HomeMy WebLinkAbout0046 CUMNER STREET �(A �U/�7/J� �cc�
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Building Performance Contracting,LLC
Nauset Insulation
P.O. Box 1044 N. Eastham,MA 02651
Phone(774)316.4464 Fax(774)316.4462
Date
RE:Insulation Permits
Dear Mr Perry,
This affidavit is to certify that all work completed for the insulation work at CAI w'
jj
l 0
has be inspected by a certified Building Performance Institute(BPI)Inspector.All work performed
meets or exceeds Federal and State requirements.
Respectfully,
Emond
c�
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application # Oo(3110, Y3
Health Division Date Issued
Conservation Division Application Fee 5�
Planning Dept.- Permit Fee 3.
Date Definitive Plan Approved by Planning Board pie
Historic - OKH _ Preservation / Hyannis
Project Street Address MM(-,4/
Village Ian n i is O vti(o�j
Owner kL+I n0 Address capuneg_-
Telephone Yct nn;.5, 1' ,4 . O,-X(o
Permit Request isrc-Prc l !Yl ®' ZipS RC j2�(� Lt 4c, d i�C.SS �oc �s' jam{ p
_5D 5a r4. was ''/ -31 cl4ss acke4 7G8 4 Oi
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuatio;k M S.3a Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Gig Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ 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 including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Others, —a
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood%o al stove.: ❑Ye ❑ No
C>
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: D.existing ❑.newize_'
w
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ' ?
4
:#Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ,
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Prop osed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name Josk ewyL Telephone Number
Address P6 e�C 1PY Y License # / V ISM
tbMl 64JTh civ-, WA- • Home Improvement Contractor# 1. fDo2.17
M1 av\:L C- &KY riZ J;L s _ Worker's Compensation # WC uoo, /g / 170o
ALL CONSTRUCTION DEBRIS RESU
LTING FROM THIS PROJECT WILL BE TAKEN TO
GZifv<.-�� 5� kev
SIGNATURE L�%�'�7 DATE
i
FOR OFFICIAL USE ONLY
APPLICATION# .
DATE ISSUED
MAP/PARCEL NO.
s£,
ADDRESS VILLAGE
OWNER
}
DATE OF INSPECTION:
FOUNDATION
y
ti FRAME
INSULATION
I
FIREPLACE
Y ELECTRICAL: ROUGH FINAL
r
PLUMBING: ROUGH FINAL
�P
,f
t GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
a
ASSOCIATION PLAN NO.
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Invesdgations
600 Washington Street
-Boston,MA 02111
www mas&gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address: b `F- 16 q�f
Ci /State/Zi Y�1� D J6�( Phone#:
tY P CCcS G� �
Are.yo employer?Check the appropriate box:
4 I am a eneral contractor and I Type of project(required):
l. I am a employer with ��5 . ❑ g 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 I I.❑Plumbing repairs or additions
myself o.workers'com right of exemption per MGL
� + p. and we have no 12.❑Roof repairs:
insurance required.] c. 152, '1(4),
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.
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:
1 am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site
-Information.
Insurance Company Name: A-Hc T/.0 Qlae4cl-z S
Policy.#or Self-ins.Lic.#: fQC'V DD5 3 c 9 uc> Expiration Date: r-OV aP
Job Site Address: City/State/Zip: Ue4 c hrlt S KA A2(�at
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.
I do hereby certify under the pains and penalties of perju the informa ' n pro ' d above is true and correct
Si afar : e:
Phone#: l �a � c) � ��lP
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#:
01/11/2013 02:58 9787778415 PAGE 01
- oATe(Mtivoert'YYr1
--o CERTIFICATE OF, LIABILITY INSURANCE ' . Fl/11/2013
THIS CERTIFICATE IS ISSUED A8 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
®FLOW, 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 Polieypp)must ha endorsed. H SUBROGATION 19 WAIVED,subject to
the terms and conditions of the policy,certain poliI may req%dre an endorsement A stetsment on this Cer0flceM does not confer tights to the
certtflco%holder In lieu of such endorsemen s.
