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Home My WebLink About0052 LINDEN STREET .Sd ,�, in<Je�t %r �� Town of Barnstable *Permit,#>4�1U�/�� RESsTExpires 6 months from issue date SEP - 4 2007 Regulatory Services Fee • -7 Thomas F.Geiler,Director TOWN OF BARNSTABLE Building Division P� Tom Perry,CBO, Building Commissioner 200.Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY r Not Valid without Red X-Press Imprint Map/parcel Number f D (� Property Address v �, [residential Value of Work _7"0 • Q J Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �✓i ��Pe L�i ? JX. Contractor's Name /C Lj �N,�% /1V C- Telephone Number _07 776, G lfl Home Improvement Contractor License#(if applicable) 13 Y b Construction Supervisor's License#(if applicable) [�Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name V {, Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken tong ❑Re-roof(not stripping. Going over existing layers of r000 �e-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. .***Note: Property Owner must sign Property Owner Letter of Permission. A c of the Ho a Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 , ' www.mass.gov/dia Workers'Compensation Insurance_Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual):. l((/'y''c._• Address: City/State/Zip Phone.#: 776 !ff/�l Are ou an employer? Check the appropriate box: Type of project(required):. 1.WI am a employer with 4. [] I am a general contractor and I employees(full and/or part-time). * have hired the stab-contractors 6. ❑New construction 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ' ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 r"I Building addition [No workers' comp,insurance comp, insurance.$ required.] 5. We are a corporation and its 10.0 Electrical repairs or additions '3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' A3.0 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. TContractors that check this box must attached an additional sheet sbowing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must providb their workers'comp.policy number. Iam an employer that isproyidirg workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: .Policy##or Self-ins.Lic.M Expiration Date: /7- Y —0 7 Job Site Address: d— L(`7Gt��j �� 'City/State/Zip: r 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 coverage verification, Ido hereby certify un t epains•an nalties ofperjury that the information provided above is true and correct: Sipmattzre: v Date: _ Phone#: Official use only. Do not write in this area,Yb be completed by city or town Official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3. City/Town CIerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: F. ghtFax H2-1 8/2912007 1 :59:27 PM PACE 003/003 Fax Server ACORN. CERTIFICATE OF INSURANCE DATE(MNADOWY) 08-25-0 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE E.")WA-RD A GRAZUL IN s AGCY MOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P"))OX ' ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE MAR.S TONS fAA_L'S,MA frZ 48 COMPANY '_8Y?K A HxRTFORDGROI!P INSURED COMPANY B R T."i., CiNTRijl:Tl(:N iT�TC; COMPANY PvlANNI i_.IRCLc. C C':P3^ RViI.,E,1,4A 02632 COMPANY D COVERAGE THIS IS TO CERTIFY'.HAT THE POLICIES OF INSURANCE JSTED 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 MAYBE ISSUED OR MAY PERTAIN.THE INSUr ANCE *FORDED BY THE POLICIES DESCRIBELI HEREIN!S SUBJECT TO ALLTHE TERNS.EXCLUSIONS AND i ONDITIC143 OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY RAID CLAIMS. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MM=WY) LIMITS GENERAL LIABILITY GENERA_AGGREGATE $ COVMERCIAL GENERAL LIABILITY PR.QDUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR PERSONAL&&ADV.INJURY $ OWNER'S 8S CONTRACTOR'3 PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) S MED.EXPENSE;Any or:e pe)sen) $ AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT $ ALL C•WNED AUTOS BODILY INJURY(Per Pelscc) $ SCHEDULE AUTOS BODILY INJURY(Per Accident HIREDAUTOS PROPERTY DAMAGE $ NON-OWNED AUTO', GARAGE LIABILITY AN Y AUTOS AUTO ONLY-EA ACCI DEN_. 5 OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE S EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE OTHER—,H.AN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'SLIABILITY UB-1051C045-0E 12:24.06 12-24-07 STA:TUTOR?LIMITS X THE PROPRIETOR/ EACH ACCIDENT c 100.000 PARTNEP.SF-XECUTIVE X INCL DISEASE-POLICY LIMIT $ 5C0,000 OFF'CERSARE- EXCL DISEASE-EACHSMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONSlLOCATIONSIVENICLES/RESTRICTIONSiSPEC1ALITEMS TEIS REPLACES ANY NRICT CERTIFICATE ISSUED I:)1'IIE C:Ek.TIFICATE HC,LDM AFFECII-NG W'':RKERS CO.W COtIERACE. . JOB SIFE:i'i-INCEN STREET E YAHNIS MA CERTIFICATE HOLDER CANCELLATION GHOLLD ANY OF`HE ABOVE DESCPI:EC POLL DIES BE CAJCFLLF.D SEFORE THE _)W[S OF BARNSTABLL EYPIR ION DATE THEP.F-O' TiE ISSUING CVi-ANY'WILL ENCEAVOR?'TMMA'i 10 D>i S'.NR"TTE,i!JOT"GE TOT:�E OERTI=!GATE HOLD eR NAMED TO THE LEFT SJT AT•TNj BUILD-,IvGDEPARTMENT PtP_LP.cTOMA!LSUC>4 NOT CSSH./LL k4POCENOOEL!GATrOUO4:CA310TYOFAN =VO MAIN S FRIFEI' vn0 uFo!J THE ccOrnl�c.Y,Ts.�w s OR R_PGc SEWTATI,,c:> iyF•.�M ,,NIA 61601 AUTHORIZED REPRESENTATIVE IPB;PIan)..Aver ACORD 25.5(3193) i Island Sid' andRoofing i 7 '-f U W a dk ision of RLTConstruction,Inc. Proposal to: August 28, 2007 Helen McKenzie Re: Back and gable end. 52 Linden St.. Hyannis, Ma 02601 We are pleased to submit the following specifications and estimates for re-siding. Remove existing cedar shingles and flashings. Install white drip edge to windows. Install Tyvek house wrap. Install Grade A R&R white cedar shingles. 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 SEVEN THOUSAND DOLLARS $7000.00 No deposit, 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 conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature Start Date: Signature 31 Manni Circle Centerville, Massachusetts 02632 Telephone 508.420.5243 and 508.833.5249 • .fax 508.420.1776 • Emailcaperoofer@caperoofer.com