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Home My WebLink About0110 IRVING AVENUE r: vt Town of Barnstable 2it Expires 6 months from issue dote Regulatory Services 'Fee + =ARNSI'ABLE, "'"SS Thomas F.Geiler,Director ' i639. ♦� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable:ma.us Office: 508-862-4038 Fax:508-790-62 0 3 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY' Not Valid without Red X-Press Imprint Map/parcel Number riProperty Address � V UResidential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address t2 ( .� Contractor's Name bJ Telephone Number Home Improvement Contractor-License# if a P licable) ��' -� - mP R S PERMIT Construction Supervisor's License#(if applicable) S _y.9 2012 ❑Workman's Compensation Insurance Check one: ❑ Lam a sole proprietor TOWN OF BARNSTABLE ❑ am the Homeowner V have Worker's Compensation Insurance Insurance Company Name ��a�'r2_`�f Ntj>r 9+41, Workman's Comp.Policy# C(- � Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) El""Re-roof(hurricane nailed)(stripping old shingles)`All construction debris will be taken to qom , ❑Re-roof(hurricane nailed)'(not stripping. Going over existing layers of roof) . x � ❑ Re-side ` #of doors ❑ Replacement`Windows/doors/sliders.U-Value (maximum.35)#.of windows "Where required: Issuance of this.per mit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property'Owner Letter-of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is • quired. - SIGNATURE: C.\t sers\deco lik�ppDat-a\LocalCl4licr"oso-ft\Win-dows\Temporary nn eme i es- ontent.0utlook)DDV87AA XPRE35. oe Revised 072110 The Commonwealth of Massachusetts Department of Industrial Accidents Off lce of Investigations r 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AnWcant Information Please Print Legibly Name(Business/Organization/Individual): L-1 J:—.0. S Addresses , ig);L UAa City/State/Zip: Laos"MA 616-Pq Phone t 5�','% S—Qq 40- ;) Are you an employer?Check the appropriate box: Type of project(required): 1.(f I am a employer with. ,1 4. [] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New constriction 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 forme in any capacity. employees and have workers 9.. Building addition [No workers'comp,insurance comp.insurance,.$ 5. 10.0 Electrical repairs or additions required] ❑ We are a corporation and its' 3.❑ I am a homeowner doing all work officers have exercised their 11. Phmzbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.&I�ofrepairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 1311 Other comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'cornpensation policy information. t lionummners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit it new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation Insurance for my employees Below is the po&7 and job site information. Insurance Company Name: L,t P,ga-f`ruti tU Iry 4�L, Policy#or Self-ins.Lic.#:JZ C, Expiration Date: I I-Lb-*ZQ i'22 Job Site Address: Wt. ' Q j � i City/State/Zip: Mir} 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 e. 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. . Si atur : Date: ' 2v 1_ Phone#: 50b 50C.4 `i6 C) Official use only. Do not write in this area,to be completedly city or town ofciaL City or Town: Permit/License# Issuing Authority(circle one): .1.Board of Health 2.Building Department 3.City/To"Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: . 01108/1012 FDI It:01 FAI 108 7711211 DQWLD & O'NBI�I IKS 0011001 if 6l2012 90207 AN PST (6MT-8) PROMs 1509778223.8 gabs: 3 of.3' o CERTIFICATE OF LIABILITY INSURANCE °'••o► , THo T@ UWASA BATMO WSOWN ONLY AND=WM NO MMM W=TH6 SATE UMM TRW SWM C�QAT@�f�T A�YtW1TNRi.Y OR N6OATN81.Y A!A®ID;,®lf�ib OlE 14 THE o0Y®tAo6 f1fiA0�DY TIOt RIP C O GIYB OR O� BQ�W Cp�.A G*XMG7 I Tim iplglilE�MRHOMD AWN Pv*;MRmmrw;lrw"• r ! !hill a�aOnd�OAlOftM�ttq�/s b1P0 1Rt/1fM4YAli1Ui�OtdO„Nf{1pft.A ilRonth1f btdmemt oldbr, i►tilQlitR . Mom WM 1yoftMA 08875 am OWN WWW OP M WAVIV OWN M A C ORWAY��T1{i��PPORM 7m POOL�am 8S"cr T0!