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HomeMy WebLinkAbout0020 SHOREY ROAD (2- c\- 40 oFtKKE ram, Town of Barnstable *'Permit# „y� p Expires 6 month 'am' e date i u3 Regulatory Services Fee G * ■ARNSTABLE, ` MASS.139. ��� Richard V.Scali,Interim Director i0rfn Ma+ Building Division 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 -� fw Not Valid without Red X-Press Imprint y Map/parcel Number 4 Property Address 2D V T UWw 1 l,� rResidential Value of Wort:$ irkMi 'mum fee of$35.00 for work under$6000.00 Owner's Name&Address ' �""�" �� V O V l S r!N vl �1 Gd D �. Contractor's Name (/ , Telephone Number b � / Home Improvement Contractor License#(if applicable) `� ( Email: _Non r oo� Construction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: Na , ❑ I am a sole proprietor r'` MAR 2 4 2014 ❑ I m the Homeowner have Worker's Co4mpensation.Insurance n n Insurance Company Name U" , �V TOWN BARVaTAB E13, Workman's Comp. Policy# LI I/y / 020 Q Copy of Insurance Compliance Certificate must accompany each permit. Permit Re uest(check box) 9 Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �'6614 CEO ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows #of doors: "El'Smoke/Carbon Monoxide detectors 4 floor plan's marked with red S and inspections required. Separate Electrical& Fire Permits required. *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&Construction Supervisors License is required.- SIGNATURE: T:\KEVIN D\Building Changes\EXPRESS PERMIT\EXPRESS.doc Revised 061313 I oFTr�ram, eaxxsTnsLe, i6g9. �0 Town of Barnstable Regulatory Services Richard V.Scali,Interim 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, 0 l q ka11 y as Owner of the subject property hereby authorize r V V to act on my behalf, in all matters relative to work authorized by this building permit application for: (Ad Press of Job) 3014 Signature of Owner bate 64�VW (1,01 Print 11me If Property Owner is applying for permit,please complete the Homeowners License Eiemption Form on the reverse side. TAKEVIN MBuilding Changes\EXPRESS PERMIT\EXPRESS.doc Revised 061313 The Cvirrir:oiiwealtli of Alassachnsetts Department of IndustrialAccidents r—t Office of Investigations 600 Ff ashington Street Boston,,-L4 02111 ..��,. ✓ ivniv.niass.goa=ldia Workers' Compensation Insurance Afficlazzt: Builders.C~ontractos,&/Electi ci:ans Plumbers Applicant Information / Please Print Legibl� Ncune`Bu�nessrOrgmizationrindividoa j: V V 1 V1 Address_ q V O l VX ovuL Cttt.ttater`Zp:. �U l V MA Phone : Are You a -einployer Clieck ti�`aPPr4pril.te,box: Type of project(required): 1 I am a employer with� 4. ❑ I am a general.contractor and I 6 ❑ '� construction New r employees(full andror part-time).* have hired the sub-contractors. ?.❑ I am a sole proprietor or parnrer- listed on the attached=lreet. _- ❑Remodeling ship and have no emplo=.•ees There sub-contractors have 8- ❑Demolition working for me in any capacity., employees and have worker P q. ❑Building addition [I�To r�;orker-s'comp.instwmce. eorup.-insurance,.-. required..] 5 oration and its 10.0 Electrical repairs or additions ❑ 's 3e are a corporation 3.❑ I am a homeowner doing all ivork officers have exercised their 11.❑Plumbing repairs or additions m}, lf. No 4 orl ers'co right of exemption per MGL f - 22. R.00frepain insurance required.]1 c. 152, 1(1),and-we have no employ Tes-[No workers` 1 ther comp..insurance required..] *Any aroplisaur that checlts boa:P1 must also fill Dut the sec:ion bekw showfng tieti s atascss'compematiou palicy infer tloo• .. 