PRODUCER E° 78 777-6415
COUNTY INSURANCE AGENCY INC PH E (9 7 8)7 7 4-2 4 63' A/C N :�9
123 Sylvan St DRE :C7
Danvers, MA 01923 iNSLRERs) AFFORDnra COVOIAot
INSURER A:COM116rCe Ir12. Co'
INSURED Building Performance Coatracti ng r LLC, INSURER 6:Ease ins Co
INSURERc:Atlantic Charter
P.0. BOX 633 INSURER D
Truro,• Ma 02666 INSURER E;
IN URER 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:Will: SUBIL LIMITS
rR POLICY NUMBER L ID MMro
LIMITS-
TYPE OF INSURANCE I WVD
GENERAL LIABILITY EACN OCCURRENCE S 1 OOO OOO
X COMMERCIAL GENERAL LIABILITY PREMISES oeGURln 5JO 000
CLAIM.A MADE OCCUR ME
EXP Am onoperton) S 1 000
B 3DE9441 11/19%1211/19/13 PERSONAL&AOVIMURY s 1 000 000
GENERAL AGGREGATE $- 2 000 000
PRODUCTS-COMP/OPAGG s 1,000,000
-
OEN'L AGGREGATE LIMIT APPLIES PER: $
POLICY P Loc •1 000 000
AUTOMOBILE LIABILITY Ea eccJdent
BODILY,INJURY(Per peraon) S
ANYAUTO I, 3983 V -. BODILY INJURY(Peracgidentl S "
SCHEDULED
AU OWNED ]C -AUTOS Z/2/1Z 2/12/1 y
A AUT03 NON-OWNEO Per I eM
HIRED AUTOS AUTOS "
S
UMBRELLA LIAR . OCCUR ' EACH OCCURRENCE s 21000,000
"
UMBRELLA
&LIAR CUBW3904112 .5/1/12 5/1/13 AGGREGATE s 2,000,000
D CLAIMS-MADE �^ Q
DED RETENTION$ W H-
WORKI:FLS COMPENSATION RY
�.
AND EMPLOYERS'LIABILITY 'YIN '.. 11/23/12 11/23/13 E.L.EACH ACCIDENT $ 500,000
ANY PROPRINTORIPARTNERIEXECUTIVE. ❑ N/A - -
C OFFICEFUMEMeeR EXCLUDED? WCV0 0 93 9 9 0 0 E.L.DISEASE-EA EMPLOYEES 500,000
(MwkdeaY In NN)
It yyeess describe under E.L.DISEASE-POLICY LIMIT, E .500 0O0
DESI:RIPTION OF OPERATIONS belpw
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE& (Attach ACORD 10l,Additional Remarks Schedule,If mots space Is required)
CERTIFICATE HOWER CANCELLATION
Town of Barnstable ;
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Barn$tab1A, ;MA= THE EXPIRATION DATE THEREOF, .NOTICE WILL. BE DELIVERED IN'.
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED ESENTATNE
01988-2010 ACORD CORPORATION. Ml Fights reserved.`
ACORD25(2010/05) The ACORD name and logo are registered marks Of ACORD
Massachusetts-Department of Public Safety
Board of Building; Re,
adations and Standards
: License: CS 7W15
JOSH EMOND'
50 SUNSET DRIVE
�EVERLY, MA 01915
�•G."�"-�"`- -` Expiration: 3425/2013
C'4inunissiuner Tr#: 13393
�e'�cmamovuaea�!/i ✓�w.toaa�tuoeQ2 � -- - • _.�.__.... .;
Office of Corisnmer Affairs 8c B aess Re- adoa License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR.. t before the expiration date. If found return to:
Registration:,. 162715 Type: Office of Consumer Affairs and Business Regulation F
Expiration: 4f6 3 individual 10 Park Plaza-Suite 5170
JO `T -,- t Boston,
EMOND MA 02116
JOSH EMOND + i
50 SUNSET DRIVE
BEVERLY,MA 01915:?
Undersecretary . Not valid without signature
f
E ,
t OWNER AUTHORIZATION FORM
.(Owner's Name) .F
owner of there _! >y � • ,- ,, :�f . �;�' ,_ m . ,
'pop rty,located at ;
(Property Address) - .
LL /
T.. •( roperty Address),4
hereby authorize ,x } �' OTC. ryl
(Subcontractor)
an authorized subcontractor for RLSE.Engineering, to act on my behalf to obtain a building ,
permit and to perform work on my property.
t is _ ! + r i F .. _ !. Yn. ,F` F' •
Owner's Signature -
Date _ ` r
IE CIE.
YOV
THE COMMONWEALTH OF MASSACHUSEI'15 For OCABR Use Only.
OFFICE OF CONSUMER AFFAIRS AND
BUSINESS REGULATION Registz ionNo: '
10.Park Plaza, Suite 5170 '
Boston, '.M A 02116, Effective Date:
Application for Re¢idmHon as a Home Improvement
Contractor or Sub-Contractor D*ition Date:
(MGL c.142A;201 CMR 1&00)
,LL(-
CariT
�. .
