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phone: 1-866-756-4676
UNV12302
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Application nu mbe .......... ...........................
................:........
Date Issued............?. . 1�......................
BUG
.082018 Building Inspectors Initials......... . .
VSFABLE Map/Parcel.................................................................
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: 8 b ��k S ` � A•U1'
NUMBER STRE VILLAGE
Owner's Name: r 1 �CG.. /Vin -�t hone Number
Email Address: 1�,M CAA �@ COIMct.S�6 ; Cell Phone Number
Project cost $ rZ 80 Check one Residential _ Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a building permit in accordance with 780 CMR
Owner Signature: Date:
TYPE OF WORK
r
Siding 0 Windows (no header change)# ❑ Insulation/Weatherization
0 Doors (no header change)# Commercial Doors require an inspector's review
Roof(not applying more than 1 layer,g shingles)
Construction Debris will be going to T
CONTRACTOR'S INFORMATION
Contractor's name
Home Improvement Contractors Registration(if applicable) # 17D J7 (attach copy)
Construction Supervisor's License# i McO (attach copy)
Email of Contractor Rgoc.(A�. XA100 • 60"^^ Phone number 500 ,3to y7
ALL PROPERTIES THAT HAVE STRUCTURES 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.
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.
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
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 * w
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back deft 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 T wn of Barnstable.
0
Signature Date
APPLICANT'S SIGNATURE
Signature Date
All permit applications are subject to a building official's approval prior to issuance.
tT
' 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):
( . (i22
Address: Cff fi (m(OV AJ
City/State/Zip: I�% � ® I G OZb73 Phone#: f0 "UD'2l , /G
Are you an employer?Check the appropriate box: , Type of project(required):
1.0 I am a employer with 4. ❑ I am a general contractor and I 6. ❑
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 me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp.insurance.:
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 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.❑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.
$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.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic. : Z g Expiration Date: /T ZD /9
4a Ci /State/Zi
Job Site Address: `� ty p:
Attach a copy of the workers' compensatio policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under ection 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 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
Investigations of the DIA for insurance coverage verification.
I do hereby certify e p ins and penalties of perjury that the information provided a ove is true and correct
Signature: Date:
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 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"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 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:
The Commonwealth of Massachusetts,
Department of Industrial Accidents '
Office of luvestigations
600 Washington,Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 4-24-07
www.mass.gov/dia
411
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68 Winslow Gray Rd
West Yarmouth, MA 02673
508-360-2749
e-mail rsoccrDyahoo.com
roo fingandsidingofcapecod.com
P� HIC REG #170787; LIC # 102600
Job Address: 856 Bumps River Rd
Name: Kendra McCarthy Town: Centerville,MA
Address: 161 Temple Street Job Phone: 617-967-5503
City: West Roxbury, MA Other Phone: 617-650-9417 (Kenneth Daly)
State: E-mail: kmccart3@comcast.net
ZIP: 02132
Estimator: Dmitry Labkovich
07/27/18
We hereby submit specifications and estimates to furnish and install new roofing as follows:
1. Strip existing roofing and remove debris. Calculated (2 layers).
2. All gutters will be cleaned out, grounds cleaned up and nails extracted with magnets. We utilize
magnets so as to minimize your exposure to personal injure and/or property damage from nails
left behind at the job site.
3. After removal of roof, wood deck will be inspected for splitting, rot or other deterioration.
Owner will be advised of need for wood replacement prior to commencement of wood
replacement work.
4. Along all eaves of house. Ice & Water Shield waterproofing underlayment (36 " wide) will be
directly adhered to the wood deck. Waterproofing underlayment is installed to eaves to protect
against interior leakage and subsequent damage from wind-driven rain, ice and snow dams, and
freeze back conditions.
5. Install waterproofing underlayment in full width (36 wide) to all valleys and 12" to all rake
edges. Install waterproofing underlayment at all vent pipe collars and any other projections and
skylights. Underlayment adds additional protection against leakage at critical terminations.
Over remainder of house synthetic roofing paper will be installed and nailed to the wood deck.
6. Install new white drip edge to all perimeter cave edges. Drip edge is installed to protect from
leakage and rot and to provide a neat and clean perimeter profile.
7. All existing vent pipes will receive new aluminum vent pipe flashings with neoprene gasket
collars, or copper if doing red cedar roof.
8. At all eave edges or roof, shingle starter strip will be cut an installed with sealing strip at lower
edge of roof in accordance with manufacturer's specifications. This provides a watertight and
wind-resistant termination for your roof.
9. Storm nailing: Because we live in a severe storm region, additional (storm) nailing is strongly
recommended by Roofing and Siding of Cape Cod, LLC, the manufacturers and the National
Roofing Contractors Association. Secure new roof with 50% more nailing, upgrade minimum
standard (4) four nail's per shingle to (6) six nails per shingle, 1 '/4 " long. Nails will be
galvanized with a rust-inhibitive coating. If red cedar roof,then using stainless steel fasteners.
10. Shingle installation: Supply and install roofing shingles according to the manufacturer's
specifications, according to the below selected material and warranty. All work to be performed
by insured professionals.
