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Home My WebLink About0074 PARK STREET aoS i i i Application nu b ............. .� '!. ......... Fee ....... ..... . ! .. ................................... '�` ` Building Inspectors Initials... ............................... ' AUG 16 2019 - / + � - Date Issued: / `h9 Map/Parcel..............a ............:............�. TOWN OF BARNSTABLE EXPEDITED.PERMIT APPLICATION: ROOF/S IDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 571 NUMBER STREET ILLAGE Owner's Name: ,6V V4 Phone Number._ Email Address: Cell Phone Number Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application fora building permit in accordance with 780 CMR Owner Signature: Date: 'TYPE OF WORK > F . ❑ Siding ❑ Windows(no header change)# ❑ Insulation/Weatherization ❑ DD °-rs no header change)# Commercial Doors require an inspector's review ILA! Roof(not applying more than 1 layer of shingles) Construction Debris will be going to _ sa.,j c> .. CONTRACTOR'S INFORMATION Contractor's name SAS Home Improvement Contractors Registration(if applicable)# `��/�o� (attach copy) Construction Supervisor's License# / �/3 (attach copy) Email of Contractor A�514W-e Coy-c4:1�►rt f Phone number; ALL PROPERTIES THAT HAVE STRU ORES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. . 0: k APPLICATION NUMBER...................................................,....... *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or> Yes No_____, if yes, a gas permit is required. Natural Gas Yes No ,if yes,a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information • �' Please Print Legibly Name (Business/Organization/Individual): Address: Pd- City/State/Zip: p, w l CfM4 06V Phone#: � b0 )6 36"' Are you an employer?Check the app opriate box: Type of project(required): 1.P mnm— a employer with _ 4. I am a general contractor and 1 6O 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. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for in an capacity. employees and have workers' g Y P h'• 9. ❑Building addition [No workers' comp.insurance comp. insurance.: ! required.] 5. E] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their. I L EJ 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' 13. Other comp. insurance required.] *Any applicant that checks box 41 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: v� C� ✓� Policy#or Self-ins.Lic.#: =I-JI/ In/ft-7 Expiration Date: 360 Job Site Address: z Atk_ City/State/Zip: 4-4_4, & e&ro.► Attach a copy of the workers'compensation policy declaration page(showing the policy num 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 up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of 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 pai nd penalties of perjury that the information provided above is true and correct. S i ature: / Date: 0 J d-�P/✓ Phone#: 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 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 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 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),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 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 permittlicense 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 bum 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.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.maw.gov/dia at ITH o m A S HOME IMPROVEMENTS r Fn. 508.328.1635 Exterior Remodeling Experts EM Web: www.thomashomeimprovements.net Fully Licensed & Insured P.O. Box 17;7.. t Construction Supervisor Lic #99913 Centerville, MA 02632 THOMAS HOME IMPROVEMENTS LLC. PROPOSES TO PERFORM THE FOLLOWING WORK: Location of proposed work: Mr. Harold Levine 74 Park Street Hyannis, MA 02601 Date on which construction should begin:, May/June 2019 _The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure-which must be repaired, creating additional work which may , need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation is not to be considered a violation of this contract. Cost for labor and materials under this contract: $10,215.00 30 yr.GAF/Elk Timberline HD Architectural shingle(Life.Time Limited Warranty) (Above proposal includes a double layer asphalt strip) Proposal to rip&install Architectural shingles over just office space would be an additional (Above proposal includes a double layer strip) $2,610.00 r f (a,s00 . R In the event that while stripping the roof or siding we find rot that needs to be replaced, the homeowner then has to agree and.authorize any,replacement or restoration.. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$65.00 for a carpenter and $55.00 for a carpenter's laborer, plus the cost of materials. Thank You for Givina Us the Opportunity to Help You Improve Your Project k ' -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather w_a%k (e* Synthetic roof underlayment,aid installed with Timberline architectural shingles using galvanized nails. (Storm nailed) -8" drip edge& new pipe collars to be installed -Cobra ridge vent to be installed on all ridges -Timbertex premium ridge cap to be installed -A 10-yard dump trailer will be needed on site; and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further,payments under this contract are as follows: 1/2 of the estimate due at the start; and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5% per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment,but the contractor shall not be responsible.for the normal.maintenance;repair due to abuse, misuse, and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition, any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a seated instrument on this date: Date: l "Homeowner 'Cociteactor ��1ze�p'o7:vrzo�.u�secc%C1 o�G/f/liaaac�iccaett �T_ ___ j ,. " Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use"only TYPE iComoration befQre.the expiration date. If found return to: 1 Re8542t�ona+y Expiration Office ofConsunler.Affairs and Business Regulation 854�22 06/08/2020 One Ashburton Place-..quite 130k.:,.. TROY THOMAS HOME1IMPROVEMENTS,INC Boston,MA 02108 Y. � M ( " " TROYTHOMAS 499 NOTTINGHAM Qki CENTERVILLE,MA o2632'" Undersecretary -.:Not. al d without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards =i Con. t{Uctiott,�St� r Specialty .. CSSL-099913 pIres: 04/1;3/2020 TROY A THOMAS R C e 4 499 NOTTING14AM;DR ' p CENTERVILLE M�1 0263 Commissioner f C��o�rivmonusP,a�o�C�ac�uiaeC�.a - , Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE tGorooration ,before the expiration date. B.found.return to: Re gistration E x r pi olion '` Office of tTonsutiter Affairs and Business Regulation 186422 =1 o6/08/2020 One Ashburton Place K lza -..Butte 930t:, 1. TROY THOMAS HOMEIIMPROV C. €MENTS,IN . 6oston,MA'02108 t4' ;Ns TROY THOMAS . 499 NOTTINGHAM CENTERVILLE,MA 022 Y Undersecretary without signature " Commonwealth of Massachusetts - Division of Professional Licensure Board of Building Regulations and Standards rN Co:n. jflictioti,Sjf�ls�r Specialty �J CSSL-099913. Tres 04/1,3/2020 TROY A THOMAS • 499 NOTTIN614AM RtV CENTERVILLE M,1 _. Commissioner c