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HomeMy WebLinkAbout0012 PARKER ROAD D � ���� �a��rOm O 11PC 12543 � � ;Na 63L0 �� WRaTlil�6e�� y "��`_ - v.:..:-�.x .. _.._.�� -'�"'r"k'"".'r"— s� - -' -=- 'tw' --�5�,-:ia.a,.�-,�.�:.:ems.•,�a� Town of Barnstable Building Yj u '�? :�'m�'�,'Yffi 'a",�3�1" .H... ;yl., 5 '.»�` '`s — " � . `e nr.' .`*' ?a�,s °'< s-r' ,A «': i v—cri�y`*,e '' ';;. ^x, m +a `,. •" • i ePost�This Card�Sot it is Visible;:Fromahe>Street roved&P.IansrMust be;Retained on Job.,and;this CardMustkbe Kept - EAR_N:1PA818. t3'.` e-. rte" ,d+x`.s'. E , ._ ,�!ed UntilrFina ection Has:BeenalVlade `� 1 >4 to s f s �$ . �6TA .1� ivy t *� #.t c�Epf,t f �ern11� r,uct Where a Certificate::ofOccupancyyiseReyuired;such Building shall>Not be Occupied until asFina4lnspect�on has beerrmade� • q lk:4fi.,:'.k,.P6Y' wakit.u: :..»w Permit NO. B-17-4217 Applicant Name: FRASER;CONSTRUCTION LLC Approvals Date Issued: 12/18/2017 Current Use: Structure Permit Type: Building=Addition/Alteration-Residential Expiration Date: 06/18/2018 Foundation: iL�2i��r ". . Location: 12 PARKER ROAD,WEST BARNSTABLE Map/Lot: 197 006 Zoning.District: RF Sheathing: Owner on Record: ROMAN CATHOLIC BISHOP OF FALL RIVER w 6 ��} Contractor Name yf FRASER CONSTRUCTION LLC Framing: Address: . P.O'BOX 2577 �a , Tl�Contractor License 112536; 2 FALL RIVER MA 02723 ' Est: Pro ect Cost: $72 075.00 J Chimney: Description: Remove and replace all windows,siding trim,and decking. Remove r Permit Fee: $705.88 Insulation: and replace deck framing same size,location remove andreplace ; titer ' Fee Paid $705.88 posts-front deck. ', : . Date 12/18/2017 Final: ProJect:ReView Req: s.: p�' ` P j v . A rE�ss ,, , Plumbing/Gas a .. .. ..... Plumbing: � x Rough Bing: --- �; x Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work auth rized£by this permit is commenced within six months after issuance. g All work authorized by this permit shall conform to the approved applicaUonand the approved construction documents for which_thls permit'has been granted. All construction,alterations and changes of use of any building and structurres shall'be in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street orroadand shall be maintained open for public inspection for the entire duration of the work until the completion of the same. ;A� 3>s u+"`� " r v � ,' Electrical xwy " 2�4 �" r' r Service: The.Certificate of Occupancy will not be issued until all applicable signatures by the Building and FireEOffmals are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: ��� s . k Rough: 1.Foundation or Footing .»'* � ` w 2.Sheathing Inspection Final: 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 Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation - Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical;Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department -Building plans are to be available on site. Final: All Permit Cards are.the property of the APPLICANT-ISSUED RECIPIENT J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �P Map �) 7 Parcel U 06 Application # Health Division Date Issued Conservation Division Application Fee �1 Planning Dept. Permit Fee / Do� • (� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address ( Z Car (?r IL oA&l Village ut Sf Owner90vW-n &;(f4 c bk o o+ F"[1 gycl- Address ft)&x ZS77 A.vc.- /14/t 07--7Z3 Telephone S b 9 -GI �J 0-71 � Permit Request atwtov,c wJl cc f�lc.�e �.1� �., l�,aaw) 5 f�Mt . ��rh" � ctec�h.a . -- Jr Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation )Z1 019 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 � w z o c Number of Bedrooms: existing _new -, Total Room Count (not including baths): existing new First Floor Room Count o `- Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other o CO Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coaIztove❑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 0 Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION - - - - - (BUILDER OR HOMEOWNER) Name Telephone Number. Z 2.9 2 Address Tt -M (1 oti-l Lc-a_ License # 09 7 I'll,4 ,E A' U1s-3 Home Improvement Contractor# Z- Email UIttc,c S.Q C U Worker's Compensation # GAG 00 l 300 I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE (2 r FOR OFFICIAL USE ONLY k - APPLICATION# rs DATEISSUED- MAP%PARCEL NO. T �y ADDRESS VILLAGE. OWNER E k DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE Y ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL w << GAS: ROUGH FINAL t4 FINAL BUILDING �i DATE CLOSED OUT . ASSOCIATION PLAN No..;� I Mckechnie, Robert From: Mckechnie, Robert Sent: Thursday, December 14, 2017 4:07 PM ; To: 'office@fraserccc.com' Subject: application for 12 Parker Road, WB Good Afternoon, The description on this application appears.be incomplete: It should include the replacement of the posts and should refer to the front