'l omeowme s who submit this affidmm indicating Thee are doing dLl work and thpu hire outside contractors must submit a Lew affidavit 3ndicatiaz such.. Ccntravo€s that check this 00%tmust attached an addiaoaa:sueet siaois ing the nat:ee of the:-ub-coutrs:tars;and state whether or not those_entices have employees. If the sub-contractors:ha-:a employees,they must provide theia workers'carp.police number. I attt art t'rttptvt sr titer tsprv+aditrg tstar&ers'cvrrtpeFtsatriFrt irtsttraFrce fctr rFrt eFlzp7gtees. Bel'vty is titepolicy and job site iFFffirFF[atit)FG Insurance Con party Name: Policy 9 or Self-ins,.Lic..4: Etpiratioi.Date:b r Job Site address,: Git :State Zip: `� D�?�' Attach a cop` of the workers'cor>apens:ation polio declaration pa1 {slnin th �i4 Frt5ag r.and expiration Bite:). Failure to secure coverage as required.rinder-Section 25A of 1 G-L c.. 152 can lead to the imposition of crirnitial penalties of a fire tip to 51,500.00 andfor one-Fear imprisonment,as well as civil penalties in tile forts of a STOP 1�,.'GIK ORDER,and a fine of up to V50.00 a day against the violator, Be advised that a cope of this statement may be forwarded to the Office of Invesl4ations of the,DUL for insurance coverage verification. I do l!tereby eerti in der the pains at ttie:.s of pedrrrt'drat fire OFF,forntafion provided bone is Fre and correct Si attire: Date: 3v "" l Phone ii Official use on . Do not write in this area,to be cvtrtpWe d bt'cio,or ton n vfficiat. City*or Town: PermitUcense A Issuing Authority(eirclt:one): 1.B®tad of Health ?.Building Depal tmertt .C'itn 7bNim Clerk 4.Electrical Inspector g.Plumbing Inspector ti.€)titer Contact Person: Phone 4: ruts Insured NMA Rea.r 1344I0 i FLYNN ROOFING CO. 408 Belmont Street Quincy MA 02170 j Office (61.7) 479-343.1 Fax(61.7) 471-7378 FlynnR®®f ngoeom jPeoposal for RogLing Services i Customer: Stephanie Pabon (6( j 467-5167 20 Shorey Road Hyannis MIA 02672 Services Included for main roof on house and addition on side; excludes any sheds or garages(1 lsq: I layer on existing r-ool): i. Strip existing roof,with extensive use of tarps on house, walkways,bushes,etc. '_. Nail down any loose decking. _. At eaves: y a. Install 18"piece of Certainteed W'interguard ice and water shield on eave with I'"over tascia. b. Install 8"WHITE drip edge on top of ice and water shield. c. Install 6' of Certainteed WintergUard ice and water shield over drip edge. d. Install Certainteed starter strips. 4. At rakes: a. Install 8"WHITE drip edge. b. Install Certainteed starter strips. 5. Install new lead on chimney. 6. Install Certainteed Winterg=ward ice and%eater shield in any valleys.around any vent pipes and skylights,a-nd 3' out from any step flashing. 7. Apply Certainteed Roofers Select felt paper to rest of roof. 8. Replace any step flashing,as needed. 9. Remove old flan(yes from vent pipes and replace with new ones. 10. Apply Certainteed Landmark shingles, using 6 nails per shingle. 11. Install hand-nailed ridge vent on main roof. 12. Install Certainteed rid17e caps(hand-nailed). 13. Install 40' of Kleerboard/rakeboard(anything over 40' would be charged at$18i1'oot). 14. install all new 5 seamless aluminum glitters and downspouts. 15. Remove all roofing debris..includin,from ;utters. Magnetic roll_rs will be used to ensure a thorough cleanup of debris and nails., Price: $10,800 As discussed;to repair/replace the cornerboards would be billed at 585,'"11ou1-per man plus materials. I1'anysoffits need to be replaced it would be billed the same. The above price includes the building permit and the Certainteed SureStart Plus dire-star warranty coverage,a 25 rear complete warranty (including workmanship)on the installation of 30-year shin des. If any plywood needs to be replaced.the charge is as follows: I"sheet is Free:remaining sheets are S8T%each(material and labor). If we use ledaerboard instead of plywood,;'-would be billed at$29lsheet. If