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Town of Barnstable Building
rsrn Post This"Card So That it is'Visible'From the Street Approved Plans Must be Retained on lob andtth�s Card Must be Kept
i -
` iPosted Until=Final,lnspect ion Has'Been
,, " iWhere a Certificate of Occupancy is Required,such Burld�ng shall Not=be Occupied until a Final Inspectionhas been made el 1t
_,. . . .., .., m ..� B ild
Permit No. B-20-546 Applicant Name: Steve J Spengler Approvals
Date Issued: 03/23/2020 Current Use: Structure
Permit Type: Building-Solar Panel-Residential Expiration Date: 09/23/2020 Foundation:
Location: 42 ASHLEY DRIVE,CENTERVILLE Map/Lot: 172-090 Zoning District: RC Sheathing:
Owner on Record: SELLIN,WAYNE G&CYNTHIA J' Contractor Name'•VIVINT SOLAR DEVELOPER LLC. Framing: 1
Address: 42 ASHLEY DR Contractor License. 170848 2
CENTERVILLE, MA 02632 Est Project Cost: $3,801.00 Chimney:
Description: Installation of roof mounted photovoltaic solar systems 8.64kw 27 Permit Fee: $85.00
Insulation:
Panels Fee Paid.:; $85.00
Project Review Req: Date: ` 3/23/2020
Final:
Plumbing/Gas
Rough Plumbing:
- � g g
Y = --- O
This permit shall be deemed abandoned and invalid unless the work authorized by this is commenced within six months afte�M�l�e. fficial Final Plumbing:
All work authorized by this permit shall conform to the approved application and the a Permit pproved construction document-for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. J, = _ Final Gas:
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided onahis permit. Electrical
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing «Fµ Service:
2.Sheathing Inspection • ��
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Rough:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
Final:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Rough:
7.Final Inspection before Occupancy
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final:
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons contracting with unregistered contractors'do not have access to the guaranty fund (as set forth in MGL c.142A). Final:
Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Final:
7
Town of Barnstable 1
-.� ". "" "t.^, .r7
`_ "�..�w T.r *' '; " ;`•:"' a" ;"ems",� g
�+er
Bui
lding
n
t PostThis CardSo That rt rs Vrsdile From the Street Approved' ]ans.Must be.Retarned on Job and#hrs Card Must be Kept
raatv�rn�s ." e
Posted Until Final Inspection Has,Been Matle '` , Permit
reduntrl a:Final Inspec#i ::has been,mad'e
Where a Certificate of OccupancyE;is Required,such Buildingshall NotbenOccup
Permit No. B-20-44 Applicant Name: Ashley Walters Approvals
Date Issued: 01/08/2020 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/08/2020 Foundation:
Location: 42 ASHLEY DRIVE,CENTERVILLE Map/Lot: 172-090 Zoning District: RC Sheathing:
Owner on Record: SELLIN,WAYNE G&CYNTHIA J CoritractorName:"`Kenneth D Kendall Framing: 1
Address: 42 ASHLEY DR r ContractorLicense: CS=075153 2
CENTERVLLLE, MA 02632 j Est Project Cost: $2,356.00 Chimney:
Description: remove and replace patio door, replace trim Permit Fe ` $35.00
Insulation:
no structural = Fee'Paid: $35.00
Date �/ 1/8/202 0
Project Review Req:
Final:
0 � Plumbing/Gas
" Rough Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorised by this permit its commenced within sixmonths after issuan ff�C�a Final Plumbing:
All work authorized by this permit shall conform to the approved application-and the approved construction documents for which'this permit has been granted.