porch (i.e.: the posts and deck of the front porch). Please make the correction the next time you are in the office, or sooner if you need the permit issued quickly. Thank you, Robert McKechnie Local Inspector Building Department Town of Barnstable 200 Main Street Hyannis, MA 02601 508-862-4033 1 AGREEMENT This Agreement made this D day of rc ��d— , 2017 by and between Fraser Construction, LLC, 31 Bowdoin Road, Mashpee,MA 02649, hereinafter referred to as the "Contractor" and Roman Catholic Bishop of Fall River, a Corporation Sole, of 450 Highland Avenue,Fall River,MA 02720/Our Lady of Victory Parish,230 South Main Street,Centerville,MA 02632, hereinafter collectively referred to as the"Owner". Witnesseth,that the Contractor and the Owner for the consideration herein stated agree as follows: 1. Scope of Work. The Contractor shall perform everything required to be performed and shall . provide and furnish all labor,materials,necessary tools,expendable equipment,and all utility and transportation services required to complete in a workmanlike manner all of the work required in connection with the repairs and replacement of windows, siding, roof/trim and deck at the house at the Our Lady of Hope Chapel property located at 1581 Main Street, West Barnstable, Mass achusetts,(sometimes hereinafter referred to as the "work"), all in strict accordance with the proposal, documents and/or specifications dated March 29, 2017 that are attached hereto marked"Exhibit A" and made part of this Agreement. Note: Any work required as a"possible extra"as listed on the proposal must first be approved in writing by the Owner. Said work shall include any and all necessary prep work and clean-up and removal of all debris.Disposal of materials shall be in accordance with applicable state and local rules and regulations. The Contractor shall also obtain all necessary building permits, and replacement work shall be done in compliance with the most recent edition of the Massachusetts State Building Code, as amended. 2. Price. The Owner shall pay to the Contractor for the performance of all the terms and conditions of this Agreement and the specifications attached hereto the total sum of Seventy- Two Thousand Seventy-Five ($72,075.00) Dollars, which the Contractor hereby acknowledges as sufficient and adequate consideration for the obligations incurred pursuant to this Agreement. The contract price shall be paid as follows: Deposit of Twenty-Four Thousand Twenty-Five and 00/100($24,025.00)Dollars due upon signing of this Contract; Balance of Forty-Eight Thousand Fifty and 00/100 ($48,050.00) Dollars upon completion of the work. 3. Time of Completion. The work to be performed under this Agreement shall be commenced on or before /= 6 7-0.,B" and shall be diligently prosecuted and completed on or before & 7,01 . It is agreed by the parties that time is of the essence in this contract. 4. Contractor's Liability Insurance.Contractor shall purchase and maintain such comprehensive general liability and other insurance as is appropriate for the work being performed and furnished and as will provide protection from claims set forth below which may arise out of or result from Contractor's performance and furnishing of the work and Contractor's other obligations under this Agreement,whether it is to be performed or furnished by Contractor, by any Subcontractor, or anyone directly or indirectly employed by any of them to perform or furnish any of the work, or by anyone for whose acts any of them may be liable: r (a) Claims under workers' or workmen's compensation, disability benefits and other similar employee benefit acts; I (b) Claims for damages because of bodily injury, occupational sickness or disease, or death of Contractor's employees; (c) Claims for damages because of bodily injury, sickness or disease, or death of any person other than Contractor's employees; (d) Claims for damages insured by personal injury liability coverage which are sustained (i) by any person as a result of an offense directly or indirectly related to the employment of such person by Contractor, or(ii)by any other person for any other reason; (e) Claim for damages, other than to the work itself,because of injury or destruction to tangible property wherever located, including loss of use resulting therefrom; (f) Claims arising out of operation of Laws or Regulations for damages because of bodily injury or death of any person of for damage to property; (g) Claims for damages because of bodily injury or.death of any person or property damage arising out of the ownership, maintenance or use of any motor vehicle. (h) Contractor agrees to submit for prior approval by the Owner a Certificate of Liability Insurance providing the insurance requirements set forth by this Agreement and naming the Roman Catholic Bishop of Fall River,a Corporation