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0033 WOODLAND AVENUE
33 C-c�ooc� la.�a2. �ve, .......-ti-..ti.. ....-� ,-�..t n _�^_._..._-�---- ten^ � ram"': i a !Z >• 4=3 tJ .��. 15oq 0 � � 15 t . t -71 � FOun11�AT1ON n� '0 •4 .41 E:�ris�• N ..�.._-- _ e 0 1 A 4 MCHA�1ARQ G . SAXTER suR r.•OcAT'I oa cY TGlzv( LZ , MA55 tic 3a �. 3uLI/ IS, IQ"1 Pi-AU 2q3 PP e r-. -7o t cr�zYt t=rE T'4P%-r 714 C rovW t>Arl oQ SHOWN O�-A TN I'$ PL.A W COiJ 1=17f?-AA'S 13AX't'eL-4Z.. .'ro T'►EE StvEU"F-= Awr-> 5ETBAGS4 t?FLl'�T 2Et�. 4-AIJD 51J21/E�(o�.S TH E Taw Q o c O ST a2 v I uz-- MASS F�12tJST•�'��, �155 Assessor's map and lot number ::`...................... .1 Sewage Permit number ............./.,'...7."............................... r tME'T��♦� TOWN OF BARNSTABLE i � • i BARNSTABLE. i i63q• BUILDING INSPECTOR OD,o� 'Fa M a' APPLICATION FOR PERMIT TO ............................................................................................................................... TYPE OF CONSTRUCTION ........................................ .......19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies/for a permit according to the following information: Location ........ J .. :..'......... '��:� .; :....4 �'Cam.... �;�%� ' ..:...................... ` Proposed Use ................................... e��rl �' :................................................................................ Zoning District ..................................J...................................Fire District ......... ..... . .. - .... L Name of Owner . .... ......Address vl� .` J .. .!i.1c L.,s:f.�.j oz& ! SS Nameof Builder .........................................Address ..........:.......................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms Foundation Ar Roofin g ..... ems' d2 Exlerior ........................................................ .......................... ..................?� #:... ..... ..... ..;<... ............................... Floors �......................................................................................Interior .................: ... ........................................................... Heating .................. ...........................Plumbing Fireplace ..................................................................................Approximate Cost ......:..................... Definitive Plan Approved by Planning Board --------------------------------19-------- . Area ............................................. Diagram of Lot and Building with Dimensions Fee .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH t � , le 06. 390 o Fbt4 :101"11 ` I 7,FX/-sS7r- I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................................................................................... Davis, Prl$o1lla . 3`5 17818 story,_ _ Permit �n _ ___ ,}single family dwelling - existing dwelling to be demolished --------------------------' 33 Woodland Location -------.��---. ----.. . � p Omtervllle Priscilla Davis ',- of --_.-"cti'o'n..........Tf'r'ame................... '....................................... . ... ' , 75 . � Date of Inspection ' "".e Completed / ' PERMIT REFUSED-- . �� � 19 . � ------------ � ................. . | | ' Approved � � ' -------------------�—'�---.. ' � � ~° . -------`---^-------------^— , ~ - is map and lot number SEPTIC BY9- �b [ o IN'ST,gLi_E.p #N COi .IA. Sewage Permit number ........:.... ................................ Ih�ITH ARTiC��E N STs�Tli= SANITARY CON . y�iTMEto�y- TOWN♦1 1 \ OF 1J.Z- R1V9r LE 3AWSTODLE, i VASIL q BUILDING INSPECTOR �a gar°'• . c• ...!�l �Il<...".... ..., !l/. ..... . ........APPLICATION FOR PERMIT TO ...... ............................ ............... Q" TYPEOF CONSTRUCTION .......... .... ...................... .............................................................................................. ..T .....19..74 TO SPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the }following information: location .....�..J.�a... �iarL ... .�.... .. C�...... . .. .. .. ... .... ,. ,� .'...................... Proposed Use ........C.. .... 1 ,.... !C. .. .............. .. ....... .... ...............................:.................................................. Zoning District ............�.