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ppIKE Town of Barnstable Permit# 02 Y�
P�' tip Expires 6 months from issue date
&AMS LE, : Regulatory Services Fee
9 amass.63q. era Thomas F.Geiler,Director
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Building Division
Tom Perry, Building Commissioner XPSPERMIT
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 JUN 3 " 2003
Fax: 508-790-6230 - R#NOFEXPRESS PERMIT APPLICATION - RESIDENTIAL BARNSTAE3LE
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address
�C]Residential 2 \ Value of Work W oa)- oo
Owner's Name&Address `-��r' CA r'Z. Oc..►%Q n
05 3 rb /U
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Contractor's Name /U i C.IC ee ! yv► < gyp_V.%P Y"J'e w,e Telephone Number 30kl
Home 1provement Contractor License#(if applicable) 3 3
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
E�j I have Worker's Compensation Insurance
Insurance Company Name L, Y�e-c /v\� L�ti� v� tnYNYLCc
Workman's Comp.Policy# W
Permit Request(check box) 1 C
[� Re-roof(stripping old shingles) All construction debris will be taken to A a K I e �"i 9 r�^'1� ..mot n �►+G�
❑Re-roof(not stripping. Going over existing layers of roof)
Re-side
Replacement Windows. U-Value (maximum.44)
❑ Other(specify)
*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.
Signatur lA
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Q:Forms:expmtrg
Revised121901
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Board of Building Regulations and Standards'
License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 133851 Board of Building Regulations and Standards
Expiration: 8117/03 One Ashburton Place Rm 1301
Type: DBA Boston,Ma.02108
NICKERSON HOME IMPROVEME
URK NICKERSON
286 SOUTH ORLEANS.RD.
ORLEANS,MA 02653 �
Administrator Not valid without signature
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Liberty Mutual Group
PO Box 8094
Liberty ty Wausau,WI 54402-8094
Mutual. Telephone(800)653=7893
Fax(715)843-2650
December 11,2002
TOWN OF BARNSTABLE
BLDG DEPT ,
367 MAIN ST
HYANNIS,MA 02601-
RE: Certificate of Workers Compensation Insurance
Insured: NICKERSON HOME IMPROVEMENT INC
PO BOX 2476
ORLEANS,MA 02653
POlicy Number: WCi-31S-318102-022 Effective: 11/6/2002 Expiration: 11/6/2003
Coverage afforded under Workers Compensation Law of the following state(s): MA
Employers Liability: y
Bodily Injury By Accident: $ 1,000,000 Each Accident
Bodily Injury by Disease: $ 1,000,000 Each Person
Bodily Injury by Disease. $ 1,000,000 Policy Limits
As of this date,the above-referenced policyholder is insured by Liberty Mutual Insurance Company under the
policy listed above.
The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions,and is not
altered by any requirement,term or condition of any or other documents with respect to which this certificate
may be issued.
This certificate is issued as a matter of information only and confers no right upon you,the certificate holder.
This certificate is not an insurance policy and does not amend,extend,or alter the coverage afforded by the
policy listed above.
If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notify you of such
cancellation.
AUTHORIZED REPRESENTATIVE "
LIBERTY MUTUAL INSURANCE GROUP
This Certificate is executed by LIBERTY MUTUAL INSUItANCE GROUP as respects such inmrvnce as is afforded by those companies.
cc-:Insured:' Producer of Record:
NICKERSON HOME IMPROVEMENT INC PIKE INSURANCE AGENCY INC
PO BOX 2476 PO BOX 1658
ORLEANS,MA 02653 ORLEANS,MA 02653
Iv1Or,.�s
e
Pane.
. Palle No. � m 2
HICKERSOH HOME IMPROVEMENT,INC.
P.O.Box 2475 s ® ®I® n
HYANNIS,MA 02601
(508)790-5880 Fax(508)255-5107
PP.aNE
TO Barbara Ochen Jo FYA64E! O no -
1-753 63rd Street 86 Stetson Street
Brooklyn NY 11204 Hyannis
JOf3 PHONE
JOB NUMBER -
2�. (�
strip shingles off entire roof W't�
Renail all loose sheathing edge on all lower edges
Install 8" white aluminum drip g g �
�aJI&C1.
In ice & water shield on all lPreoneentirendro f in all valleys �e
Install black underlayment felt Paper
around vent pipes --
In
nea: flang
— —'Y— area
tali ridge -vent at roof peak over any living hurricane 'nailinq
Ins ----y---
P properly
din"st �� 25 year 3 to roo£ shingles on entire roof using
All trash and debris will be removed and disposed of P p f es to above
All materials, labor and dump
chitect roof shingles add to above
OPTIONS- To install 30 yearto above
To.install 40 y r Architect roof shingles-add
dd
To install 5 year Architect roof shOPTIO14Ses aON RETURNED PROPOSAL
PLEASE INDICATE SHINGLE COLOR AND YES TO ANY
ded in
please note teat cifiedt above oare e ncludedpair is Niin thisOT uproposalhis prciposal
Only items sp
All materials guaranteed by manufacturer
—Nickerson Home Improvement Inc. guarantees workmanship for S years —
cat'ons.'Or Ole
sum at:
WE PPOPOSE hereby to furnish material and labor complete in accordance with the above spectfidollwr is
r
Paynt`erd to ba made as tut':
payments upon request, balance anon
deposit- upon signing# progress
completion
Ap n tlorial is 9narmlc d to be as specaieo. An s+oM ro t>e coWDl°�°�a Qrobssional
to s.jndWd Pmdc AnY a
— beation W deviolon from above spedt—
nlandW according vrraw mdI arrd will I
lions i—Mnn eNa cosu tW1 bC CT.ettil ,�cY'mMls Wn1iWJ^-m Won sN'ROS.Ocddeots W
CXim dr:u arld above 1ho eslinlatC. Our NW S 6 proposal play i>C
dciays beyond our CW1uo1. Owner to Carry(c.tWIK1do.and other cecessoY umaMx� wnhdr m by us U not 3=rA--d rtilhin30
—.kers ire futly r vV d bJ Vy0rk01Y Oornpensalion lnManCe. n
ACCEPTANCE OF PROPOSAL—Toll above Prices.specicicattW¢ ���
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and conditions are salisl3cl P,Ppand are hereby accepted• You are antlro t r¢ed _
to do the work as specified- ymen will be made as outlined above. Suture -
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05/26/2003 21:36 915087906230
Town of Barnstable
Regulatory Servkes
KM S sant�ts' Thomas F.Geiler,.Director
Building Division
Tom Perry, Building Commissioner
200 Main Sweet, Hyannis,MA 02601
Office: 508-8624038 Fax: .509.790-6236
,Property.Owner Must
Complete and Sign This Section
If Using A Builder
4 d Gh` ,as Owner of the subject property
hereby..authorize g°! '�Jv_A�!V e warn to act on nuy behalf,
in all matters relatkveF'to work'authosnzed by this building permit application for.
(Address of Job)4A Aar A'
4
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ignature of Owner D to
Print Name.
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