Sole,and Our Lady of Victory Parish as additional insureds. ' 5. Safety and Protection. Contractor shall be responsible for initiating, maintaining and supervising all safety precautions and programs in connection with the work under this Agreement. Contractor shall take all necessary precautions for the safety of, and shall provide the necessary protection to prevent damage injury or loss to: (a) all employees on the work and other persons and organizations who may be affected thereby; (b) all the work and materials and equipment to be incorporated therein; (c) other.property at the site or adjacent thereto, including trees, shrubs, lawns, walks, pavements,roadways, structures,utilities and underground facilities not designated for removal, relocation or replacement in the course of construction. (d) obtain any and all necessary building or other permits to complete the work. 'Contractor has submitted Certificate of Liability Insurance, including workman's compensation insurance, etc., attached hereto as Exhibit"B". 2 S Contractor shall comply with all applicable laws and regulations of any public body having jurisdiction for the safety of persons or property or to protect them from damage injury or loss, and shall effectuate all necessary safeguards for such safety and protection. 6. Indemnification. The Contractor shall hold the Owner harmless from any and all damages and claims to the extent caused by any negligence on the part of the Contractor, his agents or employees, in the performance of this Agreement; and in case any action is brought therefor against the Owner or any of its agents or employees,the Contractor shall assume full responsibility for the defense thereof, and upon his failure to do so on proper notice, the Owner reserves the right to defend such action and to charge all costs thereof to the Contractor. 7. Materials and Workmanship. The Contractor warrants its work against all deficiencies and defects in materials and workmanship and as called for in this Agreement. Unless otherwise stipulated in writing;the Contractor shall guarantee and warranty its work performed under this Agreement for a period of two years following substantial completion. All material and supply warranties will run to the benefit of the Owner. 8. Assignment. The Contractor will not assign this Agreement or warranty or part thereof without the written consent of the Owner. 9. Change Orders: Any extra work which is requested or required due to the condition of the building or building code changes shall be performed only after a written change order, "Addendum",is signed by the Owner upon a Contractor's change order form,and delivered to Contractor accompanied by full payment for the change order, if applicable. A change order may increase or decrease the price,provide for more or less time to complete work,for more or less materials or labor and other clauses. 10. Entire Agreement/No prior representation/Amendment: This is the entire agreement upon the Contractor and Owner. There is no representation,past or present,by the Contractor or any person acting for Contractor, which does not appear herein. This Agreement may not be amended except by a written change order or amendment executed and paid for as provided herein. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed as of the day and year first written above. OWNER CONTRACTOR Roman Catholic Bishop of Fall River, Fraser Co ction, LLC A Corporation Sole/Our Lady of Victory Parish By:- [name and title] [name and title] /y^ I W.\Marcia\DTG\Dioccsc orFall RivcrVWG-Our Lady or V ictory Parish CcntmillcTrascr Const LLC 1581 Main St cxt rcnovations.wpd e1A U,- 1)za 0 3 I 2 {P m, / }G \ ® ,IP§ 2, m --- 9 9,,,.z%, §, i %§ \2,-i „ ;, �PBm ,o zo -, m9lC)§ §] 2e !, S! /§!§zm m§ . |) § �� mJ�� `m e /g\ C P� 77@2n ,= `! .��. .§ o m# § k§ §§�§§ ;k * \ § 3§ J® g «2; §m m . §. §� . i )§ | �' m k£� )� /\ i \ (, q2 2� § z N 68 i 2m § g§� a/ § a zo! ; ! �q --I !� /�\ !� mo - §-k 0 ;Ox ' \ i |, 'n § 4ms S \ L � (n � ' --- ; z // /§ op !| `§ , f> /" m ` c 2 0 R \ CCD . q IEFN \ R . � . -- -—- q . ;§goy !§ ) ® 2 . c \ _ £ - D - �% \/ ' 2 Raj /J \ \§ 9\r s; 2a� r M) /\ \\§ I / : § \§ / Z.% . - 0,6 \\) \ \ EMUo - \ §- . !R/ � 22 RE-BUILT PORCH c mr�¥osG�&c 3_m_mm &m OUR LAD OF HOPE CHURCH -s E� e_ PH. ,274-m« . § ( 4 PARKER ROAD W B RNS ABLE MA I I 2 }}o q\ 0 \G \ \\ %-P-\ \$ m q --- omo - 9� z %nan - 2cnc'); „ a, �2m�r,;o zq `, m75az A8 §q /mF89 ** GG , !§ 7o`\m® �� "o. o �- §� 772)n ®= mm aG_ �) \§§;\ m( o/ /m Iz mz\ gm \ AT ` ,>¥ _- - | 2 Q (\\ 2k \ 0 9§m m� z ! �] ) §o m )55 \ ;` , nc m * ] (Q) 7 . . { � - � --- ;� \\ . // 4\\ p /; io \§d e` \!6 : a» o c 2 � § 20§ O | O 0� � / Q - --- q . q ; )2 §�;.� E® |-v \ ` � &a ; QJ / / r \IN %N »� 4 �/® \\ / /§ / / � . / . 