�..................................:..............Fire District ..`a "a. ... ... Name 'of Owner .. . ...JQG1'LrZ ......Address J�i. ..... . ......r................ z Name of Builder f.&. ... ................Address / . P.`!. .......................... . s Nameof Architect ............................:.....................................Address ..................i.... :.............................................. Number of Rooms ......... ........................... ..............:........Foundation Exterior ..........�.yrn.`...............��'....... ..e.. ...� 7� Roofing `J r� .... ............... ............................... Floors .Interior L ....�............ .� ....: r cF .................. �l e, Heating w / g ..'........................................Plumbing .�v...�Y'....91� / ................... ... .............. ...... .. Fireplace ���GILD• ......Approximate Cost .... ....� ...... 4.. p ...........:... PP l 4 n........ Definitive Plan Approved by Planning Board -----------____________ �`�' �••l: ------19------:_. Area ......................... .. . .. . .... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........ � ./..F'1............ ...t. ` . ( ' | ' ' . ` Davis, Prisciitia' M. f one story, � single.-family dwelling - existing dwelling to be demolished � ` ' , 33 Woodland Avenue ^ 'Location ---___—_------------_. / ' X ' - Ootarv1lle ----.--,-------------------. ^ _ ° ' ~-�~ � - - Priscilla M. ��v�o Owner ' ---------------------- �ra�e Type�f Construction ---———-------- ---.�..�---------------`----- Plot --------- Lot ----------' Permit Granted ..........Joly...l5:.............lg 75 - ' ' Ile- Date of Inspection ....7/��...................... �Y�~�� J�`. ^ ~ 'Dote Completed �v,�r�� l� . —~~. ^-----_ � ' . \ ' PERMIT REFUSED.- lA ' -----------^--------- '- -------- -----------------. .--------------____________. / —.-------------.-------.---.' ` | ' .~~ ^ ----------------.—.---.----- ' ~ - ^ / ' Approved ........................................... 19 --------------------------. ' - . ' --------------------^-----'' ' � . _ . Town of Barnstable ..��� Building s Post This Card-So That'it is.Visible From the Street-Approved Plans Must`be Retained on Job and this Card Must be Kept vests, s _ " M , AM Posted�Until Final Inspection Has Been Made.039. Permit �. Where a Certificate of Occupancy WRequired,such Buildings'hall Not beIOccupied until a Final Inspection hat been,made. Permit Permit No. B-19-2220 Applicant Name: DANIELJ PECKHAM Approvals Date Issued: 07/15/2019 Current Use: Structure Permit Type: Building-Smoke Detector-Fire Alarm Dection Expiration Date: 01/15/2020 Foundation: System a M__ p/Lot: 140-135 Zoning District: RC Sheathing: Location: 33 WOODLAND AVENUE,OSTERVILLE � Contractor Name" DANIEL J PECKHAM Framing: 1 Owner on Record: PETER TARNOFF TRUST ESTATE OF Contractor License: 15994 2 Address: 45 WOODLAND AVENUE Est. Project Cost: $0.00 Chimney: OSTERVILLE, MA 02655 Permit Fee: $35.00 Description: Smoke Dectector Basement ; Insulation: ,� Fee Paid:' $35.00 �Project Review Req: ADD SMOKE DETECTOR TO BASEMENT TO BE �,! Date: ! 7/15/2019 Final: INTERCONNECTED TO ALREADY HARDWIRED SMOKE DETECTOR ON FIRST FLOOR. ;_ � ✓ " fir Plumbing/Gas Rough Plumbing: Building Official ` Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within`six months after issuance. All work authorized by this permit shall conform to the approved application and the Iapproved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. I f — Electrical The Certificate of occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,p'ermit. Minimum of Five Call Inspections Required for All Construction Work::, ' Service: 1.Foundation or Footing 2.Sheathing Inspection F �--*` Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: I 2 2-2—in�i► Application Number..........16............... .................................. : SARNSI'ABLE. • nsn98 Permit Fee................ .. .................... er Fee:....................... i639• �0 ''rl�p MA'S Total Fee Paid........ 4Z6. ............'.................................... ...... TOWN OF BARNSTABLE Permit Approval by.... . .........................On...71/J�l /,........ BUILDING PERMIT i ® 1. Map............!.... .......... ....Parcel............. .. ................... APPLICATION ",,,, 4_ s Section 1 — Owner's Information and Project Location Project Address_ -Z-1 tom,e,mg Z.4,.,o0 Village _W.