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HomeMy WebLinkAbout0007 ARBETA ROAD�7 R�eBE��1 �� - - � _ � J � �j °p1NE ipy_ Townwn of Barnstable . ` *Permit l W Expires 6 w o f ue • ° Regulatory Services • DAMWABI E • �� MASS' Thomas F.Geller,Director NOv — 2013 Building Division Tom Perry,CBO, Building Commissioner. 200 Main Street,Hyannis,MA 02601 N of B�R. www.town.barnstable.ma.us ��w Office: 508-862-4038 Fax: 508-790-6236 EXPRESS PERMIT APPLICATION RE IDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number lS/ Property Address -7 p ' Residential Value of Work f 41 ,1 .0 ,,Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �Q OI_Y l '7L/�/ S 7 lqi�%t sI oz�c5 l Telephone Number 7/ Contracto s Nam LOOT col- y�G3 4 R Home Improvement Contractor License#(if applicable) 12-6 S—g Construction Supervisor's License#(if applicable) 0 7©O77 14,Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance. Insurance Company Name �/$ • `-'" Workman's Comp.Policy# WC. 0,3_5 Copy of Insurance Compliance Certificate must accompany each permit. Permit Re uest(check box) Re-roof(hurricane nailed)(stripping old shingles) All construc ton debris will be taken,to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ��11 #of doors Replacement Windows/doors/sliders.U-Value n 3 V (maximum.35)#of windows_ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Pro a Owner Letter of Permission. A copy of the Home Improv en Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollikWppData\Local\Microsoft\Windows\Tem rary In n Files\Content.OutiooklQPE6ZUBN\EXPRESS.doe ' Revised 053012 .J" J"! The Commonwealth of Massachusetts Print Form Department of Industrial Accidents 6 Office of Investigations I Congress Street,Suite 100 . Boston,MA 02114-2017 ov/dia www.mass. _...f g Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): I -✓ P"P o / Address: City/State/Zip: !c.N �o/c - Phone#: Are you an employer?Check the appropriate bpx: Type of project(required): I.❑ I am a em to er with 4. I am a general contractor,and I P Y 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 g, ❑Demolition and have workers'working for me in any capacity. employees9. ❑ Building addition [No workers'comp.insurance comp.msurance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions - - 3.❑ I am a homeowner doing all work officers have exercised their 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' &1144%7t comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy' ormation. 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 pokcy.and job site Information. I Insurance Company Name: 4 t,-C, 3 » h Policy#or Self-ins.Lic.#: Vj S Expiration Date: - 1 - 1 Job Site Address: City/State/Zip: l.� Attach a copy of the workers'compensation policy declaration page(showing the policy nu ber 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cov ge a ification. I do hereby certi under the pains and o alt er u th in ormation provided above is true and correct: Signature: _ .. ... _ Phone#: b3 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 494 cT> umefa , ud s y anness R , nO ice VA 10 Park Plaza - Suite 5170 � Boston, Massachusetts 02116 Ilorne Improveft ontractor Registration Registration: 126893 Type: Supplement Carcl }`,,11, ;,. c Expiration,: 8/3/2014 The Home Depot At-Home Servides ,' ANDREW SWEET _ b 2690 CUMBERLAND PARKWAY`SUI °`E_. — — --- ATLANTA, GA 30339 4, Update Address and return card.Mark reason for change. F] Address (] Renewal ❑ Employment ❑ Lost Card DPS-CA1 0 °OM-04/04-010121,,6pp ��,,��� Office oPL sYi r as rt �us es` s Kega atl�" jr% License or registration valid for individui use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business:Regulation Registrration:• , 88-93 Type: ,.. 10 Park Plaza-Suite 5170 Expirati.anc_ 13/ bZ� Supplement Card Boston,MA 02116 Home Depoji-A—M.' h9 S.p/V;das ANDREW SWE44I;. :.