11. Install waterproofing underlayment surrounding chimney. Underlayment will extend up vertical
portion of chimney a minimum of (2) two inches. Caulk all lead flashings together around
chimney with Dymonic caulk. This is not a guarantee but a maintenance procedure. We cannot
guarantee chimney from leakage with roof job only. See chimney proposal if applicable. We
cannot guarantee existing skylights or venting units unless we replace them with new ones.
12. At peak of roof,'an approximate (3) three-inch-wide continuous gap will be cut out of deck. Air
Vent, .Inc. Shinglevent II solid vinyl ridge vent with external baffle will be fastened over the
opening in the deck. Shingle caps will be cut, installed and fastened over the vinyl ridge vent
into the decking with 2 '/z inch coated roof nails. Shinglevent II comes with a 30-year material
warranty from Air Vent, Inc. Shinglevent II vinyl ridge vent provides you home with the
necessary exhaust ventilation to prolong the life of the shingles and the wood sheathing to
ensure a properly balanced ventilation system if used in conjunction with eave intake
ventilation, and provide cooler attic temperatures in the summer and less moisture-laden
damaging air in the winter.
The above s specifications are required to meet the National Roofing Contractors Association (NRCA)
roof standards, as well as to meet manufacturer's specifications for warranty requirements. Touch-up
painting may be required and is not included in this proposal.
Roofing and Siding of Cape Cod, LLC warranty: products and workmanship (100% Labor and
Materials) for 10 (ten) Years after installations.
Roofing and Siding of Cape Cod,LLC will obtain necessary permits required by the Town.
CertainTeed warrants that its shingles will be free from manufacturing defects. Below are highlights
of the warranty for LandmarkTM. See CertainTeed's Asphalt Shingle Products Limited Warranty docu-
ment for specific warranty details regarding this product.
• Lifetime, limited transferable warranty
• 10-year SureStartTM warranty (100%replacement and labor costs due to manufacturing defects)
• 10-year StreakFighterTM warranty against streaking and discoloration caused by airborne algae
• 15-year, 130mph wind-resistance warranty
Landmark, with Life-Time Warranty
Labor and Materials: $6,900.00
If acceptable, initial here / 1� Color COBBLESTONE GRAY
We hereby submit specifications and estimates to furnish and install new White Cedar Shingles on the
following areas:
Back and two sides of the house
Specifications as follows:
1. Remove existing siding and dispose of debris;
2. Inspect sheathing for rot or other deterioration and advise homeowner of any additional work;
3. Inspect existing waterways at window, door and corner boards and notify homeowner of any
additional work;
4. Install Typar breathable house wrap.
5. Install new window and door drip cap flashing;
6. Install double first course of siding. Install new siding using approximate 5 " exposure
hitting tops and bottoms of windows and door openings as allowed (may not be possible at all).
7. Siding to be secured using rust-resistant fasteners '/z inch to 1 inch above next course line;
8. Shingle joints to be at least '/a" away from fasteners and 1" away from previous course joints (to
minimize exposed fasteners when siding shingles).
9. Clean yard of all debris and utilize magnet to minimize exposure to property or personal
damage from nails left behind;
10. Remove and re-install electrical fixtures;
I
11. Last course to be hand nailed using#5 box stainless steel nails;
LABOR AND MATERIALS: $6,400.00 (Grade A)
If acceptable, initial here: X9elcl
LABOR AND MATERIALS: $1,300.00 (Tops of gable ends)
If acceptable, initial here:
We hereby submit specifications and estimates for the following work:
• Remove and replace damaged plywood.
• Remove and replace damaged trim-boards with the same material.
• Replace gutters and down spouts of both sides.
LABOR AND MATERIALS: $1,182.00
If acceptable, initial here: �1
Job is estimated to commence approximately _2_ weeks after deposit received unless otherwise
noted here:
Work is scheduted to be substantially completed in approximately: days If acceptable, (both)
initial here:
Start and completion times are approximate and subject to change due to, but not limited to, the
following circumstances:weather delays, additional work on previous jobs, permitting delays, etc.
This is the entire agreement. Any discussions or verbal agreements are superseded by this agreement.
Such agreements, even those of the smallest nature, must be in writing to be recognized.
Any work above and beyond the specifications outlined in this proposal will be priced on request. All
additional work, including travel time and lumberyard runs, will be subject to extra charge. In the
event of rot repairs, roof repairs or any related work requiring immediate attention, we will proceed
without customer approval.
We look forward to working with you;please call if you have any questions.
Sincerely,
ROOFING AND SIDING OF CAPE COD,LLC
Acceptance of Estimate
The above prices, specifications and conditions are satisfactory and are hereby accepted. ROOFING
AND SIDING OF CAPE COD, LLC is authorized to do the work as specified.
Payment will be made as such:
1/3 Deposit
1/3 Beginning of work
1/3 upon completion
Date: 8/2/2018
Signatures:
Note: No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of
such contract. You, the buyer may cancel this transaction at any time prior to midnight of the third
business day after the day of this transaction.
c �
ROOFING AND SIDING OF CAPE COD, LLC will provide cleanup on a continuing basis and all
debris will be removed from site. All products installed by ROOFING AND SIDING OF CAPE COD,
LLC will be to manufacturer specifications. All work will be performed by insured professionals.
All material is guaranteed to be as specified and the above work to be performed in accordance with the
drawings and/or specifications submitted for above work and completed in a substantial workmanlike
manner. There will be no refund for special-order windows, doors or any other non-stocked materials
after three days from approved proposal. All warranties will be null and void if account is not current
and paid in full.
Owner to move all personal objects, furniture, etc., from work areas. All items against walls should be
considered for removal during any exterior siding jobs, additions, etc. to guard against damage. In the
case of any roofing and ridge venting, dust and debris should be expected and any items in the attic
should be removed. ROOFING AND SIDING OF CAPE COD, LLC is not responsible for any
damages if said items remain in place.
Curtains, drapes and window and door treatments may need proper reinstallation or replacement by
customer due to sizing on any window or door replacements and is not included in jobs contracted with
ROOFING AND SIDING OF CAPE COD, LLC
Any alteration or deviation from above specifications involving extra costs 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 above work. Workmen's Compensation and Public Liability Insurance on above work
to be taken out by ROOFING AND SIDING OF CAPE COD, LLC. Owners who secure their own
construction-related permits or deal with unregistered contractors will be excluded from access to the
guaranty fund.
This Contract not valid unless signed by Corporate Officer:
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rl TA NT.- If ti0 m9f sate holder:is an ADOITItMAL INSUAW the per§c+yPesl must be endorsed, .It SUBROGATION tS WAIVED.subjga tzt Wwas and zonddions of the polcy.vertwn polk,les MY TeWife an endorsenw-uG A statemeM an this cetifficae doesnatcomer rlghts to the
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Rooting&Siding of Cape Gad LUC' ACCORDM#M1W'TT"THEpoL=1CPRtatslS CNS
69 Wntow Cray Road
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Board of Building Regulations and Standards
License: CS-102600
Construction Supervisor
DZMITRY LABKOVICH
68 WINSLOW GRAY RD
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WEST YARMOUTH MA'02673'
Expiration:
%Commissioher 03/27/2019
Office of Consumer tiffairs&Business Regulation Registration valid for individual use only
HOME IMPROVEMENT CONTRACTOR i 9
TYPE:LLC before the expiration date. if found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
170787' 12/18/2019 10 Park Plaza-Suite 5170
ROOFING AND SIDING OF CAPE COD,LLC.
Boston,MA 02116
VY .
DZNIITRY LA.BKOVICHs
68'NINSLOW GRAY RD Not valid wltho t signature
W.YARMOUTH,MA 02673 Undersecretary
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�o�TNETo�° TOWN OF BAR.NSTABLE
EARNSTADLE, i
7 waY 9
o BUILDING INSPECTOR
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APPLICATIONFOR PERMIT TO .............................................................................................................................
TYPE OF CONSTRUCTION &..................!�
.................. . ...........................19........
s
TO THE INSPECTOR OF BUILDINGS:
�- The undersigned hereby applies for a pefmit accord' g to the following information: -
Location �. �. T .....7' �uN► PP !'t'!P �J C� c , .?'�.. ��-.� . ..................................... .............................................. ...........................
Proposed Use I D.......E n1 E 4
......................... ............................................................................................................................................
Zoning District ............ ..............................................Fire District ..... s e 6. S InE4 V/ L L :
...... . ...............................
Name of Owner 101.,11.II.r�...F...... r Address ....................................................................................
Nameof Builder ................'✓."MA ....................................Address .......................................... .........................................
Nameof Architect ..................................................................Address ....................................................................................
Number of RoomsFoundation U ,I — D r1v1x1.,r.............S.. ............................. .......................................... ..... . ... ..............
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Exterior ........!f�. ...Roofing...:..................................:........................... ....................................................................................
Floors ....................................Interior
rieating .5...................................................Plumbing :...............................e®r...®��..................................1 ..............
Fireplace .................®,414!�...................................................Approximate Cost ......../ ..0®.0....................... ........
Difinitive Plan Approved by Planning Board ________________"______________A 9________ . / ` �➢
Diagram of'Lot and Building with Dimensions
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hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. nn
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Name .. r ! ..... . ....................................
Gilbert, Claude +
DEC 31 1970
12586 one story,
No ................. Permit for ....................................
single family dwelling
............................................................................... I
S �
�Ip Bumps River Road
Location ................................................................ ;
Centerville
............................................................................... F .
Owner Claude Gilbert iz
..................................................................
4 f
Type of Construction frame
..................................................................... t _
Plot ......................... .. Lot .............+26.............. ~
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Permit Granted ...... September 2 19 69 4
..... ........
Date of Inspection ..� ......�.t4...............19
Date Completed .............:........................19 ±
PERMIT REFUSED j
................................................................. 19 `
...............................................................................
..............................................`. .. ........ .. .
....................................................... i
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Approved ..,..,.......................................... 19
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...............................................................................
.................... .................................................. ... i
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