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HomeMy WebLinkAbout1103 BUMPS RIVER ROAD ,� . �: ; ,, � ,�k•w rA - x-a J c �+� �c � �� .. a k .. ,. .. �.+ � Y �. °,. - �, .,., a� I w r' � .. _. �.i� .eA.. �� f � � � � vaa .. � .... � 7 IKE Town of Barnstable *Permit# -7(o Regulatory Services Fee 6 mo;h. om �i6. SUR PERMIT Richard V.Scali,Director OCT 19 2015 Building Division Tom Perry,CBO,Building Commissioner TOWN OF RA R N STAR LE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY /�01 q Not Valid without Red X-Press Imprint Map/parcel Number �.�� _6 Prop rty Address �o A bumps VKP_ � .r, � e Residential Value of Work$ ��� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address IS9 69 F109.D4 . M0 3 0vo)P9 k-{/F—R 9Dj Contractor's Name C-PEXEt/( Zia_PV Telephone Number 7774 Home Improvement Contractor License#(if applicable) 0 T 17 Email: G 12E09M ZA Construction Supervisor's License#(if applicable) ❑Workman's Compensation-Insurance Check one: ❑ I am a sole proprietor ❑ 1 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Re_qu�st(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) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans 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 t sign Property Owner Letter of Permission. A copy of the ome Improvement Contractors License&Construction Supervisors License is r9guired. r SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\6ontentOutlook\2PIOIDHR\EXPRESS.doc Revised 040215 f — Massachusetts-Department of Public Safety Board of Building Regulations and Standards Con-struction Super%iwr License,CS-108208 4 ALEXEY LEBEDEV rF 60 FRANKLIN AVENUE v Hyannis MA 02601 Expiration Commissioner 11/27/2018 fc�n �r a>nz� C �e1 Office of Consumer Affairs and Business Regulation. 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Registration: 176777 gn- Type: LLC Expiration: 9/25/2017 Tr# 270447 t { _ DREAM HOME IMPROVEMENT LLC ALEXEY LEBEDEV ' 60 FRANKLIN AVE. HYANNIS, MA 02601 Update Address and return card.Mark reason for change. SCA 1 0 20M-05r1 1 ;D Address ❑ Renewal Ll Employment Lost Card '"��fe C�ararrearrrc!>at!�r�'C?i�l�.���rc�ee�ell' Office of Consumer Affairs&Business Regulation License or registration valid for individul use only _ OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ,Registration: ,`.176777 Type: Office of Consumer Affairs and Business Regulation Expiration 9/25/2017 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 DREAM HOME IMPROVEMENT L-LC.' ALEXEY LEBEDEV 60 FRANKLIN AVE. HYANNIS,MA 02601 Undersecretary Not valid without signature w DREAM HOME IMPROVEMENT 60 Franklin Ave, Hyannis, MA 02601 PHONE 1-(508) 332-8119 CERTAINTEED LANDMARK LIFETIME-ALGAE RESISTANT ARCHITECTURAL STYLE RE-ROOFING PROPOSAL August 14, 2015 MELISSA FROEDE 1103 BUMPS RIVER RD CENTERVILE, MA DREAM HOME IMPROVEMENT herby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and haul Away All of the Old Asphalt Roofing Shingles. Supply and Install CERTAINTEED LANDMARK AR: COLOR: BRICH WOOD. Supply and Install 8" WHITE ALUMINUM DRIP EDGE on All of the Eaves. Supply and Install #15 BLACK SATURATED FELT ROOFING PAPER. Supply and Install CERTAINTEED WINTER-GUARD (Ice & Water) WATERPROOF UNDERLAYMENT SYSTEM on Roof the Eaves & under the Step Flashing on the Chimney. Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Entire Main Ridge. Aluminum and Neoprene Soil Pipe Flashing. Supply and Install TYPAR SYNTHETIC UNDERLAYMENT PAPER Supply and Install ALUMINUM WINDOW & DOOR FLASHING. Clean and Remove Debris from work area after job is completed. f TOTAL INVESTMENT ------$ 9995.00 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 NormallyScheduled for Completion Within P 45 Days of Acceptance and Receipt of Deposit Providing the Materials are Available. Please make Checks Payable to: ALEXEY LEBEDEV DREAM HOME IMPROVEMENT Warranties the Shingles and Labor for 10 Years. CERTAINTEED Warranties the shingles and labor 100% for the first 10 years and the shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the shingles up to CATEGORY III HURRICANR-130 MPH WIND WARRANT. CERTAINTEED Warrants the Shingles to be Algae resistant