1. NAME OF APPLI
RA TRi75T,oRORHmurALENlII7�
Ei1S1ItANH`IDIVIDUAI,QORPO ,
BE _
2. NUMBER OF EMPLOYEES:
3. APPLICANT TYPE: INDIVIDUAL CORPORATION PARTNERSHIP TRUST
(CHECK ONE—MUST BE SAME LEGAL ENTITY AS THE ENTITY IDENTIFIED.IN#1) '
4. �. MERAL TAX ID#: 00101 7 a 9.
EMAII.rA,DDRESS•r '2 w
5. APPLIcaNTPgorrE#:I q�g ".Qq� �i��( ArPI:iCnNT n � S-Fur 73
Dot
G. MAILING ADDRESS D1� �U 33 fcc ro M b h�
STREET, CITY. STATE ZIP '
7. PERMANENT.:ADDRESS j k t A t'1 i lei n ya-ic�_ d C
STREET CTIY STATE ZIP
PLEASE NOTE THAT A P.O.BOX IS NOT ACCEPTABLE FOR PERMANENT ADDRESS. YOU MUSE LIST A STREET ADDRESS:
8. IF THE APPPLICANT IS A CORPORATION OR A PARTNERSHIP,PLEASE PROVIDE THE NAME,ADDRESS,SOCIAL
SECURITY#.AND TITLE OF.THE:INDWWUAL WHO WILL BE RESPONSIBLE:FOR TRECORPORATION'STHE
TRUST'S OR THE PARTNERSHIP'S WORK(Please review the Instructions:before answering this iluestion):
m�nn� To
TITLE
9. IF APPLICANT IS DOING BUSINESS UNDERAD/B/A,PLEASE STATE THATD/B/A,AND ATTACH A COPY OF THE
FICnCIOUS NAME:CERTIFICATE FILED WITH THE CITY OR TOWN CLERK;
DBA NAME:
10. (a)DOES THE APPLICANT OR RESPONSIBLE INDIVIDUAL HOLD ANY OTHER CONSTRUCTION-RELATED STATE, a
CITY OR TOWN>LICENSES OR REGISTRATIONS?'✓YES. NO
(b)IF YES,PLEASE FILL IN INFORMATION BELOW.ATTACH ADDITIONAL SHEETS IF NECESSARY.
LICENSE TYPE ISSUED BY LICENSE(REG.# EXP.DATE LICENSEE NAME
C.�Y�l-►-ucficis, WL,Ss.ixrf-
v, C5 lS 3 f as 13 J� Ept "
1L LIST ALL PARTNERS,TRUSTEES,OFFICERS,DIRECTORS,ANDMAJOR OWNERS(10%OR GREATER OF
OWNERSHIP)OF AN APPLICANT PARTNERSHIP OR CORPORATION,BELOW.USE ADDITIONAL PAPER IF
NECESSARY.AND INCLUDE NEEDED PAPERWORK(SEE INSTRUCTIONS PLEASE INDICATE BY AN"X"IN THE
WHO DIRE APPLICATION FOR ADDITIONAL REGISTRATION I.D.
;LAST COLUMN.THOSE INDIVIDUALS . REQ
CARDS.USE ADDITIONAL SHEETS IF NECESSARY. ..
FULL NAME . TITLE. %o OWNER ADDRESS SUPP.CARD
}
12. (a)HAVE YOU B DEEN REGISTEItE PREVIOUSLY AS A HOME IMPROVEMENT CONTRACTOR? Yi YES_NOS,
(b) IF YES,PLEASE PROVIDE THE NAME AND REGISTRATION NUMBER UNDER WHICH YOU WERE
PREVIOUSLY REGISTERED:
NAME: ��5'�. lv��:�, . HIC.REGLSTRATION#: r 3Lrl 15-
13.(a) ARE YOU CURRENTLY OR HAVE YOU EVER BEEN AN OFFICER,PARTNER,OR CO-VENTURER OF AN
APPLICANT WHO PREVIOUSLY APPLIED FOR OR HELD A HOME I1VIpROVEMENT CONTRACTOR
RLGSTRATION?, YES ✓NO
(b) .IF YES,PLEASE PROVIDE THE NAME OF THE APPLICANT/RET AND THE REGISTRATION
NUMBER:
NAME: HIC REGISTRATION#:.
14.(a) ARE YOU CURRENTLY OR HAVE YOU PREVIOUSLY BEEN EMPLOYED BY A REGISTRANT OR APPLICANT
FOR REG TION AGAINST WHICH DISCIPLINARY ACTION WAS TAKEN?,
_YES V 0 r
THE NAME OF THEtlAPPLICANT/REGISTRANT AND THE REGISTRATION I.