interested in having the job done,please return a signed copy of contract to the al-45've listed.address, indicatin`,shin ale color.Nvith a deposit of$300 to covet-the permit fee. 113 deposit is due Before the start of the job,with the balance due upon completion of the roof. Warranty information is submitted to Certainteed upon receipt of full payment. Attics: Soule dust or small debris is to be expected in your attic during the roof installation. We strongly recommend that you move breakables and cover items as needed. We are not responsible for dust or debris in your attic. If roof has satellite dish: we are not responsible for necessary adjustments to your satellite this, upon completion of your roof. Please feel free to call me at the above listed number with any questions. SincerelI W. t Stephen Flynn ,l7 Stephanie Pabon-Customer Shin'le Color: 2:'7r'14 Stephanie Pabon[stephpabonr6.hotmail.com] i ,aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `.� 3/19/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemengs). PRODUCER NAIVE:CONTACT Martin D. Conbo CPCU ARM Lynch 6 Conboy Insurance Agcy, PHONE FAx 508 941-5711 AI No: (50e) 587-1914 31 Plain Street ADS E-MAIL mart Conbo @1 nchandconbo .com PO Box 3489 INSURE S AFFORDING COVERAGE NAIC# Brockton, MA 02304 _ INSURER A:Hermita a Insurance INSURED .- INSURER B:Arbella Protection FLYNN ROOFING CO LLC INSURERC:A.I.I. Insurance Brokerage 408 BELMONT ST INSURER D:Associated employers insurance QUINCY, MA 02170 INSURER E: INSURER F:. COVERAGES CERTIFICATE N UMBER: REVISION NUMBER: 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. INSR ADDL SUBR POLICY EFF POLICY EXP - LT R TYPE OF INSURANCE INSR WVD POLICY NUMBER MIDDN NMIDDVYYYY LIMITS C GENERAL LIABILITY X L117001701 3/28/14 3/28/15 EACH OCCURRENCE $ 1,000,000 TED X COMMERCIAL GENERAL LIABILITY DAMAGE ,E PREMI ES E.a occurrence) $ 50,000 CLAIMS-MADE F—IOCCUR MED EXP(Any one person) $ 1,000 X $1000 deductible PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREG ATE LIMIT APPLIES PER PRODUCTS-OOMP/OPAGG $ 2,000,000 X POLICY PO- LOC $ B AUTOMOBILELIABILITY 1020019193 5/22/13 5/22/14 CO acccident INED SINGLE LIMIT IT $ ANYAUTO - BODILY INJURY(Per person) $ 100,000 AUTOS ALLOWNED X SCHEDULED BODILY INJURY(Per accident) S AUTOS 300,000 NON-OWNED PROPERTY DAMAGE HIREDAUTOS _AUTOS era.f,3nt $ 100,000 $ UNBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ D WORKERS COMPENSATION 4 AWC 7026917-2013 7/30/13 7/30/14 WCCRYSTATLIMU- X OTH- AND EMPLOYERS'LIABILITY FIR ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA E.L.EACHACCIDENT S 100,000 - OFFICE RIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOY EE $ 100,000 If yYes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 . . T DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is requi red) Roofing contractor and incidental related thereto CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN "for informaton only" ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Martin Conboy, CPCU, ARM ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: (610) 861-3870 E-Mail: a qq 1 �and �taCs Z�^wj�-�� - Board Construction Supervisor SpecialtN' t CSSL-098471 STEPHEN P FLYNN 408 BELMONT STREET Quincy MA 02176 04115I2015 _.. ........ ........._......- � ._ ----- .:_. :_..:- Vyie tpoma�manruetc��2 a�'✓UGa:;aac�iscael.L`.c Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: ..{34410 Type: xpiration::;::1 %3f3l20.I DBA FLYNN ROOFING CO ` STEPHEN FLYNN 408 BELMONT ST. � �pz QUINCY,MA 02170 a Undersecretary J Town of Barnstable *Permitl �� p(r� # (� Expires 6 months from issue date r Regulatory Services Fee 1�3 IS, • • BARNSfABLE • • - s 1 r "�' Thomas F.Geiler,Director.'.