2 O 2 ~ g, . n < � 2 a; 22 RE-BUILT PORCH c mEsYosGN,Lc ��m_mm . � § §§ :m OUR LADY OF HOPE CHURCH g77y 2 . . . § 6 4PARKER ROAD W.B RNS ABLE, MA 0) m , , 2 2 )\\>M/ )\ /\ / --- ;t9-n?Mzo z! @ [0 /%[%] ;2 90 , _- m0'' zo �m §* C.nczkjm§ %� )§ omozzzmm =o Ro�Am- -m " § §- §§c'—,. `m \ 0 9m* E) e /&/ -k §-R;o ;k § /� 3 f 0m -i 2Gm m . \ 2/§ . � 0C )£§ }J q ; ; ( ?/ §} § >0 mz0, \ ® M 920 ZTM " G R!@ czn > a /§.n m 5 !, | !, , §§ m 2§\ ! | |, 0 V®m \ § i !§ § ; �`] [ z // \/ \/\ \ 2 9 0 S/ ■ \§ Z� 5!\ \ a» \ 0 C. � . § 2 3§ R §§IM qF / § �.er p\@\ //\ . — °\§§;\°p9/ e a / / ° \§f !- 9 \ 0 \ a�& 9 q \ \ /;3 z RE-BUILT PORCH c mESYDESGN,±c 43� k § AD § :, OUR LADY OR HOPE CHURCH 72 TER? k PARKER ROAD W B RNS ABL, MA ��`^ 4 a I ti Manufacturing MP-Awl HARVEY ACKNOWLEDGEMENT I. BUILDING PRODUCTS Harvey Industries,Inc. 1400 Main Street.Waltham,MA 02451-1689 (781)899-3500 harveybp.com Dealer Quote Summary BILL TO: SHIP TO: Hyannis 186 Breeds Hill Road HYANNIS,MA 02601-1186 Phone:(508)775-7788 Fax:(508)771-3217 FRASER CONSTRUCTION FRASER CONSTRUCTION III I�I�II�I��I�III�III��IIIIIIII PO BOX 1845 PO BOX 1845 I� 1� I� b PO BOX 1845 MP COTUIT MA 02635-0000 Phone: 508-428-2292 Fax: 5084280123 Phone: 508-428-2292 Fax: (508)428-0123 QUOTE NBR CUST NBR"" "CUSTOMER'PO. "'ENTERED -DATE ORDERED '`"ORDERTYPE- 4277176 1005444 9/29/2017 Quote Not Ordered Charge ORDERED BY STATUS"- '-___SHIP VIA7!^ VERY AREA`__ JORDAN None Whse Pickup HYANNIS WAREHOUSE CLERK _._ _ _ - JOB NAME _'_"` �____ . _ -COUPON_._ mmd -Mike Denwood LADY OF HOPE LINE# DESCRIPTION—S'--" - -`""`"`-"QT)-"`" "UNIT PRICE—EXTENDED] 10000-1 jProductl: Tribute DH, Unit Size 25 x 41.5,RO 25.5 x 42 1 $403.41 $403.41 (Clear Opening Dimensionsl: Clear Opening Width=20,Clear Opening Height= 16.375,Clear Opening Square Footage=2.3 IScreenj: Half Screen,Virtually Invisible Mesh (Glassj: Double Glazed,Double Low-E RS,Argon Filled IFramesl: Sill rise extender =No IColorl: Base Color=White lPerformance Ratingsj: Performance Packages=E Star 6.0 2015,DP35 jEnergy Star US Climate Zone Compliancel: North=Yes, North-Central=Yes jUnit Typel: U-Factor=0.25,SHGC=0.26,VT=0.46,Custom/Call Size Option=Custom Size,New Construction lHardwarel: Integrated DBL Lock and Latch,Sash Limit Devices=Night Latch IGrillesl: Exterior&Contour In-Glass,Colonial,Match Frame,3W2H jWrapping-Overall Dimensionsl: Overall Rough Opening Width=25.5, Overall Rough Opening Height=42 jWrapping-Exterior Optionsl: Integral L Fin Adaptor,Receiver Pocket Room Location: None Assigned Last Update: 9/29/2017 5:30 PM Page 1 Of 6 Printed:9/29/2017 5:45 PM i QUOTE PVBR __L_GUST NBR 'CUSTOMER'PO ENTERED "DATE'ORDERED '" ORDER TYPE - _ . O _., _ . ERE _ 4277176 1005444 Q 9/29/2017 uote Not Ordered Charge ORDERED'BY `"STATUS"`-- _ `SHIP.VIA" "DELIVERY AREA"— JORDAN None Whse Pickup HYANNIS WAREHOUSE CLERK" - JOB NAME``" ' .-" COUPON- mmd -Mike Denwood LADY OF HOPE LINE# - DESCRIPTION` "" " -- -QT)--- ` --UNIT PRICE` EXTENDED1 11000-1 jProductl: Tribute Casement,Unit Size 40 x 35.5,RO 40.5 x 36 1 $760.98 $760.98 Clear Opening Dimensionsl: Clear Opening Width=8.875,Clear Opening Height=29.75,Clear Opening Square Footage= 1.8 — IScreenj: Virtually Invisible Mesh IGlassl: Double Glazed,Double Low-E RS,Argon Filled IColorl: Base Color=White lPerformance Ratingsj: Performance Packages=E Star 6.0 2015 jEnergy Star US Climate Zone Compliancel: North=Yes, North-Central=Yes — L2 u jUnit Typel: Unit 1:U-Factor=0.26,SHGC=0.24,VT=0.42,New Construction,Hinge Left ,o°ao Unit 2: U-Factor=0.26,SHGC=0.24,VT=0.42,New Construction, Hinge Right lHardwarel: Standard IGrillesl: Exterior&Contour In-Glass,Colonial,Match Frame,2W3H (Mullsj: Vertical Common Frame 0"thick,35.5" length jWrapping-Overall Dimensionsl: Overall Rough Opening Width=40.5, Overall Rough Opening Height=36 jWrapping-Exterior Optionsl: Integral L Fin Adaptor,Receiver Pocket Room Location: LINE# 'DESCRIPTION 'QTl"- ` ---UNIT PRICE-EXTENDED) 12000-1 jProductl: Tribute DH,Unit Size 30 x 44.5,RO 30.5 x 45 15 $405.25 $6,078.75 Clear Opening Dimensionsl: Clear Opening Width=25,Clear Opening Height= 17.875,Clear Opening Square Footage=3.1 - IScreenj: Half Screen,Virtually Invisible Mesh IGlassl: Double Glazed,Double Low-E RS,Argon Filled IFramesl: Sill rise extender =No IColorl: Base Color=White o a jPerformance Ratingsj: Performance Packages=E Star 6.0 2015,DP35 jEnergy Star US Climate Zone Compliancel: North=Yes, T T- North-Central=Yes jUnit Typel: U-Factor=0.25,SHGC=0.26,VT=0.46,Custom/Call 37 R0.X5 Size Option=Custom Size,New Construction lHardwarel: Integrated DBL Lock and Latch,Sash Limit Devices=Night Latch IGrillesl: Exterior&Contour In-Glass,Colonial,Match Frame,3W2H jWrapping-Overall Dimensionsl: Overall Rough Opening Width=30.5, Overall Rough Opening Height=45 jWrapping-Exterior Optionsl: Integral L Fin Adaptor,Receiver Pocket Room Location: None Assigned Last Update: 9/29/2017 5:30 PM Page 2 Of 6 Printed:9/29/2017 5:45 PM i QUOTE NBR CUST NBR CUSTOMER'PO - ENTERED-"' DATE'ORDERED --ORDER-TYPE ' _. _ _ _. 