All construction,alterations and changes of use of any building and st}uc`turesshall be in compliance with the local zoning by-laws and codes. Rough Gas
n f the
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration 0
work until the completion of the same. Final Gas:
The Certificate of Occupancy will not be issued until all applicable si natures ki the Buildin .and Fire-Officials-are'provided on this permit.P Y pP g :.Y -, g - _ _ ? p� Electrical
Minimum of Five Call Inspections Required for All Construction Work: r
1.Foundation or Footing Service:
A_
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue.lining is nalled = Rough:
st
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
Final:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Rough:
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final:
Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Final:
Town of Barnstable Building
a Post This Lard So That it is Visible.:From the Street Approved Plans Must be Retained on Job and this Card Must be Kept
�PostedUFinal Inspection Has
ntl Been Made. , P m
Where.a Certificate of Occupancy is Required,such Building shall Not be Occupied until-a Final Inspection'has been'rrad'ems' v�'�gilt
Permit No., B-19-3363 Applicant Name: Ashley;Walters 'Approvals
Date issued: 10/10/2019 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 04/10/2020 Foundation:
Location: 42 ASHLEY DRIVE,CENTERVILLE Map/Lot: 172-090 Zoning District: RC Sheathing:
Owner on Record: .SELLIN,WAYNE G&CYNTHIA J Contractor Name Kenneth D Kendall Framing: 1
Address: 42 ASHLEY DR Contractor License: CS-075153 2
CENTERVILLE, MA 02632 Est. Project Cost: $2,630.00 Chimney:
i
Description: Remove and install sliding door. No structural Permit Fee: $35.00
i Insulation:
Project Review Req: Fee Paid:'. $35.00
- -_Date: 10/10/2019
Final:
IZA' ' Plumbing/Gas
Rough Plumbing:
- — Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after-issuance.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
Final Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. g .
� n Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided,on thisp rmit.
Minimum of Five Call Inspections Required for All Construction Work:a Service:
1.Foundation or Footing Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �,
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel V Application #
Health Division Date Issued �" V
Conservation Division Application Fe '
Planning Dept. Permit Fee ��r
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street'Address // "
Village C_ 1117h e-
Owner f ,
�/� / Address 427
Telephone v62
Permit R quest I
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
'Zoning District Flood Plain Groundwater Overlay
Project ValuationQ Construction Type_6TLO
Lot Size �� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ff�' Two Family ❑ Multi-Family (# units) w
o
Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings ighway:'=❑Yq 0 No
Basement Type: O'Full ❑ Crawl ❑Walkout ❑ Other °`
Basement Finished Area (sq.ft.) ��� Basement Unfinished Area (sq. )
Number of Baths: Full: existing new Half: existing n1;9
Number of Bedrooms: existing _new _ rn
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: 6 Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes 0 o Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name /(-`/ � / �L�/JQiL- Telephone Number L ) 77��{l�/
Address 9 /�[ !� / ,�Ld� ��, License # C
Home Improvement Contractor#
Worker's Compensation #A/GC
ALL CONSTRUC DEBRI RESU TING FROM THIS P OJECT WILL BE TAKEN TO )9& All)
od (IZ3
SIGNATURE DATE /
F
F r
FOR OFFICIAL USE ONLY
E F.
APPLICATION#
ATE ISSUED
,r
MAP/PARCEL NO.
k
i.
ADDRESS VILLAGE
A OWNER
DATE OF INSPECTION:
Jt_yFOUNDATION�
R; FRAME -- — — — -- — —
E
rINSULATION,s-.�i:s
FIREPLACE
ELECTRICAL:.. .ROUGH FINAL
F PLUMBING: ROUGH FINAL
s
GAS: ROUGH FINAL
FLNAL BUILDING.
J
DATE CLOSED OUT
ASSOCIATION PLAN NO. +,
i
Thi Commonwealth of Massachusetts
Department:of Industrial Accidents
Offce of Investigations
1 Congress Street, Suite 100
Boston,MA 02114-2017
www.mass gov/dia
Workers'Compensation Insurance Affidavit::Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print I,epibly
Name (Business/Organization4ndividual)
Tupper Construction Co. Inc
Address: 79B Mid Tech Drive>
City/State/Zip_West Yarmouth, MA 02673 Phone#:(508)778-0111
Are you an employer? Check the:appropriate box:
Type of'projeet(required);
1.0 1 am a:employer with 4. ❑ 1 am a general contractor and l:
employees (full and/or part-time)_
have hired the sub-contractors .New-construefiom
2.❑ 1.am a sole proprietor or partner- listed on the attached:sheet. .16 ❑Remodeling
ship and have-no employees Theesub-contractors have
8. []Demolition
Working for me in any capacity'.: employees and have workers'
[No workers' comp.insurance comp..insurance.t 9: Building addition. ,
required.] S. ❑ We are a corporation and its 10.❑Electrical repairs or additions.
