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HomeMy WebLinkAbout0080 ARBOR WAY �� f�Rboz WSJ � -- - —,.. -- �- - � Town of Barnstable Building e Post This Card So That rt tsU�sible;:From.ttie Streets;A roved Plans;Must be Retained on>Job an`dthis CardMustbe Kept s BARNSTA63 163 BLB, ,. PostedUntil Final InSpectian Has Been Made F • Where a;,Cert�ficate,of'Occu anc is Re u�retl„ such°Buildm shallNot::be Occu red,until a Finatlnspection,has beenmade Permit Permit No. B-19-527 Applicant Name: Anthony Capelle Approvals Date Issued: 02/21/2019 Current Use: Structure Permit Type: Building-Foundation Only Expiration Date: 08/21/2019 Foundation: Location: 80 ARBOR WAY, HYANNIS Map/Lot: 289 132 _ Zoning District: RB Sheathing: 1 _ Contractor Name NORTHEAST FOUNDATION Framin 1 Owner on Record: SIMMONS,ALAN J& DIANNE E i � < g REPAIR LLC DBA DBA RAMJACK Address: 80 ARBOR WAYS r 2 x NEW ENGLAND HYANNIS, MA 02601 �` Chimney: o Contractor License: 185517 Description: Foundation stabilization rwt Est Project Cost: $35,000.00 Insulation: Pro ect Review Re j q: � PermitFee: $135.00 Final: u< � b Fee Fa'id: $135.00 � x Date. 2/21/2019 Plumbing/Gas % � � ) Rough Plumbing: Final Plumbing: Yu Building Official Rough Gas: _This permit shall be deemed abandoned and invalid unless the work authonzed'by�ths permit is commenced within six mg nt issuance. Final Gas: All work authorized by this permit shall conform to the approved application and theapproved construction document or whiclitFis permit has been granted. All construction,alterations and changes of use of any building and structures shall be in with the local�zon ngby lawsand codes. This permit shall be displayed in a location clearly visible from access street or oad and shall be maintained open for publie`mspection for the entire duration of the Electrical work until the completion of the same. ' R * Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Bu ding and Fire Officials arProui�e�don this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: g 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final:* Building plans are to be available on site 4 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable *Permit# 6_A/4 7 �;:_3 Expires 6 months from issue date Regulatory Services Fee s.►xxsrnsLE. 039. A,� Richard V.Scali,Directory �aW Building Division _ ..JUN 1 2016 Tom Perry,CBO,Building Commissioner, 200 Main Street,Hyannis,MA 02601 10 1M, �y'VS p p g� www.town.bamstable.ma.us nLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY. Not Valid without Red X-Press Imprint Map/parcel Number Property Address �Ja Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 toff Owner's Name&Address L Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) , ❑Workman's Compensation Insurance Check one: f ❑ I am a sole proprietor d� I am the Homeowner ❑ I have Worker's Compensation Insurance U N 20 20115 i�` r, Insurance Company Name F�tt 1V i 11alld[�1 (l� f 16, ��L% sfr5uc Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit- Permit Request(check box) ❑ Re-roof(hurricane'nailed)(stripping old shingles) All construction debris will be to ❑fie-roof(hurricane nailed)(not stripping. Going over existing layers of roof) [ Ra-side eplacement Windows/doors/sliders.U-Value (maximum.32)#of windows NOT sua r- .19 t6t ' N d 7- #of doors: ❑ 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: Prope caner must sign Property Owner Letter of Permission. A c t e Improvement Contractors License&Construction Supervisors License is r uir SIGNATURE• Q:\WPFILES\FORMS\building pyfrnit forms\EXPRESS.doC Revised 040215 u Town "of Barnstable Regulatory Services r 9 okT Richard V.Scali,Director 1, Building Division " • � �* Tom Perry,Building Commissioner x 1639• 200 Main Street, Hyannis,MA 02601 D A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 F _ HOMEOWNER LICENSE EXEMPTION DATE: _ / Please Print 7 l JOB LOCATION:. /q4?02 wdY Y1f/vA S number L _ street village "HOMEOWNER":' /( �7� �J h'I/�B�S ����'��✓ name �j home phone# work phone# CURRENT MAILING ADDRESS: Met 2 ci / state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as su ervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- 'family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more,than one . home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building eU rmit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State#Building`Codeiand`other applicable codes; bylaws,rules and regulations. The undersigne "home er"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures d e ents jind that he/she will comply with said procedures and requirements. Signature omeowner ,r Approval of Building Official Note: Three-family dwellings containing 35,000.cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness,often results in serious problems,particularly when the homeowner hires unlicensed persons: In this case,our Board cannot proceed against the unlicensed person as-it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community.: J 5 Q:\WPFILES\FORMS\building permit forms\,EXPRESS.doc Revised 040215 c� snxxsresca, Town of Barnstable �prED MA'S Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508=862-4038 Fax: 508-790-6230 ' Property Owner Must Complete and Sign This Section If Using A Build r I, 4��,1,0 ��'I6 Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authoriz by s building permit application for: (Addre s of Job) S ture of Owner D\L�icense Print Name If Property Owner is a plying for permit,please complete the Homezemption Form on the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 27ie Commomveakh of-V assadirrsetts Depaakrrent o ndrsstrzal Acciderds t� Q ie oflmwsfigadvns 600 Washington Street .. y Boston,AL4 02111 ' rvivi niassgrxv/dia Workers' Campensation Insurance Affidavit$mldersICuntractars)EIecfricians/Phambers Applicant InfGnnatian Please print LeQib -Name(j3.»sin.essU-gtnfzafion&dMdaa1) q6 !