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HomeMy WebLinkAbout0089 LAKE ELIZABETH DRIVE u _ �,a e, �. s , ( � �, �� - �� .R :a s e� :,� .. - - O a . .. 1 0 ,� r _ �„ _. t .. .. ,. . � '� ,. �- .. e 1 � ,� �' �i ,� r .� r r .. F ii� i Town of Barnstable BunflfflngPost This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Mustbe Kept Posted • ,nsivsr,�s�s, ,. ,. Until Final Inspection Has Been Made. Permit Where a Certificate of Occupancy is Required,such Building.shall Not be Occupied until a Final Inspection has been made. Permit No. B-18-963 Applicant Name: Balazs Hajdu Approvals Date Issued: 04/27/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 10/27/2018 Foundation: Residential Map/Lot: 226-017 Zoning District: CBDCV Sheathing: Location: 89 LAKE ELIZABETH DRIVE,CENTERVILLE Contractor Name: BALAZS HAJDU Framing: 1 Owner on Record: KIRK,ELEANORE H S TR Contractor License: CSSL-099159 2 Address: 24 GRANVILLE BAKER WAY Est. Project Cost: $4,600.00 PLYMPTON,MA 02367 Chimney: Permit Fee: $85.00 Description: Install 20 sheets of green board on walls and ceiling in an existing Insulation: i Fee Paid: $85.00 basement room on existing/original structure)Instal l window and Final: door trim,paint. Date: 4/27/2018 Project Review Req: Plumbing/Gas Building Official Rough Plumbing: This permit shall be deemed abandoned and invalid unless the wor0authorized by t its permit is commenced within six months after issuance. 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 structures shall be in compliance with the local,zoning by-laws'iand codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or roa&and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the-Building-and-Fire Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue,lining is-installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulatiorf 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 $Post This'C,iard°So That�'t' is=:.V""i sibP lesx'F rom th""°e. Street”Ap-ap'rFoBarn Mus;.sttable fade P BuildingI Re on egnvPs this Card Must be Kept b'� Posted Until Final Inspection HasiBeen Made £ � \ � � �� �; �" � � ,�' r " y r Permit . Where aCertficate.of Occupancy , . s Required,suchBuilding shall Not be Occupied until a Final inspection has been made Permit No. B-17-3419 Applicant Name: CAPE COD INSULATION, INC Approvals Date Issued: 10/19/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 04/19/2018 Foundation: Location: 89 LAKE ELIZABETH DRIVE,CENTERVILLE Map/Lot 226-017 Zoning District: CBDCV Sheathing: Owner on Record: KIRK,ELEANORE H STR x , Contractor Name:' CAPE COD INSULATION, INC Framing: 1 Contractor License: 153567 Address: 24 GRANVILLE BAKER WAY ( 2 PLYMPTON, MA 02367 Est: Project Cost: $3,700.00 Chimney: Description: weatherization ` Permit Fee: $85.00 4 Insulation: Project Review Req: " Fee Paid_ $85.00 . Date: _ 10/19/2017 Final: 01 - Plumbing/Gas Rough Plumbing: - Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authobzi byrth s permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application a d the�approvecl construction documents-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.. 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. Electrical The Certificate of Occupancy will not be issued until all applicable signatures�by,the Building and Fire,"Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:,. ` x Rough: 1.Foundation or Footing .. .. «. . - 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health 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. 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 OFBARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # — / .7 J' Health Division Date Issued i� /9 l7 & Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village ,oeA<z Owner ,�.s ,C'//2 Address Telephone Permit Request 11.