� 2690 CUMBERtAN6 F" — _2 ` ;05iWA,GA 30339 Undersecretary ah It ou signature , A4 _jig`' x m pxx a F,, xx. t k8¢ ''�. r � 'g: "�- 4 � �"', .� :•mot '"�' T� z �- - - � - e r -k -14 z ;r, � aye! a s r � �.. 5 #�� � � }�' ''��> �r. s ��� •�w, �"s y� a' s ,J - � e f'rt5" i � q 3•Yx,� �'r' �" � f� J�y. ��t�, Ll .af 3swH`'wTCY 3 fC yy,,+�,. �iA. "b"s^b si53 ne.am & r •5c 5 .�3 .�n"'� �. � 'y � r..,�y. a, •`:`#• s�` ,y y x7 k� �i� ���3;. Y a s j' �4 ti , ..,� le �.t+w �" x f•e' w� e„ e���l y ',h u, �'$`3 �. e -at' c rt .' ,4 }. uf,4aa• £s'a t .� ^^� g, a �.fir r ,k '."t ak £ s g t� #a F "t e S s C *�-a '�•�"Eo t u# 3 r" 4'•�'`a� ' ol ? p 55 � � e� a � fie,,.. ° ,J ',may"� �,_ `�rY t�,•'r'�i y a. ,g �-� 7 C .pq t r e j .,v,+�';�� 4��y�naa *.+t*'�ewa�.wvtNv rah � r• ? �, _ i r 55 Alt p 46rb' 1- .y� i,.'�A 4r d •.q � � '�� i' �����:,�6� � bs� �� ��:'�i ��f^� S: �d .." � � y� � n A� � �� �n ",a-:y:a m k• - ap x4 �' sit +r<r �' R' k ..` ��" " -E �� '�. a•� 5a'- }" ou 4 i k kki fi ;r�'a. ... ..t . ... s ��=F•ten. vr � _ _^'Pw f 114 sYS r,_x * :, zb ,�R� �� � .�' � r t�z..;��p �< S'� � the `.;4 �-,"� :°,�° � `�n� � �;. i;•. 45M Xt Aw o � z z k ANSI, It k5 1 FA v w y y f r� f5 ry , T z, - � �•� � � r � ter-- � � "� ='-aa� - �:r itA2 y ,rlll tt f J s ig '. aeP •. r t o6/�, 6L, 't�A 4 +p A k A 9�$ Ell a, �` ,.�t. d �. 4 ,%xbow ` low 7. p Iwo 0- It �`l*1 u IL 4/1/2013 e:16:06 All PST (GMT-8) FROM: 100005-TO: 15087302086 Page: 2 Of 2 co 09Z CERTIFICATE OF LIABILITY INSURANCE []ATS°"""OON Q " - 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 poilcy(les)must be endorsed. If SUBROGATION IS WANED,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 certlfieate holder in Ileu of such endorsement e. PRooUCER PAUL B SULLIVAN INS AGCY INC - 1467 S MAIN ST FALL RIVER,MA 02724 PHONE E-MAILD B • - . .: .. INSURER B AFFOR°INO COVERAGE. - NAIC e - INSURER 'J�SEPH DUARTE&JOHN DALEY w a: DBAJ&J REMODELING 91SUMC: 15 WILSON WAY uRERo MIDDLEBOROUGH MA 02346 NSUPoERE: N URR COVERAGES CERTIFICATE NUMBER: 15914016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCEDBY PAID CLAIMS. kcwL WWI IM Type OF NBURANCe IN SR POLICY NUMBER N POLICY F Y F LEM's GENERALLIA91LOY I EACH OCCURRENCE S COMMERCw1GENERAb'LNBIIITY P S 0 eo toErrena f CLAM3•MAOE` OCCUR MEDE�Myond en) i. � PERSONAL 6 ACV INJURY f GENERALAOCRE(IATE 11 GENLAGGREGA7ELIMITAPPLIESPER: - PRODUCTS-COMPlOPAGG f POLICY PRO• LOC s = AUTOaOe1LE LUBILRY 'HOLE LIMIT a,- l $ • ANY AUTO . BODILY INJURY(Per Person) _ ALL OWNED SCHEDULED 60DILY IWURY(Per7eddeN) AUTOS AUTOS H1REO AUT08 8 AU'T0 NON-OWNED ere eM" E f UNaRE11A IJAa OCCUR EACH OCCURRENCE_ S -. E%CESSWa :.CLAAISJMAOE AGGREGATE OEO RETENnONf A woellERe:;coNPEr ►T1oN WCS-31S•384800-013 2/2/2013 212/2.014 TwoaysLTA7m,,,T,-sT ' AND.EMPLOYERS'lfAeLLRY ANY PROPREYOR.PARTNER1TXECUTNE YIN EL EACHACCIOENT f 100000 _ OFFICERJMEMBEREXCLUVEm _ +Y NIA (Mandatory In NH) r E.1-DISEABE-EAEUPCOYEE f 0 If Yes,desubo under DESCRIPTION OF OP tow E•LDISEASE-POLICYLarIT i 500UOO .,' DESCRPTIONOfOPEMTIONS. LOCATIONS/VENIC{.Ea Ails AC011D101,AddNon RmwAuSehedult r"on spoon lsaegWred) Workers.compent ation insurance coverage applies only to the workers compensation laws of Iha state of MA. NO PARTNERS ARE COVERED BY THE WORKERS'COMPENSATION POLICY. CERTIFICATE HOLDER N SHOULD ANY OF THE ABOVE OESCWSED POLICIES BE CANCELLED BEFORE THD AT HOME SERVICES,INC.AND THE EVIRAT►ON DATE THEREOF, NOTICE WILL BE DELIVERED IN THE HOME DEPOT ACCORDANCE WITNTHE POLICY PROVItIONS. 2690 CUMBERLAND PARKWAY SUITE 300• ATLANTA GA 30339 AUTHORIZED 111"RSWATNE Jeff Eldrid e - m 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORO )i�s°teit�i �cata cariceg°s`andTlaupe s"Z�s"��(.pia�$Joua y'O�tA'slun°&e cert�ticetas. r 0 May 11.. 