3 ❑ I am a homeowner doing all'work officers have exercised their 1:1:❑Plumbing.repairs or additions.
myself. [No workers''comp. right of exemption per MGL
12 ❑Roof,repairs
insurance required.] T c. .152; §l(4),;and werhave no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box W l must also fill out the section below showing;their workers'compensation policy infomtdnoii.
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 must attached an additional sheet showing the name of.the.sub-contractors and state whether ornot those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp,policy number..
I am a>t employer that is providing workers'compensation insurance for n:y employees. Below is the policy and job site,
..
information.
Insurance Company Name: AEIC
Policy#or Self.ins: L c. #:'VUCC 500559301200.7 Expiration Date: 10/8114
Job Site Address: ` City/State/Zip:
Attach'ascopy of the workers' compensati n 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 to up' $1,500.00 and/oe,one . ..AT-atnprisonment, as well'as civil penalties in the.form of a STOFWORK ORDER and a>fine
of up to$250.00 a day again} iolator. :Be advised that a copy of this statement maybe forwarded to the..Office of
Investigations of the.D for in ur nee coverage verification;_
L do hereby certi under p 'is.and penalties of perjury that the.information provided.above is true and correct-
Si g_nature- Date:
..
.Phone# . 508-778-0111 -
Official use only: Do not:*KM in this area,to be completed by city or town official.
Qty`or Town: t Permit/License#
Issuing Authority(:circle:onej
1.Board of Hearth 2.Bulding Department:3.City/Town Clerk 4.:Electrical Inspector .5.Plumliing:Inspeetor.: .
6.Other -
Contact 'Phone#:
OWNER AUTHORIZATION FORM
(Owner's Name) '
a .
owner of the property located at E
Z ZA4%/ rl•,VP
(Propefty Address)
(Prope4 Address) K
a f
1
hereby authorize ontoU J 10
(Subcon r)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
{
permit and to perform work on my property.
Owner's Signoire
dOL
2 o Zv/
Date
ACORD,4 CERTIFICATE OF LIABILITY INSURANCE F10/31/D2013)
� 10/31/2013 ,
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 endorsement(s).
PRODUCER CONTACT NAME: Lora Lowe
Southeastern Insurance Agency, Inc. acN, Et: (508)997-6061 a N,:(508)990-2731
439 State Rd. E-MAIL
ADDRESS:
P.O. Box 79398 PRODUCER
CUSTOMER ID#:
N. Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIL#
INSURED INSURERA: Arbella Protection Insurance
Tupper Construction Co LLC INSURERB: AEIC
INSURERC: CNA Surety
27 Roberta Drive - INSURER0:
West Yarmouth, MA 02673 INSURERE:
INSURERF:
COVERAGES CERTIFICATE NUMBER: 2013/14/1 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.
ILTR TYPE OF INSURANCE WSR SWVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS
MM/DD MWDD
GENERAL LIABILITY 8SO0008743 11/01/2013 11/01/2014 EACH OCCURRENCE $ 1,000,00
X COMMERCIAL GENERAL LIABILITY DAMAGE ToRENTED
PREMISES Ea occurrence $ 100,00(
CLAIMS-MADE Fil OCCUR MED EXP(Any one person) $ 5,00(
A PERSONAL&ADV INJURY $ 11000,00(
GENERAL AGGREGATE $ 2,000,00(
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000
PRO-
POLICY LOC $
JECT
AUTOMOBILE LIABILITY 5666240000 12/01/2012 12101/2013 COMBINED SINGLE LIMIT
(Ea accident) $
ANY AUTO 1,000,000
BODILY INJURY(Per person) $
ALL OWNED AUTOS
BODILY INJURY(Per accident) $
A X SCHEDULED AUTOS PROPERTY DAMAGE
X HIREDAUTOS , 1. (Per accident) $ INC ,