(b) IF YES,PLEASE PROVIDE „.
NUMBER:
NAME- HIC REGISTRATION#•
OU WHERE DISCIPLINARY ACTION WAS
15. (a)HAVE THERE EVER BEEN ANY FORMAL COMPLAINTS AGAINST Y
TAKEN BY THE DEPT.OF PUBLIC SAFETY OR CONSUMER AFFAIRS,OR ANY COURT JUDGMENTS OR
ARBITRATIT AWARDS ISSUED AGAINST YOU?
YES V No
(b)DO YOU OWE MONEY TO THE GUARANTY FUND?
-YES ✓NO
IF YES To EITHER,PLEASE IDENTIFY BY DATE,CASE NUMBER,OR DOCKET NUMBER:
EWPORTANT FEE NOTICE: CHANGE IN LAW ABOLISHES CSL's HIC REGISTRATION FEE
EX EMPTION. As a result of a recent change in the law(Section 80 of Chapter.27 of the Acts of 2009),the holders
of Construction Supervisors Licenses are no longer exempt from the IRC Registration fee. CONSEQUENTLY,ALL
CONTRACTORS INCLUDING CSL's WHO ARE APPLYING FOR A HIC REGISTRATION MUST PAY A
REGISTRATION FEE OF$150.00,AND A.GUARANTY FUND FEE. (See=instructions;for Guaranty Fund
fee schedule.)
16. REGLSTRATION FEE ENCLOSED:$ Q. . E ENCLOSED:L E
PLEASE INCLUDE TWO(2)SEPARATE CERTIFIED'CHECKS OR MONEY ORDERS-ONE MARKED
"REGISTRATION FEE":AND ONE MARKED I'GUARANTY FUND."ONLY CERTII UD CHECKS ORMONEY
ORDERS CAN BE ACCEPTED.ANY OTHER FORM OF PAYMENT,INCLUDING BUT NOT LIIv M TO
PERSONAL OR BUSINESS CHECKS,WILL BE RETURNED AS INELIGIBLE.MAKE BOTH CHECKS PAYABLE-
TO"COMMONWEALTH OF MASSACHUSETTS."
'
I hereby swear, under the-pains andpenalties ofpedury,that.all information setforth on this
application and submitted in support hereof is true and accurate to the-best of my knowledge.
Further,I certify under G L. c 62C,§49A,that I am in compliance with.all laws of the
Commonwealth relating to i6*4 reporting of-employees and contractors, and withholding
and remitting'of child support
i tore of Applicant. If a corporation or partnership,position he D
i
NOTICE _: NOTICE
TO TO
EMPLOYEES EMPLOYEES
M sv•
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
1 Congress'Street- Suite 100, Boston, Massachusetts 02111
617-727-4900- http://www.state.ma.us/dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30,this will give you notice
that I (we)have provided for payment to our injured employees under the above-mentioned chapter by
insuring.with:
Insurance Company: Atlantic Charter Insurance Company
Policy Number: WCV00939902- Effective Dates: 11/23/2012 TO 11/23/2013
Insurance Agent: County Insurance Agency, Inc.
123 Sylvan Street
Danvers MA 01923
Employer: Building.Performance Contracting, LLC
PO Box 633
Truro, MA'02666
Workplace: Building Performance Contracting, LLC
50 Sunset Drive
Beverly, MA_01915
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical.services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee.The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary,and
reasonably connected to the.work related injury. Incases requiring hospital attention, employees are
hereby:notified that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER
THEr��y� _ TOWN OF ,BAR NSTABLE
I BARMTABLE,
9� ASIL
Q pYae�� BUJ L I G INSPECTOR
APPLICATION FOR PERMIT TO �� ®° -7��� G° ✓�' All
TYPE OF CONSTRUCTION .. ' J..........i.............�/�T 1/�'.., .....` .�`� :..............:....................
. ............ �•3�1 ...................19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for `o'permit according to the following information:
Location ... .w.... ................. ........ ........................:...................................................
Proposed Use ..... .................... .........................
.....
ZoningDistrict ...... .............................. ........................Fire District .. ...........................................
Name of Owner .........
.. ... ... ......... .........
Name of Builder .....:" .... -� Address r�� .. 1
Nameof Architect ..................................................................Address ....................................................................................
...........��`4f
Number of Rooms �' ...................................Foundation ...........................................................................
.� Q
.- Roofing ..//�� // .L Exterior...... �1 ............1.......;......................... . ...................... .......:..................
�� o �
Floors ............ ........................................:.................................Interior ......�r.�.:�.��t--..f/..............................................
Heating ..................................................................................Plumbing ...............................................................................