�/ �1 �5 r ln,,f A 5 .—Phone ------- - - AZ•e you an employer?Checkthe appropriate box: Type of project(required): wit I am a general contractor and I 1.❑ I am a employer with ❑ 6_ ❑New consfzucton: employees(full and1br part-time).* r have itiredthe sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheen 7. ❑Remodeling ship and have no employees These sub-contractors have $. ❑Demolitioa wo Dina far me in any capacity. employees and lmre workers' jNo workers' comp.insurance comp.met*ranv�2 9_ ❑Building addifiotinsurance required-] 5. ❑ We area corporation and its 10_❑Electrical repairs or additions 3. I am a homeowner doing all work o Hem have-exercised their 11_❑Plumbing repairs or additions uryse1€[No workers'i'omF right of exemption per MGL insurance regmired]1 c.152,§I(Ch and we have na L_❑Roafrepa:rs employees-[No workers' 13_❑Other comp_insurance requ red_j' Any also fillout the sectioabelow showing ihe¢wodkere compenudoupaIiiey infbm=Uan_ i Hameowners who submit This dfidnrft in Exca h,;they are doing 4 wc*and Ihuen hire autside contractors amst snhmit a new affidavit indicating sadi fCamractoas tfist cberlc ibis 6mt must attached as additional street shorting the n2me of the sub-caat wtoo-rs and state whether or not those entities have emVloyees.If thesub-cant actaishase a aployees,they=Lstpmride their workers'-amp.policy number- I arrt art ettiplay�rr t7cat i�rprotztiirtg wuarirers'catr ertsa(iatt lutsuratice jfor at}*¢nrpla}�ees 13etoty is tltapoacy and job Sta informaffon. Insurance Company Name: Policy#or Self-im Lic_# lxpiratioaDate: Job Site Address s CitplStatel,sp: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date.. Failure to secure coverage as requiredunder Section 25A of MGL c 15 can lead to the irnposinon of criminal penalties of a fine up to$1,O 00 andlor one year imprisonment as well as civil penalties im the form of a STOP WORK ORDER and a EM of up to$250_00 a day against the-violator. Be ad-t ised that a copy of this statement maybe forwarded to the Office of Invesfigations of the DIA for insurance-coverage verification- I da hereby cerh'y a) tt's and penaYes ofpcgrmy thatAa info rma&n prmirt¢d abm is��burye mid carrect Sit�tature: Date: Phone ik rj7/0 7Q G ` (06 . ajokial us¢curly: Do not write in this area;to be cotnpfeted by city arto n qffidaL City or'Town: PermitlLicease# Issuing Authority(circle one): . L Board of Health 2.Bu l ing Department 3.CityJTovm Clerk 4.Flect ical Inspector S.Plumbing Inspector. 6.Other Contact Person: Phone#: laformation and Instructions M�cca_r-huseits General Laws chapter 152 recces all employers Yn provide workers'compensation far theg empIoyees. p tO ihiS Statrite,an elripinyee is defined as_`°_.everypersonm the service of another under any coact of hire, 1 express or implied,oral or writtr: ." `' Au �Toya is defraed as"an individual,parfnessb�,associai�on.CWrpoi�tlon or other legal entity.or ray two or mole of the foregoing m a joint a aEerpIIse,and including the legal represemaiives of a.deceased employer,or the receiver or trastee of an individual,paxtamshTp,associafion or other legal entity,employing employees. However the owner.of a.dwelling house having not more than three aparhneats and who resides therein,or the occupant of the - Ma' ' dw-e house of another who employs persons is do mamtenauce,consha'hon or repair work on such dwag house or on.the grounds or building appudanaitthemto shallnotbecanse of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also sides that."every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings is the commonwealth for any applicant who has notproduced accepfable evidence of compIianc$with the insurance.coverage re aired." Additionally,MCr�L chapter M, §25C(7)states'Nt ther the commonwealth nor auy ofits political subdivisions shall eater into any contact for the performance ofpublio work until.astable evidence of compliance with the i asun ce._ requirements of this chapter have been presented to the contracting anfhority." AppIican-b Please fill out the workers'.compensation affidavit completely,by cherkmg the boxes that apply to your situation and,if necessary,supply sob-contractor(s)name(s), addresses)and phone numbers) along with theircerffficate(s) of nanuaa ce. Limited Liability Companies(LLC)or Lfi,nitedLiabllityPartaexships(LLP)withno employees other than the members or pm tams,are not rbgaiied to carry workers' compensation thsunmoe. If an LLC or LLP does hate employees,a policy is required-BeadvisedthatthisaffrdayitmaybesubmittedtotheDepartmentof Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should .. ` be retuned to the city or town that the application for the pearit or license is being reguesbA no t the