HomeMy WebLinkAbout0020 GREGOIRE CIRCLE I
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CAPE COD .
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NBIAOIASS SIAMIISS SPIAYFOAM SOSPINDID
8AYr3 ""'RB INSOIAfl." am'"' •*. .p 4.i
1-800-696-6611
Town of Barnstable
Regulatory Services ,
Building Division '
200 Main St �R —
Hyannis,MA 02601
Date: <
Dear Building Inspector
Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed&
completed the insulation and weatherization work at the property listed below. Cape Cod
Insulation did this in accordance to the specifications listed on the building permit
application. All work has been inspected by a certified Building Performance Institute
(BPI) inspector. All work preformed.meets or exceeds Federal & State Requirements.
Property Owner Property Address " Village
Kathleen Archer `20 Gregoire Circle- Hyannis
Insulation Installed: Fiberglass Cellulose R-Value' Restricted Unrestricted
Ceilings ( ) ( X ) (20) ( ) (X)
Slopes
Floors/Plates
Walls ( ) (X) ( 13 ) ( X ) ( )
Sin erely
MCod
Jr, President
ion, Inc.
I
Y.
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map � Parcel "" Application # C: a)- -
. c
Health Division • 'Date Issued
Conservation Division Application Fee
Planning Dept. Permit Fee S3
Date Definitive Plan Approved by Planning Board
Historic = OKH _ Preservation/Hyannis
Project Street Address go e O i
Village 4
f
Owner akps."�_ ALA'DAAA SOv-t'\ 9- . Moo
o)_w
Telephone SOT- 72 6_ ? 0 b
1
Permit Request I0 IV Oy' sb,
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 3 C�33.22 Construction Type
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 ❑ 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 ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ 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
� z
APPLICANT INFORMATION +-► `T�
(BUILDER OR HOMEOWNER) n
Name Telephone Number SDI 77.5=1Z
cn
Address r/W-' License# C-n �
4 Z(77 Home Improvement Contractor# 113 S 0
Worker's Compensation # �.1/C� OoSZSgD
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE h 0
FOR OFFICIAL USE ONLY
APPLICATION#
i ,
DATE ISSUED
MAP/PARCEL N0.
t ADDRESS VILLAGE
OWNER
1 DATE OF INSPECTION:
FOUNDATION
FRAME r �-
>l
' t
INSULATION ?
t FIREPLACE
ELECTRICAL: ROUGH FINAL
4 PLUMBING: ROUGH FINAL: -
;GAS ROUGHS rE -. FINAL
—FINAL BUILD.ING5 � .—Q1 -,j_ s4 Fi.
,
DATE CLOSED OUT
ASSOCIATION PLAN NO. -
'T
Date: 7/27/2010 Time: 3:58 PM To: Hank @ 9,15087785735 Rogers& Gray ins. Page: 002
Client#:4597 CCINSUIL .
ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
07/27/2010
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 SU BROGATION 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 Margaret Young
Rogers&Gray Ins.-So.Dennis PHONE 508-760-4602 FAX
A/C No Ext: - A/C No):
434 Route 134 EMAIL
P.O.Box 1601 ADDRESS:
CUSTOMERIDd: . -
South Dennis, MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIL If
INSURED INSURERA:Peerless Insurance -
Cape Cod Insulation Inc INSURERB:Ohio Casualty Insurance Company
455 Yarmouth Road INSURER CAtlantic Charter Insurance
Hyannis, MA 02601 iNSURERD:Commerce Insurance Company 34754
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 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.
POLICY EFF POLICY EXP
TR TYPE OF INSURANCE NSR D POLICY NUMBER MMIDDIYYYY ..DDIYYYY LIMITS
A GENERAL LIABILITY CBP8263063 04/01/2010 04/01/2011 EACH OCCURRENCE $1 000 000
X COMMERCIAL GENERAL LIABILITY - DAMAGE T R N ED
- PREMISES Ea occurteniq $100 QOO
CLAIMS-MADE a OCCUR MED EXP(Any one person) $5,000
PERSONAL BADVINJURY $1,000,000 -
GENERAL AGGREGATE $2,000,000
GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
POLICY 7 PRO- LOC - $
D AUTOMOBILE LIABILITY 10MMBCKVMK 4/01/2010 04/01/2011 COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident) 11,000,000
' - BODILY INJURY(Per person) $ALL.OWNED AUTOS - - - BODILY INJURY(Per accident) $ -
X SCHEDULED AU 1-0S - - - PROPERTY DAMAGE $
X HIRED AUTOS - - (Per accident)
X NON OWNEDAUTOS $
$
B UMBRELLA LIAB X .00CUR MEYAPP397725 06/17/2010 04/01/2011 EACH OCCURRENCE - $1 000000 -
EXCESS LIAB CLAIMS-MADE _ - AGGREGATE - $1,000 000
DEDUCTIBLE $
X RETENTION 10000 $
C WORKERS COMPENSATION WCA00525901 06/301 010 06/3012011 X WCSTATU- oTH-
AND EMPLOYERS'LIABILITY TORY I ,. ER
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N NIA - - E.L.EACH ACCIDENT $500,000
OFFICERJMEMBER EXCLUDED? . - -
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000.
If yes,describe under _
DESCRIPTION OF OPERATIONS below - _ E.L.DISEASE-POLICY LIMIT $500,000 •
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) -**Workers Comp Information**
Included Officers or Proprietors
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION 10'Da s for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Housing Assistance Corp. ACCORDANCE WITH THE POLICY PROVISIONS.