� , ! fllOt tylON64�D1O11 MA ltllYaBiN�iABOtiO@DLYPAIDOWMB. tfrl�aftsllwrr s carets tWR flQt. Iltltrlr�titflllRlllt f I, NRMetO 4MYilUtAlY�Prle rwm � fSOD4YQIlHRYp�►aeMl�liq l MAWM �� t�li6!lOORe�flef � due Ljmmnmmi SQ4-081 Mewl Mams m"Am � NlA • y IlIQI �"�••' t.d(t 11A►et+Rles teelllp�lon kslass!! �ii$[0 - -. I ! a+br waken,aott>pataedaiiew.a:neagBeNrti f T1161MOi#t�R4'r.OIYlP8N8k![ONP01,1GY008$IiOTPROVt�GCNtiMQiPORGI.AtaR[O�LLY W d{iEd BIiY a!'lf It A�C IOt�QId lR LtBQ�R0➢18 TOM• Y UTH - pa�s�rr�eo snrou�+► � 1� MLMM W MA 02694 4402 ti amlell�eea / ' Jafflml v��. o"""MOMMUMNS. BREW" AI 29(i0tON41 TWA==�stmitaco4nnW$btattl=ftofAMM wniseti44sl►�e a Iwlt tw�lVW +i ioffu WL m! l N t snnivsrna MASS. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, � � a 6A ,as Owner of the subject property IL hereby authorize®L%- to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) 1 q, Signa e UbVheN UU Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 I Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,-Massachusetts 02116 Home Improvement Contractor Registration Registration: 128957 Type: individual Expiration: 6/14/2013 Tr# 2' Oliver Kelly W Oliver Kelly 8 Rhine Rd Yarmouthport, MA 02675 Update Address and return card.Mark reason t u St.A 1 ES 20U-05r1 1 Address GI Renewal 0 Employment j scx Cyns �co Affai Oren Business Regular/u.:clh License registration valid for individul use Office of Consumer Affairs&Business Regulatioa J� only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistr"on: 128957 Type: Office of Consumer Affairs and Business Regulation xpiration: :.61-1412013. Individual 10 Park Plaza-Suite 5170 Boston,VIA 02116 Oliver Kelly - Oliver Kelly 8 Rhine Rd. Yarmouthport,MA 02675 Undersecretary Not valid without signature as 11assachusctts-Department ul'Public Saretc. Bnarcl of Building, Rcguiatittn.antf St- andard License: CS SL 99167 Restricted to:. RF,WS OLIVER KELLY 8 RHINE ROAD YARMOUTHPORT, MA 02675 Expiration: 9l2812013 t ntnti.�iatrr Tr*: 5155 r C.T ;TT Ilya r,� Town of Barnstable *Permit V Expires 6 months om' e Regulatory Services Fee �CJ Q Thomas F.Geiler,Director Building Division ��+� Tom Perry,CBO, Building Commissioner k,,` `� 601 .� ``� OF�� Z00 Mani Street,Hyannis,MA 02 % N www.town.barns table.ma.us 019e: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint C� Map/parcel Number j: '-& 7 / 3 Property Address l0 C� esidential Value of Work �_ Minimum fee of$25.00 r work under$6000.00 Owner's Name&Address Contractor's Name G�Lr 1 Telephone Number J4?4 7? Home Improvement Contractor License#(if applicable) aT6 .. Construction Supervisor's License#(if applicable) Workman.'s Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 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) B'R //e-roof(stripping old shingles) All construction debris will be �19 4-4 taken to 64 e_411P41� ❑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: Property Owner must sign Property Owner Letter of Permission. . Hom rovement Contr tors License is required. SIGNATITRE- Q:Forrrs:expmtrg Revise071405 1 ne t ommonweacin of Irluasucnua&iiY Department of Industrial Accidents -, Office of Investigations 600 Washington Street Boston, M4 02111 y . M www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Tndividual): /4Q_7— Address• 4 A'l l City/State/Zip: o e�� `L� Phone#: T I 776 Are you an employer? Check the appropriate box: 'Type of project(regained): 1. /Iam a to er with . ❑ I am a genera contractor an I� � Y � 4 l d I — 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 $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I 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. - oof 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 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 their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and,pob site information. —� Insurance Company Name: Policy#or Self-ins.Lie. #: Expiration Date: Job Site Address: &0 f iC City/State/Zip: _ �- Attach a copy of the workers compens ion policy declaration page(showing the policy numb r and a iration 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 d r the pains and enalties of perjury that the information provided above is true and correct. Signature: Date: a - Phone#: 776 I Official use onHy. Do not write in this area,to be completed by city or town officiaq City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clink 4.Electrical inspector 5.Plumbing Inspector I " I 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 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 caner of