2013 Barnstable Building Dept. The following is a list of our approved sub-contractors for The Home Depot: Ericsson Torres — CSSL # 100546 HIC # 163528 Michael Viola — CSSL# 099403 HIC # 140993 Vincent Smith - CS # 106837 HIC # 165927 Timothy Thomas CS # 51899 HIC # 152121 Ronaldo Solano - CSSL# 101027 HIC # 152206 Joseph Duarte - CS # 70077 HIC # 132349 Douglas Szynal —CSSL# 103950 HIC # 146142 Brian Laroche —CSSL # 100478 HIC # 152612 Joseph McKeon — CSSL# 98863 HIC # 132614 If you have any questions please contact Mike Bedard our permit coordinator at 508-962-6942,or myself at 617-438-9017.. S' erel uss one Bra Installation Manager THD At-Home Services,Inc. - 908 Boston Turnpike• Unit 1 -Shrewsbury,MA 01545 Phone:774-275-2139-Fax:508-845-6076-Toll Free:800-657-5182 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Fumis hod and Installed by: Branch Name:Boston North&South DsitedJO/Jd-_�_ - THD At-Home Services,Inc. dWa The Home Depot At-Home Services Branch Number:31 and 33 908 Boston Turnpike,Unit I,Shrewsbury,MA 01545 Toll Free 977-903-3768 Federal ID#75-2698460;ME Lie#C 02439;RI Cent.Lie#16427 Lie#HIC_0565522;MA Home Improvement Contractor Reg.#126893 Installation Address: �� rs Alra 0 zz fv • r+� City State Zip KA f t� Purchase s r( :) ' Worke:Phone: Home Phone: Cell Phone. a � t Home Address: (if different from installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing emails from The Home Depot Pr�o'eet information: Undersigned("Custamer'7,the owners ofthe property located at the above installation address,agrees to buy, and THD t-Home Services,Inc.("The Home Depot')agrees to furnish,deliver and arrange for the installation("installation")of all materials described on the below and on the m6:2,6noed Spec Sheet(s), all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, . "Contract,,): Job#: a"4rmAiwr,.ce) Pr ud6= S s ft ProjectAmount Roofing Siding mdows U Insulation QGutters/Covers DEntry Doers ❑ r oofing Osicting 11 windows 0 insulation {p ers/Covers oEntry Doors ❑_ $ Roofing USiding U Windows U Insulation 00un=/Covers DEntry Doors 0 Roofing Siding U Windows U Insulation OGlmers/Covers ❑Entry Doors n $ Minimum TS"/o Deposit of Contract Amountdue upon emenetion of this contract Total Contract Amount $ 'r Maine Purchasers may not deposit more than one third of the Cow Amount '7' } Customer agrees that, immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder_ The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(q)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold asbestos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract: Payment Summary: The Payment Summary# included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You arc endued to a completely oiled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. in the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Aeee t'atace and Aut o ' ti : Customer agrees and understands that this Agreement is the entire;agreement between Customer and The one Depot with regard to the Products and installation services and supersedes all prior discussions and agreements,either oral or written,relating to Said Products and installation.This Agreement cannot be assigned or amcttded except by a writiog signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily aucepts the terms of and has received a copy of this Agreement. AC d by: Subm' by: X X C er' igt. ci Date Sales C sultant's Signattue Date ey /8 � Telephone No. 'h 147 b Cust ign „Date IF Sales Consultant License No. : USTOMER MAY CANCEL THIS (as applicable) G EEMENT Wfi HOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE - SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN r CUSTOMER'S STATE. ' ` E AND ARE PART OF THIS CONTRACT NOTICE;ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SID 0&1893 Y White—BraricliFile Yellow—Customer Tel Wd££:Z 0TOZ £Z 'adtj TLZZZ9£80S: 'ON XU_1 pe6waf: W0�_U