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Home My WebLink About0033 NOB HILL ROAD 33 /l�c+a f/%/ `�f d Town stable *Permit f Barnstable A Q a # Expires 6 months from issuedate Regulatory Services Fee X-PRESS PERMIThomas F.Geiler,Director AUG - 4 2006 Building Division Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLEO Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY p. Not Valid without Red X-Press Imprint Map/parcel Number Property Address [Kesidential Value of Work � ��'Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address (d n Lic 33 Contractor's Name th LT Telephone Number "�� Home Improvement Contractor License#(if applicable) 3 7 04 irL or's-i�cense#{�aPP�a� aPW/orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Iam the Homeowner I have Worker's Compensation Insurance Insurance Company Name 2l/+� Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) OD--<e-roof(stripping old shingles) All construction debris will be taken to Ql4JtZJ 40 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-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 copy of the Home Improvement Contractors License is required. c SIGNATURE: Q:Fomvs:expmtrg Revise061306 4 Isla nd S iding a nd Ro ofing a division of RLTConstruetion,Inc. June 22, 2006 The Taylors 33 Nob Hill Rd. Hyannisport, Ma. 02467 We are pleased to submit the following specifications and estimates for re-roofing: Strip existing asphalt shingles and flashings Install new aluminum drip edge and pipe flashings Install ft. Ice & Water Shield to eaves, interwoven w/step flashing on cheeks and skylights Install 30 yr. architectural grade 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: NINE THOUSAND EIGHT HUNDRED DOLLARS $9800.00 PAYMENT TO BE MADE AS FOLLOWS: $9,800.00 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. RL i 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 specified. Payment will be made as outlined above. Date of Acceptance:p Signature Start Date: Signature 31 Manni Circle • Centerville, Massachusetts 02632 Telephone 508.420.5243 and 508.833.5249 • Fax 508.420.1776 • Ennifcaperoofer@caperoofer.com y 1 ne t,ommonweairn g j lvlussacnuyeew Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 � www-mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Pluli'mbers Apiplicant Information Please Print Les_ibly Name (Business/organization/Individual): L 7— 641IJ T, J/ — Address: 3 f ��i �� ' � �i�c� �601 City/State/Zip:_('�. P�vi��. Phone#: _S 7 776 711 fL ArSKU an employer? Check the-appropriate box: Type of project(required): 1.!!_/J I am a employer with I_ 4. ❑ I am a general contractor and I 6 ❑ New construction employees (IL' and/or part-time).* have hired the sub-contractors 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 forme in any capacity. workers' comp.insurance. g• ❑ 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.❑ 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.Fg of 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 tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy inforrration. lam an employer that isproviding workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: S �V Policy#or Self-ins.Lie. #: // Expiration Date: .lob Site Address: Un P, a � r �Ji, 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$1,50Q.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 cer#ify u he pains and a aloes of perjury that the information provided above is true and correct. Si ature: Date: ' t/— e 6 Phone#: if 7 7(0 y V Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing c Inspe or 1 6. Other Contact Person: Phone#: Information and. Instructions y 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 employmentbe 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),address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLQ 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 applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that mast 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 maybe provided tote 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 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. T 617-727-4900 ext 406 or 1-877-MA SSAFE r aX f 617-727-7749 Revised 5-26-05 w vr.mass.4ov/dia AT E MM Ll'.; :.;... D .::� ;:�:.:........�.:�:�:.;:.:.;::::::'':::;:;; ...;.:::: .: :: :;:.:`�:::.;:::�:: :: ::; ':.;.`.;::: :.::::;:;;:::; ;:::.;fir:::;:: A ( \ \Y1tJ .... :..:::. AIE.. .. :: :::::.: ........................................... 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 28Y2K A HARTFORD UNDERWRITERS INSURANCE COMPANY INSURED COMPANY R L T CONSTRUCTION INC B 31 MANNI CIRCLE COMPANY CENTERVILLE MA 02632 C COMPANY D C:... RAQES 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 T=RMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LT R DATE(MM\DD\YY) DATE(MM\DD\YV) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE F7 OCCUR. PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $. HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per Accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY ALITO 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 A EMPLOYER'S LIABILITY (UB-1051 C04-5-05) 12-24-05 12-24-06 STATUTORY LIMITS EACH ACCIDENT $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE DISEASE—POLICY LIMIT $ 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 COMP COV ::..:............................DEkI:::...:::•::::.::::::::::.:::::::::::::::::.:::::::::.:.:::.::::::::::.:::.:::::::..:,::.:::..::.. .::::.:........................:... Ir. 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 CERTIFICATE HOLDER NAMED TO THE TOWN OF BARNSTABLE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 200 MAIN STREET HYANNIS MA 02601 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE f ►ndtytdul u eQ: on1Y for .. . 4fr 4 Valid re tstrat►on foxt1d"Yetwt se or g date. if dard Y : ,tcen teattonand Stan olations and Standard. .. netore the adtng Regulations oard og Bu�1d�n Rel .. CONTRpC iO �je Ashb Of n p18-ce$m301 � urton B VEMENTil HOME IM?ROostott,R2a trat�on�,��4285 Re9� on = fl�'22007 3 OOFIN 7ro 4 IN AgSP Q S r o Vh� tivttl»,, 't`F DNS .�-0 R� Gif�EL� � �d;�►n�s:. 3 M 4' ILLS A 02� fi