-J:21 ,/ f0 &4e X 5Z �li�gS / G��`� IeT � d�cl ,%® /'��� ..��,a r� �O�•t.J ��G ��✓EGG Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2 !N® 6 Construction Type / Lot Size Grandfathered:, ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes *No On Old King's Highway: ❑Yes 0 No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: 0 existing w0 newer-,-, size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: j 74 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ " Commercial ❑Yes ❑ No If yes, site plan review# a �- Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name a8if C' f!,�=,/�14 Telephone Number Address J9 f�P��Ir/� �'i � License Home Improvement Contractor# Email( �� �C,���l00/�,�«�,q �i� Worker's Compensation #�1/�®� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE r • OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at CA (Property Address) (Property Address) C 'hereby authorize. 006 (Subcontractor)- 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 Sign lure The Commonwealth OfMassaollusetts Department of 1'ndustrlal AccIdelfr$ 1 Congress Street, Sulte 100 Boston, MA 02114-2017 www,mass,govN1a Workers, Compensation insurance Afildavltt Buliders/Contractors/Elsetrlclans/Plurnbers, AppIl"Ilt XnNrmadon TO BE FILED WITH TUE FEWItII.0 MTHORITY, Name (Business/Organlzadoryindlvldual); Cape Cod Insulation le se p n Address; 18 Reardon Circle City/StatdZipl South Yarmouth,MA 02604 phone #; 608.775-1214 Art you an tmployer?Mock the Appropriate bort I-©I am employer with 48 employees(full end/orpan�time),e Type of project(required); 2,❑I am a role propeotoror partnenblp And have no employees working forme In 7, ❑ Now oonstruotion any oapaolty,NO workers'oomp, iruurMoo required,) $, ❑ Remodeling 3,❑!am a homeowner doing ell work myself,.(No workers'comp, Insuranoe roqulred,)r 9, ❑ Demolltlon a,❑1 am a homeowner end will be hlring oontraotor7 to oonduot all work on my property, I will 10 ❑ Building addition ensure that 01 oontraotom either have workers'oompenaatton lnsurnnoe or are sole Proprietors with no employeos, 11,❑ Blootrloal repasts or additions s,❑1 am a general oontraotor and I have hlmd the sub•oontreOto"I,Mod on the btuohed about, 12,❑plumbing repairs or additions Those sub•oontraotors have employees and hove worker,'oomp,insuranoO 13,❑Roof repairs 6,❑we are s oorporadon and Its Oloert have exorolsed their right of cxem on per MOL o, 132,ll(4),and we hays no employees, No workers'oomp,Insuranos MquInd,) 14.2)Other.Weatherization 'Any applloent that oheekax�1 must also fill out the scot on below showing their workers'oompensatlon policy Informetlon t Homeowners who submit tdaYlt indloating theeyy dro doing all work and then hire outside oontraotore must submit a new aEYldavlt lndloadri tcontraotors that ohaok this bax moat attached m addldonal shoat showing the none of th0 sub.00ntraotols end state whother or not those anodes ha employees, if the sub-eontraators love n to eoa must royids their workers'oom , llo number, g auofL YO t am an employer'rhal is provldtnff Workers I eompenratlon Insurance jar risy employee:, Blow is the Ali and tr�or=don. p cy Job site Insuranoe Company Name; Atlantic Charter ' P011oy If or Self-Ins,Lio, #i WCE00431902 Explma on Date' 06/30/2018 Job Vte Address; � 3� Attacb a copy of the workers' eorapensatlon policy declaration page(showln Its etatlp���oy'�,�� Fallure to secure coverage as required under MOL o, nal g policy number and explrallon date), and/or one•year lmprlsonment, as well as civil Penalties 2n�the form of a STOP WORK punishable by a fine up to$11500,00 day agalnst-the violator, A copy of this statement may be forwarded to the OfI oo�����R and a flee of up to 3250,00 a coverage vodgoatlon, tigatlons of the D1A for Insurance ;do t¢reby opun re ris and penalties of penury that the OH provldod above is true and n correct: 1 a �,iZni iv"Tidr�4wµw�rv�n�+N.