484 Weft Main Street'
.. Hyannis,MA'02601 AUTHORIZED REPRESENTATIVE
01988-2009 ACORD CORPORATION.All rights reserved.
ACORD 25(2009109) 1 of 2 The ACORD name and logo are registered marks ofACORD
#SS48141M53353 MEY
Mass:rrhulsetts-.Department of"Public Safety �
Board of Building Re"fulation and Standards n
' Construction Supervisor License
f Lice n e.`•'CS: 10D988
Restricted to: 00
Hjig
ENRY CASSIDY
8 SHED ROW ;
WEST YARMOUTH, MA 02673
Expiration:" s
11/11/2011
uuui�i�siv�ier Tr#: 100988
t P
B i ula ons an �a, ,
One Ashburton Place'- Room 1`301
Boston a RMass chusetts 02108
Home;Improvement Contractor Registration .
a Registration:' 153567
Type: 'Private Corporation
Expiration: 12/15/2010 Tr# .278247
CAPE COD INSULATION, INC
HENRY CASSIDY
455 YARMOUTH RD.'
HYANNIS, MA 02601 '« r
`Update Address and return card.Mark reason for change."
`E "Address Renewal Employment D Lost Card
IS-CA1 Co 5OM-07/07-PC8490
s6�rrtt �sofls*d ,
License or registration valid for individul use only
-HOME IMPROVEMENT CONTRACTOR ;* before the expiration date.,If found return to.
Registration. 153567 Board of Building Regulations and Standards'
- ; ' .` '•
Expiration 1 2/1 512 0 1 0 Tr# 278247 One Ashburton Place Rai 1301
_':Type Rnvate Corporation Boston,Ma 02108
CAPE COD INSULATION,INC `
`HENRY.CASSIDY
455 YARMOUTH RD _ ~ `
HYANNIS,MA-02601 Administrator'^ <, t id wi ut ignature ` '
Aug, 17. 2010 5:07PM HOUSING ASSISTANCE CORP - ENERGY No. 4584 P. 2
1
;10 APR 16*1;0:43:i 7
l
ell ezqve 6 yh4 to
DLORD �" TENANT iG
r, a r i
PRONE - PNDNE
Dear Landlord,
Your tenant is eligible for services through the Weatherization Program- program regulations
permit us to spend an average of$5,000.00 in materials and labor per dwelling unit.
Program regulations require us to weather-strip and caulk doors and windows-, insulate attics,
sidewalls and floors. All work is professionally done by established private contractors. We will
wnduct a final inspection to make sure that all work is completed to specifications. Prior to making
the inspection and doing the work we must have your permission_ If you want your tenant to
participate in the program,please sign the agreement and return the form to me, This agreement
states that
1. You will nut raise the rent because of the Weatherization work or for one year from the time
the work is completed.
2. You will not evict your tenant for one year following work completion date except for good
cause related to the tenant's failure to pay rent or serious or repeated violation of the terms
of tenancy.
3, if you sell the property during the specified period,either the new owner must assume the
oblidations under the agreement prior to sale,or you must refund to us the entire amount of
materials and labor we spent in weatherizing the unit.
If you request,you will be informed of the estimated measures before they are done and
provided with a list of the actual measures and costs following the completion of the work,
�`-y5le;also rieet9` rbvf that you own'the property.. A copy of,a CURRENT TAX BILL.OR!DEED
listing you as the owner will satisfy this re461rement. Please fill in all blank areas of the
enclosed agreement and return with the proof of ownership as soon as possible. Failure m fill
out the entire,form will result in a delay in processing the application.
" F If you have any questions please call Michael Sartori at 508-790-7105,ext 105.
Sincerely,
lf` i, -1•
Ruth Bechtold.
Assistant Director
Energy and Home Repair Department
S
Aug, 17. 2010 5:07PM HOUSING `ASSISTANCE CORP ,- ENERGY . No. 4584 P. 3
TENANTIPROPERTY OWNE=E7IAGENGY W.EATHERIZATIO.N.AGREEMENT
I_ The Partles to this Agreement are the following'
(hereafter known as Tenant);
(print your tenant's name)
_- --(hereafter known as Property Owner)
(print your name)
and Housing Assistance Corporation(hereafter known as Agency).
In consideration of the mutual promises hereafter stated,the Parties agree as follows:
2. The date of Agency's signature will be the effective date of this Agreement
3, Property Owner and Tenant consent and agree that the Agency may do the following with
respect to the property located at(street, town)
unit# ,and currently
leasW or rented to the.Tenant
f a
a) Enter the premises for the purpose of,performing a Weatherizatlon'inspection.
b) Enter the premises to perform Weatherization work which the Agency datermines `
in its discretion is necessary and appropriate as a result of the Agency's .
inspection of the property and in accordance with the appropriate priority list for
the type of dwelling_ The Agency and the Agency's contractors may also enter the
appropriate common areas of the bulldlhg for the purpose of accomplishing the
Weatherization work. The Agency and representatives of the Commonwealth of.
Massachusetts, Department of Housing&Community Development(DHCD)may'
further enter the property to inspect any and all work hereunder. The Agency will
provide reasonable notice of the fiming of the Weatheftation work and
inspections_' The Weatherization work will be performed in accordance With`the
Property Owner's consent as further specified below:
INITIAL ONLY ONE OF THE FOLLOWING
- I consent to performance by the Agency and its contractors of any
Weatherization work determined necessary and appropriate by the Agency as a
result of Its inspection of the property. I understand that the Agency will provide
a detailed statement of the actual work performed and the associated value at
the completion of.work
MI provide a separate consent to performance by tlfie Agency and its
contractors of Weatherization work following my receipt of the Agency's
inspection report and a statement of the estimated work and associated value.