— Owners Name Owners Legal Address City State Owners Cell # E-mail Section 2 — Use of Structure -' Use Group ❑ Commercial Structure over 35,0 0 cubic=feet ❑ Commercial Structure under 35, 00 cubic?feet m Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar ❑ Renovation ❑ Pool ❑ Insulation nn _ Other—Specify as v u�o�.� d `,�c_70A, 1,.4 A& a��.�✓ Section 4 - Work Description nn Last undated: 11/15/2018 Application Number.................................................... Section 5—Detail Cost of Proposed Construction Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom I Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot'Coverage' !" # of Dwelling Units-(on site) Setbacks Front Yard Required Proposed Rear Yard Required ` Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 A—PP lication Number........................................... 4 Section 9- Construction Supervisor Name Telephone Number Address City State - Zip License Number License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE ��ecfi1 r'G+Gt ti Signature ��,�,'d,t�,6 o�S £ Date Print Name t (��'_ ,, Telephone Number Lij��_ 7 2G—aj a E-mail permit to: Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ - Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approvak Section 13— Owner's Authorization i I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name Last updated: 11/15/2018 dabep signature vedlodm:d urahHQV%dBvp Town`of Barnstable :. Regdlatory Services sues " Thomas F deker,Director ><� •��:9. Building Division Tom Perry,Bnilding Cownfl over 200 Mein Sneet,HyannLs,MA 02601 WwwAOwn-bar4stable.m;:ns QMW: 508-862403$. Eax: 5.08=790-b230: • Property Owner Must OFp Complete and.Sign TWs:Section. ✓��• 1 T 22 If Using A Builder TOwN OF B 01,9 • ggNSTqeC� , orge T.Padula Jr.Trustee,Peter Tarnoff Trust as Own er of the subject propeify hereby authorize b,-. ��.�/, '? " - -r to action my behalf • in all-matters relative;to work authorized by this biau"tiiag penult • 1 **Pool fences and alarms are the responsibility of the applicant. Pools, are not to be filled_ before fence s;installed and•pools are not to be utilized until all final-inspections are performed and.-accepted. eez��7rPa �ur - qn,-r.;�zre Signature of Owner Signature;of .-pplicant , orge T.Padula Jr.Trustee,Peter Tarnoff Trust Print`Nitne Print N7. ame Da r- Q;FORMS:OIOI�OOIS= . <: 0MoW -BU AD`' ELECTRtCIA LLOV111NG`ICENSE ISSUES:.-T#i!E PO r�i� T �i2Lb MASTER ELEell CTRICIAN ?� r� . pA%IEL J P.ECKHAIIiI t 7 AUDREYS.:IN`;'�'�>.... MARS?.t�:NS> ,�►:>::p264 't�2�t �'s;:.._ <�,�a j r ::.'. 1202 ... 6 52704 J z`LTH,OF' ► HUS COM ON� • [f ' y.. .. .: .iii. >:::::` LLOWING"LICENSE :ISSU,ES;T#IE FO .: jj RNEYMAN ELEGTRICWNd. ftEG J�3lJ pANIEL J PECKHANI 1 AUDREYS:IrN< >' A . .°MARSTt7NS Q26 a18-1:B29 �.: • 20 65 2707 2 707 q 11 2: 830 3 � . l Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who asides 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 budding 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 Shan 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(LLQ or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation innrance. 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 permW]icense number which will be used as a reference number. In addition,an applicant that must submit multiple permWlicense 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 firt re 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 barn 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 dull. 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 MASSA.FE Revised 4-24-07 Fax#617-727-7749 www:maw.gov/dia The Commonwealth of Massachusetts Department of IndustrWAccidents Office of Invesfigadons ir 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/ogpnizati �dual)-��.,,� ��! . Address: City/State/Zip: Phone#: — Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with- 4. ❑ I am a general contractor and I mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in my capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp•insurance 2 mod-] 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.❑Roof repairs insurance rimed-]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required•] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signstore: !