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HomeMy WebLinkAbout0070 DUNN'S POND ROAD - - _ � - i p Town of Barnstable = enn;;?Z6 7 O Expires 6 mo from issue ate 4 Regulatory Services Fee �-- o jARNS`1AHL% e' 1639. q0� Richard V.Scali,Interim Director IopFQ��A Building Division ®'� ,� Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 NOV 0 4 2015 it%,1�t=.totm.bamstable.ma.us Office: 508-862-4o)8 TOWN CjUc 0a G)TA B Ld: MUSS PEA APPLiCATI®l�r - RESIDENTIAL ONLY Not Valid withow Red X-Press Lnprint it�ap/parcel Number a-7() - Q �,Q - 4 PropeA-Y-Address t n [Residential Value of Work S _3,� Minimum fee of S35.00 for work under$6000.00 . Owner's Name&Address i Ch If U 1"nn rs5 Contractor's Name r r�n a�.� �;n�rr� S / �; men�i Telephone Numberap 11)2— CC DO i Home Improvement Contractor License_(if applicable) /7 3 y S Email: Construction Supervisor's License--"(if applicable) p ci 5 7 0,7 ZWorkrhan's Compensation insurance Check one: ❑ I am a sole proprietor ❑ .I°am the Homeowner I have Worker's Compensation Insurance Insurance Company Name A rem n a it :.nSurg Y1Ce_ (' T Workman's Comp.Policy 1 1<uC 1 2_= S$3 2 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles)_ All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ED'Ieplacement Windows/doors/sliders.U Value .3 O (maximum 35)s of windows of doors: - ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked.Nvith red S and inspections required. Separate Electrical&Fire Permits required. Where required. Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. '"Nate: Propertyl�Owner must sigh Property Onmer Letter of Permission. A copy o�,the Home Improvement Contractors License Construction Supervisors License is .� required. V SIGNATURE: a Q:11k,PF1LES1FORr14S%uiiding permit formslEXPRESS.doc Revised 061313 R.Efi;L1�AL BY.A�NDM , Arr-iUM >e3�4S Renewal �/Wl�Ya ri".s���!':iY � Lf��CjB7�e Y.C1�N15i� erwavw smretwe .r" n Ib?.14i,.vi Rm4 + Lkwok.RE MO O "�a�_mltfagr . 9aat�e�.NewE�end fti�edmvs,.W+C dfbf':. eff 90 . Cuum"INDoi MD DOOR ©DZJNG• ;% ' g a dEAL6mc -r� ■��1i'IMP.�1` 1[ qe;v}5uer4,0.tl'�•axG�$utcwd 26� �— �.�yr- p,�. : G1ItiFh ar' �. FRr7d�'cansl�yal c��✓ (J! 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E �$ dn3Ea'UEttGA5�1P-I 9�' nlht '.9f]�Oif.M�lltl,Y6On�p�y�1An#$'n�IfetoellY�al[t�dlM`C�' — ey �e.Ee pea+xn a the r ro dirk tFio tot�n sltipnt�tc.vltl job at e Set oisli.U€tcuv der iral�Nee, oweeelebrle SdIr:P's 111G 11Td ride I}yoga!der malye the avar7asbl'o 't;o thee,=vondl;tlev Selfer.donee nac ptltk't�iap wtRtFW �' tws tho, oar—34 th4 Salter daai not pldf up v�htn of tke daft'of Ctnc® oar 1 rtmn ark ds af'the'dake of jrmu.rnag reFm oc' d of dos,goods vrii lei o r furdaer ab iSafie if X liy dltpmee o thte;=cede w'Ct tut at y hwil er afaQr�tivn ti jnnn,. 1ai, flee a t+he,goaflfo:iivWMbit do" f8$ee'er If you erg vv, q ,m�elfae tt goody s ra: ,1®:4o d1e�ielleP,tit If agaus;, to -the tiaadd tv tisuv[far aid tdl oo der so,twe» rro �, to Pet�irn the.gg000dh to SeIFd{ram to theo„ „vt tts IQ pee[orana ace ot(s[I ohUga:$me# urtd@r de@ �. r1Ff»siF'n �i ito;fir parfbirenNCO°pt atll N711�ttlon9'undo!rhea Eon�rtLTa csnedl tft4 :malt arietQYw.e s irgned' Gontrac Ta canal"via,b°aTetiai�t%u mitt or'dvtirer a sggrisat_, oerid dst of At an nvtF 4eY r li, did oio of !fire eeaFcell'itdOn 'natee ter': Ot41RR: wflq�tvn nuttevors.r��s RACloviril6 istr/4nrfersen of wtet6ait rtobw�v� +i�i it eseFvgg��rrarn to WtlrFwal byes,of 9ovtMaielN{�v at A16ocrittaaadial8htohe,Rl019d1� 1! .SoL=h&6fl Ni* d:tt26Atbton t�nl" FIIO g6g;; NOT LASER T tDFttGkU't Ot` ` , li NOT ER T -MMNIOW OF �,g� .... y„r�...p_ �`�:}..}•Ems° rr = .` 1 S _ RNRY CELTH e@rcaks . ewys'!»OilI—; I�a,.caa�:wre��� �-a��core:Yee ' I�;,��vv;; • • Southern New England Windows d.b.a Renewal by Andersen of SNE j Massachusetts-Department of Public Safety Board of Building emulations and Standards Construction Supervisor License:CS495W ; BRIAN D DENNU-6 7 LAMBS POND Chariton MA 01*7 1 Expiration Commissioner 09/0812016 t Office of Consumer Affairs find Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement.Contractor Registration Regisiratbn: 173245 Type: SuppWment Card Expi SOUTHERN NEW ENGLAND WINDOWS L ' a/lsnol6 DENNISON.BRIAN l-- -- 26 ALBION RD LINCOLN,RI 02866 'Update Address and return card.Mark reason for change. sCA r O 2w4Mm Q Address ❑Renewal (D Employment Lost Card �.fo�porromauruu�/�c�6�wa6rwoQ2 a of Conremer A 7 &Basioeu Regoladoa License or registration valid for individui use only IAAPROYEMEliT CONTRACTOR before the expiration date. If found return to: . Office of Consumer Affairs and Business Regulation oBbtratlon. i7 TYPo• 10 Park Plim-Suite 5170 Expkatlon: 9/19/2016 SupplemeN aid Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS I.I.C. RENEWAL BY ANDERSON" DENNISON BRIAN } 26 ALBION RD a e r L INCOLN,RI MM Undersecretary Not valid without signature The Commonwealth of Massachusetts JFDepartment of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston, MA 021142017 www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Auplicant Information Please Print Legibly Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are you.an employer? Check the appropriate box: Type of project(required): 1.X I al a employer with 20+ 4. I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contrdctom 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. F1 Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers' comp. insurance comp.insurance.: required.] 