` PR ES Building Division,` MIT Tom Perry,CBO, Building Commissioner AUG 14 201 200 Main Street;Hyannis,MA 02601 2 www.town.bamstable.ma.us Office: 508-862-4038 " '; TowNb-FbA-�NSTq EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY BLE Not Valid without Red X-Press Imprint [� �1 V J r a t Map/parcel Number l V C Property Address residential Value of Work M_ inimum fee of$35.00 for work under$6000.00 Owner's Name&Address , r l GIKV Contractor's Name— Home � e l�Ll�'l/ Telephone Number �Q 0 c Home Improvement Contractor License#(if applicable) ! g C1 I Cons ion Supervisor's License#(if applicable) A � Workman's Compensation Insurance Check one: ❑ I am a proprietor s - - ❑ I the Homeowner r _ have Worker's Compensation Insurance Insurance Company Name I 'u U Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ` ❑Re-roof(hurricane nailed)(not stripping. Going over: existing layers of roof) ❑:Replacement e- e #of doors Windows/doors/sliders.U-Value (maximum.35)#of windows_ ' *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. : ^�Ii '.a•I,.�-:1 r�Frr��tS9 .. :�o'n"al � H ,t 4,�x. : 1 � d W.'w ',9C.e,'l .a Tr,-r.:i't ;4i �=w ar�,; :k'rf,� d a.`1!�d: ***Note: Property Owner must sign Property Owner Letter of Permission A copy of the Home Improvement Contractors License nstruction Supervisors License is required. SIGNATURE: C:\Users\decollikAAppData\Local\Microsoft\Windows\Temporary Internet Files\C6ntent.Outlook\DDV87AAZ\EXPRES.S'.doc Revised 072110 . t � ' n s • IME NAM Town of Barnstable. Regulatory Services Thomas F:Geiler,Director Building Division Thomas Perry,CB t" Building Commissioner .J r 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 �_.r.. `'L Fax: 508-790-6230 Property Owner Must ' Complete and Sign'This Section If Using A Builder I; l ° \ C\ Gt C Lc d Naas Owner of the subject property hereby authorize 'SIC n tq C 7J CyL I to act on my behalf, in all matters relative to work authorized by this building permit application for: ftZ (Address Job) VVV Signature f r 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 Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 The Commonwealth of MassachuseI6' 1 . Department of Industrial Aidderds j Office ofInvesdgetiot s 600 WassIdugton Street,_" Boston,MA 02111 wmv.mass gouhhn . fi , -•, Workers' Compensation Insurance Affidavit: Builders/ContracborslElertricians/Plumbers Applicant Information Please Print LezibI Name(BusimessJOrganizatimbdivvidoal): - u ^l 1�UN j e 1ti �U4i Address: City/State/Zip: z-G 3 Phone#: V r I T -0 G(U .Are.yo employer?Check the appx6priate boa: Type of project(required):. 1_ I am a er unth emP 1oy 4• ❑ I am a general contractor and I �— 6_ ❑New oonstsaretion . employees(full andlor part-time)-" have hired the sub-contractors proprietor Pam listed on the attached sheet 7. ❑Remodeling 2.❑ I am fl sole Or or r shop and have no employees These sub-contractors have S.'❑Demolition w for me in an capacity- employees and have wodms' working y cape ty__ I 9_ ❑Building addition [No worloe[s'comp_insurance comp_insurance required] 5. ❑hWe fire a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a hameawner doing"all work 2'' officeis have exercised then 11.❑Plutiibing repairs or additions f • .�- myself.[No worlcers'commp- right.of exemptOn per MGL' ❑Ot 12.❑Roof repairs insurance required.]1 r C. 152,§1(4),and wie have ao her ° • rY . �-.: y' • en�¢rloyees.[NoW7or9cers' 13. •. , comp.msurance required.] 