Department of Tnrhact,iai 14 ccidentg. Shouldyon have any question regarding the law or ifyou am req�ed in obtain a workers' compenSaEOn.policy,Please call the Departmentnu at the mber listed below: Serolf- sined companies should enter they selfga�ce license number on the appropriate line. City,or Town Officials t - Please be sure that the affidavit is complete and priined.legilily. The Department has provided a space at the bottom of the affidavit for you to fM out in the event the Office of Investigations has to confiact you regardm g the applicant Please be sure to fill m the pen it cease number which will be used as;a reference number. In addition,an applicant that must submit multiple pemitllicenae applications in any given year,need only submit one affidavit indicating current policy in fb= ation(if necessary)and under"Job Site Address"the applicant should write"all locations in (G'tY 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 file is on e for furore Pmmlits or licenses. A new affidavitmust be filled out each year. hew a home owner or citizen is obtaining a license or permit not related to any business or comet ea�ial venfise W (i-e. a dog license or permit to bum leaves etc.)said person is RIOT required to complete tors affidavit The of of Inves6g3frons would hke to thank you in.advance for your cooperation and should you have any questions, please do not hesitate to give us a ca1L The Department's address,telephone and fax number_ 'Fl> CGMjnMWeRjtfj of MassachuseM . 7�egarb�aent cif Izid�sirial Arci��nts , Office Q.f Ito+ afiO= ngtan B MA U2111 Tf,-1.4 617' -4900 cxt 4€6 or 1-RW-MA CAM Fax 617'27-7M Revised 4-24-07 Town of Barnstable o� BARNSPABLE Regulatory Services 7 MASS. 1639. Building Division RFD MAC 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection N Location _ ftf�-Ky►L Permit Number Owner Builder One notice to remain on job site,one notice on file in Building Department. The following items need correcting: 1M y S 7— G AA-s PA' 8 c. e Please call: 508-862-4038 for re-inspection. Inspected by Date_J 6 / _.-., �.- , �.. ..- .. .,,.+.-ra...,,,. +'+.,+.,-r^--.".a. �e d rv�: .+-r a. -....*'a�,r„e..� w�:.s .t*... ,..a -'•- ..-4 '�^'.'+...,..+. w, _• �. . � ,w Assessor's map and lot number " �. 47 ....... � �� � Sewage Permit number .........................�................................. TMET��y TOWN OF ,BARNSTABLE I A$H9TADLE, i 16 BUILDING INSPECTOR t APPLICATION FOR _PERMIT TO TYPE OF CONSTRUCTIONS�,, x....... ` . ?. .*.... ..... �! `!!...�.°'. ................................................... ' ............... . ..... . .... ........ 19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Locatian ....... r' -7� _i. f/ l ..r .. of a✓r���h .�................................... !....... .. .................... ............................/:, ...........�,. �. ........ Proposed Use 4. 3.:. c .'... ..c:.......................................................................................................................... ................. ............ Zoning District .............r{!... ...............................................Fire District .............,All, . I i?. .: ................................... Name of Owner��. e.....11��'*v.. `� ....f.. .' .....AddressU. ..... ...�:!. .. � � .':.� f:........... (,,11 •%�/„lam/ �.. Name of Builder.¢.....,*t......r� � ....Address Al lr... Name of Architect qnt!�','Aq.j...... f..............Address ................................................................... r .............. Number of Rooms ................... .......................................Foundatio.n ....:,......:......,,,. ................................................ �t r� t'/ Ia r � ` Exterior ........... .:.. ...... `' / ,.t. �' 4 ..................Roofing %4,E-��y / �...................................... , i ......... Floors ..... Interior .... a} r H P A...................................................... //....... ...... .i, ............................................................. �. ......... HeatingL(�.� r. ►+, fr^...........................:.........Plumbing .................................................................................. r� Fireplace ..... .�� +�".d.f�............................................................Approximate Cost ....................a`..�.�.�.v�i/................................. Definitive Plan Approved by Planning Board ________________________________19________. Area ........ <. -�?. ..............:. Diagram of Lot and Building with Dimensions f g 9 Fee .......e......:...�.......'.rZ-�............. SUBJECT TO APPROVAL OF BOARD OF HEALTH R� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 1"9 1 ��4 , 7�ms Name ........... .. ...: -T- Jale Realty Trust A=289-132 18880 1 1/2 story, No ................. Permit for .................................... single family dv'e—tl ing ............................................................................... Location OQ Arbor Way ...... ..... ........... ......... ................ ....................Hyannis....................... .................. Owner .......Jale Realty Trust, ........................................................... Type of Construction ........f.ram.e........................ .................................................... 0. 