4277176 1005444 9/29/2017 Quote Not Ordered Charge ORDERED BY STATUS—- ' SHIP VIA_._ _�`'DELIVERY AREA. `- JORDAN None Whse Pickup HYANNIS WAREHOUSE CLERK - - -JOB�NAME-...._--w, -- - -- - mmd -Mike Denwood LADY OF HOPE LINE# DESCRIPTION -QT)" "UNIT PRICE- EXTENDED,' 13000-1 jProductl: Tribute DH,Unit Size 30 x 57.5,RO 30.5 x 58 10 $408.24 $4,082.40 Clear Opening Dimensionsl: Clear Opening Width=25,Clear Opening Height=24.375,Clear Opening Square Footage=4.2 IScreenj: Half Screen,Virtually Invisible Mesh IGlassl: Double Glazed,Double Low-E RS,Argon Filled IFramesl: Sill rise extender =No R IColorl: Base Color=White & lPerformance Ratingsj: Performance Packages=E Star 6.0 2015,DP35 EU jEnergy Star US Climate Zone Compliancel: North=Yes, North-Central=Yes jUnit Typel: U-Factor=0.25,SHGC=0.26,VT=0.46,Custom/Call Size Option=Custom Size,New Construction lHardwarel: Integrated DBL Lock and Latch,Sash Limit Devices=Night Latch IGrillesl: Exterior&Contour In-Glass,Colonial,Match Frame,3W2H jWrapping-Overall Dimensionsi: Overall Rough Opening Width=30.5, Overall Rough Opening Height=58 jWrapping-Exterior Optionsl: Integral L Fin Adaptor,Receiver Pocket Room Location: None Assigned LINE# -DESCRIPTION- "'QTl``�"'- '--'UNIT PRICE'TXTENDED1 14000-1 jProductl: Tribute DH,Unit Size 31.5 x 28.5,RO 32 x 29 2 $402.03 $804.06 lClear Opening Dimensionsl: Clear Opening Width=26.5,Clear Opening Height=9.875,Clear Opening Square Footage= 1.8 IScreenj: Half Screen,Virtually Invisible Mesh jGlassj: Double Glazed,Double Low-E RS,Argon Filled T, IFramesl: Sill rise extender =No a IColorl: Base Color=White & lPerformance Ratingsj: Performance Packages=E Star 6.0 2015,DP35 jEnergy Star US Climate Zone Compliancel: North=Yes, Liluj North-Central=Yes 3.5 jUnit Typel: U-Factor=0.25,SHGC=0.26,VT=0.46,Custom/Call RO-32 Size Option=Custom Size,New Construction jHardwarej: Integrated DBL Lock and Latch,Sash Limit Devices=Night Latch IGrillesl: Exterior&Contour In-Glass,Colonial,Match Frame,3 W I H jWrapping-Overall Dimensionsl: Overall Rough Opening Width=32, Overall Rough Opening Height=29 jWrapping-Exterior Optionsi: Integral L Fin Adaptor, Receiver Pocket Room Location: None Assigned Last Update: 9/29/2017 5:30 PM Page 3 Of 6 Printed:9/29/2017 5:45 PM QUOTE NBR 1.__ CUST NBR "CUSTOMER PO -."ENTERED DATE'ORDERED. _-ORDER'TY_PE- 4277176 1005444 1 1 9/29/2017 Quote Not Ordered I Charge ORDERED BY " "STATUS- ' SHIP.VIA- - _ " __ "DELIVERY`AREX- JORDAN None Whse Pickup HYANNIS WAREHOUSE CLERK` ."" _" _ __—JOB NAME "_ _-" __"` -"'COUPON mmd -Mike Denwood LADY OF HOPE LINE# 'DESCRIPTION` - "'" QTl` "``UNIT PRICE` EXTENDEDI 15000-1 jProductl: Tribute DH,Unit Size 34 x 31.5,RO 34.5 x 32 1 $403.18 $403.18 Clear Opening Dimensionsl: Clear Opening Width=29,Clear Opening Height= 11.375,Clear Opening Square Footage=2.3 IScreenj: Half Screen,Virtually Invisible Mesh jGlassj: Double Glazed,Double Low-E RS,Argon Filled n IFramesi: Sill rise extender =No n IColorl: Base Color=White m lPerformance Ratingsj: Performance Packages=E Star 6.0 2015,DP35 jEnergy Star US Climate Zone Compliancel: North=Yes; North-Central=Yes jUnit Typel: U-Factor=0.25, SHGC=0.26,VT=0.46,Custom/Call RO.31,RO. —~� ! Size Option=Custom Size,New Construction IHardwarel: Integrated DBL Lock and Latch,Sash Limit Devices=Night Latch IGrillesl: Exterior&Contour In-Glass,:Colonial,Match Frame,3W 1 H jWrapping-Overall Dimensionsl: Overall Rough Opening Width=34.5, Overall Rough Opening Height=32 jWrapping-Exterior Optionsl: Integral L Fin Adaptor,Receiver Pocket Room Location: None Assigned LINE# - DESCRIPTION` ` `Y- - QT•)-- - "UNIT PRICE -EXTENDED) 16000-1 jProductl: Tribute DH ,Unit Size 38.5 x 44.5,RO 39 x 45 1 $407.32 $407.32 Clear Opening Dimensionsi: Clear Opening Width=33.5,Clear Opening Height= 17.875,Clear Opening Square Footage=4.2 IScreenj: Half Screen,Virtually Invisible Mesh _ jGlassj: Double Glazed,Double Low-E RS,Argon Filled IFramesl: Sill rise extender =No IColorl: Base Color=White 9 jPerformance Ratingsj: Performance Packages=E Star 6.0 2015,DP35 H jEnergy Star US Climate Zone Compliancel: North=Yes, North-Central=Yes jUnit Typel: U-Factor=0.25,SHGC=0.26,VT=0.46,Custom/Call 38 RO,l9 Size Option=Custom Size,New Construction jHardwarej: Integrated DBL Lock and Latch,Sash Limit Devices=Night Latch IGrillesl: Exterior&Contour In-Glass,Colonial,Match Frame,4W2H jWrapping-Overall Dimensionsl: Overall Rough Opening Width=39, Overall Rough Opening Height=45 jWrapping-Exterior Optionsl: Integral L Fin Adaptor,Receiver Pocket Room Location: None Assigned Last Update: 9/29/2017 5:30 PM Page 4 Of 6 Printed:9/29/2017 5:45 PM QUOTE NBR CUST NBR_- _ OUST_OMER'PO" -ENTERED_'_""DAT&ORDERED " _OR_DER TYPE' 4277176 1005444 9/29/2017 Quote Not Ordered Charge ORDERED BY - STATUS— '" ` -SHIP VIA- """ `-DELIVERY AREA ` JORDAN None Whse Pickup HYANNIS WAREHOUSE CLERK - _ _JOB NAME"'-_._: ,....