This additional consent will be sent under separate cover as AttachmenfA.
understand that the agency will provide a detailed statement of the actual work
performed and the associated value at the completion of the work.
4. The Property Owner understands and agrees that any and all work;Including related
repairs for which the Property may also be eligible,will be performed at the Agency's
discretion. The Agency estimated completion of the Weatherization work by the end of
5. If the Property Owner is required to make repairs to the property prior to the
commencement of Weatherrcation work by the Agency,the Property Owner will be notified
by the Agency and will be required to make the repairs as soon as possible. Except where
the Property Owner receives a written extensiorrfrom the Agency,time is of the essence in
the performance of repairs by the Property Owner:
a
Aug, 11. 2010 5:08PM HOUSING ASSISTANCE CORP - ENERGY No. 4584 P. 4
B. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel
suppliedutility supplier as to the quantity of fuellutilitles used at the above address In each
of the past three years and the future three years. The Information Is to be used only to
determine the cost effectiveness of the Weatherization improvements.
7. The Property Owner agrees that the rent for the dwelling unit will not be nalsed because of
any increase'in the value thereof due solely to the Weatherizabon work performed,
8. In consideration of the Weatherization work hereunder,.the Property Owner further agrees
that upon the effective date of this Agreement and during a period extending through
...288W..approximately one year from the time the work is completed`
a) The present rent$ r moot ill not be raised for any reason. (The
rent amount must be Filled in)_
However,this Paragraph(8a)will be waived by the Agency In writing if,and
only If,the premises are leased under a state or federal rent subsidy
praaram,in which case the actual rent charged by the Owner shall conform to the
standards of the rent subsidy program
Please state which Housing Subsidy program your tenant Is on and through
which Agency:
b) The Property Owner will not institute any summary process action for possession .
except in the case of non-payment of rent or other good cause related to the
Tenant(or any successor Tenant).
c) In the event the Property Owner decides to sell.the-premises,Property Owner
shall comply with one of the two requirements below-
-The Property Owner shall not sell the premises unless the buyer agrees twlth a
copy forwarded to the Agency)in writing prior to sale to assume all obligations of
the Property Owner set out in this Agreement;or
—The Property Owner shall pay the Agency an amount equal to the cost,as
certified by the Agency,of the Weatherization materials installed and labor
performed in the premises as of the date of sale. Said amount shall be paid to
the Agency immediately upon sale,
9_ (Applicable only if Tenants cheat is included in rental payment and blanks are filled
in) At the end of the period set forth in Paragraph 8 above,the rent shall not be raised
more than _ Of per for an additional period of one year,and the
provisions of 8b and 6o above shall continue in effect for such period, However,the rent
provisions of this paragraph g may be waived by the Agency in writing if,and only if,the
premises are leased under a state or federal rent subsidy program,in which case the actual
rent charged by the Owner shall conform to.the standards of the rent subsidy program.
10. The Parties agree that the terms of this Agreement are incorporated into any other lease or'
agreement between the Property Owner and the Tenant,and between the Property Owner
and any successor Tenant,and if there is any conflict between the provisions of this
Agreement and the provisions of such other lease or agreement,the provisions of this
Agreement shall govern. However,if such other lease or agreement,including without
limitation a lease or agreement under state or federal rent subsidy program, contains
stronger protections for the Tenant,such stronger protections shall apply.
Aug, 17. 2010 5:08PM HOUSING ASSISTANCE CORP - ENERGY No, 4584 P. 5
11, For breach of this Agreement by the Property Owner, the Property Owner shall reimburse
the Agency in an amount equal to the cost,as certified by the Agency,of the
Weatherization materials installed and laborperformed on the premises,as well as
attorney's fee and court costs. The Property Owner may also be liable for damages to the
Tenant in accordance with applicable law,in such instance, the Property Owner shalt
reimburse the Tenant for attorney's fees and court costs. Without limitlna the foregoing,the
Agency may at its option terminate this Agreement,by providing written notice to the
Property Owner and Tenant, in the event of breach by the Property Owner or Tenant_
12, Performance of the Weotherization work hereunder by the Agency is contingent upon the
availability of funds to the Agency from the commonweaM of Massachusetts and the
federal.government,as well as the eligibility of the Tenant under WAP program
requirements. The Agency may terminate this Agreement, by providing written notice to
the Property Owner and Tenant, if the Agency determines that the unavailability of funds or
ineiigiblity bf the Tenant warrants.termination. _
13_ The Parties acknowledge that this Agreement is under seal.. It is intended by the PartJes
°that the Tenant or an successor Tenant is the intended beneficiary of the
,. y ry Agreement and ,
shall have aright of enforcement.
