-e ,o,, .
• ' sn>K f LL ��u�
The 0"'Te4t`-'eR)tion for"hameMcts"arse odcndcd to mcWe er.o icd dWof siz ax less and to allow homeowAcm to mpgr-en indMdnel for bke who does not sews a 110m .
po e,nuz�vrided that
sunuvis()r. ttatiownear act$as
DMMON OF Homlgowmm .
Parson(s)who owes a Pahl]()Plead 0n wb14 be(she residas or iatraads to rtsidc,QA rovfiich tt=is,ar i5 irate nded to•
bc,a one or two-fgmily Qwenin&act m6d of detached siructt w awzssmY to sfth use anWor farm eituct ir6V. A
person who cemettucte mm than one home in a 19m-year pes;od shall not be eonsademd a homco%=. &ch
' "honaaown&'2W sltmitto the BuMns Official on a f=acceptable to tha BWdm O
L�Snonslhle fbr alLsath work e�rfnrmryl++++dct tlio gaL ib&t sal c
(S�tlon 109.1.1)
x Tile=derlagncd`boweuwm?'as===Spa()stbiiity four camplience a►idt the State Bm7diag Code and other
appliaablc codes,bylaws,roles and r0gn1at 0=.
The 1mdcrsWacd.."]>Ameowne Carb=&Mbc/sha undcazataAc�s cite laws of�a�astably Bttt7duig Aepaztment in& cola Face&=mad mquit'e=nhs and that bask grill comply a+ifh said prgcaduaes and
�zyts. .
Rivadim of H rT
Aprm"j of Burlamir Offsdat
Note: Thrct-f4=3Y dwellings wntaitft 35,000 cabie&at ar latW vKR be �1y
Stale Building Code Section 127.0 Conftetion Control. ' °��to with Zbr:
The code somas dmL-da b
a • b • $O1btLOwiV='S�0x
of ttds m@tka(Section 109.1.1- >> 9 worn far which tt 4ft p�{
Td is eaaitrnotipA Sbpetvisprsk q►avlQa4 that tE tht horns os►imr dSI1 bo eactveytt from tho ptavldians
rtC that such Hamcownat Asll t+ei as smparyianr" [xm It P—mW for hoe so do such
wo
10,1cs May h as Who ues Ibis Qca"cm am nnmme that OW a e Amumnx the ramDmslbrltdeS of a sapw,*Or(Sm Appatdk Q.
what�lertitms far 1.iaaueing oat�po'visms,�C4tm Z,Y� 17fne krk of awarsn -
S A meow=huts na6ca�pinprop.In IME mwft our F.)atQd eaanDt ptacted a ofha nrsulpe fA sarovs ptnbtt mr,pnrdcuh�y
uPe is r. The hwncowne nt ft m bVpmVEwr fo utd=toly TesPCM--p1, n ttu mttc=ased peraodu it Umm wflh It tip
h-sma that tits>mrneoomrris @Q1y xwr&e pfb{pl „�Aoswl ties,mroly cote Wn19es mydm
that e>Zo ht>mcowner eatiy thAt 7frJ$K�dax d¢d respomjVtiea of a supa�♦, On 0't'lan as Part of me Dp m9t RDpn on
ct:vcral tewns You may t}ar t aa=,b and adopt such a f ti.Sutivo-iLr►aw_m t*so Of duo ttmm is a Arm etmnnay osd by.
Yae tmnrtratnity.
Qs�:ht��mpt .
121
tO allOW homeovM=to edge in tmdf"(hw for
gqpmdWe Who aOeS notpp38PS9 a 1iCgDSe,
' ��. �ttle a�tf�8Ct8 8E
Pe DEFINMON1OPHOIV30WNTR .
Person(®)who owes a parcel of Iead On Which bdlsbe resides or iat=&era raid
be,a one or two-fan �r dwe]1in&attac 6d ow Bch were is,Of is intended f�
porson wbo comatructe more tbaa one hm=m a�tIovaW st=�a�ery t3 c0c'no arrd'°r flu stntchucs. A
'bonarD =e'Shall SubmiC to the$ttit ' r I �sb81I not be eonsideted a itomcott�ucr, S�1ch
b e fbr all ft Official'on a fora acccptablc Co 91c BtldldiAs Og�a,tbai
C baI be
Lrncdtbc b1t0n- p�Pe�n I09,1.1)
ne mdenigaed`10meowuW3= tnmrs msj •b�,for�ym2oe
APPlicabl with t}1c Statc Btnitlmg Codc toad other
e codes,bylffv,%rnks and le8nlations.