+w,+� 508• 5.121 ' MOO use fl! only, Do not write in this area, to be completed by olty or town oJylclaG Clty or TownI PermIVLlcense 9 Issuing Authority(circle one)l 1, Board of Health 2, 13ulldin� Department 3, CIty/Town Clerk 4, Electrical inspector, 5t Plumbing in 6,Other g Spector Contact Person) Phone�r� MaaaaQhusalta DepaHman! of publly safelyy ��,,,,,,,� 9,oard of 9ullding Regula{'Ions And standards �Ivense109�100088 Uai�atruvtlon 9upervlsor, 11 HENRY to 0A1li'v� $ "13 0 ROW t ' WW YARMOUM (i WJxtit' Ip01 J 1 00 �m�lssioner sxplratlonl ' �� 11/111201r , vffive of Consumer Affairs and Business Re 10 Park Plaza . Suite 6170 Regulation Boston, Ma� b. usetts 0211'6 Home Irnprovemel;� ,m lraotor Registration ( }lt!(�fl1lll�ti1''1� 'Ili�i4�r�i�f WY,f c 1��41t t (lvil l,i , v� Insulation a I,I,��'�Gl,' 1� �' Clr ,no Cape^01 . Reard„� ole I ;,IIY,;t,'I.I�' 'r� (� Rs tra i 16368r So ;yy �;.II' �s�'�}�,� r xplrationi 12/1 a/2018 Yarmouth, MA MI$4 V. ' qr 1'Nr,' I•I:f '1 ,, ,>•.,,.�,....__,.._..,..�..1,..... �.,.., _ vpdale Address and rslurn oard , Mark reason (or ohan GNlvi of OontumerAllelrs � wainass Raqulallon .� ".�rrplv'�m'anil`Cl.�„�,�-t'' HoMB�MpROygM�NT OoNTRAOTOR . �� Y'���'e,i, Oorporallon Reglalretlon valid IorindlVidual use onl 11ty.'�';,, balor�the axpirallon date, If Ioun ONlae of oonsumar AFfelra end urn toi ►;; it1' , �� 12/14�2016 10 park pleas a a1T0 el es Ragulallon Oapa 0od Install' I ('' 90e1Cn Henry 0assldy'y y t M 1 i 18 Reardon Olro� •����, ,�';'' >�,c , moulh 90 Yar ,M � "" Vndarsevrelary ! al hout sl atu . , .r, AC�. CAPECOD-27KDQYLI CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD/YYYY) 06130/2017 THIS CERTIFICATE 18 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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed, If SUBROGATION 13 WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rl hts to the certificate holder In IIOU of such endorsbment a , PRODUCER ACT Rogers&Gray Insurance Agency,Inc. ONE 434 Rte 134 A�c No Ext; A/C No; 877 816.2156 South•Dennis,MA 02660 ,mall ro ers ra ,com NACN INSURER A,P erl ss Insur nce Com an 24198 INSURED R •Safet In a C an 39464 Cape Cod Insulation,Inc, ER Endurance American Speaialt Insurance Company 41718 18 Reardon Circle INSURER Atla tl Charter Insurance Company 44326 INSUSouth Yarmouth,MA 02884 RE e INSURER F; COVERAGES CE FIC BE • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABVISION OVE 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. INS& TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY LIMITS CLAIMS•MAOE �X OCCUR CBP8283083 ACH C R E E 1,000,OOC 04/01/2017 04/01/2018 DAMAGE RENTED 10O,OOC D E P n Person) 6100C E 'LAGGR ELIMITAP ES PER; PERSL A INJURY 11000,00C X POLICY JECT U LOC R 2,000100C THER: T / 2,000,OOC B AUTOMOBILE LIABILITY COMBINEOSINGLELIMIT 1,000100C ANY AUTO 8232707 COM 02 p L a AIUTOS ONLY 04/01/2017 04/01I2018 BODILY INJURY Per Person) _$ X -MRS ONLY B DILY Y Peraccident) • �t08 6Rdenl AMAGE� C' UMBRELLA LIAX EXCESS LIAR EXC10006636002 EA H RREN E 2,000,00004101/2017 04/01/2018�� OED RE RE 2,000,000 D WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X P R OTH• ANY CdErIM ETORIPARTNER/EXECUTIVE R/O WOE00431902 08/30/2017 08/30/2018 FICEgqIMgffl))EXCLUDED? /N N/A E 1,000,000 andatory In NH T II es describe under I •E EMPLOYEE 1,000,000 D S RIPT NOPERATIONSbelow -91 .L.DISEASE• LICY LIMIT 1,000,000 workers DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Addillonal Remarks Schedule,may be attached It more'Paco is required) Add llonal Insured sttatus Is l provided under udes Officers rthe Proprietors, Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, E D SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Thlelsch Engineering Inc, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 196 Frances Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Cranston,RI 02910 AUTHORIZED REPRESENTATIVE ACORD 26(2016/03) ` 9 CORD CORPORATION, All rights reserved, The ACORD name and logo are registered marks of ACORD r /3 l//(v Town of Barnstable *Permit# Expires 6 months from issue date �T Regulatory Services Fee 35. snarrsrns[.E. 1659. 