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HomeMy WebLinkAbout0060 ARBOR WAY 6o q�P, sn lva� a O jU✓ �TF4E Town ®f Barnstable *Permit it * O� Ex 'r.s G montl�n issue date nax Reo ulatory Services --T s Thomas F.Geilcz Director �J -"FRS � 7� / Buitdin, Division ' ir CT. 8 4� U Tom ferry,CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 JOINN ,OF BARNSTABLE. www.town.barizstablc.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without RedY-Press Ivrpritef. � � t Map/parcel Number Properly Address • I [4 idential Value of Work �>`� Minimuuz fce of$25. for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number y home Improvement Contractor License#(if applicable)_� �/cif Construction Supervisor's License#(if applicable)__ Z,' ❑Workman's Compensation Insurance Check one: ❑ I am a sole Droprietor ❑ I m the Homeowner l have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy it Copy of Insurance Compliance Certificate must be on fi e. Permit Request(check box) Re-roof(stripping old shingles) All construction debris wia be taken to ❑Re-roof.(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuancc of this permit does not exempt compliance with other town department regulations,.i.e.Historic,Consmalion,etc. ***Note: Property Owner must sign Property Owner better of Permission. Ho 1provernent Contractors License is required. SIGNATURE: Q:Forms:cxpmtrg. Revisc071405 Property Owner Must Complete & Sign This Form if using a Roofer I Builder. 1 (print) as Owner / Agent of the subject property hereby authorizes Paul J. Oazeault& Sons Roofin_.Q Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for. Address of Job Signature of Owner Mailing Address of Owner �d' Telephone# Date 6F­_/Q (Please return this form to Cazeault roofing along with your signed contract;.It is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you) fax#508-420-4555 r J`�_ 7� - Office of Consumer Affairs and Ifusiness Regulation 10 Park Plaza - Suite 5170 Boston, MassacWsetts 02116 Home Improvement ' tctor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2012 Tr# 297676 33.E PAUL J. CAZEAULT & SONS, IN �.,­' = Paul Cazeault iv 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Mark reason for change. E- �—= Address Renewal Employment Lost Card )PS-CA1 0 SOM-04/04-G101216p ✓fze i�Jomvnaaruueau� _p✓vGaGaae�ivael�aoSti< krt License or registration valid for individul use only 'us Office of Consumer Affairs&Business Regulation s HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: -9 , Registration ;A,1:03714 Type: Office of Consumer Affairs and Business Regulation T � k_ 10 Park Plaza-Suite 5170 Expiration 7 ©12 Private Corporation Boston,MA 02116 r -- vt � PA L J.CAZEA �—1T Y �t1 � Paul Cazeault \ 1031 MAIN ST „ OSTERVILLE,MA 0265$3� i' Undersecretary Not valid without signa re �; a3•x -r'r*^e-- �e c .: �T ��+.�.`.� -z'' -ems "a�� '"' •`�*"" `�`�-x. Fr'+"`^z. ax , e .� ' RM q, �' tit,,,.�v� ;�.`,,;�'.`^ +ln•',,..` MA mn ZE ' a i"s�,''�'^-+Qa"'fig-����s �">`�f � � �--. .. �.• ���d1�lE r?Y}-tiE.�l b ���<hrrt lTYf:i}�•�Ot"]�ll�'{MrC�'�x�t:C)r��"�, ����`� ""`�"'�-� _�T�'� � x h r'�x'�^� Y' �: =gUaLC E) BUI�t tGl'�l °slll�lY�knM<6n r p�LEff F tigsM g NN --2.„Z ,., .y,a-i „�. �5 - -:�, �x s s y ,a �' Y r.(2rTSiIL1rQ(li �eC?RhQrI �S :� � a xs tcense Gsxs 26325.F.�' �^"c�'_-�`Vim' � ��U�r� -2"ky-i"� � �.��' � a�,� '`�'` > d �',}�-�- •.�.�- �� '�''' `.v" v'- - � r Q°p' �' Zi -: -.m-+ �'�z's �t"t '...�s"'� ,yr„ '2's .. .� ". *'". ?' G"''-i ""' '€'� - s "- r• v t � PAR -''s"5,x.,' xm,.p., .Fxs, x'-r`� r •. ''f',p• ,' -'a--. � -' u " e`"-'-- �.�T" `" f -•`^ems -" .`- _� '.'�•5�, _ ns � Q �E�t�r�> � Ivra a26s� � r .?t'- su{.`aas'i"--' -� a^ r r car x OR - IlR1nFi��YtN1Cr zZON S s nygg 'r.- wry. RN ,.t 3. 