The,> do d'�emeovvae>;"txrti£1ea foathclsho undcc km s the To'tva of'sazastabl�
wind�inspection pros &zm and refit =obis lad that lie%she wgl �parfmwt
�q oE�ts• $'w said psoccdurea ud
SignatinnofH cr
AMruval ofBut1ttiaR Offaal .
Note- Tluto-'--fl dtseMAP containing 35,000 cubic feet or lager wil]he re'CJt*ed to comply with @�
51ate Building Code Section 127.0 Consttttction Control.
EICBMMON
of s
Y (Secs
n 1 C4.1.1-�t Arglyoirreoave7 pe utTrrptg wetf�for whlah a hwIdbV Pcmtfi ti:required-hell be=c6Mt f m dto pmvW0m
tfi Serlion(Seebttn 10 Y�mtt�of eanrat:ction bbpgvisorsk pmvide0 that it the honteown����a P�+6�)foor h6r to do Sur?t
wok that such Homeavmcrsba so al svpevk;
Many homeowgm"Mum air eurnpsm tac mmwace>hai dtey ae wy,i,s d.rsrpoebtbtlit(es or a BopgviM(Pee Appatd➢x Q.
i JWkv&]tagulatim far U=tzia&Cmr&=Son Sq=vi=%&action 2.15) 171is tack of tWa=mm ottm rrat►IM 111 Sa1ouS pteblem4,partiivlarly
*Vaal thpltorroevwna tta�ttrtfiaaaed pasono. Fn t]t1s�ottr$oard ranootprmeod n�}the>mli�-a�Q pp8rn,•ar 9t Vroa1B tvi tb 8 licensed
supervlsa�. The hon�eownerat�ga8uper�fterteufA�e]]'t'cs7�]t ,
To cmvre that the IIaQoeowea t6 tblly savate efltirJAa ytaponstly►7ider,rytany emnm+tnities regtmr,ea part of tM perrrdl applicpti0]y
"t 910 hOmctt` W eotdlY 9dts Ae/she 1md0FrtMdS tbt t=P=**h%Wot of i Supavixor.Op 0*lobtIMP of WB iMo is o fen c ..%GY used by
v:�eral ta.,,& You may con(2tl a and adapt mcb a 4atr,JcrJtif ratan.fat use ie your eaeanueity,
Q:forms:homcccea�t '
♦a
005 06:11 7814611636 MARTY LUNDY PAGE 01/04
,,vvu IV-Jun,,, IVo. iIov r,
rMALL ROOFING
' #30 7illiann's'VV'ay M P C O O S a. 1
azstons Mills,MA,02648 p
508420-4456
Page No, of Pages
PROPOSAL 5..MITTED TO PHONE
f i.�b DATE
STREET 1' J09 NAME t� � �
CITY,STAtE AND ZIP CODE
JOB LOCATION
ARCHITECT I 33 to
DATE OF PUNS JOB PRONE
We hereby submit specifications and estimates for:
Furnish and install new Class"A"Roofing as Follows.
A. Strip existing roofing and remove debris,
13, Check all boarding and nail as necessary.
C. Cheep all flashing.
D. Install aluminum drip edge. V
E. Includes ice and water shield to be adhered to roof 18" along entire lower edge of roof to prevent ice leaks
also around chimneys, skylights,roof stacks,and roof valleys.