__. mmd -Mike Denwood LADY OF HOPE ALINE# DESCRIPTION - QT) `UNIT.PRICE 'EXTENDED] 17000-1 jProductj: Tribute Casement, Unit Size 24.5 x 28.5, RO 25 x 29 1 $384.17 $384.17 Clear Opening Dimensionsl: Clear Opening Width= 13,Clear Opening Height=22.75,Clear Opening Square Footage=2.1 IScreenj: Virtually Invisible Mesh jGlassj: Double Glazed,Double Low-E RS,Argon Filled IColorl: Base Color=White a lPerformance Ratings]: Performance Packages=E Star 6.0 2015 & ]Energy Star US Climate Zone Compliancel: North=Yes, North-Central=Yes ]Unit Typel: U-Factor=0.26,SHGC=0.24,VT=0.42,New Construction, Hinge Left jHardwarej: Standard IGrillesl: Exterior&Contour In-Glass,Colonial,Match Frame,2W2H ]Wrapping-Overall Dimensionsl: Overall Rough Opening Width=25, Overall Rough Opening Height=29 ]Wrapping-Exterior Optionsl: Integral L Fin Adaptor,Receiver Pocket Room Location: None Assigned LINE# DESCRIPTION QTl ' _ UNIT PRICE-EXTENDED] 18000-1 jProductl: Tribute DH,Unit Size 23.5 x 40.5,RO 24 x 41 1 $402.95 $402.95 Clear Opening Dimensionsi: Clear Opening Width= 18.5,Clear Opening Height= 15.875,Clear Opening Square Footage=2 IScreenj: Half Screen,Virtually Invisible Mesh IGlassl: Double Glazed,Double Low-E RS,Argon Filled '} IFramesl: Sill rise extender =No = IColorl: Base Color=White " lPerformance Ratings]: Performance Packages=E Star 6.0 2015,DP35 ]Energy Star US Climate Zone Compliancel: North=Yes, North-Central=Yes ]Unit Typel: U-Factor=0.25,SHGC=0.26,VT=0.46,Custom/Call 23' ao.. Size Option=Custom Size,New Construction lHardwarel: Integrated DBL Lock and Latch,Sash Limit Devices=Night Latch IGrillesl: Exterior&Contour In-Glass,Colonial,Match Frame,2W2H ]Wrapping-Overall Dimensionsl: Overall Rough Opening Width=24, Overall Rough Opening Height=41 ]Wrapping-Exterior Optionsl: Integral L Fin Adaptor,Receiver Pocket Room Location: None Assigned Last Update: 9/29/2017 5:30 PM Page 5 Of 6 Printed:9/29/2017 5:45 PM t: QUOTE NBR GUST'NB " "CUSTOMER PO —ENTERED•.._. -DATE'URDERED —ORDER TYPE" 4277176 1005444 9/29/2017 Quote Not Ordered Charge ORDERED BY STATUS `"""""'SHIP`VIA "" --DELIVERY AREA - —'Y-y` ' JORDAN None Whse Pickup HYANNIS WAREHOUSE CLERK ____`.'.` _JOB NAME'.."''_ -- COUPON'-" - 1_ _—._ mmd -Mike Denwood LADY OF HOPE "Note: Delivery charges may apply and are not included on this quote. This quotation is based on our interpretation of the information provided. All quantities,sizes,extensions, SUBTOTAL:" $13,727.22 grand totals,and specifications should be verified by the contractor prior to his/her bidding or ordering of - materials. Harvey Industries,Inc.,is responsible only for the items as quoted above. Any changes or TAX:` '""", $857.95 addendums will be subject to a requote. We propose to supply the materials as described above,subject to - the terms and conditions as required by our credit department. The prices are guaranteed for 30 days from ORDER TOTAL: $14,585.17 the date of quotation unless otherwise noted. Delivery charges may apply and are not reflected on this — ' quote.We appreciate the opportunity to quote this job. If you have any questions,please call your local warehouse. 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'.} 1- ``�y4�d rrjgw 'M— ;. k r� kTf' �S-•� Z 1! i 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: guilders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/lndividual): ,, cy �oviiictii Address: 3/��o�� �. fzt City/State/Zip: t, ,07,64 Phone M yz,'r--Z:Zq z Are you an employer? Check the appropriate box: Type of project(required): 1.Rrl am a with employer O 4. ❑ I am a general contractor and 1 �—* have hired the sub-contractors 6• ❑New construction employees(full and/or part-time). 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 50 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.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, 51(4),and we have no 13.❑ Other employees. [No workers' comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: c5�4�d �.2si.rnki� ��vvi/Javt%L,/ — Policy#or Self-ins.Lic.