'Any appficm that checks box#1 must also fill out the section below shorting their wmkera'carsopemsation policy informir ion 1 Homeowmets who submit this affidant indicating they are dGmg all wok and then hide otrM&contt Mrs rawt submit a new affidavit indicating such. lConttactors that check this box mast attached sn additional sheet showing the name of the sub-contractors and state whether or not those enrutees have employees. If the subcontractors have employees,they mast provide weir workers'comp.policy number. I am art employer that is provMkg workers'compensadan insurance for Tray enipioytiees. Below is tha policy and job site ; , •• •t; information. C Insurance Company Name: , l�S U C,(Gv c-c'`1 -N'0L ty Policy#or Self-ins.Lic.#: w C L 0 �. I Gl j 0 1 Z 0 Expiration Date Job Site Address: 2.o 1Ac.)yue,✓I 1_ City/State/Zip: k✓trjk�✓)`, 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 tine up to$1,500.00 andfor one-year imprisounumt,as well as civil penalties in the form of a STOP WORK ORDER_and s fine. of up to$250.00 a day against the violator. Be advised that a'ropy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ida hewe semi under the ns and naiYies a u that the in orination rovided above is fine.and corrrect b3' f1' 1� Pe 1P� /3' . f P �. Sianahge• Date: , '±p l Pht1IIe : -- — a Official use only.,Do not saute in than area, to be completed by city or tomm official. _. a .� • r.'•:fin. .._.. .., ,4, 6 r` f . , t�P.R�:.. .tt t., , City or Town: PermitUcense# 'Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.other Contact Person: Phone#: -- - -- 6 f � Town of Barnstable Regulatory Services anRxsrnBLe' Thomas F.Geilerl Director ' Building Division' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us, Office: 508-862-403 ax: '508-790-6230 HOMEOWNER LICENSE EXEMPTION, , Please Print DATE: JOB LOCATION: number street villa "HOMEOWNER": name home phone# f ork phone# CURRENT MAILING ADDRESS: city/town state 7 zip code The current exemption for"homeowners"was exten d to include owner-occ ied dwellings of six units or less and to allow homeowners to engage'an'individual for hire who does of possess a license provided that the owner acts as*supervisor. DEFI TION OF HO WNER Person(s)who owns a parcel of land on which he/she resi or intends t reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory t uch use d/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeown Su "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be res onsi le or all such work erformed under the buildin ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for co Hand with the State Building Code and other applicable codes, bylaws,rules and regulations.' t The undersigned"homeowner"certifies that he/she unde stands the Town f Barnstable Building Department minimum inspection procedures and requirements and that he/she will comp with said proced s and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings co taining 35,000 cubic feet or larger will be re uired to comply with the State Building Code Section 1.27.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that:. "Any homeo er performing work for which a building permit is required shall exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervis s);provided that if the homeowner engages a person(s)for hire to do s ch work,that such Homeowner shall act as supervisor." Many homeowners who use t s exemption are unaware that they are assuming the responsibilities of a supe isor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,S tion 2.15) This lack of awareness often results in serious problems,particularly en the homeowner hires unlicensed persons. In this case,our Board cannot proce against the unlicensed person as it would with a licensed Supervisor. The homeown acting as Supervisor is ultimately responsible. - : . To ensure that the ho ewwner is fully aware of his/her responsibilities,many communities require,as part of the p it application,that the homeowner certify that he/she understands a responsibilities of a Supervisor. On