Property Owner's
Signature: ,.Date_ - _ 1 C3 _
s� }
Phone: -750
U
Address:
Tenant 5ivgrtaturec ` "" 'fl{ Date �s��-V;e
Agency SignatUr*e Date
09/01/2010 04:40 5087785731 CAPE COD INSULATION PAGE 01
pia \ T/T.e Co Ill.mor veall/i 0f'A-fo.,ssrcch.Lis rlls
_ -- L)cparltrr.e7xt ofl iduslrial.Accidetxhs'
Im'csi'tl;adorns
600 Wash.in.g taxi S"beet
Boston, MA 02.111
�pl-uati.rnrtsr.gnt�/ditz
Workers' Compensation In.sura:nc.e Affid i +it' Builclers/Contra.ctol-s/Electl-icians/P1txmbers
leant Information Please Print Legibly
NaMe (tausincss/0rganization/Individur�l); � (ZQ, (1I
Address: ._ XA
City/State/Zip: _ Q. )'hone #: S—O 7 1
Are you an, employer?•Ch.cck th appr,opriate box:: Typr.oCproject (required):
1: ,i• am it,amploycr with 7
— 4, ❑ 1 ant a gcncral contractor and 1
6., ❑Now construction
C7MP.oyees (full a.ndJd patL•time). have hued the sub-contractors
2-❑ 1 ani a sole propriotor.orpartner- listed on the attached shcct. 7. ❑ Remodeling
ship and have no cmployccs Thiess cub-contrtictors have 8. ❑Demolition
working for me in any capacity. omploycos and have Nvorkcra'
m insurance.f 9, ❑l3uild.ing eddilion
[N cor
n workers' comp. insurance ]
required,] 5. ❑ Wa me a t,orporation and its 10.0 Electrical rcpair.g or additions
3.❑ I am a horneowrncr,doing all work nfricers have exercised dicir 11,0 Plumbing repairs or additions
my.etf• [No workers' comp. right of exemption per MGL. 12 n,Roof rq irs
insurtlncc required:] f c. 152, §1.(4),and we h'1.ve no
miployees, [No workcts' 13.CJ 0therf,�,[
comp, insurance rcquued.]
"Any applira,nt.that checks box#1 must Also fill out die section below showing diem wor•kcrs'aompcnsAtion policy information,
t Hnrnmwncrs who submit This AfGd.avii indicating they arc doing n.11 work and[lien hiro owsaidc contractors mu^t submil a mw,.Mdovil indicating such,
lControc(om that cherk this box must nnncht-d rM tirlditiona.l sheet shnwing the nnmc or the sub-contrne(ors and oeto whether or not(hose n0tirs hnvc
omployms, Irthe sub-conimHons have employocs,they must prWidc their workurs'comp.policy nuntbrr.
Cam an.eniployr•-r(ha.(is providing workers'compensation in.secr-nn.ce for IftQ Prnplo)+ees. Belo is thepaliey anal jab sits
irrfnrrnation-
I.naurancc Company Nsmo:�
Policy#nr Self-itts. Lic.ll; G�•ZL�Q—OO..Sr�.�O-�, _• Lxpia-iitiou Daf.e:__- b�3b __,
Job Site Ad.dross:
Attach a copy oC the workers' compm50011 policy dr6s.ra.tion page(showing the policy utinaller add expiration date).
Failure to secure coverupo as required ixd<:r Scctiot7 7.5A ofMGL c, 152 cau lead to i:be imposition of:crimi..dgl penalties of
fiat up to $1,500.00 and/or one-year 1r0P1'icoarncnt, as well as civil,penalties in lbe for'M of a. STOP WOTt1C ORDER and fl lane
of up to$250,00 a day agai,rast.,tho violator, Bo advised that a copy of dais sta,tcnirnt may be forwarded to the Office of
investigations o[the Dln.fnr insurance coverage vcrilication,
r.do hcrely certify tU e 1 pa and pen.nitirc ofpeljlary that Me inforwatioir proi+ided above Fs frets and correct
Sigw1lurc; Ji At /m —�
Official rose only. Do nor writs.in this aria, to be completed IJy city or tow,,i offciaL
City or Town;- FermitJ1.1cense
IssUin.p'Authority (circle one);
1. Board orReAlth 2, Suildtng Department 3, CJty/Toirn Clcrk 4. Lfrctrical lnspcctor S. Plorri ling Inspector--
6. Other'
Contctet PCrson: �..�`. '-• P11onc l'(; •
HOUSING ASSISTANCE CORPORATION WEATHERIZATION WORKSHEET
Client Name/Address: Contractor:
Kathleen Archer
20 Gregoire Street Date: JIM
Centerville
Phone: 292=1599 Installed Program: Weatherization
JOB #
Units
Description Price D ; G/N C DOE GAS/NSTAR CLC QC�
DOORS
ea. 43. 00 3
ea er np - on r eq ° 129.OUT-
Fixec Sweep ea. 15.00 3 - 45.00
Automatic Sweep ea. 22.00 _
R-5 Ductwrap or R-max on door ea. $ 44.00
Lockset/Schlage or equal ea; $ 70.00 _
Repair/Refit Door $ 50.00 _
...... - -
32-36".Steel pre-hung replacement door w/lite ea. $ 610.00 _
32-36" Wood pre-hung replacement door w/lite ea. $ 580.00 _
28-32" interior solid core door ea. $ 300.00
Basement/outside door-door only ea. $ 350.00
Basement/outside door-w/jambs ea. $ 415.00 _
WINDOWS
Weatherstrip Window/Schlegal or equivalent ea. side 5.00 _ _ _
Top Sash Lock ea. 9.25
Side Press Lock ea: 9.25
Glass Replacement to 64 ui ea $ 42,00
Glass Replacement per ui over 64 ui $ 1.40 _
Replacement grids(per window) ea. $ 40.00
Energy* R4 prime win.repl.mentw/low-e to 73 ui ea. $ 390.00 _
Energy*R4 prime win. repl.ment w/low-e to 74-83 ui ea. $ 4 00.09
Energy* R4 prime win.repl.ment w/low-e to low 84-93 ui ea. $ 410.00
Energy*R4 prime win.repl.ment w/low-e to low 94-101 ui ea. $ 425.00
Basement window replacement(awning/hopper) ea. $ 325.00.
