Loading...
HomeMy WebLinkAbout0059 CASTLEWOOD CIRCLE s9 CA-s�.�wo o �p G�y r #1 Town of Barnstable *Permit � '� Expires 6 months r m issue date kp' - ' ]regulatory Services Fee , AUG - 2 2006 'Thomas F.Geller,Director Building Division `TOWN OF BARNSTA oEPerry,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 o� . Property Address l���X e A? jj;�Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ! r 1 1✓l d4 Contractor's Name Telephone Number Cl- Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) K[Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensaatio_n Insurance Insurance Company Name Workman's Comp.Policy# 2 LI x ( } / o J Copy of Insurance Compliance Certificate must be on file. 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 tovm department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Im eut Contr License is required. SIGNATIJRE: Q:Fomu:expmtrg Revise071405 Fraser Construction Roofing & Siding Specialists P.O. Box 1845, Cotuit MA. 02635 Email: fraser_construction@verizon.net www.fraserroofing.com Phone 1-508-428-2292 &FAX 1-508-428-0123 Partial White Cedar Sidewall and Red Cedar Clapboard Proposal Date: June 23, 2006 Tel: 508-775-4761 Name: Mr. Joe Silva Job Location: 59 Castlewood Circle Hyannis, Ma. 02601 FRASER CONSTRUCTION herby proposes to perform the following services in neat and professional like manner and in-accordance with the manufacturer's specifications and local building codes. Supply and Install 16" WHITE CEDAR R&R EXTRAS on South Facing Gable Supply and Install Red Cedar Clapboard left side of the house up to the windows only Supply and Install TYPAR 30 house wrap/entire Supply and Install 1-3/81' HOT DIPPED GALVANIZED NAILS on sidewall Supply and Install STAINLESS FASTERS on the clapboards Supply and Install COPPER WINDOW CAP Clean-and Remov*- --Debris_from_w-ork_area_daily- Homeowner to move the electrical power Fraser Construction to remove and re-install awning f i TOTAL INVESTMENT: $2,295 Payable immediately upon a completion NO MONEY DOWN—NO Payment AT THE START OR PART WAY THRU Payments accepted are: CASH—CHECK—MASTER CARD—VISA—AMERICAN EXPRESS *Any payments not made within 30 days of completion will be charged 1 '/2%for every 30 day the payment is late. POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards, Plywood Sheathing or Other Carpentry Needing Replacement will be done and charged for As an Extra at the Rate of$45.00 per Hour Plus Materials Plus 20% Overhead Mark-up on The Total Extras. FRASER CONSTRUCTION is the Only Approved Applicator/Member of The CEDAR SHAKE and SHINGLE BUREAU on CAPE COD THE CEDAR SHAKE AND SHINGLES BUREAU and the TREATING COMPANY WARRANTY THE SHINGLES for 10 YEARS if installed by approved applicator. Any alteration or deviation from above specifications,will be executed only 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 fire, tornado, and other necessary insurance upon the above work. FRASER CONSTRUCTION carries Workman's Compensation and Public Liability Insurance on the above work. This proposal may be withdrawn by us if not accepted within thirty days. DATE OF ACCEPTANCE: _�,J.,I q/a(, SUBMITTED BY: ACCEPTED BY: HOMED ER FRASER CONSTRUCTION r '4 C 1 ne t ommonweaiTn of jyjazzacrluseti ' ` Department of Industrial Accidents Office of Investigations 0 600 Washington Street Boston, M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plulinbers Applicant Information Please Print Legibly Name (Business/organization/Individual): C_� Address: City/State/Zip: Phone#: Are you an employer? Check the-appropriate bog: Type of project(required): 1.CB-i-arn a employer with -;?— 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 $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition . working for mein any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t . ` employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#I 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy,andjob site information. Insurance Company Name: G✓�,, Policy#or Self-ins.Lie. #: :2 / k t7 ie g. w _ Expiration Date: Job Site Address: C'U-o 4'4r "A>0 City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c..152 can lead to the imposition of criminal penalties of a fine up to$1,500,.00 and/or one-year imprisonment,.