F. Apply abingle under layment-(felt paper),
G. Includes new flashing around all roof stacks.
H. Apply customers choice of shingle. _ f2TA Iro77� A�1do ,
I. Apply continuous ridge ventilation. CNf'T ?Yl —e.Ot.l11f "
1 ir(�TGfQWI�
C--tY*f,mV Ay& -- Rl✓P iz
Any unforeseen rot that ma be uncovered during construction, the owner will be informed and made aware of
the'extra cost.
nyment to h>C de as o lows'
Odollere( Q too
Dolan
All checks to be made payable to TYNDAX.l:.
ttantlel wo/km.nitka manner aoeo►ding to eoeclfIrAil nSAll work O hs SUDmItteA,eDeldl:tandem
prAcIlces. Any de
Or deviation from, eDaVo soecln4ti Submitted,
involving extra Autherlttd
costs W111 Oo executed only upon written orders,and will Deeome nn extra charge Signature
over anp above our
estimate,A„aorn„mOnts ecntingewt upon otrlkes,aCCloents or
Delays .our our cantrol. owner to carry fire,tornado pnd other necessary in. Note;this Droposal May be
turenoe.Our workers are fully covered by Wo,kmen'a compensation Ihsurenea.
withdraran by ut 11 not eeeeplad wlthl ayt
ACCEPTANCE OF PROPOSAL The aeove a artd tondi-
atone ere satisfactory and are hods o at;cepled ortaot, epeelftcatlon
,you are nutho ,rred to do the work
aF aDlCl/lap.Pay+nant w1I1 Da me ■OYtllne nt)ove,
nature '
Date of At"ptance:
51�nNure
¢� �w RKERSCOMPENSA ONAND, n:. r.
7 } ,
irL' 'iy �a_ �T«,:.. ` # wy,. ✓' {l a..r>:., IIPL_OYERS '.` R, r <,
LIABILITY I�ISJRANC {� ,
�` �' �
r � �. 4Informa#ion=P � i .k � : r d
Atla
NCCI Co. No.:29211 o tic Charter Insurance Company VDAC
1. INSURED: Policy Number: WCV00730202
Tyndall Roofing, LLC ~' Prior Policy Number- WCV00730201
30 Jilliah's Way _ Producer:
Marston Mills, MA 02648 Federal ID Number:204616445 Ic Fredericks Insurance Agency,
Risk ID Number: 1046 Main Street
Business Type: Limited Liability .Osterville, MA 02655
Other Named Insured: SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS
Other Work Places: See WCE107
2. POLICY PERIOD: The Policy Period Is From: 7/f 1/2008 To 7/11/2009 12:01 A.M. S tandard Time
3. COVERAGES: at The Insured Mailing Address.
A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation
here: MA
P Law of the states liste
B. Employers Liability Insurance: Part.Two of the policy applies to work
liability under Part Two are: in each state listed in item 3A. The limits of o
Bodily Injury by Accident $ 100,000 ur
Bodily Injury by Disease $ .500,000 each accident
Bodily Injury by Disease $ 100,000 Policy limit
C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: each employee
COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A
All states except Monopolistic State Fund States
D. This policy includes these endorsements and schedules:
See WCE105
4. COVERAGES: The premium for this policy will be determined by our Manual of Rules Cla
Rating Plans. All information.required below is subject to verification and change by audit ales &
Classifications Code Premium Basis Total Rate Per
Estimated Annual $100'of Estimated
No. Annual
Remuneration
Remuneration Premium
i See WC 00 00 01
Minimum Premium: Deposit-Premium:
$500 $500`
Interim Adjustment: Annually
Servicing.Office: Estimated Premium (Minimum Premium)25 New Chardon Street $500
Boston, MA 02 1 1 4-4 72 1
Issue Date 07/01/2008 e
Countersigned By:
opyright 1987 National Council on Compensation Insurance Date
Form.-loom
-7
i �TKEAO The Town of Barnstable
Department of Health, Safety and Environmental Services
t�►arlsreer.e. ► Building Division
NLAM
1659• ,0 367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph M.Crossen
Fax: 508-790-6230 Building Commissioner
Home Occupation Registration
Date:
Name �GV��' � Phone#• J o
Address
Type of Business: (A l 1V a� Map/Lot: �G _
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within 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 dwelling there shall be no increase in noise or odor,no visual
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
following conditions:
• The activity is carved on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more.than 400 square feet of space.
• Tliere are no external alterations to the divellint;which are not customary in residential buildings,and
there is no outside evidence of such use.
• No traffic will be generated in 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,in excess
of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one 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 Occuparion.
• 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 in the Customary Home Occupation who is-not a permanent resident of the
dwelling unit
I,the undersigned, v ead 4 e-with the above restrictions for my home occupation I am registering.
Applicant: Date:
Homeoc.doc