1nsa. Richard V.Scali,Director Building Division ° oF Tom Perry,.CBO,Building Commissioner „ s 200 Main Street,Hyannis,MA-02601 - - -- - -- www.town barnstable ma us Office: 508-862-4038 r �� �Fax-�ARN9STABOLE • EXPRESS PERMIT APPLICATION - RESIDENTIW10a Not Valid without Red X-Press Imprint Map/parcel Number Property Address 81 Residential Value of Work$ 2 D C.-S Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address . 1 rYl 5 12 . —v Contractor's Name Q $ Q k%a Telephone Number ?g/ 581 0938, Home Improvement Contractor License#(if applicable) Email:aA 114 Z 5 Q 4. -zTa21FN '7 Construction Supervisor's License#(if applicable) _5548-7.10 to 9 Z CaVI..grtt."c r'�At , Co ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [rI have Worker's Compensation Insurance Insurance Company ,'' 'n,, P Y Name �- b���'ti Y' 1�rL, 0. � .. Workman's Comp.Policy# (JC. (A F sq 0 Ll 1b,4 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�Q�ruS?y9�Jl� tyC�tJ3 ❑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 SIGNATURE: Q:\WPFILES\FORMS\buildin ermit forms\DTRESS.doc Revised 040215 t05/24/2016 12:58 17812932171 BORHEK INS PAGE 01/01 _ OP ID:SW - CERTIFICATE OF LIABILITY INSURANCE DATE 5 24120 6 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 endorsemen s. CONTACT PRODUCER N WM.F.Borhek Insurance Agency PHONE 311 Plymouth Street ac Ne Exq; a c Ne Halifax MA 02338 A DRE89: Scott d Casagrande PR CUSTOMER ID re:AZCON-1 INSURER 8 AFFORDING COVERAGE NAIL S INSURED A-Z Green Construction INSURER A:Liberty Mutual Balazs Hajdu t/a INSURER e; 142 Precinct St Mlddlebo►o,MA 02346 MSURER C: MSURER D: INSURER E; INSURER F COVERAGES CERTIFICATE NUMBER: 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, rN9R TYPE OF INSURANCE POLICY NUMBER MMlDD OUCY a LIMITS OENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY COP 9491665 08/16/2015 08115/2018 PREMISES(Ea omurrerxa) S 100,000 CLAIMS-MADE a OCCUR MED EXP(Any arm parmn) S 16,000 X Business Owners 08/1512015 08116/2016 PERSONAL a ADV INJURY S 1'000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG S 2,000,00 POLICYFX7 TAT F7 LOC 8 AUTOMOBILE LIASUM COMBINED SINGLE LIMIT 3 1,000,0O (ED ocddent) A ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED AUTOS BA1031673 02/22/2019 02122/2017 BODILY INJURY(Per sceldentl A %WF-DULED AUTOS PROPERTY DAMAGE 9 X NIREO AUTOS (PER ACCIDENT) X NON-OWNED AUTOS $ $ UMBRELLA A LIAR X OCCUR EACH OCCURRENCE S 1,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 100100 A CURB39294 08/15/2016 08/1512016 DEDUCTIBLE $ X RURNTIQN 1 10,000 S WORKERS COMPENSATION X WC STATU- ITH- AND EMPLOYERS'LIABILITY ORYLRdIIS FR A ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N/A C2-31S-368384-045 04126/2016 04/25/2016 E,L•EACH ACCIDENT $ 500,00 OFFICERIMEMBER EXCLUDED? (MandDmry In NH) RENEWAL ' 04/25/2016 04/26/2017 E,L.DISEASE-EA EMPLOYE $ 500,00 If describe under DSCRIPTION OF OPERATIONS below 61.DISEASE-POLICY LIMIT S 500,00 71 - 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD tot,Additional Remarn Schedule,if more apace Is required) Workers Cpmp Cer flcats being Issued diIrect b Liberty Mutual due to rnsured�I q ale r r[etoF. olic WC2-31568384 045. Policy dates ate 4/25116-41ZS12017.Policy limits 906-600-600. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town Of Barnstable ACCORDANCE UYITM THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORMD REPRESENTATIVE Scott C Casagrande C 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD A-Z Green Construction Your Green Tech Home Improvement&Repair Contractor. Serving Eastern New England and Anywhere Building GREEN is Paramount. Balazs Hajdu Cell: 781-589-0838 Fax: 774-961-3630 Licensed Contractor: CS SL 99159 Proposal Customer: James Kirk Address: Plimpton, Mass. Worksite location: 89 Lake Elizabeth Dr., Barnstable We hereby propose to furnish all materials and perform all labor necessary per industry specifications for the completion of the fallowing project Scope of work: R&R roof section the location mentioned above, install thirty-year architectural shingles color match as best as possible over upper dormers only. • Remove two layer of existing shingles • Re fasten deck, replace two 4x8 sheet of 1/2" plywood. Expected to be water damaged. • Install 100%of ice&water barrier instead of industry standards of 3; Extend ice&water barrier under drip edge all the way to the fascia board. • 30 Year architectural shingles will be installed above ice&water shie . • - All debris will be properly disposed. e Workmanship warrantee 5 years. • Due upon completion. Total Cost : 6200 .00 Date 04/19/2016 Payment Terns: Due upon completion Respectfully submitted by:Balazs Haidu(contractor) Mailing Address:142 Precinct St.,Middleboro,MA 02346 ...the bitterness of poor quality remains long after low pricing is forgotten... 4 . pT BSB ' B f r _ Ile CominomVeakh of Massaedi is Deparbmaitrefr4dusbialAccidm& { Ojace of 1atigaticw ' 600 Washangtnr:,Si`ireet Boston,AIA 02 furvmma=gov1dia' - J- - - --Warlcers CumpensaUunInsu agic av Bmlders/Carntract r rEI h cianslP" hers-___ App�ca�tt Infarmaffon — Please-Prof f�eei�Iy - Name Mume �on al Address: lf e-r>-l• Phone Are you an employer?Check the appropriate bo= Type of project(required)- 1.A I am a employes vim_9�— 4. ❑I am a general contractor and I 6. ❑New constuciaon employees(full anWbr pad-ime * have hired the sub-contractors 2.❑ I am a sole proprietor orparluer- listed on the attached sheet 7. ❑Remodeling ship and have no employees . Mese sorb-contractors have g- ❑Demolition warldng forme in any capacity. employees and have wad=' 9. ❑Buiidmg adriitiozF [No-Wrorkm,comp.insurance comp.msurance--i required] 5. ❑ Wi a are a corporatim and its la❑Elechical repairs or additions 3.❑ I am a homeowner doing all work officers have esercise:d their 1I-❑Plumbing repairs or ad€&tioms o yuor� op- � Roofr ' iigU of exemption per MGL spans ' �n" required-]F c.152, §1(4�andwehaveno 1 employem[No workers' 1.3.❑Other camp-insurance required.] ` 'Any pp fiatcherlsbasfflmastalsoM=4 the sectionb9owshavdagfie¢Waivers'cegpmrsaticnpoTuyiafnemafrob T Hameoarners wbo submit this afiidant in atmg they axe doing all we*and dum hire a amst submit anew affidavit indicating mcTL ZCantractors tft cbecl<figs boa:mast attar�as additi— sheEt sbnwiag the--of die sub-car aad state whether ar not those emlitkshave empimlees.If the sob-casters have empioFee%they mast pmaide their wmters'gyp.pdky number- am an empLar Heal isgrtlui�ing�vdrrkers'coerrlrerrsatirrn insairand:s for eerrpb leer Below is thepa Hey q{fd job site enforaradam r Insurance Company Name: 13 f' ay-G Policy*44,or Self--ins.I.ic. W c ?j_d�(4 Riratioa Date: t-7 Job Site Address: Q_[ �G[i1� ' L��•(? �T� � Ciwstate 4p: Attach a copy of the workers'compensation policy declaration page(showing the policy number and eViration date). Failure:to secure coverage as required.under Section 25A of M1L c.15 can lead to the imposition of criminal pdmalg s of a fine up to$1,54aOD an for one-year imprisonment,as well as ciO penalties,in the form of a STUP WORK ORDER and a fine of up to$.250-00 a day against the violator. Be adtised that a copy of this statemesd