5. n 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 r( employees. [No workers' 13. Other (�1�'1Q 0 c,.1 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 is the policy and job site information. Insurance Company Name-ARGONAUT INS. CO. Policy#or Self-ins. Lic. #:WC 928058352394 Expiration Date:8/21/2016 Job Site Address: 7d 1 a ►VI I s �� 2d • City/State/Zip: /1 r S A 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--Uf 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)risurance coverage verification. I do hereby certi under the and penalties of perjury that the information provided above is true and correct. T � Signafore: Date: — Phone#: 4012289800 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License#f 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#: f SOUTNEW-01 SHETTYSHT DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/19/2016 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(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 CONTACT Willis Certificate Center Willis of New Jersey,Inc. a"Ic°NN ,(877)945-7378 AI No:(888)467-2378 c/o 26 Century Blvd P.O.Box 305191 E-MAIL ADDRESS:certificates@willis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of Southeast 39926 INSURED INSURERB:OneBeacon Insurance Company 21970 Southern New England Windows LLC INSURERC:Argonaut Insurance Company 19801 D/B/A Renewal by Andersen 26 Albion Road INSURER D Lincoln,RI 02865 INSURERE: 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 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. INSR TYPE OF INSURANCEADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MWDD MWDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR S 2029459 08/10/2015 08/10/2016 DAMAGE TO RENTFIT__ PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY a JE O FX]LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANY AUTO S 2029459 08/10/2015 08/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S 2029459 08110/2015 08/10/2016 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A X 0000068028 08/21/2015 08121/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Workers Compensation WC928058352394 08/21/2015 08/21/2016 See Attached DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) , CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance 114 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 6'�0l 3/ 3 Town of Barnstable *Permit# 7 7 l '`1_ �FTHE Tpk� Expire l mouths front Issue date .� O Y - ; Regulatory Services Fee 2a + $aarrsTAB Mass. $ Thomas F.Geller,Director 619 Building Division Tom Perry, Building Commissioned ®®® 200 Main Street, Hyannis,MA 0260 -PRESPEW. Office: 508-862-4038 JUN X 2004 Fax: 508-790-6230 - EXPRESS PERNIIT APPLICATION - RE l TIAL ONLY Not Valtd witi,olit Red X-Press Itnpri t U E3ARNSTALLLZ Map/parcel Number_C;.C?01-01 CA Property Address �. Value of Work 49Residential _ Owner's Name &Address Telephone Number Contractor's Name Home Improvement Contractor License#(if applicable)^ Construction Supervisor's License#(if applicable) [gWorkman'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# Copy of insurance Compliance Certificate must be on file. Permit Request(check box) All construction debris will be taken to Re-roof(stripping old shingles) 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: Pro a Owner must sign Property Owner Letter of Permission. ome Im o e o ct s required. Signature QTorms:expmtrg . Revise053003 iJ r raser k_,0I1S L1-uL;LltJl1 Roofing 8v Siding. Specialists Payable immediately,upon completion NO MONEY DOWN - NO Payment at the start or part way thru Payments accepted are: CASH - CHECK- MASTERCARD -VISA -AMERICAN EXPRESS *Any payments not made within 30 days of completion will be charged 1'/2%for every 30 days the payment is late. Possible Extra-After the shingles are removed from the roof, we will life one sheet of plywood to make sure that the insulation be not up against the plywood sheathing so that ventilation cannot-occur 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$4.00 per panel including Materials & Labor._There are.6 Panels per sheet of plywood. 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$40.00 per hour, plus materials, plus 20% overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the shingles and labor for 10 years. FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. CERTAINTEED Warranties the shingles and labor 100%for the first 5 years, and then on a pro rated basis for 30 years total if the shingles become defective. CERTAINTEED Warranties the shingles to be ALGAE resistant for a full 10 years. 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 fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. 'FRASER CONSTRUCTION: Carries Workman's Compensation and Public Lialiility Insurance on the above work. DATE OF ACCEPTANCE: SUBMI TTED BY: (a Homeowner Fr on Results: Page 1 of 1 Home Improvement Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City, Name, or License number Select Search type: r! AND C' OR Search,.` Search Results Reg. No. Applicant 11 Street City lKiie Zip Name Title Expiration FRASER 71 FRASER, 112536 CONSTRUCTION TARRAGON COTUIT MA 02635 DEAN OWNER 3/23/2005 co CIR Total of 1 Records matched. Back to Home Page BBRS Privacy Statement http://db.state.ma.us/bbrs/hic.pl 6/22/2004