Basement.window replacement with frame ea. $ 350.00
wzPList Page 1 of 4 04/12/2010
HOUSING ASSISTANCE CORPORATION I Contractor: 0
Client: Kathleen Archer
BILLING SHEET (Cont.)
Date: JIM Installed Program: Weatherization
Units
Description Price D G/N C DOE GAS/NSTAR CLC QC,J
MISC. MEASURES
w/s(Q-Ion or equal)attic hatch ea. $ 30.00 $ _ $ $
w/s(Q-Ion or equal)R-30 attic hatch ea. 32.00 1 - 32.00
Blower door set-up with pre&post tests ea. 45.00 1 - 45.00 -
Attic sealing with two-part foam man/hr. $ 75.00 3 - 225.00
Basement air sealing with two part foam man/hr. $ 55.00 3 - 225.00
Seal ducts with mastic or butyl backed tape hr. 22.00
Cut-finish attic-kneewall.access ea: 100.00
Cut/close attic-kneewall access ea; 75.00 _
Vent kit/bath fan V/h
1 - 85.00
Clothes dryer vent incluidng Exhaust Duct
Replace Clothes Dryer Transition Duct Only(H&S)
Bath fan-Panas. Whisp.w/exstng pwr&timer(H&S)
Bath fan-Panas. Whisp.w/o exstng pwr&timer(H&S) 1 450.00
Labor only charge _
ATTIC INSULATION
R-49 unrestricted-settled cellulose sq. ft.
R-38 unrestricted-settled cellulose sq. ft. 1.40 _
R-30 unrestricted-settled cellulose sq. ft. 1:30
R-18-20 unrestricted settled cellulose sq. ft. 1.23 864 - 1,062.72
R-10-12 unrestricted-settled cellulose, sq.
R-30 restricted-slopes/floored fill w/cellulose sq. ft. 1.41
R-18-20 restricted-slopes/floored fill w/cellulose sq. ft. 1.35
R-10-12 restricted-slopes/floored fill w/cellulose sq. ft. 1.24 _
Attic stairs &common wall-fill w/cellulose stairwell 130.00
R-11 FGB in open rafters/walls/kneewalls sq.ft. 1.25
R-19 FGB in open rafters/walls/kneewalls sq. ft. $ 1.40
Kneewalls R-12 Cellulose behind permeable membrane sq. ft. $ 1.65
Reinforced poly/R-20 cellulose open rafters sq. ft. $ 1.75
Reinforced poly/R-30 cellulose open rafters sq.ft. 1.95
Site Built pulldown stair insul.2".foambox//Thermodome ea. 1 55.00
Attic/Kneewall Floor Transition Dense Pack w/cellulose ln.ft. 2.40 _
wzPList Page 2 of.4 04/12/2010
TIOUSING ASSISTANCE CORPORATION
. Contractor. 0
Client: Kathleen Archer
BILLING SHEET (Cont.)
Date: JIM Installed Program: Weatherization
Units
Description Price D G/N C DOE GAS/NSTAR CLC QC,J
WALL INSULATION
Wood clapboard/shakes/shingles or vinyl(dense pack) sq. ft. 1.70 _
Single nailed asbestos/asphalt(dense pack) sq.ft. 2.10 _
Double nailed asbestos/aluminum(dense pack) sq.ft. 2.20 _
Brick/Stucco(dense pack) sq. ft. 2.75 _
Drill rough plaster patch or finish wood plug(dense pack) sq. ft. 1°.73
Drill finish patch plaster(dense pack) sq.ft. 1.81 _
Vinyl over asbestos(dense pack) sq.ft. 2.20 _
Test drill 4 sides flat rate 60:00 1 60.00
Interior wall blow sq. ft. 1.40 - -
sq.ft.L v
BASEMENT INSULATION
Garage ceiling cavity filled with blown cellulose .q ft. $ 2.00
Sill two-part foam w/fiberglass batt sq.ft. $ 2.00 96 - 192.00
Sill insulation faced R-19 In. ft. $ 1.50
Basement overhead insulation R19 Fiberglass sq. ft. $ 1.50 _
Basement overhead insulation R30 Fiberglass sq. ft. $ 1.73 _
Crawlspace overhd.insul.4'high or less R-19 sq. ft. $ 1.78 -
Crawlspace overhd. insul.4'high or less R-30 sq.ft. $ 1.87 _
Perimeter wrap R-5 reinforced foil or vinyl faced ductwrap sq. ft. $ 1.82
Pe
rimeter 2 foam board sq.ft. $ 2.17
6 ml poly on ground`
sq - -
.ft. $ 0.75
• _ _ t
MISC. INSULATION
Duct insulation R-5 s :ft.