#: It/G Expiration Date: Job Site Address: P,-t'k-,l City/State/Zip:0. NNSf- 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 D1A for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. Si ature: Date: (Z S F 6-7 Phone# �' e/71r Z3O Z Offrcial 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#: GRANITE STATE INSURANCE COMPANY 0103090-00 WC 009-93-0601 13102 0.13-82-0917-70 FRASER CONSTRUCTION, LLC P.O. BOX 1645 COTUIT, MA 02635-2443 An AIG.company EXECUTIVE OFFICES: SEE EXTENSION OF ITEM 1.OF THE INFORMATION PAGE- WC990610 175 Water Street New York, NY 10038 LD# MA UI#: + TKG WHOLESALE BROKERAGE INC WORKERS COMPENSATION AND EMPLOYERS 144 TURNPIKE ROAD LIABILITY POLICY INFORMATION PAGE 'SUITE 150 SOUTHBOROUGH MA 01 2-0000 INSURED IS PREVIOUS'POUCYNUMBER LIMITED LIABILITY COMPANY RENEWAL 0099 0601 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1.OF THE INFORMATION PAGE- WC990610 ITEM 2 POLICY PERIOD 1291 A.M.stand and timo at tho Insurod'a moiling addroee FROM 09[26117 To 09126/18 ITEM a 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 the work in.each state listed in item 3.A- The limits of our liability under Part Two are: Bodily InjuryAccident S 500.000 each accident by Bodily Injury by Disease S 500.000 policy limit Bodily Injury by Disease $ 500.000 each employee C. Other States insurance: Pan Three of the policy applies to the.states. Wany, listed hero: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RISC SD TN TX UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE EXTENSION OF ITEM 3.0.OF THE INFORMATION PAGE- WC990612 rtEM 4 The premium for this policy will be determined by our Manuals of Rules,.Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rato Par Estimated Oessificatlons Odde Number Total It,- 'ttion $100 OF Re- Premium Annual1:1 3.Ye6r muneration Annual ❑3 Year SEE EXTENSION OF ITEM 4.OF THE INFORMATION PAGE- WC7754 TAXES/ASSESSMENTS/SURCHARGES $1 ,.676 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BYSTATE) $3 8 MA MINIMUM PREMIUM $500 MA TOTAL ESTMATED ANNUAL PREMIUM $38,995 If indicated below,interim adjustments of premium shall be made: ❑ Semi-Annually 0 Quarterly Monthly DEPOSrrPREMIUM 08/24/17 PARSIPPANY 82 losuo DSto tasuin9 Ofneo Authoremd Ropresontativo WC 00 00 01A 39967(Wd 04108) Commonwealth of Massachusetts Division of Pr'ofes4ional licensure i S Board of Building Regulations and Standards ii Consiructrd►1$dpervisor CS•097668lEzpires:06/OT12019 I '+ 4 DEAN CFRASER =� r 104 TWINN ViP LANE:=s EAST FAlMO TH th1A 021i38\. MISS tcl�i Commissioner C� •9 i "r Office of'consumer,AfE2irs and Business Regph&on 10 Park Plaza-Suite 5170 Boston,.afimacbusets 02116 Home,lmprcvemeb o__k�Or,Registration FRASER CONSTRUCTION:LC?a�-. —F; Exp eon: �1z2/2�s P.O:Box 1345 ly,. Cotte,MA 02635 UpdatoAddras ac,C rctua►c=C. :or dsmsc. I xa, a zoai n _ O Address O'Renowal';O Ernploymen; C Los:Cvd' �T/��m�».00xcrald oj�Gl�rY.�,erc .. Orrteo d Connorarsrs a eo9u=Regm won HOME IMPROVEMENTOONTRACTOR Rog U-Teonv*FdtozhrCivldrmt=aNy . - TYPE:LLC befomtho expieYSondam.C.:ound retum W A oEfioc of Corrsrrter Affair and t:cSnc Rogr9a5on 10 ParkPta=-Suite Si70 Y�,ti�`,:�nw�•:Y'1,`2536-; •OCi/22120f9 Seetor4 sIA'02T16 ERASER COvS'l�Rl`�_CF[OtEC DEAN FiA:ER'a`'a:;h+��'\`?�_.;• ' 3t Bowdoln Roa2 Mashpoe,MA 0264t2",' Und ersecretmy Fiat valid"withoutSigrzt M , yam`^�• TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7 Parcel Permit# � Health Division e , Date Iss d Conservation Division �o 2 clq Fee �0 o Tax Colle ; _Y,STE7 � T Treasurk IMMALLE'®IN COMMLIANCE WITH TITLE 5 Planning Dept. ENVIRONMENTAL CODE AND Date Definitive FI roved by Planning Board OWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address ? lvi Village Owner , Address Telephone Permit Request �t e Square feet: 1 st floor:existings�z proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Typtkolwj.ZVA!14f Lot Size Grandfathered: EPt9's__ 0 No If yes, attach supporting documentation. Dwelling Type: Single Family 5--�_Two Family 0 Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes O No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other 4E 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 0 Electric ❑Other Central Air: 0 Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No Detached garage:Z xisting ❑new size Pool:0 existing ❑new size Barn:0 existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 0 No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name4 41 16 e 4_ Telephone Number Address 6f License# as ~ Home Improvement Contractor# Worker's Compensation# 41Z d22 2>>Y�- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r FOR OFFICIAL USE—ONLY r PERMIT NO. DATE ISSUED _ MAP/PARCEL NO.. r ADDRESS 'd :$ VILLAGE r OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION _ FIREPLACE ELECTRICAL: ROUGH T FINAL PLUMBING: ROUGH FINAL r ' GAS: ROUGH' ! FINAL FINAL BUILDING ' ` DATE CLOSED OUT �L000 ASSOCIATION PLAN NO. S 15 STANDARD LEGEND me ld,a0 E1aboN.m NM®m o maP 'k� GW I116I FAIRWAY 0 OEUMMTREFS -. O FOR OF UIR I, Ems' ORUMOA xuRSEtO' UINOiRWFSTM maw AREA n W OF WATER WRTRW 1�PARON6AUFf / RIB-���AVED ROAD OWES P197 '� PA,N/""a� PROPERff UNES 3 E�MAP NOUSF NUAIBB # 34 RFOMMKOIRUNE �. 