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. Town of Barnstable ` *Permit#
�6-1 ?_
E�Tres 6 month rom issue dote
Regulatory Services IFee s, —
RA UMABLE
MASS. Richard V.Scali,Director1639.
Building Division 0 ow
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601 � ,
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address 7
Residential Value of Work$ 2�(� Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
/r
C:t rt-"t S
Contractor's Name �j'L C C: C �-� .u to �� C Telephone Number �2 2 7—/73
Home Improvement Contractor License#(if applicable) /S'Z,3 72 Email: S lf'rVf 'N (0/,Q
Construction Supervisor's License#(if applicable) .0191 7 7�
(Workman's Compensation Insurance `
/ Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance/
Insurance Company Name
Workman's Comp.Policy# G/C. ,� -- -31 -s- :��`/9
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 l�i�4-t>
❑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 must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
r ed.
SIGNATURE:
Q:\WPFILESTORMS\building permit formslEXPRESS.doc
06/20/16
t
.77Fe Car moynveah*qfMavYadJtxetts
Departmeut cif rndustrial Acc dews
Off"aOMWAkatrans.
600 Washirtgion&reef
-- Bi ant CIA 02111
tPlV1T.t.masmgor/dia
Tar.keys' Compensation Insurance Afffiwt B•.uilders/ContracWrs/Blectr cianrJPlunbers
ApplicantEformiatinn Please Pit
Nm=(Bncin�n ffiffr*E&GAn�zcG
Add€es
Cityfsta&Zig �. Q10"Nhone:41k ��/-�� ��7-� 7
Are you an employer?:Checkthe appropriate box: T of project r
I am a eueral conf=sctar and I� YI}e Pam] (required):..
,
I.❑ I am a employes vvith. ❑ 6- ❑New eaasf ruc c'n
employees(fall andfor part-ime)-* have Lured the mb—contractors
2.❑ I am a sole proprietor or partaer- fisted an the attached sheet.: I- ❑Remdeliug.
ship and have no employees Mese sub-contractors have 9. ❑Detndlitioa
worlang forme in any capacity employees and hare worms' 9..❑Building addition
[N¢wod:ers'comp.i4aa=ce ' Corm].incararArr ,
required-] 5. We are a ccorporation and its 10_❑Electrical repairs or a,dddions
3.El mn a homeovmer doing all wcnk officers have esamised their 1L❑Plumbing repairs or adclifians
of orc per M(M
Mysel€[Trio wodcers'comp- §I( and a havered 12_❑Roof repairs
i mar a=e rude]i _
employees-[Trio workers'
cam-instusace wed-)
•Any appNCzatesc dhecimboa isl test also fino tthe swdonb9awshcaving fieuwo&ere cnmpensatinupnrcyinffirmad=
#Homeuwnersvho salon dtis affidavif i—Mr— su5mit a mwaffidavit mdiatin sadt
fCont<ac' Yfist chart this box mast attache fi=addi5®al sheet showing&a-a me of the and stare whether or not These emitieshWM
emp9ayees.Ifthebuh-cantsctashaveeniplayw-%dupmustpmtidetheir wodEeWcump.policy number.
f am are erliployw drat is prervhUng tvarkers'couqensadait ftasrsrance far atya eurphxy�eM Se1019 is dlepu cy and joh site
hzfbrnraliars
Insurance Company Na=-.
'Paficg�or pelf-ice.Lie.�`_ , F�piratiaa Date:' '
Job Safe Address= CitylStatelp: L-
Attach a-copy of the work corapensationpolicy declaration page(showing the policy number and expiration date).
Fail:=to secure coverage as required under Section 25A of MC L c.15-7 can lead to the imposition of crimivai pecaldes of a
fine up to$L,50D00 aadfor one-yearimprisortmerik as well as ivil pen,119 s is the fam of a STOP WORK ORDERand afime
of up-to 0-00 a day against the violator.Be whised that a copy ofthis sfiatement maybe forwarded to the Office of
Irrirestegafions ofihe DJA for imsmance coverage serfficatiom..
Ida heraiiy car*wu
UeMePains aTed aloes gedury fhatfhe ire,fornra#iauprm toed abmw is true and correct
Date:suture: ` ate:
1,7
Ph;d=A l �r �..G � �7�- 7
t)filkiat use wily. Do swt write in f ds arer,to 5e vinpWad 5y c4 artown gjol a£ ,
City or Town: PermitUcense .,
Lw in Auflwrity(dr&one):
L Board of lraa fi M1 >BmIaTag Dgmtmeat 3.CStp Town Clerk 4.Elech icatl Im peetor S.Plumbing Fnspecter
CL Other
Contact Person: Pho #-
6
Taformation and InstrUC ons ;
yassachoseft cem=al Lags chi M rega=all empIoyas to provide warkeas'Compeusatian for fliea=3pIoyees-
Pursaantto this sty,an�Iayewis dcfined as=evezypeasanm a service of another ceder any ra* of3�e,
express or implied,oral a wzh=t "
An Ioym-is d�frned as"an mdividn.A pM-tn ip,association;carporatM or oche r Iegal eazfsiy,or any two or more
to m a omt and mchhdmg the legal -P9'- es of a dEceased eMpIayer,or�.e
of�.f�reg0'.`b � J i r
receiver or tmstee of an individnal,parbetsbip,assoGialian or otherlegal entity,employing employees_ However the
owner of a.dwellinghousehavingnotmoretihanthree apartmenis andwho residestherein,or the occupant ofthe -
dwmelling house of an.of=who employs persons t0 do mabtenmm,c sftucti on or repair woo on such dwelling house
or on the grounds or bai dmg appmtmmof l hem SbO not b=ause of sack employment be d=aed to be an employer
MOL chapter 152,§25C(6)also sites that"every sty or local Heens ng agency shaII withhoId fhe issuance or
renewal of a Bcease.or permit to operate a:business or to mnstrnet bufldaxgs in the commonwealth for any
applimniwho has notproduced acceptable evidence of cdmpr=m with the insurance_coverage required."
Additionally.MGL chapter L52,§25CM stairs¢Neifhe:r thm=r m mwealth nor�3'of ids political subdivisions shall
enter into any contract far the p�anco 0fpubho work u a:E acceptable:evideam of compliance with fam fi=a c.6.
reqaxemcats of this chapter have been presented In ths g anihOLIty."
APP�cants • .
Ple2se fill out the worla'as' compensation ar'fida-TA completely,by checking ire bones!hat apply to your situation anc�if
ne essahy,supply s)name(s), addrms(es)andphMI nm e nbea(s) alongwithiheir cetifieatC(s)Of
ins=a ce. Lmnitn 1 Liability Companies(LLC)or LimitedLiabEity'Pmtatasbips(LIP)widino employees other tha .fine
merhbers or part a s,are not mquired to cany workers'campe nsafion msUI=,ce_ If an LLC or LLP does have
empioyee:s,apolicyis=gau-ed- Be advised Ent this affida-vrtmaybe sabmitti--dto the Depar[ment of ladustrial
Accidents for confnmatim of iT,crr m=coverage Also be score to sign and cafe the affidavit The affidavit should
be mtrmmed to!he city or town that the application fo=the permit or license is being reques A not the Dep arfineat of
Ladastrial a rzadm-L-. Shouldyou bane:any questions regardmg the Iaw or ifyou iris retpmedto obtain a woriO='
mmpensaiio n policy,please call the Depmlment at the number lhted below. SeIf_ftmn-ed eoxupanies should enter their
seIf_i sura ce license number on.the appropriate line.
City or Town Officials
Please be sore that the affidavit is complefa and prided legibly. Ilhe Departmentbas provided a space at the bottom
of the affidavit for you in f M out in the event the Office ofIuvmtigaiio.�has to contact yam regardiaglhe applicant
Please be m a to fill in the pen�iit/Iiccnse rnmber which will be used as a mfe==m=ber. In addition,$n applicant
that must submit mubiple P=ib icense applitations i a any given year,need only submit one affidavit indicating emrent
pohcy mfornation(ff nerssary)and under`Job Site Add e the applicant-should writ- "all lomfiGns n (_c`it_Y or
town)_"A copy of the.a.ffidae that has be=officially stamped or maimed by the city or to may be provided In the
applicant as prooftbat a valid affidavit is on file for b3trae pmmip or licenses_ A new a.ffidavitmust be fne d oiat each
W year. here a home owner or citizen is obfa>IIing a license or peamitnot relatmd.in any business or mmnaemal ventIm
(Le.a clog license or permit to bum leaves etc.)said person is NOT regnftMd to complee Ibis affidavit
The Oft=of Timcs gaiions wouldIzke to lbank you m advancer fur your cooperation and should you have any gaes ions,
please do not hesitate to give us a caIL
The Departmenfs address,telephane and fax rYumber.
men#Of lu&Es dEd Arcideuta
face�.f��g�tio�
man
Bostw,MA 02111
Ta 4 617 -4900=ft 4€6 car. 147 MA W,4M
Fax 617 727'749
xwised 4-24-07 WW. g
s Town of Barnstable
Regulatory.Services
MAM Richard V.Scali,Director
%639
�a Building Division.
Paul Roma,Building Commissioner.
200 Main Street,Hyannis,MA 02601
www.town.barnstable:maxs
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section `
If Using A Builder
as Owner of the subject property
hereby authorize to act on my beb4
in all matters relative to work authorized by this building permit application for: .
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signature-of Owner Signature of Applicant
Print Name Print Name
Date
Q:FORMS:OWNERPERMISSIONPOOLS
Town of Barnstable
Regulatory Services t
a1Ft Richard V.Scali,Director ;
Building Division
KAM Paul Roma,Building Commissioner
039. A�� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 - Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
-JOB LOCATION:
number street village
"HOMEOWNER":
- name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply with said procedures and requirements.
Signature of Homeowner
.d
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt
from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often
results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
06/20/16
i
m P
Contract # 676
CUSTOMER INFO: JOB LOCATION:
Skip and Lisa Simpson 79 Camp Opechee rd,
1 South St. Centerville, MA 02632
Hyannis, MA 02601
AGREEMENT BETWEEN
Skip and Lisa Simpson
11/27/2016
AND
Baltic Company, Inc
Linas Revinskas
10
t21, �
Baltic Company Inc,hereinafter referred to as General Contractor(GC),on the one
hand and Homeowner Skip and Lisa Simpson hereinafter referred to as Customer,on the other
hand,have concluded the present contract as follows:
1. THE SUBJECT OF THE CONTRACT
L I Contractor undertakes hereby to supply all labor necessary to complete the Asphalt Roofing
installation as proposed in the job estimate#640(11/01/2016),said proposal being an integral part
of the contract.
1.2 Customer undertakes to,pay in the order and terms established by parties in the present
contract. '
a ,
1.3 All work is. to be performed according to the specifications submitted, in a substantial
workmanlike manner, per standard practices. Any alteration of or deviation from the submitted
specifications involving extra cost will become an extra charge over the estimate, but any extras
must be submitted between parties.of this contract.
Z THE PRICE AND THE TOTAL SUM OF THE CONTRACT
2.1 Estimated price for the home improvement project is five thousand two hundred and fourty
dollars($5,240.00). This price includes the cost of labor and materials.
Baltic Company 87 Camp Opechec Rd,Centerville MA 02632
Linas Revinskas 781-267-1737; oMcc/fax(508)744-6811
M.C.S.Lie.N 094476 1-11C q 152372
3. 13ES`CRIPTI0IV,OFIHE PROJECT::
Permitting performed
Roofing materials and supplies supplied_
Ix'tsting;rooling rernoved
Ice and Water Shield applied;on the battanI edge of the>4r66f line, on the sides of the roof hne`arid.
of all criticat reas
415 felt;paper.applied nn entire roof
Al:um}nm dripedge°installed=cin.the bottom edge ofihe roafl!ne
Architectural aspHalt(Certairiteed)roofng sh}nglcs installed:
Ridge vent and:ridge capping rnstal.led'
Roofing;debris removed and disposed
Nate:'The rate.for additional c arpeittry services 'rt*n ded.}s $55/h plus material; costa It will'be
performed onl y:after hanie.riwner' :approval;_.
n.
4; PEk -:OF PAYMENT
1 Customtrr:undertakes to pay rn tuvo payments schedule;
:`2 30%deposit of the estimated Roolrng arrrount' 1,57100)
3 The.renaarn ng amount for roofing($ 3,668 QO) should be'pard after project:completior
S:. OTHER,CONDITIONS
S PA hanger and addrt>ons,under the given,Contract are valid; ff they are: accomplished an;
writing a►id signed by>both part of the Contract:The.presentCarr"tract}s made iri dupl}cate oFe one
for each of fhe partXes.All copics'liave an equal val}d ty :I he contract Inures frciirr the date of`its
s nrng.-Af `srgnmgAhe Contraet;aIt prey}aus neguttdtJ. hs and carrespondtrnee on it losc force.
:2 GC:may at'its discretion engage subcontractors to performwork,hereunder, provided CC:
shall fully pay said subcontractor and. to al:l ns: tances remain reslaoi sfble ':far the proper
completion of this Contract
3 GC agrees to remove all debris and leave tho premises in l morn;clean condition' .
5. GC shall not be liable for any due;to circumstances beyond its control including istrikes;
:casualty,weather co ditrans•ar general i}nava}lability.pf supplre5 and materials;
Contractor Linas.Revinskas Customer Skip , isa ran;
S, gnatue5
Dates
Baltic Company 87.Camp t pech�c Rsf,:Curtcrvill�M 026i 2?
Linos Revinskns 78r-267-1737'. ;ofriie/Ux(.jOg 744-6 11
M C S.Lit; 0Q4476:: H LC A 5?372.
T .� _. .�.::.,.... ...........
Mass. Corporations, external master page Page 1 of 2
Secretary William Francis Galvin
of • i of ak=v as
Corporations Division
Business Entity Summary
ID Number: 042238763 j Request certificate ;New search
Summary for: HYANNIS BUILDING AND DEVELOPING ASSOCIATES, INC.
The exact name of the Domestic Profit Corporation: HYANNIS BUILDING AND
DEVELOPING ASSOCIATES, INC.
Entity type: Domestic Profit Corporation
Identification Number: 042238763
Date of Organization in Massachusetts:
09-06-1955
Last date certain:
Current Fiscal Month/Day: 03/31 Previous Fiscal Month/Day: 03/31
The location of the Principal Office:
Address: 1 SOUTH ST
City or town, State, Zip code, HYANNIS, MA 026b1 USA`
Country:
The name and address of the Registered Agent:
Name: GEORGE F. SIMPSON
Address: 1 SOUTH ST.
City or town, State, Zip code, HYANNIS, MA 02601 USA
Country:
The Officers and Directors of the Corporation:
Title Individual Name Address `
PRESIDENT LISA A, SIMPSON 75 NORTHWINDS LN. W. BARNSTABLE,
MA 02668 USA •
TREASURER. GEORGE F. SIMPSON 75 NORTHWINDS LN. W: BARNSTABLE,
MA 02668 USA `
SECRETARY LISA A. SIMPSON 75 NORTHWINDS LN. W. BARNSTABLE,
-f' MA 02668 USA
DIRECTOR GEORGE F. SIMPSON 75 NORTHWINDS LANE W. BARNSTABLE,
MA.02668 USA
DIRECTOR LISA A. SIMPSON 75 NORTHWINDS LANE W. BARNSTABLE,
MA 02668 USA
http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=04223 8763&... 1/.10/2017
i
Mass. Corporations, external master page Page 2 of 2
Business entity stock is publicly traded: ❑
The total number of shares and the par value, if any, of each class of stock which
this business entity is authorized to issue:
Total Authorized Total issued and
outstanding
Class of Stock Par value per share
No.of shares Total par No.of shares
value
CNP $ 0.00 2,000 $ 0.00 77
❑ ❑Confidential ❑Merger
Consent Data Allowed Manufacturing
Note: Additional information that is not available on this system is located in.the
Card File.
View filings for this business entity:
ALL FILINGS
Administrative Dissolution
Annual Report
Application For Revival t
Articles of Amendment u'
-� _ �.. .j
View filings
Comments or notes associated with this business entity:
ENew searchM
http://c.orp.sec.state:ma.us/CorpWeb/CorpSearch/C orpSummary.4spx?FE1N=04223 8763&... 1/10/2017
Office of Consmer Affairs
airs veaCC�o�Caczc/auaeGti.
&Business Regulation License or registration valid for individual use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration 0 <1,52372 Type: Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Expiration;`$ 3%2018 DBA Boston,MA 02116
1:=1 'r;'
BALTIC COMPANY I '
LINAS REVINSKAS
87 CAMP OPECHEE
CENTERVILLE,MA 02632 Undersecretary Not valid without signature
e a�rnent of Public Safety
Regulations and Standards
Massachusetts D p
,Board of Building t
': CS-094476
License. ;
Su ;$.
Construction pe
� .
LINAS REVINSKAS p
87 CAMP OPECHE
CENTERVILLE A 0263 _
� I
Expiration:
n 010212017
Commissioner - - "
i