2.95
q
Dostic water pipe wrap In.ft.
me 2.50 20 - 50.00
Hydronic pipe insulation to 1"copper pipe R-5 In.ft. 3.25
r Hydronic.pipe insulation 1.25- 1.5"copper pipe R-5 In.ft. 3.50
Steampipe insulation to 1.25 iron pipe R-5 - In.ft. 5.25 _
Steampipe insulation to 1.5-2" iron pipe R-5 In. ft. $ 6.05
Steampipe insulaiton 3" iron pipe R-5 In. ft. 7.25
wzPList Page 3 of 4 04/12/2010
MOUSING ASSISTANCE CORPORATION Contractor: 0
Client: Kathleen Archer
BILLING SHEET (Coat.)
Date: ,J I M Installed Program Weatherization
Units
Description Price D G/N C DOE GAS/NSTAR CLC QC�
ATTIC VENTILATION
Rectangular gable.vent ea. 88.00 _ _
Varipitch vent, ea. 109.00 _
Roof vent 135(1 sq. ft.NFV)large ea. 95.00 4 - 380.00
Roof vent 865(A sq. ft.NFV)small ea. 76.00 _
Turbine Vent ea. 160.00
Stack Vent ea. 145.00
Proper Vent ea. 3.75 14 52.50
Rectangular soffit vent ea. 26.00 _
Ridge vent In. ft. 22.00
DEADLIGHTS &OTHER
Deadlights ea. $ 100.00 $ _ $ _ $ _
Rigid foam Board price(charge under A/S or labor only) sq.ft. $ 1.75
Window quilt ea.
Sliding glass door ea. $ 1,290.00
Bldg. permit baseline price(input unit accordingly) ea. $ 50.00
Notes:
BLOWER DOOR RESULTS CFM @ 50 PASC.
PRE / 1188
POST /
TOTAL DOE $
LEVERAGED FUNDS $ 3,033.22 -
TOTAL JOB COST. $ 3,033.22
Photos and attic'inspection form are required at time
invoice is submitted.
wzPList Page 4 of 4 04/12/2010
�pFtr+e'Owti Town of Barnstable *Permit#
,Y p� Expires 6 months frqojssue date
ei ,�„B , ; RESS pERggulatory Services
^ Thomas F.Geiler,Director
A U G
6 20.07 Building Division
TOWN erry B, uilding Commissioner
OF BARNSTA,� C ii .
am Street, Hyannis,MA 02601
Office: 508-862-4038
Fax: 508-790-6230
EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number. / .d
Property Address 6 Cl ii2AC a j A
I S
[(Residential Value of Work E3 1 1 15 00
Owner's Name&Address (-A�(1S`�� I�. [4(a u J l r1G t )t-h a` Q
Contractor's Names 6') I° N _ KA6—AJi Telephone Number 156g-7-75r -1-1?1
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) .it cis — 6 d L�
❑Workman's Compensation Insurance,
Check one:
❑ I am a sole proprietor
' I am the Homeowner
have Worker's Compensation Insurance
Insurance Company Name Q ✓ '�- z �'� �of Y1�J U�XfAcu -
Workmen's Comp.Policy# D (A S`i 5 D L '3Dp -
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: ust sign Property Owner Letter of Permission.
m vement Contractors License is required.
Signature
Q:Forms:expmtrg
u.,,; .nsznna
,y 1 ne L ommonweacrn of IvlusYucnuaeci3•
Department of Industrial Accidents.
' Office of Investigations
600 Washington Street
Boston, MA 02111
y www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectHelans/Plulnbers
A]20cant Information Please Print Legibly
Name (Business/organization/Individual): SP z I JQ L �p M�Rd IY121�T
Address:
City/State/Zip: - Phone #: 5 o 8 -7-2 s -:l-?-7 R
Are you an employer? Check the appropriate box: Type of project(required):
I.DI am a employer with 5 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 S. ❑ Demolition
working for mein any capacity. workers' comp.insurance. 9, ❑ Building addition
[No workers' comp. insurance 5• ❑ We are a corporation and its 10.❑ Electrical r airs or additions
required.] officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11-❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no 12.E Roof repairs
insurance required.] t 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 contactors must submit a new affidavit indicating such
cContractor;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 and job site
information.
Insurance Comp any Name: R S S o C►A-r e N'l fl5S P,C, u Ssz
Policy#or Self-ins.Lie. #: Expiration Date:5l•13)07
Job Site Address: 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 ge verification.
I do hereby ce n he p Ind enalties of perjury that the information providM
true and come
111 ct
Signature: Date:
Phone#: 505
Official use only. Do not write in this area,to be completed by city or town q ffici d
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk e.Electrical inspector 5.Plumbing laspector
6. Other
. a �
Contact Person: �
Phone#:
Information and Instructions v-
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,partnership, 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 or building appurtenant thereto shall not because of such employment be deemed to be an employer."
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),addresses) and phone number(s)along with their certificate(s) of
insurance. Limited Liability Companies(I,LC)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 applicamt.
Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permittlicense 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. Anew 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 hlse 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-o77-MASSAFE
Fax # 617-727-7749
Revised 5-26-05
www.mass.aovlaia
W 4. Contractor is not responsible for existing conditions of residence.
5. Contractor is not responsible for damage to such items as, but not limited to: sidewalks; driveways;
patios; lawns; shrubs; sprinklers; and other such appurtenances. -However, reasonable care will be
taken. <J
1r
6. All agreements are contingent upon strikes, accidents, or delays beyond Contractor's control.
7. Homeowner is to carry fire,and other necessary*insurance: Contractor's'workers are fully covered
by Worker's Compensation Insurance.
8. Fencing, carpentry, painting,plumbing, electrical, dry wells, etc., and all other work necessary that is
not contained in this contract, shall be the responsibility of the Homeowner.