a dwelling house having not more than three apartments and who therein, or the occupant of the o g g P P 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(LLC)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 fur 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 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 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. l 617-727-4900 ext 406 or 1-a77-MASSAFE Fan 617-727-7749 Revised 5-26-05 w-w-w.m.ass.zo-W(pia "} Island Sul' andRoofing a division of RLTConstruction,Inc. July 18, 2006 James Shea 110 Irving Ave. Hyannisport, Ma We are pleased to submit the following specifications and estimates for reroofing: Strip existing asphalt shingles and flashings _ Install new aluminum drip edge and pipe flashings Install 3 ft. Ice & Water Shield to eaves, interwoven w/step flashing on cheeks and skylights Install Typar 30 roof underlayment to remaining roof Install 30 yr. architectural grade shingles and red cedar shingles Install continuous ridge vent to all ridges Clean up and haul away all debris to landfill We hereby propose to furnish materials and labor—complete in accordance with the . above specification, for the sum of: EIGHT THOUSAND FIVE HUNDRED DOLLARS $8500.00 PAYMENT TO BE MADE AS FOLLOWS: $8,500.00 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 Workers 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 work as speci ied. Payment will be made as outlined above. Date of Acceptance: Signature ' - Start Date: Signature aix5h 062-an 31 Manni Circle Centerville, Massachusetts 02632 Telephone 508.420.5243 and 508.833.5249 • Fax 508.420.1776 • Emdcaperoofer@caperoofer.com DATE(AAM\DD\Yll) - - PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EDWARD A GRAZUL INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO BOX 337 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MARSTONS MILLS MA 02648 COMPANIES AFFORDING COVERAGE COMPANY 28Y21K A HARTFORD UNDERWRITERS INSURANCE COMPANY INSURED COMPANY R L T CONSTRUCTION INC B 31 'MANNI CIRCLE COMPANY CENTERVILLE MA 02632 C COMPANY ' p �.:::.;: :.::....t...::5....::. .. ..... .::.. ..::: 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(MM\DD\YY) GENERAL LIABILITY t GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE F1 OCCUR. PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS ` BODILY INJURY SCHEDULED AUTOS + (Per Person) $ HIRED AUTOS BODILY INJURY f $ NON-OWNED AUTOS (Per Accident) r . PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM - AGGREGATE $ . OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND "'' ' Q EMPLOYER'S LIABILITY (LIB-1051C04-5-05,) 12-24.-05 12-24-06 STATUTORY LIMITS EACH ACCIDENT $ THE PROP P.!ETOR/ INCL PARTNERS/EXECUTIVE X DISEASE-POLICY LIMIT $ son ow OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE 1$ 100.000 OTHER - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIIIATE:HOtDER:>:;;:><:>: :::>::>;:: ::;;:: :::> <::: : :::::::: ::>::;»»::»>:<::>::;::;::<:»:<:::>::>;:;:««:><::«:>: ......................................................................................................................N..:::.....:...:::.:.::.::::::::.:::.:.::......:::.::::.: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE -.THE EXPIRATION .DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL BARNSTABLE BUILDING DEPARTMENT 10 DAYS WRITTEN NOTICE TO THE CERTIFIC ATE HOLDER NAMED TO THE TOWN OF BARNSTABLE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 200 MA I N STREET' LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. HYANNIS MA 02601 AUTHORIZED REPRESENTATII . ........::...`::.`.::: .. ..... :................ ,:: :: ... .. .. n�I-� H/t. .....:.... [A P ' tl�:. $>:>:i:::::>::::;::;:;::;::;:":»>:»::i :::: :::::::::::;:;:;;::;:isi::s:::i:::::;::::::::;::;<: ::':;:.;:.>;:.;;;:.;;:.::.;:.;:.;;::;:>::>.>:.>::>:'::;:>::>:<:>:.;::s.:<»s:,>::»»>::i:::::»::>::i::i:::.::::::::. »>i:«<:ii:;:i::. . . ........ .................................................................................:::::::::.:::::::::::::::.:::::::::::::::::::::::::::::::::::::::::::.::..::::. .:.:.::...:.:.....:.. .... ... 02904-AM FORD 2420 LAKEMONT AVE STE 100 ORLANDO FL 32814 BARNSTABLE BUILDING DEPARTMENT TOWN OF BARNSTABLE 200 MAIN STREET HYANNIS MA 02601 ACORD CERTIFICATE OF INSURANCE (On Reverse)