X NON-OWNED AUTOS $
$
UMBRELLA LIAB X OCCUR 4600058368 11/01/2013 11/01/2014 EACH OCCURRENCE $ 1,000,000
A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000
DEDUCTIBLE $
RETENTION S $
WORKERS COMPENSATION T
AND EMPLO ERS'LIABI ITY Y/N WCC5005 59301200 10/03/2013 10/03/2014 X I TORY LIA ITS X OER
ANY PROPRIETOR/PARTNER/EXECUTIVE RICHARD TUPPER I 'E.L.EACH ACCIDENT $ 1,000,00(
.B OFFICER/MEMBER EXCLUDED? N/A
(Mandatory In NH) I LUDED FOR WC COVERAGE E.L.DISEASE-EA EMPLOYEd$ 1,000,OO
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ _ 1,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE,
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
"For Information Purposes Only"
Tupper Construction CO LLC AUTHORIZED REPRESENTATIVE
27 Roberta Drive {:
W Yarmouth, MA 02673 Lora Lowe
C 1988-2009 ACORD CORPORATION. All rights reserved.,
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD `
�. 13Ut1�3D+iti'F�EFfiFt�F31 N(.'t IN3T1 1E,iNCy M;Issachuset#s-flePartmeitt of Public-Safety `
107 Hl MIS P49d,StdtA 110 �� �,Eloiyird'b#l3u tdrng.Regulaliorts and i5tandartls �
MOL W 12020 Construction Supen' snr
(dI77►274.1274
WVAY.Dpi.mn License: CS460058
RICHARD S TUPP£R
79 B MID-TECHL DR ;
WEST YARMOUFI'H
Rk Wd Tumor
MRTMED FROFESSIONAL `.%+4 . .tJ. c, t,�,�' Exp'rra#ton
.�(sRR StCEFOR itutlQtlSult! iu►rio►roArEsl Commissioner 12/31/2014
tt _
Offdcc &of Coasamer Alfairi D edstsa iteal4dan
People Helping People Build a Safer W6'rldTM9'a
HOME Iti/JPROVEAAENT CONTRACTOR
TattitNAtt NAr Reglrttratdon:44 845 Type:
CODECOI" �° Y Expiration f 14 Individual
MEMBER' _.
RICt ARO TUPPER
:t
``Richard
Tupper L
r RICHARD TUPPER : L
f Tupper Construction .E
' 29 Roberta Drive
x Building Safety Professional W.YARMOUTH,MA 02t313'M., ' U,dt weretary
.Membpr.# 8158149 ; - Exp: 4/30/20,14
y
010 P.
TU FMFZE R
CONSTRUCTION CO_u_c
79B MID-TECH DRIVE,WEST YARMOUTH.MA 02673
PHONE: 508-778-0111 FAX 508-778-5010
Vwm.TUPPERCO.cOM
Date:
Town of Barnstable -
Thomas Perry CBO
200 M
ain Street
Hyannis, Ma 02601 .
(508) 790-6230 fax
Re: Insulation Permits
Dear Mr. Perry
This affidavit is to certify that all work completed for permit application
Issued on % has been inspected by a certified
Building Performance Institute (BPI) inspector. All work performed mee
ts
or exceeds Federal and State requirements.
i� l 3 0 13 3
Sincerely: a jS hie V dj
t n tin...v;'
Richard Tupper
`Ctcense # CS-69058
Town of Barnstable *Permit# cxo-7 6 V 7 S�
Expires 6 months from issue date
Regulatory Services Fee �P 3�e . ID
Thomas F.Geiler,Director
Building Division (:o?)
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 PERNUT APPLICATION - RESIDENTIAL ONLY
` Not Valid without Red X-Press Imprint
Map/parcet Number 1�ja �9(7)_
Property Address _ $ /,.y Di
❑Resideatial Value of Work j C'�4) Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address l? V Ate A 01-J
Contractor's Name__0 d Telephone Number
Home Improvement Contractor License#(if applicable) 4
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance Xwr RESS PERMIT
Check one: J U L
❑ I am a sole pro etor—" 9 2007
❑ i omeowner TOWN OF BARNSTAKE
ave Worker's
�Compensation Insurance
Insurance Company Name 1 V? t/� (�✓ S
Workman's Comp.Policy# `? 0
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
a-re--roof(stripping old shingles) All construction debris will be taken to
i
❑Re-roof(not stripping. Going over existing layers of roof)
i
❑ Re-side .