123Plot .........................k. Lot ............ De\-cmber 17 76 Permit Granted ........................................19 Date of Inspection ............. ....................19 Date Completed ... ...................19 PERMIT REFUSED ....... .. ..... ............. .............. 19 ............. ..... ...... . .. ............. ......................... ............ . . . ............ ... ......... .......................... ..... ............ .. ...... ..... . .... .................................. ...... ............ .............. ........ ........................... Approved ...................................... 19 ............................................................................... ............... .............................................................. ' r C IV .�,�t `Y✓— µi, 5 O tt-�1Ln I 44s.9)44 . �,� ��3-ti r jet�-�t.-�N'• .dam:0— � Z , °1 Arl q�)-;M d ..�#-�"�•ate ��'��.•,9/ t � ,. � �,�'` Assessor's- map and lot, number ... ......�.�.. .. ...... ,44k /O , • - - SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE SeWage`Permit number .......................... .............................. WITH ARTICLE II STATE - SANITARY -CODE AND TOWN yo�'If NE ro�o TOWN- O_ F B ST 1 L E- Z ,BASH9TULE, • C "6 9 RUYILDING INSPECTOR ,off 0 Mpy a• APPLICATION: FOR PERMIT-TO �...:( (Z/ TYPE OF CONSTRU �CTIONiy• �... •. ./e�*/.../ ...... . � !''.' .!"l:.e. ............................... �- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby appliiees for a permit according to the following information: Location .......4.A..X..........a...y...................... .......... ...,/�..yf.�2.C1/.., .................................. ProposedUse ......... .e4v/.•.Axe R....7..c. ................... ... ............................................................:.......................... Zoning District ........... ...lile. ......:........................... .....Fire District ........ .��..�l.,l.?.�.,5......................... ..... �/ / .....Addressce. Name of Owner . ....4�............ �'.a�.. ..i..j...... ............. I , Name of Builder .J. e..d.....�..�.�.�.....................Address �l.4.......... ........y�.. I'.�! .............. Name of Architect.S`JCry!!.4. ...... 4., V..0............Address .....j..................................................................... � Number of Rooms ..................... rr.......................................Foundation ..!. ... .U..!'.f°. .(. .4..e7. /^ ..I-le.............. Exterior ........... lL(®..o.C!........v. )l../7 ../��.'/C.................. ........ .. .� �'../7....................................... Floors .........................................................Interior .... HeatingW. .Y...h^........... 1..../�`.....................................Plumbing .......................,.......................................................... Fireplace .:... .� Ir`1..G .................................... ...........Approximate Cost...............r. . ?.�..Q.QU... ........................... Definitive Plan Approved by Planning Board ________________________________19________, Area ....... �........... Diagram of Lot and Building with Dimensions Fee .......� ........ SUBJECT TO "APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and 'Regulations of the Town of Barnstable regarding the above construction. Nam •. . ........... rvS <L Jale Realty Trust No'•18880° Permit,fob 1 1/2 story' .............. �. . sin�le famil.. dwellin$....................... ................ 0 i Location..V Arbor Way.............• .......... ...................... 'f ................... ..... s........................................ t , Owner Jale Realty Trust f ................................................................. 1 flame Type-of Construction .......................................... r • l ........................................................ ................... t _ .,Plot .....- Lot ................................ Permit Granted December .17 19 76 t Date of Inspection .......... Date Completed .................9 PERMIT REFUSED ............................................................... 19 ............................................................................... F .......................................................................... ..................... ........................................................ 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"'+ ' `� ^,4 .•., . 3. .%c. vf','Nc a:i, € k�.xm3��.,eav :v�d.�..n`.k"Lr.."^aSa"tuf_c y't° _,z sue_ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / Parcels Application # Health Division E Date Issued Conservation Division Application F y " Planning Dept. Permit Fee ✓ "00 Date,Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 80 A-62 Bad uv Village f� A- JO' 5 Owner L � S� "VVC0 V 5 Address 60 AyLsof W-A Telephone Permit Request �'eVLOI -� Or— LA)1►4 K bA-vc A&r--� bG c.k-, �e/14Ue�-- �'� �,A•G�- �(/✓l.(�IOS�/c/Y! 1C� /�/P" �G'-� YO�� /r� �O A/N-CG�Uh�/�!J IV/ 77 1ijJN5'�. � x/`,s�'"W� ' s'l,•aE,t {p S/I f7'�,c /�iRc� xrj°f+.� p a.+��lcvw,?`�.Q_, /' Squarefeet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District A6 Flood Plain Groundwater Overlay Project Valuationk6s_D.orConstruction Type Lu 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 O�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 Number of Bedrooms: existing —new Total Room Count (not includi g baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas . 16 Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Bar ,U existing LJ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)- Name W5 s���'`'SG Telephone Number �7� 7 T Address Z7-- License# Home Improvement Contractor# Email Worker's Compensation # � Jr438� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �aavcc 16 F05PIC( A-1Z elk SIGNATURE DATE I� FOR OFFICIAL USE ONLY APPLICATION# ` DATE ISSUED MAP/PARCEL NO. " r ADDRESS VILLAGE I, OWNER I' DATE OF INSPECTION: FOUNDATION 3 FRAME INSULATION 'F FIREPLACE fY ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. L. f •*< - Ri-'t d.•Y ..Kra f'. 'jr • ' ,. ."L�:Y � "-. " � _ � ,Y.' gyp..... r.' � d , - �+��� �>�°�"'��"�'�.���. q'�,.9 'a J.it �l'a•�F�.. .. L All ell Ar s �. y Aug 241601:09p Hyannis California Closet 5087782666 p.1 Restoration Services Inc. fire.Smoke.Soot;Water&Mold Remediation Services Cleaning . Deodorimition . Reconstruction Specializing in Fire Restoration —All Work Guaranteed Access, Authorization and Direct Payment Request Form (we) authorize WHALEN RESTORATION SERVICES to perform work as per estimate at property located at 80 Arbor Way, Hyannis, MA 02601,to repair damage caused by weight of ice, sleet,&snow. As owner(s) of this property, I (we) understand that I (we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work and accept responsibility for payment upon completion. I (we) authorize and direct my Insurance Company, Mass Prop Ins Und Assoc, Claim #337608, Policy#0942645,to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim specialists,for doing this work and to that extent I (we) assign the benefits applicable to this loss.to WHALEN RESTORATION SERVICES. I (we) acknowledge receipt of a copy hereof. J J l�1 DATED OWNER STONED OWNER WHALEN RESTORATION REP. SIGNED 2-2 American Way.Soud,Dennis.ILIA 02660 Phone:(508)760-1911 . Pat:(509)7G0-9995 . 1-500-344-_1393 E-Mail:I:,;aelmaniu)w•hatenrestoraii ons.com_ Weh Page:http://,vww.tivhulcnrestorutions,cum Massachusetts -Department of Public Safety � ,,,,,,,,norcvealt/.a��/ljefvrue/u;e Board of Building-Regulations and Standards Office of Consumer Affairs&BusinessRegulation ulatioa Construction Supervisor ' _,=,POME IMPROVEMENT CONTRACTOR License: CS-074928 r _ Registration: I1 9244 Type: ```Wit.r r.c „� - JwExpiration -7/30/201:7 Private Corporati0, WMUAM wHALXN <_ �', t 122 POND STREET Whalen Restoration Serviceslnc� , BREwSTER MA-0263i Ys t J� William Whalen q3 r 22 American Way r¢< �-- v Expiration p South Dennis,MA 02660 Commissioner 08/10/2016 Undersecretary UnrLstricted-Buildings of any use group'wl ich s, a. 1 License or registration valid for individul use only ' contain less than 35,000 cubic feet(99lrn Of t L r- before the expiration date. If found return to: enclosed space. r _ ,l .,,. t Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. ., 4 Not valid without signature ' For DPS Licensing information visit: www.Mass.Gov/DPS 1 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991m3)of License or registration valid for individul use only. before the expiration date. If found return to: enclosed space., , Office of Consumer Affairs and Business Regulation r i 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license.;( • ( �_ For DPS Ucensing Information visit: www.Mass.Gov/DPS.. Not valid without signature l Fo:TheresaTo:K, Spelman, Whalen Restor/Alan Simmons Certifi 09:56 08/12/15 ET Pg 3-4 Client#:245206 WHALENREST A .O� CERTIFICATE OF LIABILITY INSURANCE DATE 15 d/12/2015 THI CERTIF ATE 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 lieu of such endorsement(s). PRODUCER John Powers HUB International New England o-MAR. Ex):508-945.7866 (glc,No): 866.323-0182 205 Orleans Rudd ADDRESS: North Chatham,MA 02650 INSURERS AFFORDING COVERAGE NAICs 508945.0446 INSURER A!Arbella Protection Ins Co. INSURED INSURER e; _ Whalen Restoration Services Inc.; INSURER C: Whalen Services Inc, - — - 22 American Way INSURER D: -- South Dennis,MA 02660 . INSURER E: 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. _ INSR ADDLFSUB POoLICY EFF POLICY EXP — LTR TYPE OF INSURANCE IN SR _ POLICY NUMBER MMiDD1YYY1� (MMIDD ^ww LIMITS A GENERAL LIABILITY 10200166T8 4101/2015 04/01/20110 EACH OCCURRENCE $1 000000 COMMERCIAL GENERAL LIABILITY V I!� EjiENTrED nce $1 OO OOO CLAIM&MADE nOCCUR MEOEXP(Any one person) S5 000 PERSONAL BADVINJURY $1,000000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPIOP AGO S POLICY FO� LOC S A AUTOMOBILE LIABILITY _ 1020016678 410112015 04/01/201 ED�a ddeOISINGLE LIMIT 110001000 _ ANY AUTO BODILY INJURY(Per person) $ ALL OS X AUTOSSCHEDULED BODILY INJURY Peraccidenl $ AUTOS AUTOS 1 ) X HIREOAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per s"Idenl S A UMBRELLA LIAR OCCUR 4600055369 0410112015 04/011201C GACI I OCCURRENCE $1 OOO 000 EXCESS LIAR CLAIMS-MADE AGGREGATE. $1 00O 000 OEO I X RETENTION51OD00 _-- _ $ WORMERS COMPENSATION WCSTATU- OER EMPLOYERS'LIABILITY ANY PROPRIETORIPARTHER/EXECUIIVE YIN E.L.EACH ACCIDENT q OFFICERIMEMBEREXCLUDED? NIA (Mandalory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is required) Project Address:80 Arbor Way,Hyannis, MA 02601 CERTIFICATE HOLDER CANCELLATION Alan Simmons SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SO Arbor Way ACCORDANCE WITH THE POLICY PROVISIONS, Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 01988.2010 ACORD CORPORATION,All rights reserved, ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S14363161M1380122 TC002 Rightfax N1-1 8/12/2015 8 :09: 57 AM PAGE 2/002 Fax Server i� � s CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) T. IFICATE 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 ACONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE HOLDER.PRODUCER.AND THE CERTIFICATE IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to he certificate holder In lieu of such endorsements. PRODUCER CONTACT NAME: HUB INTERNATIONAL NEW EN PHONE FAX 265 ORLEANS RD (A/C,No,Ext): (A/C,No): E-MAIL NORTH CHATHAM,MA 02650 ADDRESS: t 77GKF INSURER(S)AFFORDING COVERAGE NAIC p INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY WHALEN RESTORATION SERVICES,INC. INSURER B: INSURER C: INSURER D: 22 AMERICAN WAY INSURER E: SOUTH DENNIS,MA 02660 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THISIS TIFY 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 LR SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DD\YYYY) (MAADD\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) U LALIAR OCCUR EACH OCCURRENCE $ LIAB CLAIMS-MADE AGGREGATE $ IBLE $ ION $ $ A WORKER'S COMPENSATION AND X WC STATUTORv OTHER EMPLOYER'S LIABILITY Y/N US-5B894542-15 04/01/2015 04/01/2016 LIMITS ANY P ROPE RITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION ALAN SIMMONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 80 ARBOR WAY BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL B DELIY D IN ACCORDANCE WITH THE POLICY PROV HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE , ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORP RA r ghts reserved. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite.100 Boston,MA 02114-2017 www..m.ass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Amlicant Information Please Print Legibly Name(Business/Organization/Individual): Whalen Restoration Services Address: 22 American Way City/State/Zip: South Dennis, MA 02660 Phone#: 508 760 1911 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 25 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 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.❑ 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 t2.❑ 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. :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 i,the policy and job site information. Insurance Company Name: Ace American Insurance Company Policy#or SelPins.Lic.#_UB-5B894542-15 Expiration Date: 4/1/16 QQ� Job Site Address: 90 /G�`�0 g— w _City/State/Zip: n�f 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. 1.52 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$250.00 a day;agatnst the violator. ;Be advised that a copy of this statement maybe forwarded to the Office of Investigations of.the DIA for insurance :coverage verification. I do hereby certi under the 'a and penaldes ofperjury. that the information provided above is true and correct AA Si nature: Date N� =Phone#` / l ro/ 3 Official use only. Do not write. this area,to be completed by city or town official City or Town Permit/License# Issuing Authority(circle one) 1 Board of Health Z Building Depactment.3.City/Town Clerk 4.Electrical Inspector 5.Plumbing:Inspector 6.0ther Contact Person Phone M p I I ck TI- i T Town of Barnstable -Fe xm t*0 0 Fapim 6 nw Is from issue Regulatory SerAces Fee MI MITThomas IF.Geiler,Director MAY 0 5 2015 Building Division Tom PeM-,CBO, Building-Commissioner. TOWN OF BARNSTABLE 2001,46nstreet;$y=is.7vrA02601 www town b amstab le.=.us Office_- 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RE+SIDF.,,NT A.L ;�J LVoz Valid svitjtOitt REfI X-PrESS Ils�ff77tt Map/parcel Nttmb-.. PropettyAddress,Aes idersial VaIL,of Work S 1Vfini�a�nxnfee of S35.00 forwork underS6000.04 " Owner's Name&Address Ak Cf Conrra«or's Namei(fi�� Home Lmprov=ent eonrractorLicense T(ffapplicable) 1053 COnsmxtionS'4=%,isor'sLi-,nser(ifappkable) workram's Compensation Insurance --- Check one: ❑ I ama sole proprietor amthe Homeowner I have Worker's Con3pematix Insurance IxI�CompanyName [ S](,�,'r� � �j(.���{�(r� Co I Workman's Como.Policy- �� EIVA01 Copy oflusuraace Compliance Certificate must accompany each permit. Permit e (check box) P t -roof(lwrrieanenailed)(strippia---oldsbiatr_]es} AllconstmctiondebriswMbetakento r Y ❑Re-roof(hur-icane nailed)(not spin! Goft over layers ofzoof) Q Re-side Q *laceme=Windows/doors/sliders-U-Value (m-%-imm1.35)#ofwindows - ofdoots: ❑ Smoke/CarbonMonoxide,detectors 4 floorplans marked with red Sand inspections required. separate Mectrical&Fire Permits required. "iGhce reouired I-==afthis pamk does not exempt eoapbaace n ah o3�c town d regn�as,ie Historic.Coasernzia ac. ***Note_ Property Ownertr=rsigpiopextyOwnerLetterofPeamission_ A copy of e HOme ImprovementContracrois License&Construction Supervisors License is required. SIGNATURE:. C-\UsrrsXd--coMk'-4ppDamLocaLMicrosofdViiiadows\T=Vormy FQs\C=e=0tr1*ol-%M76SDVAMUpR S-&c Revised 061313 -J The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street w" Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le Al Name(Business/Organ' ation/Individual): r Address: 'O X I --t City/State/Zip: _jt jq Phone#:_�_0 ��fa�- a9a Are On an employer? Check the appropriate boa: Type of project(required): 1.t9 I am a employer with 10 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. 