RIGHTS TO CANCEL r
The Owner may cancel this Agreement if it has been signed by the Owner at a place other than the
address of the Contractor, which may be-his main office or branch thereof, provided that the Owner notifies the .
Contractor in writing at his main office, or branch by ordinary.mail posted, by telegram sent or by delivery, not
later than midnight of the third business day following the signing of this Agreement.
WARRANTIES r
The Contractor warrants that the work furnished hereunder shall be free from defects in workmanship for a
period of two (2) years following completion and shall comply with the requirements of this Agreement. In the
event any defect in workmanship, or damage caused by the Contractor,his subcontractors, employees or agents,
is discovered within two years after completion of any job, including clean-up,the Contractor shall, at his own
expense, forthwith remedy,-rbpair correct, replace,_or cause to be remedied, repaired, or replaced such damage
or such defect in workmanship as long as the owner has paid their agreed contract in full. ' The foregoing
warranties shall survive any inspection performed in connection with the agreed upon work.
All warranties for product supplied by the Contractor under this Agreement shall be those given f by•the
manufacturers of such product, which shall be and hereby passed directly to the Owner. Such manufacturer's
warranties,the Owner may be required to register`or mail in a warranty card or other evidence of ownership,
and use of such product in order to activate such warranties. The Owner's failure to send in or register such
documentation, which failure voids that.manufacturer's warranty, shall not create any responsibility for the
Contractor to warranty,such product.
Note: Any changes in the contract during the duration of the project which results in additional monies "
due will be paid in full to the contractor at the time of the change.
I authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be
performed on this job (i.e. permits, applications etc.) if necessary..:
a
5
Barnstable Housin'' Authority . Date Brad Sprinkle 4. Date
Celebrating 61 years in business?u
i
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration 1A3757
'� °'` ,Expiration 7(:9/2008
Type PrJ�Vate Corporation
SPRINKLE HOME IMPROVEMENT;INC.
Brad Sprinkle
199 Barnstable Rd. -
Hyannis, MA 02601 Deputy Administrator
� J
lie "toarfvr�uy�ucN?CZGGi2 4�✓1��i31lz!'fLCIaP.�1
BOARD OF BUILDING.REGULATIONS
License: CONSTRUCTION SUPERVISOR
yy � Number CS 006643
=1� ' Birthdate - 0/6,8/1955
- Expires 10/08/2'007 �Tr. no? 6638'0
Construction -CS,
Restricted 00
BRAD K SPRINKLE
190 LOTHROPS LANE t, ,ems
W BARNSTABLE, MA 02668
Commissioner t
ISSUE DATE 0512112007
CbA
PRODUCER "
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Bryden&Sullivan Ins Agency CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
Inc POLICIES BELOW.
88 Falmouth Road - — — ------- —
Hyannis,MA 02601 COMPANIES AFFORDING COVERAGE—
INSURED — --
Sprinkle Home Improvement Inc
199 13arn'st•abl6'toad COMPANY A A.I.M.Mutual Insurance Co
LETTER __ ...
Hyannis,MA 02601
2 f 3
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE. POLICY EXPIRATION LIMITS
LTR DATE(MM/DD/YY) DATE(MMIDD/YY)
. GENERAL AGGREGATE $
GENERAL LIABILITY -
r-� PRODUCTS-COMP/OP AGG.
u COMMERCIAL GENERAL LIABILITY PERSONAL&ADV.INJURY $
=CLAIMS MADE=OCCUR
- EACH OCCURRENCE $
OWNER'S&CONTRACTOR'S PROT, -
FIRE DAMAGE(Anyone tire) •$
MED.EXPENSE(Anyone person)
AUTOMOBILE,LIABILITY COMBINED SINGLE
'LIMIT
ANY AUTO BODILY INJURY 'i
ALL OWNED AUTOS (Per person) $
SCHEDULEDAUTOS
HIRED AUTOS
INJURY -----
- -.--. Per acci enQ —
GARAGF,LIABILITY
PROPERTY DAMAGE $ _- _---------
EXCESS LIABILITY --_-----' - ---^- - - --' EACHOCCURRENCE
---_$ ------_-- ----_--
UMBRELLA FORM AGGREGATE $ -
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND STATUTORY LIMITS OTHER
EMPLOYERS LIABILITY X
HE PROPRIETOR/ EL EACH ACCIDENT $ 500,000
A PARNERS\EXECUTIVE
OFFICIERS ARE: 7004943012007 05/13/M07 05/13/2008 EL DISEASE--POLICY LIMIT 500,000-
MX INCL EXCL -
EL DISEASE--EACH 500,000
EMPLOYEE
--- -------------- — —. _.__ — -- -- _-- --.. —. ------. _. --
COMMEN'I'S/DESCRIPTION OF-OPERATIONS OR LOCATIONS: - -
�r,�,►IFI��T.,�I.�r `DFtR�' ..c �� � `r� i IH»p„J.w, ,� "", s t ;�',�C�A+I�G�E�LATIO... ,sc°��a `` " '-.�.�,r'�c� ..:
fa
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
BRAD SPRINKLE HEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 WRITTEN NOTICE TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
199 BARNSTABLE ROAD
HYANNIS, MA 02601 AUTHORIZED REPRESENTATIVE
Town of Barnstable !Ptrtxdt a
a XV&As J nanthrJ}vn+bsue date
e a:xntrrweuc,.B Regulatory Services Fee
Thomas F.Geiler,Director
s
° Building Division
Tom Perry, Building Commissioner, -PRESS PERMIT
200 Main Street, Hyannis,MA 02601
Office; 508-862-40313 - JUL i'. 9 2003
Fax; 508-790-6230
EJTRESS PERIbGT APPLICATION - RESIDENTI nlYnF B,gRNSTABLE
273 7 b/ Z Not Ya1td without Red x-Press rntprtnt
Map/parcel Number
•Jy
Property Address 2.O O C —
[�Residential Value of Work # =�
Owner's Name&Address BF} ML_0�5LF_ �Vs11�G- UT CZ1Ty .
