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Home My WebLink About0168 MAIN ST./RTE 6A(W.BARN.) (2) a N s M EA® No.53LOR UPC 93543 smead.com Made in USA SH MSR c ,Jr AWN OF � CAPE COD AUG. 0 f INSULATION �i�E]NIP7177771 NOLR OlA05 SP uLA10N BCIILIN000 BATTS vc> iN 1-800-096-6611 l own of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the sj)tc-ifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address , Village II Y Insulation Installed: Fiberglass Cellulusc R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) ( ( ) ( ) ( ) Floors ( ) ( ) ( ) ) ( ) Walls ( ) ( ( ) ( ) ( ) Sincerely He y E Crid , President Ca e Codn, Inc. Town of Barnstable *Permit# Expires 6 rs�ya die. Regulatory Services Fee • wtxse M MASS. Thomas F. Geffer,Director . 9� i639 ♦0� Building Division Tom Perry,CBO, Building Commissioner �U Y 200 Main 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 V.)LA � 0 o S Property.Address t cu,s1 St��V'. C'l to r��w� e IQ�� N. G�f1/1 5 •�� ER Residential Value of Work � I Q Q O Minimum fee of$35.00 for work under$6000.00 Owner's'Name&Address x V 4-1 , - 067-7 Contractor's Name'Q,C11 cok 0-e V1 �l 1� 11C�C J:0 fe(,PrUs 5 Telephone Number Home Improvement Contractor License#(if applicable)' 3 S CJ Construction Supervisor's License#(if applicable) G S U nci 311 ❑Workman's Compensation Insurance X-PRESS. PERMIT Check one: ❑ I am a sole proprietor 1 3 2012 ❑ am the Homeowner []�I have Worker's Compensation Insurance TOWN OF B ARNSTABLE Insurance Company Name " t�"tr � I�� ' Workman's Comp.Policy# 00 s 4 Z) 10 4 11 .Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) E9 Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #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. . i Separate Electrical&Fire Permits required: *Where required: Issuance of thus permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. • I SIGNATURE: I Q:\WPFIiM\FORMS\building permit formslEXPRFSS.doc Revised 053012 r 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 Lep_ibly Name(Business/Organization/Individual): CaQ UA)1/'�•Q —,V I 1 S. LLL Address: 1S ,3 V VNW\,l'_VC.l. CU is City/State/Zip: V ►' 051& tf� MP 09,ULt hone#: 51),b L4-11 ?n-1 Are you an employer?Check the appropriate box: Type of project(required): L a I am a employer with D'- 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors ❑ 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 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 1 I.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.©Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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: L} Policy#or Self-ins.Lic.#: nU .5Ll-b-70 ` t I Expiration Date: Job Site Address: � _ , � City/State/Zip: a r N�� IVIPT v9468 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 Signature:._. _ Date: -7 1 -5 1-2- Phone#: - Sv �_ -7L -7 Official use only. Do not write in this area,to be completed by city or town official City or Town: Perrdit/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#: i Client#:51439 CAPEENT ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY) 04/16/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER Linda Taddia Rogers&Gray Ins. Kingston Paco N E,, 508-746-3311 IFAX A/C No): 877-816-2156 63 Smiths Lane ADDRESS:II Itaddla@rogersgray.com Kingston, 02364-3700 INSURERS A AFFORDING COVERAGE NAIC 508 746-0055 55 INSURER A:Arbella Protection Co 17000 INSURED INSURER B: Capewide Enterprises LLC URER C J.P.Macomber&Sons ININSURERD: PO Box 763 Centerville,MA 02632 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE OL UB POLICY EFF POLICY EXP 1 POLICY NUMBER MMMD MMID LIMITS A GENERAL LIABILITY CPP8500050813 4/30/2012 04/30/2013 EACH OCCURRENCE $1 000 000 PREMISE X COMMERCIAL GENERAL LIABILITY S &Eo ED a s250.000 CLAIMS-MADE a OCCUR MED EXP(Any me $5 000 