10 FOOF MMUR UNE SPOT EIEYA t P 19 � _. STONE WALLU • --' RETAMINO mu # 1.2 m RAUROADT AONElE1w11' • $ S%IMMIN6 POOT J PORUI/OEUE .. Q• RUIIOINf/STRUUURES MAP 197 o ASSEOSOmmumNRAOP 4 197 a ym o WARS IUST F # 18 o so o SIOEMOPz KU mm X # O USM O am SITE MAP T.O.R.UNIAPNIC INFORMATION SYSTEMS UNIT SCALE:in feet 0 30 60 1 INCH=60 FEET` N S E1161®•�m.E NOTL THE PACES UNESARE WA ROW ATPPBFNIATRMSW P WE ft WU =TMTAff WW LFE0WW h&3-% I>$t�1MINBOCM➢01�Mf®IAf AfdImm NOIOMxxExl•�EW.N1®fID[ENAMNCmBIMAi1K ' 011R IIC�NIENI'NW.W YI®O Y�IW. EMMOOIMat I �IW9®E�SWSIE9/. • 'OmNNEMOY­WIW.1 R WfIR1®OA OM® • SWIMxA@H. \sitemaps\Public\m197p006.dgn Jun. 22, 1999 09:44:24 .... rT - ;;�; _�� Department of Industrial Accidents ' O1fC8 0MY8stl98li RS 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit f1C�rSE:i[tfQiTrt3t2 //// / //"""•••, name: A/l/ . C.'- location: city C�,e, il��X� �� .. �02 phone# -50 F- /`a y 03 S�s� ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any ca achy ❑ I am an empioyer providing w rkers' compensation for my employees working on this job. comnnnv name: C A OA / d �e address:-3a- '�� 6S city: 2 t �� phone#• 7 a U insurance Co. l�L/ �� niicv# GC/C, / a 71 V,�- ❑ I am a sole proprietor, general contractcr, or homeowner(circle one)and have hired the contractors listed below who h�c•e the follovs•ing workers' compensation polices: companv name: Gr d C address. �3 adty hone#- .......... insarnnce cn. ' l/y✓Lt��.rt�c� .� oiiiv#:....�r.�'.�.-.. :> f ::::b.;<::. camnanv name- :;.......: :,.;. ;:::•:;;•:>;:>,.;:.::..... :::......::::. :•: address: city- ... phone#' :,:;.....::.:::.:. . :::.. faaarance co. pong Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crtminai penalties of a ate up to$1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP♦VORK ORDER and a ate of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the 011tce of Investigations of the DIA for coverage veritleation. I do hereby certify'under the pains and penalties of perjury that the information provided above is tru,-and coned Signature Date Print name Phone# Echeck do not write in this area to be completed by city or town oill iai pertniti lcense# QBuilding Department ❑Licetuing Board ediate response is required ❑Selectmen's Office ❑Health Department phone#; ❑Other (Rvtaea 9,95 PIA) swumons Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their. employees. As quoted from the "law", an employee is defined as every person in the service of another under anv cow- of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or anv two or more o: the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rece:ie: 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 c. building appurtenam thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews: 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,neither.the . m comonwealth 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 = authority. contrac - Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be :•submitted to the Department of Industrial Accidents for confirmation ofing,rance 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 cal'the Department at the munber listed below. City or Towns 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 curt in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pmmit/licease number which will be used as a r6mrace number. The affidavits may be returned io the Department by maul or FAX unless other arrangements have bees made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. ------------------------- The Department's address,telephone and fax member: The Commonwealth Of Massachusetts Department of Industrial Accidents 0mce of Imlenfoadoes 600 Washington street Boston;Ma. 02111 fax#: (617) 727--7749 phone#: (617) 7274900 ext. 406, 409 or 375 i HOME IMPROVEMENT CONTRACTORS REGISTRATION Board 'f Building Regulations and `Standards One Ashburton Place — Room 1301 Boston , Massachusetts 02108 j :. _ ----- ------------------------- HOME IMPROVEMENT CONTRACTOR �� Registration .113239 Expiration 05/27/01 j Type — INDIVIDUAL HOME IMPROVEMENT CONTRACTOR j. Registration 113239 . .: Type - INDIVIDUAL Expiration 05/27/01 MICHAEL J . DINOIA 32 OUTPOST LN - MICHAEL J. DINOIA CENTERVILLE MA 02632 j:.� 2 OUTPOST LN TERVILLE MA 02632 ADMINISTRATOR ' _.. _ .. 4'�� '(!)ryp7/rltO9tltlClLIUL O�✓G7.CIJ:1Q.C�LCJ6�J !. OEPARTMENT OF PUBLIC SAFETY c. CONSTRUCTION SUPERVISOR LICENSE Number: Expires: —— Restricted 4 .BB MICHAEL 3:, OINOIA 32 OUTROST"LN CENTERVILLE, MA 01632 • I HOME IMPROVEMENT CONTRACTORS REGISTRATION I ' ° Board of Building Regulations and "Standards• One Ashburton Place — Room 1301 I . Boston , Massachusetts 02108 I. --------------------- ----- HOME IMPROVEMENT CONTRACTOR Registration .113239 Expiration 05/27/01 Type — INDIVIDUAL I HOME IMPROVEMENT CONTRACTOR I. Registration 113239 Type - INDIVIDUAL t; Expiration 05/27/01 v , MICHAEL J . DINOIA 32 OUTPOST. LN MICHAEL J. DINOIA CENTERVILLE MA 02632 t 2 OUTPOST LN I�CD'"cO TERVILLE MA 02632 I ADMINISTRATOR _. - ... -VaI)7/IYLIYILCIICQtiLIL d�✓�ZClOdILC/LLCJC�J ' I ' OEPARTMENT OF PUBLIC SAFETY i ` rONSTRUCTION SUPERVISOR LICENSE Number: Wires: —— Restricted::To 99 MICHAEL 3 OINOIA 32 OUT20ST LN a i CENTERVILLE, NA 02632