the last page of this issue is a form currently used by se v I towns. You may care t amend and adopt such a form/certificati for use in your community. C:\Users\decoll' ppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doe Revised 07 10 J Office of Consumer Affairs and VUSness Regulation 10 Park Plaza- Suite 5170 'a Boston, MassacbmsettS 02116 k: Home Improvement ` actor Registration -- = Registration: 131941 . -•,c -� , Tyne: Private Corporation p - f €xoft on: 9f2612012 Trf# 2t1291'i CENTRAL CAPE CONSTRUCTIO � `# STEPHEN DEVLIN W 820 MAIN ST. COTUIT, MA02635 date Address and return card.Mark reason for change. Address ❑ Renewal Employment 0 Lost Card WS-CA1 0 5OM•04M4-Gw1216 0 ff.ceAkAiff"Y`► FAI iir"� License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: . Registration: 131841 Type: Office of Consumer Affairs and Business Regulation , Expiration: 6i2012 Private Corporation 10 Park Plaza-Suite 5170 Boston;MA 02116 WLCAPEQ-c1fric0.INC. STEPHEN DEVU . `-.'. 820 MAIN ST 3 _ COTUIT,MA 02635 — ` Undersecretary lWot v id without signature Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-047993 tigIIS STEPHEN J DLIP�T ?,r 820 MAIN 9V- Cotuit MA of-.�.• 1e"Na Expiration Commissioner 0210412014 v , 2CENT CA �l�Ol3Q,� INSURANCE BINDER 8S/17/,2 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE COMMONS SHOWN ON THE SIDE OF THIS FORME. PRODUCER BONE EA. 508-77S-1620 COMPAW BOWERS FAX LALC No• 5087781218 Assodated Eames bmwapce Comp yYCC50D91990129 Dowling S O'Neil DATE cTnrE T DATE Insurance Agency 973 Iyannough Rd., PO Box 1990 85MM2 12:01 X A' 05/14113 X 12M Am Hyannis,MA 02601 Pnu NO°" THiS BINDER IS ISSUED TO EXTEND COVERAGE INTHE ABOVE NAMED COMPANY GODS SUB COGS: PER EXPIRII IG POLICY# AGENCY 3114 $ QF BISURFD Central Cape Construction,hm Lori:820 illla n Wit,Cotuit,MA 820 Main Street 02636 Cotult,MA 02635 COVERAGES LIMITS TYPE OF INSURANCECOVERAGENMRM DE E 'CONS x AIitOUlTT PROPERTY CAUL OF LOSS BASIC ❑BROAD❑SPEC GENERAL LUIBILRY r EACH OCCURRENCE COMMERCIAL GENERAL LIABRITY DAlARL�TO $ CLAIMS MADE OCCUR MED EXP(Any one person} $ ta8Vf3iAiAGGREGATE $ RETRO DATE FOR CLAW MADE: PRODUCTS-COMPMP AGG S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO BODRY INJURY person $ ALL OWNED AUTOS SODILY KR1RY(� $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ ' NON-OWNED AUTOSA�IC&PAYMENTS $ ` KFURY PROT $ UWASUREDMO70M AUTO PHYSICAL DAMAGE DEDUCTIBLE ALL VEH=iS Lj SCHEDULED VEHICLES ACTUAL CJkSfi VALUE COLLISION: STATEDAAIOUNT $ OTHER THAN COL: _ OTHER GARAGE LIABILITY s AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY° EACH ACCSISHT $ EXCESS LIABILITY AGGREGATE S EACH OCCURRENCE $ UMBRELLA FORM -- OTHER THAN UMBI8 LA FORM RETRO DATE FOR CLAMMALTS: AGGREGATE X I WC STATUTDRY LM= WORKER S COMPENSATIONAND EL EACH ACCIDENT ^o rJ00,000 EMPLOYEIYSLIABILITY E.LDISEASE-EAHO[AYEE S ifI110 .SEe C idis EL.DISEASE-POLWYLWIT $SWIM WM NSI IAL Central Cape Construction,Inc,.DM $ cavD OTHER TAXES $ COV " See attached Spec Conditions/Odw Covs LET®TI Tat PREI $ NAME 8r ADDRESS MORTGAGEE —.HINSURED LASSPAVE� ' LONNS ACORD 75(2001101)1 of 3 #34126 NOTE:WORTANTSfk-TiE =ORUATION ON REVERSE SIDE KJM g AC QI DCORpOR—iij 1899 of IKE y RARMAeLE � fp,� Town .of Barnstable Regulatory Services Thomas F.Geiler;Director Building Division Thomas Perry,CBO Building Commissioner y 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 wi C 1�[C Vkx 6 NPaS Owner of the subject property hereby authorize S��' rJ, to act on my behalf, in all matters relative to work authorized by this building permit application for: 20 s f z-o K)o Ct 'FQYW (Address Job) —I Z— Signature IT r Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. 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