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Home My WebLink About0036 IRVING AVENUE �- - \ � - J c c Town of Barnstable *Permit 42 9v�'�� oti tom.r� vi•c: y Expires 6 months from i sue dated Regulatory Services Fee ■ARNSTABLE, Thomas F. Geller, Director. y MASS. �+ Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.towri.barnstable-ina.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not valid without Red X-Press Imprint r- Map/parcel Number �(� / 0a l _ -----------� Property Address 3 V [lResidential Value of Work , Minimum fee of$25.00 for work under $6000.00 Owner's Name &Address / 0 t14 Contractor's Name ��.�` ('1)/U� /� Telephone Number . - 7 7l0 ' O Home Improvement Contractor License# (if applicable) F'Workman's Compensation Insurance Check one: 0 I am a sole proprietor -PRE PENT I am the Homeowner [?`I have Worker's Compensation Insurance SEP 3 Z008 Insurance Company Name e- F Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check.box) [&/<c-roof(stripping old shingles) All construction debris will be taken to Ct.✓ rt S, to �J -arkr ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where-equired: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. ***No'e: Property Owner must sign..Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: �Lv" Q:\WPFILES\F0R1VS\building permit forms\EXPRESS.doc Revise020108 Island Sd' andRoofing a division of RLTConstruction,Inc. Proposal To:. August 30,2008 McDermott 36 Irving Avenue Hyannisport, Ma We are pleased to submit the following specifications and estimates for re-roof. _Remove existing asphalt shingles`and flashings. . Install aluminum drip edge arid pipe flashin gs. Install 3 ft. ice shield to eaves, valleys, skylights and chimneys. Install 15 lb. paper to remaining roof Install 30 yr. Certainteed Woodscape architectural grade shingles.(Weathered wood) Remove.and replace rubber roof on north facing dormer. Install ridge vent or aluminum vents as needed. Clean up and haul away debris. We hereby propose to furnish material and labor- complete in accordance with the above specification, for the sum of: $14,350.00. PAYMENT TO BE MADE AS FOLLOWS: Payment in full due upon completion All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,.accidents,or delays beyond our control. Owners to carry fire,wind damage and other necessary insurance. RLT Construction,Inc. carries General Liability and Workman's Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and c ditions are satisfactory and hereby accepted. You are authorized to do the work as e ifred. Payment will be made as outlined above. Date of Acceptance: ` 3 � Signature Start Dater Signature 7e& 2�� IV 31 Manni Circle • Centerville, Massachusetts 02632 Telephone 508.420.5243 and 508.833.5249 • Fax 508.420.1776 Email caperoofer@eaperoofer.com The Commonwealth of Massachusetts Department of Industrial flecidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/diet rc lnm Workers' Compenation finsurance Affidavit: Builders/Contractors/Mcte' Frint Legib Applicant Information Pleas l Namr,(BusincsslOrganization/lndividuan: a2- " Address: � t �.Q.n o�r CFs7�P City/StatelZip: �� vt l,e /t(( ao Phone.#: Z F2-FI you an employer? Check the appropriate box:- 'Type of project(required): � I ama employer with 4. [] I am a generalc ❑ontractor and 1 6. New constructionemployees(full and/or part-time).* have hired the shb-contractors I am a•sole proprietor or partntr- Jistcd on the attached sheet 7 ❑REm dcling ship and have no employees These sub-contractors have g. Demolition emloyees and have workers' working for me in any capacity. 9. ❑Building addition . No workers' corrgi.-insi�nce cam'au��'$ 5. [] We are 3.❑ I am a corporation and its 10.❑"Electrical repairs or additions 1 ara a h homeowner doing all work] officers have exercised their l l.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12 ❑goof repairs incnranca requued_]t c. I52, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance requir� *Any applicant that checks box#1 nnnt also fill out the section below showing their worictxs'cmopalsation policy information. t Homeowners who submit this affidavit indicating tbcy arc doing all work and thrn lure outside contractors must submit anew affidavit indicating such rCantractors that cbmk this box must atfathcd an additional short showing the name of the sub-contractors and staft whcthrr or not thosd cnti$ have employees. ff the sub-eonixaetrn s have ernploycrs,flay rrnist prat idt their wrarktxt'camp•policy.numba. I am an employer nid is providing workers'compensation insurance for my employees. Below is the polity and job site information. Insuiancc Company Name_ QU Policy#or Self-ins.I ic.#: Expiration Date: Job Site Address: r3 U r� Pi/!U City/Statc/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy n er an%, Lration date). Failure to scm rc coverage as required under Section 25A of MGL c. 152 can lean to the imposition of criminal pcnaltics of a fine tip to $1,500.00 and/or one-year imprisonmLut, 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 statcmerit maybe forwarded to the Office of Inve9tjgPgonS of the DIA for ffisi ranee cavern e vcrificat:ion. do hereby ceriinunparns• enalties of perjury that the informationprovided above is true and correctDate:Phone O fetal use only. Do not write in this area, tb be cotrtpleted by city or town officIaL City or Towa: Permit/License# Tsstung Authority(circle one): 1.Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Phone#: t_ HE i Town of Barnstable Regulatory Services SARNSrrABLE,/s Thomas F. Geiler,Director Tfb Building Division Tom Perry, Building Commissioner 200 Main Street, 14yannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and. Sign. This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in altmatters relative to work authorized by this building permit application for: (Address off ob) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Towns of Barnstable �opTHE T�ti Regulatory Services •(BARNSTABLE, Thomas F.Geller,Director MASS. lbsq. �w Building Division pTFD �a Tom Perry,Building Commissioner 200 Main Street, Hyannis, N A 02601 vl'ww,toym.b arnsiabl e.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: J03 LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1). The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department mji:Limum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(sec Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. F Zli,� Al ula tions and St andards Board oMuildin g Reg. H TOR i OME ImPROVEMENT C ONTRAC 134286 Regist,6&h% /22/2009 Tr# 133426 EjkpirqtiOwi�40 '-.'DING&ROOFIN RLT,CbNSt.I N. 'RONNIE TAYL MANNI CIR A02 2-' Adininistrator CENTERVILLE.. RightFax C2-2 8/20/2008 8 : 25 : 24 AM PAGE 3/003 Fax Server ACORD. CERTIFICATE OF INSURANCE DATE(MM\DD\YY) 08-20-08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EDWARD A GRAZUI_INS AG CY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO BOX 337 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE MARSTONS MILLS,MA 02648 COMPANY 28Y2K A HARTFORD GROUP INSURED COMPANY B R L T CONSTRUCTION INC 0 COMPANY 31 MANNI CIRCLE C CENTERVILLE,MA 02632 COMPANY : ° I C-1 COVERAGE THIS ISTO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN'DI ATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO.WHICH THIS CERTIFICATE MAY BE ISSUED-G'R MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUC POLICIES.- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFF POLICY EXP t i IA LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM\DD\YY) DATE MITS r } fTi GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one tire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-1051C045-07 12-24-07 12-24-08 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 100,000 PARTNERS/EXECUTIVE X INCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS CONIP COVERAGE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUT ATTN:BUILDING DEPARTMENT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF 200 MAIN STREET - ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE. ACORD 25-5(3/93) Ramani Ayer