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Home My WebLink About0032 BLUEBERRY HILL ROAD �a � i�b�� ; � � ��, I r 5 ^z?—r Co :7 Town of Barnstable *Permit#V--,) A0 FYpir onths from issue dat� Regulatory Services F 2016 v se 9 Richard V.Scali,Director ®��Fot HNS]ABLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ' Map/parcel Number Property Address d_ e I Road xzar, A aaiO 1 [+residential Value of Work$ �{ 7,°O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address r111t. `�QC l ,es S� r.1 '�aSl��:t 5 � a_ 1W &IwSM4 2ora ric F Ftmovi� Ti'm ws7g Contractor's Name_ IgdmAb �d'me �(lr��xw.crl�i Telephone Number uo Home Improvement Contractor License#(if applicable) /t lS�(('-� Email: Construction Supervisor's License#(if applicable) [L;4orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [ have Worker's Compensation Insurance �_ Insurance Company Name Workman's Comp.Policy# aQd 1 W A05- Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Eyie-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to or_✓ ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #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: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\Decollik\AppData\Local\Micros ft\Win ws\Temporary Intemet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215' � r The Commonwealth of Massachusetts Department of Industrial Accidents .1Office of 1wesfigations 600 Washington Street _ Boston,3 L4 02111 �� n�+tht:nrass got/din Workers' Compensation Insurance AfSda-tit: Builders/Conti•actors/Elec.tricians/Plumbers Applicant Information Please Print Leeibh Ntarise(BusinessOrganizahon Vidual) 9 OM45 Zdx 1;�d vc.M" Address:j�� City/State/Zip' V i//�, MA W 6 L� Phone# goo Arse,you an employer!Check the appropriate box: Type of project(required): &J 1;. I am a employer with 1 _ 4. ❑ I am a general contractor and I' .employees(fall and/or part-time). s have hired the sub-contractors b: ❑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 we in any capacity, employees and have workers; (No workers'comp:insurance comp. T 9. Building addition ' c insurance. wed-] 5. ❑ Are are a corporation and its 10_❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their i LE]Plumbing.repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]r c. 152,§1(4),and we have no � employees.(No workers' 1313 trier comp_insurance required.] *.AM,apphcant that checks box#1 must also fill out the section below showing their workers'compensation policy information. l Homeowners who submit this affidstra indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check,this box must attacked an additional sheet showing the nsme,of the sub-coturactors and state whether or not thm entities have employees, If the sub-contractor have eVloyets,they must provide their worker'comp.policy number. I ant an employer that is prosiding workers'conTensation insurance for my employees. Below is the polio-and job site information. Insurance Company Name: Policy 0 or Self-ins..Lic.#; n/n�lldd 1 /nJ80S��/r Expiration Date.:.S`t W-7 Job Site Address: 32i IyC H /�i l� &Got City/State/Zip: 147",is ✓�A ® 0/ 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 N1GL c. 152 can lead to the imposition of criminal penalties of a fine tip to S1,500.00 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 certTy under the 'ns and penatties of perjurs1 that the information prosided above is true and correct Sitmature: Date: B Phone#: A 31' 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#: 6 Thomas Home Improvements Proposes to perform the following work: Location of proposed work: Mr.Joe Hayes 32 Blueberry Hill Road Hyannis, MA 02601 Date on which construction should begin: May 2016 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work;the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may need to be carried out in order'to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation is not to be considered a violation of this contract. The total cost for labor and materials under this contract: $8,538.85 30 yr.GAF/Elk Timberline HD Architectural shingle(Life Time Limited Warranty) In the event that while stripping the roof we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$45.00 for a carpenter and $30.00 for a carpenter's laborer, plus the cost of materials. -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier,Synthetic roof underlayment, and installed with Timberline architectural shingles using galvanized nails. (Storm nailed) -All new 8 " drip edge and pipe flanges to be installed -Cobra ridge vent to be installed on all ridges -Timberetex premium ridge cap to be installed -A 10 yard dump trailer will be needed on site; and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property 4 NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start; and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5% per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse, and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form, content, and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition, any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Date: 1eA1 /&4 Hom owner Contractor s ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMroD/YYYY) 05/03/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR.ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED;the policy(les)must have ADDITIONAL INSU ED provisions or 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 endorsemen s). PRODUCER CONTACT Mark Sylvia Insurance Agency,LLC Kris Ko reski' FAX PHONE 404 Main Street 508 957-2125 fAIC,NI-, 508 957-2781 A MI RE :mark marks iviainsurance.com Centerville,MA 02632 INSURERS AFFORDING COVEI tAGE NAIC# INSURER A:Farm Family Casualty Insurance INSURED INSURER B: Thomas Home improvements LLC INSURER C PO Box 177 _ Centerville,MA 02632 INSURER D: INSURER E: INSURE F: COVERAGES CERTIFICATE NUMBER: REVISIO, 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 DOCUMEN r 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 ADDLSUBR POLICY EFF MIDYFOP T TYPEOFINSURANCE POLICY NUMBER POLICY D LIMITS A X COMMERCIAL GENERAL LIABILITY 2001X1416 5/1/2016 5/1/2017 EACH OCC RRENCE $ 1,000,000 CLAIMS-MADE X❑OCCUR D PREMISES Ta occurrence) $ 100,000 M RENTED c MED EXP my oneperson) $ 5,000 PERSONAL,&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO JECT ❑LOC PRODUCT •COMP/OP AGG $ 2,000,000 OTHER: I $ AUTOMOsILELIABILITY CO BIN D SI GLE LIMIT $ Ea accide L ANY AUTO BODILY IN URY(Per person) $ OWNED SCHEDULED BODILY IN URY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPER DAMAGE $ AUTOS ONLY AUTOS ONLY Per awlde t UMBRELLA LIAS OCCUR EACH OCC JRRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED I I RETENTION $ A WORKERS COMPENSATION 2001 W8053 5/1/2016 5/1/2017 1STR ER ❑Y H AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE YIN NIA E.L.EACH CCIDENT $ 1,000,000 OFFICER/M EMBER EXCLUE (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEA E-POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Carpentry Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained ir the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBEC POLICIES BE CANCELLED BEFORE Troy Thomas THE EXPIRATION DATE THEREOF, OTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVIS ONS. 499 Nottingham Drive Centerville,NIA 02632 AUTHORIZED REPRESENTATIVE 01988-2016 ACORD CO qPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Coelgistration: ice of Consume rAffairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 945954 Type: Office of Consumer Affairs and Business Regulation piration 3t15f2017 Private Corporatio 10 Park Plaza-Suite 5170 V Boston,MA 02116 DOYLE+THOMAS CONS?INC TROY THOMAS 499 NOTTINGHAM DR ` K CENTERVILLE,MA 02632 Undersecretary Not v id wiflkout signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099913 ' Construction Supervisor Specialty TROY A THOMAS 499 NOTTINGHAM OwW-100 V: CENTERVILLE MA 0263� ` CIA, Expiration: Commissioner 04/13/2018