maybe farvarded to the Office of Invesfigations ofthe DIAL for insurance coverage verification. I do hereby vanity audsr the pains ale pear ' s afper,jxtry that the irt,formatrarr provi&d abmw is bare and correct Sites: ' Duke: '�2 � (6 i Phone ik '7 lcpqpg (loeiai use only. Do ttot write in this area,to be ca mpleted by tarp ortattn offic&L - City or Town: PerndtM tense# Issue Autharity(circle one): I.Board of Health 3.Building Department 3.Cityfrown Clerk 4 Electrical Inspector S.Phrmbh g Inspector 6.Other Contact Person: Phone 9: 6 laformation and Instructions hf aceacb:-= tts CTcb=al Laws chap m 152 regoiies all employers'D provide w03i--eas'compensation for their employees. Pursoantto this sfaftt:,an.errplayr�-is defined as_"_.evmy person in the service of another under any contract ofhire, eggress or implied oral or writhr Au,Mrpkgy�is defined as"an individnal,partnm h:ip,association,anporation or other legal entity,or any two or more of the foregoing mgaged in a Joint emtmTdse,and including the legal represeutdives of a deceased employer,or the receiver or trustee of m mdi4iclaal,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 - dwelE g house of another who employs persons to do mahtenaa ce,r nnsh7acti on or repay work on such dwelling house or on the gronnds or buflding apprn�Thereto sh0notbecanse of such employment be deemed to be an employer." MOL Chapter 152,§25C(6)also st3fts that"every state or local 11=nsiag agency shalt withhold the issaance 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.covez-age required." Ad.ditionaIly,MOM chapter 152, §25C(7)state$'Neither the commaawmalfh nor gay ofits political subdivisions shall eutrr into any contract for the perfoffiance ofpublic work uoti I acceptable evidence of compliance with the msuran.ce.. requn-emerLts of this chapter have been presented to the confractiag authozity_" AppHcaats- Please fiIl otit the wows'compensation affidavit completely,by chDc1dug tit e boxes that apply to your sitnation and,if necessary,supply sub-contractor(s)nam(-_(s), addresses)and phone Tn— er(s)along with their cer(ifacate(s) of T„e=ce. Limited LiabUrty Compames(LLC)or Limited LiabR7ityPm1nerships(LLP)withno employees other than the members or partners,are not required to corny workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidayk maybe submitted to the Department of Industrial Accidents mr conformation ofms ce coverage. Also be sure to sign and date ihe affidavit The affidavkshould be retained to the city or town that the application for the permit or license is being requested,not the Department of adustrial Accidents Mould you have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please caR the Department at the mumLberlisted below: Self-hm=d ccunpanies should enLxr their s elf-fi samn ce license number on the appropriate line. City or Town Offrciabs t _ Please be sole that the affidavit is complete and primed leglly. The Department has provided a space at the bottom of the affidavit for you to fM out in the event the Of ofInvestigafioas has to contact you regarding the applicant- Pleas a be sure to fill in the pen�iitfIicense member which wM be used as a reference number. In addition,an applicant that must submit M.Uhipla p ennit/Ecens a applitaiions in any given year,need only submit one affidavit indicating cmreut policy information Cif necessary)and coder"Job Site Address"the applicant should write"all Iocaticns in (city or town).'A copy of the-affidavit that has been officially stamped or marked by the city or to maybe provided to the - applicant as prooftlzat a valid affidavit is on file for future permits or licenses Anew affidavit must be fMed oif each year.Where a home owner or citizen is obtaining a license or permit not related t+o any business or commercial venture (i.e. a dog license or permit to bum leaves eta.)said person is NOT req0ft1rd to complete this affidavit The Of of Invesfigsfims would like to thank you in advance for your cooperation and should you have,any questions, please do not hesitate to give us a caIL The I}epartm enfs address,telephone and fax mmmbm- Tht W-jt�E of Massachn , I�egaz`fmr of 1-idugtial AoCdent% �tc�of�t�e�garf3oJa� . 