❑ Replacement Windows/doors/sliders. U-Value
*Where required: issuance of this permit does not exempt compliance with other towndepartment regulations,i.e.Historic,Conservation,etc.
hi< r1
***Note: Property Owner must sign Property Owner LeLT e of i'Ier"misdjdn.jI 1
A c of Home Improvement Contractors License is required.
n
SIGNATURE:
Q:Forms:expmtrg
Revise061306
-; UREY
O RE,, Y
&- ;
--e-
9®
T :
RoofflioS Cape C ®, ( 8. 1see t970
1694 Falmouth Rd- #115, Centerville, MA 02632
C ( 1 ; TEED
LANDMARKIWOODSCAPE 30, -FAR.
RE, R, Q GMQ P. R.Q QSAL
July 5, 2007
WAYNE SELLIN
42 ASHLEY DRIVE
CENTERVIL,LE, MA 02632 Phone: 1-508-428-0066
COREY & CORES' 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. (TWO LAYERS)
Supply and Install CERTAINTEED LANDMARK/WOODSCAPE AR 30: 30 YEAR WARRANTY_ ,
10 YEAR SURE START PROTECTION, CLASS A FIRE RATED,ALGAE
RESISTANT, 245 POUND EXTRA HEAVY WEIGHT, SELF-SEALING, 70 MPH
WIND WARRANTY, MULTI-LAYERED, LAMINATED ARCHITECTURAL
STYLE, FIBERGLASS BASED ASPHALT SHINGLE with New England's exclusive
COPPER/CERAMIC STONES with a FULL 10 YEAR WARRANTY AGAINST
ALGAE CONTAMINENT COLOR:= _P
Supply and Install CERTAINTEED WINTER-GUARD (lee& Water Shield )WATERPROOF
UNDERLAYMENT SYSTEM on Roof Eaves & Under the Step Flashing
on the Chimney and Gabel Walls.
Supply and Install 8" WHITE ALUMINUM DRIP EDGE on All of the Eaves.
Supply and Install 8"WHITE ALUMINUM RAKE EDGE on All of the Rakes.
Supply and Install ALPHA PRO-TECH SUL SYNTHETIC UNDERLAYMENT
Supply and Install SMART SOFFIT VENT SYSTEM on All of the House Eaves.
http://www.dciproducts.com/btml/smadvent.htm
Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Two Ridges.
Supply and Install COPPER& NEOPRENE SOIL.PIPE FLASHINGS
Clean and Remove Debris from work area after job is completed.
COREY CO RE
Th
Y_
TOTAL INVESTMENT --- $ 8950.00
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 Signing 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
COREY & COREY Warrants the Shingles and Labor for 5 years.
CERI'AINTEED Warrants the Shingles up to a 70 MPH WIND WARRANTY.
CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years.
CERI'AINTEED Warranties the shingles 100% for the First 5 Years
and then on a pro-rated basis for 30 Years Total if the shingles becomes defective.
Any alteration or deviation from above specifications,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. Owner to
carry fire,tornado,and other necessary insurance upon the above work...This proposal may be withdrawn by us if not accepted
within thirty days.
COREY & COREY
carries Workman's Compensation and Public Liability Insurance on the above work
DATE OF ACCEPTANCE:
ACCEPTED BY: SUBMITTED BY:
AYN SELL,IN CHARLES CORE
HOMEOWNER COREY & C69E-V/
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 Le 'bl
Name(Business/organizationandividual): .
•Address: eQ V F3 uroy �'�► Y��
City/State/Zip: PM—A.vv1 Iltp Phone.#: �4,'��` 17 7s-15%a�6
Are you an employer? Check the appropriate box- Type of project(required):,
1.❑ I am a employer with 4. am a general contractor and I
6. []New construction .
employees(full and/or part-time).* have hired the stab-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 for me in any capacity. employees and have workers'
9. ❑Building addition
[No workers' comp.insurance comp.insurance.
$•
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their 11.❑Plumbing eP r airs or additions
'3. ffi idh
❑ I am a homeowner doing all work
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' . 13.0 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 arc doing all work and then hire outside contractors must submit anew affidavit indicating such.
xCdntractors 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.policynumber.
I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site
information.
Insurance Company Name: >V,,!w✓S
Policy#or Self-ins.Lic.#: / Expiration Date:: /)
Job Site Address: �S 1.0 City/State/Zip: V I A.,
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 e. 152 can lead to the imposition of criminal penalties of a
fine tip to$1,500.00 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
Investieations of the DIA for insurance coveraie verification.