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: (�i;4 t J L aa �(,�,�(� 1 ll-X, Co a Policy#or Self-ins.Lic.#: WC V 067 T DOa© I _ Expiration Date: (�l(L �` Job Site Address: /J City/State/Zip: /4/ Attach a copy of the workers'c9mpensation 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 ofperjury that the information provided above is true and correct. Sign Date: afore: q a? 1 Phone 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#: FRASCON-01 PAAS CERTIFICATE OF LIABILITY INSURANCE DA9TE 1291DDlY2014 9/29/ 4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA71ON 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(ies)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 lieu of such endorsement(s). PRODUCER {508)676-0309 CON�("E cT Ashley Paiva 375Airp Insurance Agency,Inc. AICINo EXt:508-689-2713 FAX 508-324-4553 375 Airport Road Fall River,MA 02720 AODREss:APaiva Viveirosinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Granite State Insurance Co INSURED Fraser Construction LLC I SURERB: PO Box 1845 INSURERC: Cotuit,MA 02635 INSURER D: INSURERS: IN SURER 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR TYPE OF INSURANCE LTR INS WVD POLICY NUMBER MNIfDO E I MMIDD P LIMITS GENERALLIABILITY I EACHOCCURRENCE` S COtv1 Jh9MERCIALGENERALUABIUTY I L ( PREMISES Ea occurrence S CLAIMS-MADEOCCUR MEDEXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ GERLAGGREGATE UMrr APPLIES PER PRODUCTS-COMPIO?AGG $ POLICY r PRO- J LOC $ AUTOMOBILE LIABILITY CO 4 S NG Uh:11T Ea acddent} $ ANY AUTO BODILY 114JURY(Per psrson) S AUTAUTOS OWNED SCHEDULED BODILY INJURY(Per ar_idenq $ 1 NON-OWNEC I E HIREDALROS AUTOS 1 (PERACCIDENT) $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTION S $ WORKERS COMPENSATION 111C STATU- OTH- AND EMPLOYERS'LIABILITY X TORY LIMITS ER A ANY PROPRIETORIPARTNERIEXECUTIVE YIN WC009930601 9126/2014 1116/2/11 E.L.IACHACCIDENT $ 500,000 OFFICERIMEMBEREXCLUDED) � NIA (Mandatory In NH) E.L DISEASE-EA Eh.?LOYEE $ 500,000 Ifyes,eescribe LinderDESCRPTION OF OPERAIlONS below E.L.DISEASE-POUC"UhltT $ 500,000 DESCRIPTION OF OPERA71ONS I LOCATIONS IVEHICLES (Attach ACORD 1011,Additlonal Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable Building Division THE EXPIRATION DATE -THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601- AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD lvlassachusakFS .tJepa�Wen(of Pubtic Safety 800rd of Bullding Regul<•ttions and Stancla(c is Cb�istructtuu$uitw'ti•istn• J License: C$U97688 .'�r I ANCRRASFR, 1041`WIIVN MW 1,A � BAST I'ALTvIOYITkX 1 t_rplo.itfan ' Commissloner 06/07/2015 _ a 71 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 112536 Type: DBA Expiration: 3/23/2017 Tr# 263597 FRASER CONSTRUCTION CO. DEAN FRASER P.O. BOX 1845 CO T UIT, MA 02635 Update Address and return card.Mark reason for change. sCA 1 0 20M-05/11 Address 7 Renewal CI Employment Lost Card �ze cpa����c�uuealG/o- � /�ica:rac/uaeGZd rLicense or registration valid for individul use only. Office of Consumer Affairs&Business Regulation b y. w ( IOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 112536 Type: Office of Consumer Affairs and Business Regulation eExpiration:. 3/23/2017 DBA 10 Park Plaza Suite 5170 � � .Boston,MA 02116 , FRASER CONSTRUCTION CO. DEAN FRASER 104 TWINN VIEW LANE E FALMOUTH,MA 02536 Undersecretary Not valid without signature Q f Fraser Construction, LLC 31 Bowdoin Rd. Mashpee, MA 02649 Email: info@fraserconstructioncapecod.com j www.fraserconstructioncapecod.com FAX 1-508-428-0123/ PHONE 1-508-428-2292 HILL#,112536 CS#97668 RE-ROOFING PROPOSAL Date 4 28 15 Name Paula Kenworthy . Email -p.kenworthy@comcast.net Phone 508 `771-6598 Job Address 13 Megan Rd. Hyannis 02601 FRASER CONSTRUCTION hereby proposes to perform.the following services in`a neat, professional manner in accordance with the manufacturer's specifications and local building code. CertainTeed Shin le Options Good` ' ;Better Best Shingles Landmark =_ Landmark Pro Landmark TL Algae Resistant 10 years 15 years 15 years Wind Warranty 130 MPH 130 MPH , , 130 MPH Weight/square 240lbs 260-270lbs 305lbs ------------- Shingle design Two-Piece `Iwo-Piece Three-Piece Color Palate Standard Max Definition Max Definition Valleys — se cut ` -Closed cut _ Open copper Investment $4,125 $4,650. $5,600 * All above shingles quoted with,CertainTeeda50 year non prorated 4-Star warranty Shingle Selection: 416"V Color: YJSa-,/�J 5, 1V.V CE_1nitial: Trim: Remove right side rake boards and replace all old rotted sections. Price includes electrician removing power and resetting. s .< Price: $350 Initial• Ironclad, Lowest Investment Guarantee Any contractor can price your roof for less by cutting corners and utilizing cheap materials and unskilled labor. It's important to know what is and isn't included in the roof you choose for your home. You don't want to be left with an inferior roof built by an untrained labor force. That's why Fraser Construction offers the Ironclad, Lowest Investment Guarantee. Not only do you receive a state-of-the-art roof built by highly skilled craftsmen, you also receive peace of mind knowing you obtained your roof for the lowest investment possible. If you later discover a comparable roof for less money than the one we constructed for your home, we will pay you the difference plus a $'50 bonus. All we ask is the comparison be "apples-to-apples." "We have no quarrels with-.the man.