PERSONAL&ADV INJURY $1 OOO 000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO E 2,000,000 POLICY . PRO LOC E A AUTOMOBILE LIABILITY 58944400004 4/2012012 04/20/201 E°.9I FDtSINGLEUMIT 110001000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) E IX HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS Per aocl nt $ A X UMBRELLA LIAB OCCUR 4600050814 4/30/2012 04/30/201 EACH OCCURRENCE $5 000 000 EXCESS UA CLAIMS-MADE AGGREGATE $5 00O 000 DED I X I RETENTION 10000 $ A WORKERS COMPENSATION 0054370411 4/14/2012 04/14/201 WCSTATU- oTH- T'O AND EMPLOYERS'LIABILITY ANY PROPRIERIPARTNERIEXECUTNE Y/N E.L.EACH ACCIDENT $500 000 OFFICERIMEMSER EXCLUDED? E@ N I A (Mandatory 1n NH) NO EXCLUSIONS E.L.DISEASE•EA EMPLOYEE $500 OOO If yyeess describe under MRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT f5O0 OOO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S80369/M80368 CJF 1 P,tassachusetts - Department of Ptihlic SafeiY Board of Building RegUlations and StandardS ( ut�lructinn Surcr�i� u• - '`;�; License: CS-089273 RICHARD M CAPEN ~{ 122 W>IITMMI RD'-::N. COTUTTXij .i•: _ 02635: 0, `'� Expiratian Commissioner 11/27/2013 . ............. - �e Tpomvnzoazcuecr�!/Z 10��aao/icwelte License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR Type: office of Consumer Affairs and Business Regulation egistration: 143358 10 Park Plaza-Suite 5170 xpiration: .:7/872:0 94 A 02116 Ltd Liability Corpc: Boston,M CAPEWIDE ENTERF}.I; ; RICHARD CAPEN 4507 R RTE 28 —1— Not valid withou gnature COTUIT,MA 02635 Undersecretary Ca e wide p ENTERPRISES, LLC Construction Proposal J.P. MACOMBER & SON •Since 1928 June 29, 2012 153 Commercial Street M a s h p e e POM AL4 SU BMITTED TO.: WORK TO BE PERFORMED AT: NAME: Mrs. Crane ADDRESS: Same as Opposite ADDRESS: 168 Route 6A Barnstable, MA 02668 e AA� ®a(-108 West Ba , PHONE: 508-362-4458 Capewide Enterprises, LLC pi'opose to furnish the aterials and perform the labor necessary for the completion of work at 2145 Main Street, Marsto s Mills. Roof • Remove approximately 6 square of existing 3-tab roof shingles on driveway side of house • Install new drip.-edge'at eaves • Install ice and water barrier— 15t 3 feet from eaves .. Tar paper roof as needed • Install new ridge vent Install new 30 year 3-tab shingles to match • Install white cedar behind chimney Total including permit and disposal fees.................................. $2,300.00 The material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in aWsubstantial workmanlike � �' manner. � � K' �. ," � ,s�y, Y, }t-.''.1 � y ,r- r; to ,�` », `. .r: Payment Schedule; F � 't ,`a ,,��£ ti r , Signing of Contract........................... 50% ,_ Completion. ......... 50% Note-This proposal may be withdrawn by us if not:acceept�ed within 30 clay Any alters o or deviation from above specifications involving extra cost will be executed only.upori written o fder,and willl�become an extra charge over and above the estimate; payment for the extra is due`in full before the change is made. Alllaagreements, 'ntmgent'upon r � strikes, accidents or delays beyond our control. _......�..,�,....�...-..�.._..._..._.....__�,,.,.._•.: C r� .;.v. {q � ze°^�� g�x 4 ti 9>rr^S °.� �o�a�t"'�r �" ACCEPTANCE OF PROPOSAL'" �r "i a a{ The above prices, specifications and conditions are satisfactor ,and are herebytaccepted. You are, authorized to do the work as specifiedwv . P edayments,wilkbe made�as,outlin above .:. a r rn4r-`•N.i 5:a a� , ter w Ky � �, T, t a',e••'"`•'.s Y �`' r {Rug 13 4Customer Sigriatu re, 3 . Date: �Sl Signatures V '� ,�-a e'er• - .h' t ? r ,. horized Capewlde Enter. ri�s3es°Re 'resentative:X rt Own Phone: 508.477.8877 4 m � a i Fax: 508.477.4977 �� Rich@CapewideEnterprises.com Joao@CapewideEnterprises.com ' ',� "," 'sF 1r i Roof ProposaCraner6/28/12 r�HY ' + {� www.CapewideEnterprises.com