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification.. 1 do hereby certify under?j�pal penalties ofperjury that the information provided above is true and correct. Si afore: - Date: < Phone#: Official use only. Igo 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 wealth 2.Building Department 3.City/Town Clerk e.Electrical Inspector S.Plumbing Inspector 6. Other Contact Persona: Phone#: Information and Instructions `} Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,pgmership, association, corporation or other legal.entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds orbuilding appurtenant thereto shall not because of such employment be deemed to be an employer." • r MGL chapter 152,§25C(6)also states 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 in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one-affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city 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 is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit_ The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. -617-727-4900 ext 406 or 1-877-MASSAFE a aA 617-727-7749 Revised 5-26-05 WVFVV.mass.Zov/d1a , 3 � HOME d'ngRegulations an r 1 CV EMENT CONT 4C d Standards Re ist 2 12536 TOR Licen s -,.. a or re p � 2007 befor i the gistratiod FRASER CONS Boat;'of explration d Valid for indi BEAN F T f one. Buiidin ate. [ffoun rydul use onl RASER A&� lshburton PlaRegulatio and retupn Y Bostrsu�IVIa 0210g 130]an Standards OTAR- CIR, _ „> UIT,IIWA 02635 Adjninistrato r Not valid wi* hnut signature OATS(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE og/22/2ooS PRODUCER (508)588-1260 1 FAX (508)588-7236 I T}tIS C ''IFICATE IS ISSUED AS A MATTER OF INFORMATION Wise & Quinn Insurance /1yeIT:`y Inc. ONLY AN `CONFERS NO RIGHTS UPON THE CERTIFICATE 449 Pleasant St. '. HOLDER, ?1h15 CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE:OVERAGE AFFORDED BY THE POLICIES BELOW- Brockton, MA 02301 CISR, Paul Crowley INSURERS AFFORDING COVERAGE NAIC# INSURED Dean Fraser INSURERA: Har-tford Insurance Company , DBA: Fraser Construction Co. INSURERS: 71 Tarragon Circle ;Nsu�IER c: Cotuit, MA 0263E-2443 1 INSURER D. (INSURER E: _ COVERAGES —� - THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAM-D A8OVc FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDIN( 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 CiAINIS. INSR DO' TYPE OF INSURANCE POLICY NUMBER ?�LtC EFFEC'IVE TPOLICY EXPIRATIONIm _ LIMITS GENERAL LIABILITY EACH OCCURRENCE 8 COMMERCIAL GENERAL LIABILITY ( DAMAGE TO RENTED $ f � CLAIMS MADE Q OCCU? MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER � PRODUCTS-COMP!OP AGG S POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO f (Ea accident) $ 1 ALL OWNED AUTOS ( BODILY INJURY $ SCHEDULED AUTOS (Per parson) HIRED AUTOS + BODILY INJURY NON-OWNED AUTOS �•'. (Per accident) $ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDE14T $ ANY AUTO OTHER THAN EA ACC S w ( AUTO ONLY: AGG S EXCESSIUMBRELLA.LIABILITY EACH OCCURRENCE $ OCCUR r CLAIMS MADE EACH $ S DEDUCTIBLE + $ RETENTION 5 S WORKERS COMPENSATION AND 6S60UB-794X619-1-05 09/26/2405 09/26/2006 X wcsTATu- oTH- EMPLOYERS'LIAINUTY A ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT_ S 500,000 OFFICERIMEMBER EXCLUDED?' E.L.DISEASE-EA EMPLOYEE S S00,00 It yes,describe under o SPECIAL PROVISIONS kelow E.L.DISEASE-POLICY LIMIT -$ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VE!�'CLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS On the operations usual to carpentry. CERTIFICATE R A L TI N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL lO D?,YS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Fraser Construction Co. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 71 Tarragon Circle OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Cotuit, MA 02635 AUTHORIZED H VE C ACORD 25(2001l08) FAX: (508)428-0123 ©ACORD CORPORATION 1988 I_