� Date: 16 zz Phone#• �'! —2?6`"c`3 l>S Ojftial use only. Do not write in this area,to be complded by city or town ojjkiaL 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#: 5SMOKE DETECTORS REVIEWED Z1i 9 A L U ING D DATE IRE DEPA MENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING Barnstable Bldg.Dept. SApproved by: Permit#: 1-222v o 1 ST Or i�01�,I,�„�s 9S :6 WV 01 f!i 61E d SEP/25/2020/FRI 09: 37 AM COMM Water Dept FAX No, 5084283508 P, 001/001 CENTEIiVMLF-OSTF,RVILLE-MARSTONS MILLS WATER DEPARTIVI NT FO BOX369-1138 M.A,IN STMT OSTERVII LE,MA 02655 WWW.COMMWATER.COM OFFICE OF BOARD OF WATER COKWSSIOMRS OS \ w.A,TZR SUPERAVTENDENT c T Tel 508-428-6691 nn,,G `� ` - TER � C FX 508428-3508 n```�D`1V � DEPT. . SE September 25, 2020 �OwN 0 Town of Barnstable Building Division Via Fax-508-790-6230 RE: 33 Woodland Ave, Osterville Acct: 307 To Whom It May Concern: On Thursday, September 24, 2020 the water service was disconnected after the curb stop for the property mentioned above. It is our understanding that the owner plans to demolish the house, re-build and will install a new water service at a later date. If you have any questions regarding this do not hesitate to contact our office Monday through Friday, 8:OOAM until 4:30PM at 508-428-6691. Since ely, ` aig C oc er, Superintendent Centerville-Osterville-Marstons Mills Water Department CC/cvb Town of Barnstable *Permit#2-6I969&3 Reulato Services ExpFee 6 months from issue date g rY BARNSTAMIM �6�� ' Richard V.Scali,Director Building Division �" ' Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 DEC 0 1 www.town.batnstable.m �N OF 2 Z015 . Office: 508-862-4038 FBgRNs ax. 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL (At 1 1 Q 5 Not Valid without Red X-Press Imprint Map/parcel Number (J Property Address 33 AZooD 1...jgA D , 0STF_Q3,n U LF-_ . M P- � o0 4 2-5 Residential Value of Work$ e:I © Mmimum fee of$35.00 for work under$6000.00 Owner's Name&Address PETEk _59"O 'F 3"-13 WOOD LA)`D� 05-i F-'{ZTJ Contractor's Name ,4LEXCN Lc�VF_v 2 Telephone Number � f- Q& Home Improvement Contractor License#(if applicable) '� T�-f Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance %-Wck one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit R st(check box) t/ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to P Pic-(-FTH -i ,9A)5F£,e ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) 5'14TIO,U ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. a Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of th ome Improvement Contractors License&Construction Supervisors License is !Nquired. SIGNATURE: C:\Users\Decollik\AppData\L.ocal\Microsoft\Win ws\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 DREAM HOME IMPROVEMENT 60 Franklin Ave, Hyannis, MA 02601 PHONE 1-(508) 332-8119 CERTAINTEED LANDMARK LIFETIME-ALGAE RESISTANT ARCHITECTURAL STYLE RE-ROOFING PROPOSAL October 22, 2015 PETER TARNOFF 33 WOOD LAND OSTERVILLE, MA DREAM HOME IMPROVEMENT herby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and haul Away All of the Old Asphalt Roofing Shingles. Supply and Install CERTAINTEED LANDMARK AR: COLOR: GEORGETOWN. Supply and Install HICK'S VENTED ALUMINUM DRIP EDGE on All of the Eaves. j Supply and Install #15 BLACK SATURATED FELT ROOFING PAPER. Supply and Install CERTAINTEED WINTER-GUARD (Ice & Water) WATERPROOF UNDERLAYMENT SYSTEM on Roof the Eaves & under the Step Flashing on the Chimney. Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Entire Main Ridge. Aluminum and Neoprene Soil Pipe Flashing. Supply and Install TYPAR SYNTHETIC UNDERLAYMENT PAPER Supply and Install ALUMINUM & NEOPRENE SOIL' PIPE FLASHING. Clean and Remove Debris from work area after job is completed. TOTAL INVESTMENT ------$ 5250.00 PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 45 Days of Acceptance and Receipt of Deposit Providing the Materials are Available. Please make Checks Payable to: ALEXEY LEBEDEV DREAM HOME IMPROVEMENT Warranties the Shingles and Labor for 10 Years. CERTAINTEED Warranties the shingles and labor 100% for the first 10 years and the shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the shingles up to CATEGORY III HURRICANR-130 MPH WIND WARRANT. CERTAINTEED Warrants the