-with,lower prices,for he knows what his product is worth." PAYMENTS ARE DUE IMMEDIATELY AFTER JOB COMPLETION. 1/3 initial payment, remainder to be paid upon completion Payments accepted are:' •�t CASH - CHECK -,MASTERCARD,."-VISA- AMERICAN EXPRESS- *Any payments not immediately paid upon job completion will be charged 0.005%for every day after the given 5 day grace period upon day,of job completion. * Please note that roof prices reflect removal of(1) layer of existing roof unless otherwise indicated in contract. If additional layer or layers are removed additional charges will be assessed. Possible Extra-After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation is not up against the plywood sheathing preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then re-installing the plywood. If needed, this would be charged for as an extra at the rate of$6.00 per panel including Materials 8s Labor. There are 6 Panels per sheet of plywood. 4 Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$75.00 per hour, plus 20% mark-up materials. b ' FRASER CONSTRUCTION guarantees the labor for LIFETIME of roof. FRASER CONSTRUCTION guarantees the shingles against Blow-Offs for 15 years. Please note that all pricing is contingent upon current market pricing. If contract is not accepted within thirty days of date of proposal, change in price may occur due to deviation in material price. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over,and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry necessary insurance upon.the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: Homeowner Fraser Construction, LLC r Roofing Product-&Installation Details Supply & Install- (Soffit denting) Hick's Ventilated Drip Edge or O" Aluminum Drip Edge with existing soffit vents. Smart vents over white drip edge. Protection against damage to the roofing materials and structure. The most effective system is a balance of air intake and exhaust that creates a uniform flow of air through the attic. This system creates a condition in which the roof temperature is equalized from top to bottom, supplying a uniform air flow along the entire underside of the roof deck. Supply & Install- Ice & Water shield Waterproof Underlayment System (3ft. on eves and valleys, 18" on rakes, walls, and skylights) Ice and Water Shield is a self-adhering roofing underlaynient used on critical roof areas such as eaves, rakes, ridges, valleys, dormers and skylights to protect roofing structures,and interior spaces from water penetration caused,by wind'-driven rain and ice dams. Supply & Install - Surround'Underlayment (A.Typar.Brand)- A smart alternative to felt,it is water's toughest opponent, creating a secondary water barrier that reduces the incidence of:leaks caused by storm damage, wind-driven rain, ice dams and worn roofing"materials. It is.a waterproof, synthetic-polymer material that will protect your home against moisture intrusion. Supply & Install- CertainTeed Swift Start With self-adhering asphalt'starter course on all eves, and,rake edges. CertainTeed requires this product for Integrity Roof Systems.and upgraded wind warranties. Supply & Install-Aluminum & Neoprene,Soil Pipe Flashing Supply & Install- CertainTeed Ridge Vent High performance ridge vent with external baffle. Supply & Install-Pre-Cut CertainTeed Hip & Ridge shingles- Shingle Ridge meets the hip and ridge accessory requirements for the CertainTeed Integrity Roof System which is comprised of_underlayment,.shingles, accessory.products and ventilation all working together.The Integrity Roof System is designed to provide optimum performance--no,matter how bad the weather conditions are.' (As recommended by CertainTeed) Clean & Remove - Debris from work area daily: 3 7�/SIG 3 ` p,IKE rpy, Town of Barnstable *Permit# :70 ti p,^ Expires 6 months from issue date ,,,MS'r„BLE, . Regulatory Services FeeHAM Thomas F.Geller,Director z Building Division Tom Perry, Building Commissioner Office: 508-862-4038 200 Main Street, Hyannis,MA 02601 ..PRESS PERMIT A... Fax: 508-790-6230 JUL 16 2003 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint I uvVN OF BAR N S TA B L E Map/parcel Number Property Address � � (�y -S Residential Value of Work Owner's Name&Address Contractor's Name Telephone Number >" -2 7/ aBS 6 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) -AWorkman'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# Permit Request(check box) - ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows. U-Value (maximum.44) *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. H e provement Contractors License is required. Signature Q:Forms:expmtrg Revise053003 �JCtIL �]- ► ` , - `, i- 7.4 IM h p 1 1 �l �. _ _ir _l► ., ff � _� t � , � � � � alas —�— _ T f-4- 1 ,s• i -�-�- �; -� "- .4._ _�{ _. _F �_� �I -QUO; •f .� . - a 1 1 1 �- ,7 _ 1 _ I _ 1 i t _ _ � '—}�. ,.r-"j' fir— —�--r--.�••---,..��. _}-,- F ._.��..�, ,--t---.�._.�_.....�e _�}_._. �1 - - - t � x �ff 44, Tr I All: i r if 7-1 • t — -