1!At2 S au% S�: �4 u A u N is MA o ze o f
Contractor's Name T cw &ZeGZ i%l �j X)(�S g` �` Telephone Number �:)(��)'� G( - �\_
Home improvement Contractor License#(if applictible)
Construction Supervisor's License#(if applicable) aCV
f5Worl man's Compensation Insuuancc -
Chock one;
❑ I am a sole propriator u
❑ I am the Homeowner
I have'Worker's Compensation Insuiance -
Insurance Company Name VrG.V���1j 1�>
Workman's Comp.Policy# PJ'u g-- .a a.x3, - 50 2—
Permit Request(chock box)
ffrRe-roof(stripping old shingles)All construction debris will be taken to r Mn ol LAtjDFlLL_
❑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 par nit does not exempt compliance with other town dqutsi ent repittiona,i.e.Mstonc,Conservatism etc. i
Signature Ad
r.
Q:Forres:exptntrg
AeviReA t Z l 901
ACORD.- CERTIFICATE OF LIABILITY INSURANCE
PRODU%ER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Mc Shea Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Osterville, Ma. 02655 INSURERS AFFORDING COVERAGE
-42 - 11
INSURED Paul J Cazeault & Sons Roofing Inc. RINSURERA: rn H ri In COr v l r In mni f Illin i
1031 Main StreetOsterville, Ma 02655
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING I!
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 CLAIMS.
INSiR POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MMIDD/YY
GENERAL LIABILITY EACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one(ire) $ _
CLAIMS MADE OCCUR MED EXP(Any one person) $
A TBI 04/30/03 04/30/04 PERSONAL&ADVINJURY $1TUM-0-0 I
GENERAL AGGREGATE $' QQQIWO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1 _
POLICY PRO LOC
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO —I
ALL OWNED AUTOS BODILY INJURY $
(Per person)
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY $
(Per accident)
NON-OWNED AUTOS --
PROPERTY DAMAGE $
(Per accident)
AUTO ONLY-EA ACCIDENT $ _
GARAGE LIABILITY
ANY AUTO OTHER THAN EA ACC $ __
AUTO ONLY: AGG $
$ _
EXCESS LIABILITY EACH OCCURRENCE
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE
c
RETENTION $
WC STATU- OTH-
WORKERS COMPENSATION AND TOR,LIMITS ER
EMPLOYERS'LIABILITY 7 P JUB-9 2 2 X 6 5 3-5 0 2 0 8/10/0 2 0 8/10/0 3 E.L.EACH ACCIDENT $1
E.L.DISEASE-EA EMPLOYEE $1
B
E.L.DISEASE-POLICY LIMIT S
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC'
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SFIALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHO ZED REPRESENTATIVE !
r
0 ACORD CORPORATION 1988
= Board.of Building Regula ions and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 103714
Type: Private Corporation
Expiration: 7/9/2004
PAUL J. CAZEAULT & SONS, INC.
Paul Cazeault
P.O. Box 2781
Orleans, MA 02653
Update Address and return card.Mark reason for change.
l `1 Address I—j Renewal I?mployma�t i lostC:ud
\ ✓/ze (iyr�vmaocuie�� o�✓ iasat�iuvel7(4
d d d St ti l R Building
f B d Boar of Regulations and License or�registration valid for individul use'only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
nn
Registration: 103714 Board of Building Regulations and Standards
. •
One Ashburton Place Run 1301
Expiration: 7/9/2004 Boston,Ma.02108
Type- Private Corporation _
PAUL J.CAZEAULT&SONS, INC.
Paul Cazeault
22 Giddiah Rd. G� i ` , ✓�r ��r nziieo>rued/,1� lr..ict��irJel�d
Orleans, MA 02653 . Administrator Noi s ' BOARD OF BUILDING REGULATIONS
i License: CONSTRUCTION SUPERVISOR
} a Number: CS 026325
Birthdate: 10/20/1959
Expires: 10/20/2003 Tr.no: 7310
Restricted: 00
PAUL J CAZEAULT _
1585 MAIN ST —
OSTERVILLE, MA 02655 Administrator
Board of sBuildin Regulations
One Ashburton Pace, Rm 1301 ,
Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959
Number: CS 026325 Expires: 10/20/2003 Restricted To: 00
PAULJ CAZEAULT ,
1585 MAIN ST
OSTERVILLE, MA 02655
Tr. no: 7310
Keep top for receipt and change of address notification.
Ji11�1
U-�
Property Owner Must Complete and Sign This Section If Using A
Builder
Zync� c4cfC Q , as Owner of the subject property
hereby authorize e-k Z ear to act on my behalf,
in all matters relative to work authorized by this building permit application for (address of
job)
�0 ®Q).r(p far]ems r-111*11e , M6 ( wz-
Signature of Own Date
Print Name