6Q4�a�hingtan t Bosta2 MA 01 111 Tf,-1.4 617 -4900=t 406 car 1-977 MA&3AFF Fax#617-727'749 Revised4-24-07 s. gagfdia A-Z Green .Construction Your Green Tech.Home improvement&RepairContractor: Serving Eastern New England and Anywhere Building GREEN is Paramount Balazs Hajdu t Cell:781-589-0838 E-Mail: Balazs@a zgreenconstructiorf&2M==- Licensed Contractor.CSSL 99169,HIC 163775 Owner: Project manager: 4 Massachusetts Department of Public Safety Board of Building-Regulations and Standards l Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099159 ®z License: CS-020213 _ Construction Supervisor Specialty r Construction Supervisor BALAZS HAJDU ROBERT W JACOBSON 142 PRECINCT STREET t .� 292 MAIN STREET �. MIDDLEBORO MA 02346�' P PLYMPTON MA.02367 f Expiration: r\/j...�n Commissioner 04/08l2018 �� tt `C Expiration: Commissioner 11/26/2017 i C�fie�p'ar�t�na�uaeal�o�c�l`�i�rc/tutett�t °�04't Office of Consumer Affairs&Business Regulation �7I11[i ME IMPROVEMENT CONTRACTOR isb2d0nType: } ,tp775 This card acknowledges that the recipient has successfully completed a Oration [2�172017, Individual 30-hour occupational Safety and health Training Course in BA S HAJDU _ aka Construction Safely and Health ° j h _.. BALAZS HAJDO BALAZS HAJDU � 142 PRECINCT ST. 4 MIDDLEBORO,MA 02346` Marie Athey 11I26/20i2 rs Undeecretary -"fm Course end date) (!ruiner name—print or type) -414 OP ID: BM 3c DATE(MM/ODIYYYY) tki C � FIC./ATE OF LIABILITY INSURANCE 03/22/2016 xz V. I �.€&I MD.AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS U :-..Wk�APFIIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES if NTi2 OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED Pit ODUCElt,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 endorsements. PRODUCER CONTACT WM.F.Borhek Insurance Agency NAME:PHONE FAX 311 Plymouth Street ac No Ext: A/ No): Halifax,MA 02338 ffi Scott C Casagrande PRODUCER CUSTOMER ID t AZCON-1 INSURERS AFFORDING COVERAGE NAIC A INSURED A-Z Green Construction INSURER A:Liberty Mutual Balazs Hajdu t/a INSURER B: 142 Precinct St Middleboro,MA 02346 INSURER c INSURER D: INSURER E: INSURER F• COVERAGES CERTIFICATE NUMBER: REVISION NUMB - 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 POLICY NUMBER MMIDDY EFF MPOM oCY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTEU- A X COMMERCIAL GENERAL LIABILITY CBP 8491665 08/16/2016 08/15/2016 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ 15,00 X Business Owners 08/16/2015 08116/2016 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 1-1 POLICY X JECT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 A ANY AUTO (Ea accident)X ALL OWNED AUTOS BA1031673 02122/2016 02/2212017 BODILY INJURY(Per person) $BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (PER ACCIDENT) X NO"WNEDAUTOS $ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,00 A CUB839294- 08/15/2015 08/16/2016 DEDUCTIBLE $ X RETENTION 10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N LIMITS I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101;Additional Remarks Schedule,If more space Is required) Workers Comp Certificate being i*sued-_�firect by Liberty Mutual due to insured being Sole Pro netor. olicy# WWC2-31S368384-045. Policy dates are 4125/15-4/Z512016.Policy limits 500-500-500. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE Scott C Casagrande ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD