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Home My WebLink About0090 KATHERINE ROAD ry , Ff ` K a v n h * . r , o ' e a ' : r r r e ♦ _. .� a - ... � � :., .. _ ., � _ .. e .. ,. a .. .. ... r .. .-.. .. -. .' ., R .� - _ i� � �. .. t. t '.: ,, fi .,. .. .. i - � � - p ��tNE,pi, Town of Barnstable *Permit#-9 5 Expires 6 months from issue date UARMARly, Regulatory Services KAM Thomas F.Geiler,Director Fee iOlFp��a Building Division Tom Perry, Building Commissioner X-PRESS 200 Main Street, Hyannis,MA 02601 a Iffice: 508462-4038 .1 U L. 1 8 2005 ax: 508-790-6230 . EXPRESS PERMIT APPLICATION - RESIDENTIALT@WF BARiVSTABLE Not Valid without Red X-Press Imprint parcel Numberrj a ;rtyAddress q O K AT1A if R( � esidential Value of Work (nOno"' Minimum fee of•$25.00 for work under$6000.00 er's Name&Address _ (j Aj rah s4- S�h �� ractor's Name Telephone Number o J] Le Improvement Contractor License#(if applicable)__ (3 3 ;truction Supervisor's License#(if applicable) d a(p torkroan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance rance Company Name Tr c T kman's Comp.Policy# t' y (J 9 y of Insurance Compliance Certificate must be on file. ' nit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows. U-Value (maximum.44) '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. Home Improvement Contractors License is requira iature nns:expmtrg sc063004 - i �oFTME, Town of Barnstable Regulatory Services i BARtIMBU, Z Thomas F.Geller,Director . usass. . Fo 1 a`e� Build ng Division Tom Perry, Building Commissioner 200 Main Street, liyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 • �I Property Owner Must T - -Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorized to act on my behalf, in all natters relative to work authorized by this building permit application for, (Address of Job) Signature of Owner . Date Print Name . ._ .�.,. ..,,� �'e-d a ."':J ."'t;?�.{ i. rr�Li . f 4 r. . �r�-:lrr;�-i s "?{. __ t .�. •�)'7u.:�i r a,, - fi,r�J rJ!�r,'31:r..��f;5�_�:0: ..d..�._._._ _ *.11 �`��.7 5��•1.�w3.�•er` . ..�.. _ .._._._...�_._,...._.......- J 12\7 .ice Ur 0TORMS:OWNMERMISSION _ -- i The Common wealth of Massachusetts r= = Department of Industrial Accidents "= Office Of/nsestigaliens -,- - -_- 600 Washington Street ~ Boston, Mass. 02111 Workers' Compensation Insurance Affidavit ica`rit to rm'a 3onu' ,:. I aser Rl e t L ; :ram y,nam_c� Q *location: 9 K An± i21 E city �-� �� phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity so � 8 ��— 53 a I am an emplo er providing workers' compensation for my employees working on this job. com an�n�amr�c. -�^ 4- r a r $ 5+ city: phone iv: insurance co : NS oIi # �1�1 rm sole proprietor, general contractor, or homeowner(circle orte) and have hireontractors listed below who the following workers' compensation polices: company name address 6 city hone#• x ..:, q insurance co ;^ olio # company name. address city: hone insurance core zr t max• �.�,u� 011 C # ,p�.';.� x ? _ Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties ora fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the office of investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name ✓l i Phone# t official use only do not write in this area to be completed by city or town official city or town:. permit/license# {f. []Building Department ❑check if immediate response is required (:]Licensing Board .1 ❑Sclecnncn's office phone#; ❑Health Department f; conhtet person: I�Other `i n Board of Building Regulat'ons an tan ar s One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement-.Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2006 PAUL J. CAZEAULT & SONS, INC.; ' Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 , Update Address and return card.Mark reason for Chang DP8-CAI Ca 50M•04/04-G101216 11 Address E] Renewal Employment 0 Lost Card ' tC &II.XvIcaal. O _... --- '"- Board or Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individal use out%• Registration:,S' . 103714 before the expiration date. If Ibund rcluru lu: Expiration`;7/9/2006 Board of Building Itcl;ulalious:uul Sl:uid:u ds a Uuc \shl�iu•ton III Itn1 1301 Type:'Private Corporation Boston,Ala.02108 PAUL J.CAZEAULT;&.SONS,INC.: Paul Cazeault 1 /.% 1031 MAIN ST OSTERVILLE,MA 02658 Administrator i /+� DoeJirit�iuoer��. /�; lu�ur/eule((a N(f BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 026325 Birthdate: 10/20/1959 Expires: 10/20/2005 Tr,no: 8603.0 Restricted: 00- PAUL J CAZEAULT 1031 MAIN ST ,� OSTERVILLE, MA 02655 Administrator 677-7 Board of Buildin eq _--1 ulations One Ashburton Pace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/2005 Restricted To: 00 ,PAUL J CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 " Tr.no: 8603.0 Keep top for receipt and rhnnnn of,.,a.,,.... ; D- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McShea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Osterville, Ma. 0265"5508-420-9011 INSURERS AFFORDING COVERAGE INSURED Paul J Cazeault & Sons INSURER A: Lloyd's of London Roofing Inc. INSURER B: TraVelerfS Insurance 1031 Main Street INSURERC: Osterville, Ma 02655 INSURERD: 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 POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. " INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE MMIDD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE ®OCCUR MED EXP(Any one person) $ A 'LGLO34776 -4/30/04 04/30/05 PERSONAL BADVINJURY, $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS. (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: qGG $ EXCESS LIABILITY - - EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $. $ I DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X ORY L MITS ER EMPLOYERS'LIABILITY 7PJUB-0095664AO4 _ 08/13/04 08/10/05 E.L.EACH ACCIDENT $ B E.L.DISEASE-EA EMPLOYEE $1 E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE"THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL J_O_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED RE )� A A ACORD 25-S(7197) 0 ACORD CORPORATION 1988 Client#: 19989 2CAZEAULTPA ACORD,M CERTIFICATE OF LIABILITY INSURANCE 0DATE(MM161YYY 5/09/05ID 3 PRODUCER r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling'&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St. PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western World Paul J. Cazeault&Sons Roofing, Inc. INSURER e: 1031 Main Street INSURER C: Osterville, MA 02655 INSURER D: 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 POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE MMIDD/YY DATE MMIDD/YY A GENERAL LIABILITY NPP925580 04/30/05 04/30/06 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAG MISE TO RENTED El(Ea occurrence) $50 000 X PCLAIMS MADE a OCCUR MED EXP(Any one person) $2 500 BIIPD Ded:1,000 PERSONAL&ADV INJURY $1 OOO 000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1 00O 000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY. AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE . AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- 'RYEMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Paul J.Cazeault&Sons DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 n .DAYS WRITTEN Roofing,lnc. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1031 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Osterville, MA 02655 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #M38166 LS1 O ACORD CORPORATION 1988 d