for a Full 10 Years. DREAM HOME IMPROVEMENT Carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: 9/16/15 ACCEPTED BY: Aal 671 MELISSA FROEDE AL 4LEBEDEV HOMEOWNER DREAM HOME IMPROVEMENT The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AvOicant Information !! Please Print Le ibl Name (Business/Organization/Individual): eL� Wit` Address: b4, , /W-4--TV OVA? J`[,rya X11J, City/State/Zip: Phone #: 7/- °"co-©4: Are you an employer?Check the appropriate box: Type of project(required): I.F-1 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition en re that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions p prietors with no employees. 12.�Plumbing repairs or additions 5. am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.F_1 we are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#i 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 the policy and job site information. Insurance Company Name: _ Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under th pai s and penalties of perjury that the information provided above is true and correct. Sign • 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): I 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other j Contact Person: Phone#: j I i i 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 adeceased 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-contractor(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 i 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 I 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. i The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents j 1 Congress Street, Suite 100 I Boston, MA 02114-2017 i Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia r 09/17/2015 THU 11: 05 FAX 5039923538 eouthea&tern IA W001/002 CO a CERTIFICATE RT I FI C DATE(MMIDDIYYYY) �,.- ATE OF LIABILITY INSURANCE 01111101s 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 '119PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cerdNcate holder I9 an ADDITIONAL INSURED,the pollCy(lee)muat be endorsed. It 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 tights to the certificate holder In Ileu Of such endorsement s PRODUCER CONTACT NM,, Ashley 8aiva Southeastern Insurance Agency, Inc. HONE (508)997-6061 (eoe1990-z7s1 439 State Rd. .MAIL - AIC )LT pRos.apaivaB■outhsanternl.na,cam B.O. Box 79398 ----- _IN9u1EMAP►ORDINe COVERAGE NAIL# North Dartmouth tea► 02747 INSURERAArballa Mutual Ina Co 27000 INeuRSD .— INSURER a AEIC - Armen Safaryan, DBA; Corey and Corey INSURER0; 67 Sea Street -- - IN&URER D: INeURER E• _ H annia MA 02601 INBU API COVERAGES CERTIFICATE NUMBER:2015 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. NOTWITHSTANOING 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. LTA TYPE OF INSURANCE Dot au —— PDLIcr LACY EItP " P NUMBER LIMITS R COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A — CLAIMB-MADE D ocouR (Eseeeurr.n,2) a 100,000 TBD 9/10/9015 9/10/2016 MEDEXP(Any onqEtLd%L S 5,000 PERSONAL 6 ADV INJURY 6 1,000, 000 GEN'L A0096OATE LIMIT APPLIES PER; OENERALAOGREOATE S 2,000,000 X POLICY 0 JET l_j LOC PRODUCTS-COMP/OPAGG 6 a,000,000 Employee Bene4la $ AUTOMOBILE LIABILITY E COMBINED SIN 6 ANY AUTO I BODILY INJURY(Per person) 6 AUTO$ALL ED AUTOS BODILY INJURY(Por sceldenl) S HIREDAUT08 NON-OWNED ERTYA08 AUTOS DAM (Per/aoldepl�_ 6 6 UMBRELLA UAa OCCUR EACH OCCURRENCE $ EXc59S LIAR _ CLAIMS-MADE AGGREGATE ; DE RETENn WORKERS COMPENSATION 6 AND EMPLOYVRV LIABILITY YIN ER ANY PROPRIETOR H OFF(CERIMEIABER RwwDED7 �NIA E.L.EACH ACCIDENT 6 (Mandator/inNMI TED 9/19/2015 9/1B/9016 1.000r000 rc • deaorlb.under E.L.DIBEASE-ERA EMPLOYE 6 1 000 000 T,ON OF PE few E,L DISEASE-POLICY LIAIT S 1 000 DESCRIPTION Or OPERATIONS I LOCATIONS I VEHICLE&(ACORD 101,AddlSonal Remarks Schedule,may be attached 11 more apace Is regWrad) l CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Display Burpogea Only THE EXPIRATION DATE THEREOF, NOTICE WILL Be DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ashley Paiva/AMP 01968-2014 ACORD CORPORATION. All rights reserved, ACORD 25(2014/01) The ACORD name and logo are reglatered marks of ACORD INS026(201401)