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Home My WebLink About0080 IRVING AVENUE �o �v � ��. f - - � - - - - -- - --- I I I I i i �, s 'l Town of Barnstable *Permit e� Expires 6 months from issue date Regulatory Services Fee L (�_ Thomas F.Geller,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towmbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ap/parcel Number tL67 ao V operty Address rl ef Ale 44e✓ 1esidential Value of Work. /�� Gl0V . 4^J Minimum fee of$25.00 for work under Sb7000.00 Peter's Name&Address /v f%G�G�Gl✓I )ntractor'sName ZLT GOn/-pL /A1 _ TelephoneNumbez 77�ji ?f/y ome Improvement Contractor License#(if applicable)_ sot�s-bicEirse#(zEappiinble) _.. ]WOrlonan's Compensation Insurance. PERMIT Check one: ❑ I am a sole proprietor SAY 1 7 2007 ❑ I am the Homeowner CY3 have Worker's Compensation Insurance TOWN OF BARNSTAKE surance Company Name 2�1 _orkman's Corn.Policy# - - - - - - opy of Insurance Compliance Certificate must be on file. znn t Request(check box) / 2/Re-roof(stripping old shingles) All construction debris will be taken toCl- ❑Re-roof(not stripping. Going over existing layers of roof) E r . 0 [ te-side : V. ❑ Replacement Windows/doors/sliders. U-Value (maxiinum .44) Z. —p "Where required: lssuance of this permit does not exempt Compliance with other town deparGnent regulations,i.e.Historic,C servatio z4te. L W � r~ ***Note: Property Owner must sign Property Owner Letter of Permission, rn A copy o Home Imp vement Contractors License is required. iGNATURE: For=expmtrg Mse061306 The Commonwealth of Massachusetts Department of Industrial accidents Office of Investigations a d ' • 600 Washington Street Boston,MA 02111' www.mass.gov/dia ' Workers -Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le gib Name(Business/Orgm&atiowIndividual): Address: City/State/Zip: ( fi�'i �Ut�� . Phone.#: 77� flX FFII employer?Check the appropriate box: :Type of pioject(required):, employer with //Q 4. [] I am a general contractor and I mp __L 6. ❑New construction . ees (full and/or part-time).* • have hired the sub contractors listed on fhe'attached sheet. 7. ❑Remodeling 'sole proprietor or partner- These sub-contractors have ship and have no employees 8. ❑Demolition: • '-�torlring for m employee4 and have workers ❑e in any capacity. $. 9. Building addition [No workers' comp,insurance comp,insurance. 10.❑Electrical repairs or additions required.] 5. � We are a corporation and its , 3.❑ I a homeowner doing all work . officers have exercised their 11.[]Plumbing repairs or additions myself.[No workers'comp. right 6f exemption per MGL 12,0 Roof repairs insurance.required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp,insurance regired.] *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 anew affidavit indicating.such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot 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 ComganyNauie: '1� Policy#or Self-ins.Lic,#: Expiration Date: - Job Site Address dl K City/State/Zip: Attach a copy of the workers' co:mpe sation policy.declaration page'(showing the policy nun).er 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 tip 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 maybe forwarded to the-Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and a pains•and naltips of perjury that the in prgvided above is true and correct . Si mature: Date: Phone#: Offctal use only. Do not write in this area, tb.be completed by,city or town official. City or Town: ' .Permit(License# Issuing Authority(circle one): es :1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6.Other Contact Person: Phone#: Information and instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hiie, 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 construO buildings in the commonwealth for any applicant who has not producedlacceptable 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 evideaea-af•compli=e y,+ith:t?ie 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,it' necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(S)of insurance. Limited Liability'Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the . members'or partners, are not required to cant'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 requirea to obtain a workers. . compensation policy,please call the Department at the nun;ber listed below, Self-insured companies should enter their self-in=ance license number on the appropriate'line. City or Town Officials Please be sure that the affidavit is complete-and printed legibly. The Department has provided a space at the bottom of the-affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all•locations in (city'or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant.as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e.a dog license or permit to bairn leaves-etc.)said person,is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone-and fax number- The Cqmmonwwth of mmaohusotts Dquuftneat of M td Aeezdents of fte of investigations 600 Wasbingtori met Bwto4l.MA 02111 TO.#617-727-00 ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 11-22.06 WWW.m .8ov'/di0 Isfand Siding and Roofin� a division of JiiLTConsttuctmn,Inc. Proposal To: May 8 2007 Newman's 80.Irving Avenue Hyannisport, Ma. 02601 We are pleased to submit the following estimate for re-roofing, Remove existing asphalt shingles and drip edge.(2 layers) Install new aluminum drip edge and pipe flashings. Install 3ft. Ice&water shield to eaves,valleys, chimneys. Install 151b. Felt paper to remaining roof. Install 30yr. Certainteed Woodscape architectural grade shingles.(Pewterwood Gray). Clean up and haul away all debris to landfill. We hereby propose to furnish material and labor- complete in accordance with the above specification,for the sum of TEN THOUSAND FIVE HUNDRED.DOLLARS. S101500.00 PAYMENT TO BE MADE AS FOLLOWS: No deposit,Payment in full is 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 Workmen's Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the W% k as specified. Payment will be made as outlined above. l p Signature Date of Acceptance: ( Start Date: Signature 31 Mand Circle Centerville, Massachusetts 02632 Telephone 508.420.5243 and 508.833.5249 F'ax 508.420.1776 Emaitcaperoofer@caperoofer.com I ti Boas d or Bln rhng t<eguiat�.ns and Stanc(�i r1+ P _ j !; HOME IMPROVER9ENT CQN:TRA x y �cense or registration val ct for indi�,niil us o a1y' CTQ}� it RegistratiorE 134285 fto�rd of P s .4 Cat irat�on Ip12�/20U7,. ��i uild�ng Re utations:in re et�Ek4 M1 4 Wore the ex �r ation date: If fb t P g c!Stand ar'.tic < Ashburton Place Rm ]301 q Yn �b(3A[ cincfnu;D[a.0210 i� � F 81: 1`C�C�'NS ING,s'JEA ISl iAN[� �. ' 1NNG&ROOFIN w �3 RGNfvIE TAYLOR � e ` �>" "' a , 7� A�l�N�11 CIRCLE' \' � -�• c fl: " �� Y i ,e a•.zs