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HomeMy WebLinkAbout0041 PRAM ROAD ��/� r i � Town of Barnstable �pFiKE Tp Expires 6 nionflis from issue dale 7 , Regulatory Services Fee hcaes. Thomas F. Geiler, Director [/i ! ZO .� 3 � AIFo ��, wilding Division Tom Perry, CBO, Building Commissioner �`--- 200 Main Street, Hyannis, MA 02601 1 www.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-86274038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid with oni Red X-Press Imprint Map/parcel Number Property Address y/ esidential Value of Work R/�t� Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address Telephone Numb Horne _> e Contractor's Narn G Home Improvement Contractor License#(if applicable) i /1G to Construction Supervisor's License#(if applicable) afs$1 "SPESS g'�� � orkman's Compensation Insurance AUG � s Zaoy Check one: Rf�STABLE. ❑ I am a sole proprietor TOWN OF Bp� ❑ I am the Homeowner [J_ ( ave Worker's Compensation Insurance Insurance Company Name 'T{�T U� w v S - Workman's Comp. Policy It Copy of Insurance Compliance Certificate must be on rile.' Permit Requ�S,cIt k box) roof(stripping old shingles) All construction debris will be taken to 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 wrier mu gn Propert Owner Letter of Permission, Ho e I pr vem t Co ors License Construct Supervisors License is required. SIGNATURE: n-\WPFII:Es\rORMS\Express\EXPRESSPERMIT.DOC l ». The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + 600 Washington Street Boston, MA 02111 ��•'� www.mass.gov7dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): Address: 1 City/S ate/Zip: 0 A. Phone.#: Are y er P u an employer? Check the appropriate b 'Type of project(required): 1. I am a employer with ene al c actor and I Y 6. ❑New construction employees (full and/or.part-tim.e).* have hired the sttb-contractors 2.F1 I am a sole proprietor or partner listed on the attached sheet. T. 0 Remodeling ship and have no employees These sub-contractors have g• Q Demolition workingfor me in an capacity. employees and have workers' Y P �'• 9. ❑Building addition [No workers' comp:insurance comp. insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 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. lContractors 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. I am an employer that is providing workers'compensation insurance for my employees. Below.is the policy and job site information. Insurance Company Name.:_�'�' (��.,ie �✓S — Policy#or Self-ins.Lic• #: Expiration Date: 99 Job Site Address: ��i./ IA� _ City/State/Zip: 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 crimi ia,i_penalties of a fine tip to$1,500.00 and/or one-year imprison-nent,as well as civil penalties in the form of a STOP WORK ORDER and a fine_ of up to$250.00 a day again st•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 Ch e ins and penalties ofperjury that the information provided ab ve is true and correct Si afore: Date: _ Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: PermiULicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other 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 triutee of an individual,partnership, association or other legal entity,employing employees. However the not more than three a artments and who resides therein,or the occupant of the owner of a dwelling house having 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 Iocal 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." shall . of its political subdivisions Additionally,MGL chapter 152, §25C(7) states Neither the commonwealth nor any p enter into any contract for.the performance of public work until acceptable evidence of compliance«zth 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-cont�actor(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 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 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"1.he 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 mayA p provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Wh ere 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. ue Office 0. nvestigat'ons would like to than-k 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 Massaohusetts Department of lad stri:al Accidents `4 Office of lztvestigati.ans 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax 4 617-72777749 Revised 11-22-06 www.mass.gav/dia _08A.. CERTIFICATE OF LIABILITY INSURANCE OP ID CS1 DATE(MMIDD/YYYY) COREC50 1 08 04 09 _�ucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GOLDMAN & ASSOCIATE_ S INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FINANCIAL SERVICES INC. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 933 FALMOUTH RD. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HYANNIS MA 02601 Phone: 508-775-6010 Fax:508-790-0249 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A* WESTERN WORLD CHARLES COREY DBA INSURER B: ST PAUL TRAVELERS COREY & COREY HOME MPROVEMENT INSURER C: 1684 FALMOUTH ROAD 115 wsuRERO: CENTERVILLE MA 02632' INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1R D LTR NSRrGENERAL E OF INSURANCE POLICY NUMBER DATE MM/DDm DATE MMIDDm LIMITS BILITY EACH OCCURRENCE $100F000 A CIAL GENERALLIABILITY NC782 06�06�09 06/06/10 PREMISSAGE7OEaoccurence) $SOOOO IMS MADE �OCCUR MED EXP(Any one person) $5QQQ PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $100 00 0 0 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS. (Per accident) $ PROPERTY DAMAGE $ (Per accident) - GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO ' OTHER THAN EA ACC $ AUTO ONLY: AGG '$ . EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F1 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND " $ EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE #0241M37" 09/14/08 09/14/09 E.L.EACH ACCIDENT $100000 OFFICERIMEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 100000 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $500000 , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER - CANCELLATION FOREVID SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN FOR EVIDENTIARY PURPOSES ONLY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE No OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. 14A AU �IZ D REPRE IVIE ACORD 25(2001I08) ©ACORD CORPORATION 1988 CH` ARLE- S ' COREY' 4'a '100f, ­�-T R oo,,AWho - T�OTAL NVES I'NIEI tT - x -- S275.00 POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards, Plywood Sheathing, Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$ 60.00 per Hour PAYMENT SCHEDULE: A Deposit of One Half is due at.the Sigriing of this Roof Proposal and the Final .Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 30 Days of Acceptance and Receipt of Deposit providing the Materials are Available. . .Please Make Checks Payable to: CHARLES COREY CHARLES COREY Warranties the Shingles and Labor for*10 years. CERTAINT.EED Warranties the shingles and labor 1.001/0 for the First 10 Years and the Shingles your30 Years if the shingles becomes defective. C.ERTAINTEED Warrants the Shingles up to a CATEGORY .1141URRICANE-1.1.0 MPH WIND WARRANTY . CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. This Provosal May Be Withdrawn-By.Us II'Not Accepted & D_ ep Aed. Received Within Thirty Days Or Before The Next Price Increase In Materials. CHARLES COREY carries Workman's C mpensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE ACCEPTED BY: SUBMITTED BY: HARkVS A. ER CHARLES COREY HOME NER ROOFING CONTRACTOR a H. A, R, LE S C3 0 RE-Y The Re o,or s Ro. af,ia'gr Cz. p, t C ® d, Ri. it s 1970 1694 FALMOUTH RD #115, CENTERVILLE, .MA 02632 RNA NA 1-5:08: TIT 5.,5€ 40 C3 u . o I , tF T E . AROWTECTURAL S YI July 29, 2009 - HAR.RY SCHALLER INSTALLATION ADDRESS: 18 SCHALLER ST 41 PRAM ROAD NAT.ICK, MA 01760 HYANNIS, MA Tel: 508-981-5632 Cell Tel: 508-771-6405 Cape CHARLES COREY 'hereby proposes-to perform the following'services in a neat and professional manner and in accordance with the manufacturers specifications and local building codes. Remove and Haul Away-All of the Old Asphalt Roofing Shingles (Both Layers). Remove and Replace All of the Rake Boards and the Corner Boards with AZEK PVC BOARDING Using Stainless Steel Nails. The cost of the Electric Company and/or Electrician to disconnect/ remove and reinstall anchor bolt and electric head are included. Supply and Install C.ERTAINTEED LANDMARKIWOODSCAPE 30 AR: 30 YEAR WARRANTY, 10 YEAR SURE START PROTECTION, CLASS A FIRE: RATE1?, COPPER/ ( R,AkMIC STONES for a FULL 1.0 YEAR WARRANTY AGAINST ALGAE CONTAMINENT, 250 POUND, EXTRA HEAVYWEIGHT, 110 MPH WIND WARRANTY, CATEGORY II HURRICANE, STORM /HURICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED, LAMINATED ARCHITECTURAL STYLE, FIBERGLASS BASED ASPHALT SHINGLES. x COLOR.. Supply and Install 8" WHITE ALUMINUM DRIP EDGE on All of the Eaves: Supply and Install CER,rA1.NTEED.WINTER-GUARD ( lce & Water Shield ) WATERPROOF UNDERLAY MENT SYSTEM. on Roof Eaves & Under the Step Flashing on�the Chimney and Gable Walls. Supply and Install #15 BLAC.K`SATURATED FELT ROOFING PAPER Supply 1 and Install SMART SOFFIT V ENT SYSTEM.on the Rear Main House Eave. Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Both Main Ridges. Supply and Install COPPER & NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. /� p :. e /../✓I. C/JO7I7/y17.0i/2CIJ CL/A,iG p I Board of Budding Regulatio sand Standards ' Construction Supervisor License License CS 2881 111 Tr# 18106 Expifation 2/14/2010 i . ; -A r 4 4116stridtion j w1� E CHARLES E COREY ' r� 1694 FALMOUTH RDA 1�15 CENTRERVILLE,MA 02632 Commissioner a ^ ✓die -C�Jan�mearzu�ecllu� �✓�a4°ac�u�de�b Board of Building Regulations and Standards ^ HOME IMPROVEMENT CONTRACTOR ' ,,yam Registrafian 136066 Expralion 6 lug Tr# 268785 ` - (T� TYPe QBA� COREY&CORE�HOMEIMPR� EMENTS Y '- CHARLES CORE tia,� ,�/•,i( �u . 1694 FALMOUTH CENTERVILLE,MA 02632 Administrator � License or registration valid for individul use only before the expiration date. If found return to: ulations and Standards Board of Building Reg One Ashburton Place Rm 1301 Boston,Ma.02108 Not valid without signature , 00-35,000 cf enclosed space lA-Masonry only 1G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code +� is cause for revocation of this license.