....................................Approximate Cost Q
Fireplace ............................................. .........�........ .....
Definitive Plan Approved by Planning Board __________________________
Diagram of Lot and Building with Dimensions
Lu
SUBJECT TO APPROVAL OF BOARD OF HEALTH r�? rr`���r � V)
i r0 m' _Z
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oLLJ
a Q0 m � �
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w�W� tire-' �A
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//
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .... .... .. .................................................
Atsalis, Russell
No ..15856... Permit for ...add..to single
farm dwel
../�....?............. .....................................
Location, �. ?er Street I
..... ..............................................
......................Hyanrds.........................................
Owner .........Russell Atsalis-
Type of Construction ...................fry............
........................................................ ....................
Plot ......................... . Lot ................................
Permit Granted ....J!.. ry 26.............19 ?3 i
Date of Inspection ,f ...........
Date Completed ............:.1�`" .............19
it
PERMIT REFUSED
................................................................ 19 t
I
r
........................................... ................................. ,}
...............................................................................
...................................... . ...................................... ,}
Approved ................................................. 19
............................................................................... a
...............................................................................
f
o - r i own of Barnstable *Permit#
Expires 6 months from issue date
aAtttvSUBL = Regulatory Services Fee
9 te?y. ��MAS& Thomas F.Geiler,Director
BuildingDivision
Elbert C Ulshoeffer,Jr. Bailding Commissiy#ePRPZ7
367 Main Street, Hyannis,MA 02601w
Office: 508-862-4038 FAAR. ) ` 2004
Fax: 508-790-6230
WN OF BARNS t,A*L-; .c..
�- PE-ASS P��2iVII�APPLICATI
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address. '7 2,&Q
Residential OR Commercial Value of Work a (�
Owner's Name&Address
'l
Contractor's Name ���� �(_ Telephone Number ✓6va-',3
Home Improvement Contractor License#(if applicable)_
Construction Supervisor's License#(if applicable) i+
7Workman's Compensation Insurance
Check one:
Ej I am a sole proprietor
I am the Homeowner
,5i f ve Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy# 6k .d 0
Permit Request(check box)
e-roof(stripping old shingles)
Re-roof(not stripping. Going over existing layers of roof)
Re-side _
�] Replacement Windows. U-Value (maximum.44)
Other(specify)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation.etc.
Signature )OW.,ol
expmtrg
P
David Sawyer Construction
318 Meiggs Backus Road
Sandwich, MA 02563
(508)-539-1992
Proposal Submitted To: Work Place: Date j
?31/ �S
(p
Strip, Remove, and Haul Away all old roof shingles.
SUPPLY&INSTALL:
"Fa 4- w bad u, 0 a
CLEAN&REMOVE ALL DEBRIS FROM WORK PLACE AFTER
JOB IS COMPLETED. ALL DEBRIS TO LANDFILL.
TOTAL INVESTMENT FOR MATERIAL&LABOR$
All material is guaranteed to be as specified,and the above work to be performed in
accordance with the specifications submitted for the above work an co_ leted ' a
substantial workmanlike manner. Payments to be made as follows U&i�'
Any alteration or deviation from the work specifications involving extra costs will be executed only upon
written order,and will become an extra charge over and above the estimate. All agreements contingent
upon strikes,accidents or delays beyond our control.
1OYEAR LABOR WARRANTY/PLUS MANUFACTURES SHINGLE WARRANTY.
NOTE-This proposal may be withdrawn by us if not accepted wither days.
Respectfully submitted
ACCEPTANCE OF PROPOSAL
The above prices,specifications and conditions are satisfactory and are hereby
accepted. You are authorized to do the work as specified. Payments will be made as
outlined above.
Dat --� Si natu
Board of Building Regula. ions and Standards
One Ashburton Place - Room 1301
V
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 134313
Type: DBA
Expiration: 10/24/2005
DAVID SAWYER CONSTRUCTION
DAVID SAWYER
318 MEIGGS BACKUS RD.
SANDWICH, MA 02563
Update Address and return.card.Mark reason for change.
Address Renewal Ej Employment Lost Card
�1ze �omvnzovzuieall� a�_Auaauc�u�ael ---
Board of Building Regulations and Standards License or registration valid for individul use only
_ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to-
Registration: 134313 Board of Building Regulations and Standards
Expiration: 10/24/2005 One Ashburton Place Rm 1301
Type: DBA
Boston,Ma.02108
DAVID SAWYER CONSTRUCTION
DAVID SAWYER
318 MEIGGS BACKUS RD.
SANDWICH,MA 02563 Administrator Not v li wi out signature