Shingles to be Algae resistant for a Full 10 Years. DREAM HOME IMPROVEMENT Carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: 11/9/15 ACCEPTED BY: PETER TARNOFF ALEXEY LEBEDEV HOMEOWNER DREAM HOME IMPROVEMENT �• ay n r� .0 1111IS Massachusetts -Department of Public Safety Board of Building Regulations and Standards Cumtruction Supen isor License: CS-108208 ALEXEY LEBEDEV 60 FRANKLIN AVENUE Hyannis MA 02601 "$ 6� Expiration Commissioner 11/27/2018 I`U%/ -����fiLf/1%[f�r"/�?rGU�P/(/t�J Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 176777 Type: LLC Expiration: 9/25/2017 Tr# 270447 DREAM HOME IMPROVEMENT LLC, - ALEXEY LEBEDEV 60 FRANKLIN AVE. HYANNIS, MA 02601 Update Address and return card.Mark reason for change. SCA 1 0 20M-05/11 Address Renewal Employment Lost Card _.__-._-i�� --- •��n. tLa�ctireonuncc�l�a�CJ'�lz�aur,�re�ell' -_ — --- .�� __—.�_ _ O(fice of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: '176777 Type: Office of Consumer Affairs and Business Regulation Expiration: 9/25/2017 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 DREAM HOME IMPROVEMENT LLC:' ALEXEY LEBEDEV 60 FRANKLIN AVE. HYANNIS,MA 02601 Undersecretary _�� Not valid without signature Cx The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations s I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NarT18 (Business/Organization/Individual): Alexey Lebedev Address:60 Franklin ave City/State/Zip: Hyannis, MA, 02601 Phone#:7742083589 Are you an employer?Check the appropriate Vox: Type of project(required): 1.❑ I am,a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ 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.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lip. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify an r the pains d penalties of perjury that the information provided above isr true and correct. Signature: Date: Phone#: 7742083589 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#: t 9/17/2015 THV 11: 05 FAX 50tl99Z353U eoutnenetern IA 10901/002 kl � CERTIFICATE OF LIABILITY INSURANCE DATE(drrll°°"""Y' 9/17/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the Pollcy(lea)must be endolved. If SUBROGATION 18 WAIVED,subject to the terns and condltlona of the policy,certain pollcles may require an endorsement, A statement on this aertlflcate does not confer rights to the certificate holder In Ileu of such endorsement a . PRODUCER .;Am"rACT AehloY Paivs Southeastern Insurance Agenoy, Inc. HONE (5O9)997-6061 ��rpp�( �,,� (509►990-2791 439 stale Rd. MAIL - ORUS:apaiva@aoutheesternins,00m P.O. Box 79396 -- _INSURER(8)A"ORDINO COVERAGE NAIL N North Dartmouth MA 02747 INSURED INeURERA:Arbells Mutual Inn Co 27000 ' INSURER a tAg= — Armen Safaryar►, DSA; Corey and Corey INSURER0; 67 Sea Street - INSURER D: INSURER E: H annis MA 02601 RFc COVERAGES CERTIFICATE NUMBER:2015 REVISION NUMBER: THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUGH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTA TYPE OP INSURANCE OL Jim POLI MBER POLICYPOLICY EXP x COMMERCIAL GENERAL LIABILITY LIMITS I� EACH OCCURRENCE ! 1,000,000 CLAIM84M L^J UE OCOUR IS(Eeneeur 3 100,000 _ T8D 9/10/2015 9/10/2016 MEOFXp(ArWonqperWj E 5,000 PERSONAL 6 ADV INJURY 0 1,000,000 OEN'L AGGREGATE LIMB APPLIES PER; GENERAL AGGREGATE 3 2,000,000 X POLICY JE - FI LOC PRODUCTS-COMPIOPAGG 3 a,000,000 Emptayee Beneryts 3 - AUTOMOBILE LlAeIUTY 0 ZI E ANY AVrO BODILY INJURY(Per person$ m AUTOS OWNED SCHEDULED —-- BODILY INJURY(per acddem) 3 HIRED AUTOS NON-OWNED DAMAGE _ A11T08 6 tl UMBRELLA LIAa OCCUR EACH OCCURRENCE 0 Excess I" I -I CLAIMS-MAOE AGGREGATE 3 DE RErFign WORKERS COMPENSATION S AND EMPLOYlRS'LIABILITY YIN ER gANY PROPRIETORIPARTNERtexco nVE 1,OOOr 000 (OMFFI�CEa�in NM EXCWOED7 NIA TBD E.L.EACH ACCIDENT s; I► a tlea rlbe urtler 9/le/201g 9/19/2016 E.L.DISEASE-IA EMPLOY ID 1 000 000 ON OF PE elaw E.L DISEASE-POLICY LIMIT 3 100.000 DGBCRIPTION OF OPEMTIONe I LOCATIONS I VEKICL!e(ACORD 101,AddlHonal Romaraa sehedula,may be ettaahed 1(more apace le required) CERTIFICATI3 HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIE9 BE CANCELLED BEFORE For Display Burposa® Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIUD REPRESINTATNE Ashley Paiva/AMP 01980-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD INS026(201401)