I do hereby c fy un er th nd penalties of perjury that the information provided above is true and correct
Si ature: Date:
Phone#:
Official use only. Da not write in this area,tb 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 In ' tructions
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 1522,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permitto'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 commonovealth nor any of its political subdivisions shall
enter into any contract for.the performance of public work until acceptable evidence of complfarice with the insurnce
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-conti 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 subunit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Sile Address"the applicant should write."all-locations da _(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
(Le. 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:.
Thy Commonwealth of Massaohusci t
Depxi went of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel.#617-727-49Q4 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 11-22-06
www.mass.gov/dia
ACORD CERTIFICATE OF LIABILITY INSURANCE °"TE"MMID""'""
T04/09/2007
PRODUCER THIS CERTIFICATE CEOFICATE IS ISSUED AS A MATTER OF INFORMATION
SCHLEGEL INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
34 IOLTY ST HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
WEST. TARISDUTB, MA 02673 INSURERS AFFORDING COVERAGE NAIC#
NtURED INSURER A:NORTBLAMD INSURANCE
Paul Buckailler
INSURER B: TRAVSLSR.4
DBA BUCA4YLI-RR ROOFING INSURER 0:
INSURER D.
Hyannis, MA 02 601 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
POUCIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
am OUCYMWMTM
LTR IRD TYPE OF INSURANCE POLICY NUMBER OA7� P
N LMMIT$
A GENERAL CP46959503 05/15/2006 05/25/2007 EACH OCCURRENCE $1,000,000
X M GEL LIABRRY - PREMISES(Ea ma nee) $50,000
4LMMAE. _OCCLt______ -- MED.E�Aasperen) s X6LDD BDCNa
PERSONAL S.ADV DWRY $1,000,000
GENERAL AGGREGATE s2,000,000
GENL AGGREGATE LIMIT APPLIES PER. - PRODUCTS-COMPIOP AGG , s2,000,000
POLICY ,fir LOC
AUTOMOBILE L L40UW
COMBINED SINGLE LIMIT s
ANY AUTO (Ea gym)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDIREDAUTOS
HIRED AUTOS
8001LY NUURY- $
NON-OWNED AUTOS aabam)
PROPERTY DAMAGE s
(Peracemenq
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSIUMBI AA UASILITY EACH OCCURRENCE s
OCCUR F—I CLAIMSMADE AGGREGATE S
S
DEDUCTIBLE $
RETENTION S $
WORKERS COMPENSATION AND 7PJUB-7430A7-06 64/11/2007 04/11/2008 X I roRSTU T3 ER
EMPLOYEW LIABILITY B ANYPROPRIETOR/PAATHERIMCUTIVE E.LEACHACCWENT S1OO.,000.
oFFR ExcLUDEm ---- —.-_-- _---_ ELL OrsEASE=-EcvarcvYEE- -200;00a.__._...
_ _Hues'-----n.W.. _ .___. -----'----
—YES
-' ePECULpROVISIONSb' ww E.L DISEASE-POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL.PROV K MS
PAM BUCIQULMR IS EXCLUDED FROM HIS WOPMM COtlPLNMTICIN
-ERTIFICATE HOLDER CANCELLATION
"ORZY 6 CORRY ffiIOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
1694 FALlaDMR RD DATE THEREOF, THE mum INSURER WILL ENDEAvoR To MAIL 21 DAYS WRITTEN
:ENTERVILLE, MA 02632 NOTICE TO THE CERTIPICATR MOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF D UPON THE INSURER, ITS AGENTS OR _
REPRESENTA
AUTHORIZED REPRESEMKINE
\CORD 25(2001108) _ 0 ACORD CORPORATION 1988
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:
g g
RegiBoard of BuRdin Regulations and Standards
stration? 136066 f
Expirafinxr:St /2008 One Ashburton Place Rm 1301
C- -�--TPi j Boston,Ma.02108
t, = TYF�e�' D�
COREY&COREY`NOME IMPRQVEMENTS g
CHARLES COREY, �
1684 FALMOUTH
CENTERVILLE,MA 02632 Deputy Administrator, valid without signature