3 F illa y .,.,_ frF,. KT ax Client#: 19989 2CAZEAU LTPA ACORD. CERTIFICATE OF LIABILITY INSURANCE ago 010 YY' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A- First Mercury Insurance Company Paul J.Cazeault&Sons,Inc. INSURER B: National Union Fire Insurance C 1031 Main Street - INSURER C: Osterville,MA 02655 INSURER D: INSURER E: COVERAGES 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 SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'LPOLICY EFFECTIVE POLICY EXPIRATION LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE M D LIMITS A GENERAL LIABILITY FMMA0027012 04/30/10 04/30/11 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY - AMA DGE TO Sr =SSRENTED $SO OOO CLAIMS MADE 7 OCCUR MED EXP(Any one person) $O X BUPD Ded:2.500 PERSONAL&ADV INJURY $1 OOO OOO GENERALAGGREGATE $2 O00 000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG s2,000,000 POLICY 7 PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUfO.S (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ - RETENTION $ $ B WORKERS COMPENSATION AND WC003603096 08/10/10 08/10/11 X J�BYJ I ru OrR EMPLOYERS'LIABILITY E L EACH ACCIDENT $5OO OOO ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NO EL DISEASE-EA EMPLOYEE $500 000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER _ — 7-77-7 ljESCRIPTION OF bPERAtIONr,i LOCATIONS rvEmiciEtt EXCLUSIONS ADDED.'BY ENDORSEMENT'SPECIAL PROiiisid S- r Operations performed -y the named insuredsub�ecfta pnlr coridltrons and:exclusions. :. : . - T 5 H - wc� t CERTIFICATE'HOLDEIZ SNOUt D ANY OFTHE ABOVEDESCRIBM POUCIES BECANCEU:ED BEFORE THE EXPIRATION - PaUI.J.CaZQdUlt :SO[1S DATETHF3tEOF THE ISSUING INSURER WILL ENDEAI/OR TO MAIL' 1-IT :DAYS WR[FTEN Roofing,lnc a NOTICETGTHECERTIFICATEHCLDERNAIID=DTOTHE+LEFT'BUT:FALURE.TODOSGSHA}1r = 1 O31 Ma1n;Street = 7MPOSE'NO OBLIGATION OR LIABIUTY OF ANY KIND OPON THEINSURER;RS AGENTS:OR = Osterville;MA 02655 ".' REPRESENTATIVES.- :. AUTHORIZED. REPRESENTATNE._ AULH ACORD 25(2001/08)_1 of 2. #S71.730/M71729 LSf:- 0.ACORD CORPORATION1988 The Commonwealth of Massachusetts Page 10 of 10 Department of Industrial Accidents - t u Office of Investigations " 600 Washington Street floston,llbf 4 02111 r z_ www.massgov/dia F Workers' Compensation Insurance'Affidavit: Builders/Contractors/Electricians/Pluul hers Applicant Information Please Print (L' g eibly p fl; Name(Business/Organization/Individual): 1 A U L S' C2 Z C 0.U 9 e .S S � t OO -r N G-T tJ L Address:_na,— a 1 Yl s City/State/Zip: 5 T 2 y 1 Y`nPro2lo GS Phone#: So& 2 - 1 1 ^? Are you an employer?Check the appropriate box: Type of project(required): I am a employer with [2 4.-(] I am a general contractor and I 6. El 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 i 7• ❑Remodeling ship and have no employees These sub-contractors have -. 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9_ 0 Building addition [No workers' comp.insurance 5•. We are a corporation and its 10:Q Electrical repairs or additions required.] " ' officers have ekercised their right of exemption per MGL 11.❑Plumbing repairs or additions 3.❑ I am a homeowner,doing all.work g p c. 152, 4 ,and we have no myself.[No workers.' comp. §1O 12.�Roof repairs insurance required.]t employees.[No workers' 13.[]Other comp.insurance required.] *Any applicant that checks box#l must also fill out the section below showing their workers'compensation.policy information. ' t Homeowners whosubmit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-convectors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees.,.Below is the policy and job site' information. _ n Insurance Company Name:�i�/ .��ia r��_�� I �zl�r1 -�A1A �� & 1� ✓q'�G l��11 Policy#-or Self-ins.Lic.#: L/]C' —rlrJ H Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation po'cy declaration page(showing the policy mum er 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 cemfy unde the pains and penalties of perjury that the information provided above is true and correct Signaturei. Date: o t Phone#-. SOS- 427 Official use only. 'Do not write in this area;to be completed by city or town official City or Town. Purnit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Citynfown Clerk 44(Electrical Inspector. 5.Plumbing Inspector 6.Other + Contact Person: Phone#:°