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Home My WebLink About0198 LAKE ELIZABETH DRIVE .� ::�., � .. _.. �. ,. . .. . _ . . �.. .. . � � �_ 0 t 1► Town of Barnstable *Permit# (`Z � , . Expires G months from issue date B�� gtory Services F • . Thomas F.Geiler,Director &UMSfABLE 059�. g 2100 MA Y 2 7 0, I8dWing Division ArED Nay Tom Perry,CBO, Building Commissioner _ 200 Main Street,Hyannis,MA 02601 wwwo i.barnstable.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 a)G Q 7 Property Address EkI residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address jot JhAl4„ ( � •°/ � Contractor's Name__&��f/'/✓1'� �/'�C- Telephone Number 71, �C� Home Improvement Contractor License#(if applicable) 13 7 dw "Or 's Compensation Insurance. -PRESSPERMIT Check one: ❑ 1 am a sole proprietor MAY 2 7 2008 ❑ in the Homeowner have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name A Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file., Permit Reques (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/doors/sliders:U-Value (maximum sal *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 is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doe Revise020108 RightFax Cl-2 4/23/2008 8: 58 : 36 AM PAGE 3/003 Fax Server ACORD. CERTIFICATE OF INSURANCE DATE(MM\DD\YY) 04-23-08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EDWARD A GRAZUL INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO BOX 337 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE MARSTONS MILLS,MA 02648 COMPANY 28Y2K A 14ARTFORD GROUP INSURED COMPANY B R L T CONSTRUCTION INC COMPANY 31 MANNI CIRCLE C CENTERVILLE,MA 02632 COMPANY D COVERAGE, 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. - CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM\DD\YY) DATE(MM\DD\YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Anyone person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY- EACH!ACCIDENT._$ AGREGATL' EXCESS LIABILITY a UMBRELLA FORM EACH OCCURRENCE ! OTHER THAN UMBRELLA FORM AGGREGATE _$ WORKER'S COMPENSATION AND -' PQ A EMPOLYER'S LIABILITY UB-1051CO45-07 12-24-07 12-24-08 . STATUTORY,-LIMITS X. THE PROPRIETOR/ EACH ACC[DENT $ r: 100,000 PARTNERS/EXECUTIVE X INCL DISEASE-POLICY LIN11T $ 500,000 OFFICERS ARE:. EXCL DISEASE-EACH EMPLOYEE _$ ::-.-100,000 OTHER ; DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THECERTEFICATE HOLDER AFFECTWG WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT ATTN:BUILDING DEPARTMENT _ FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY 200 MAIN STREET KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. - HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE ACORD 25-5(3/93) Ramani Ayer The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers A100cant Information Please Print LeLriblv Name(Business/Organizationftdividual): N< Address:_ V� f' �Cie City/State/Zip: Phone.#: 3-0T 77 G y Vaeyo ,in employer? Check appropriate box: Type of project(required): m a employer with 4• ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the stab-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, E]Demolition working for me in any capacity. employees and have workers' 9 Building addition comp.insurance.$ [No workers' CAIIIp.inct,rance required] 5. We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their l l.❑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 chw3m box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arz doing all work and then hire outside contractors must submit a new affidavit indicating such. I--Mtractors 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 subcontractors have employees,they must pruvidt 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.Lie.M Expiration Date: Job Site Address: Lli ZG� 1 ®I' - 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 Section 25A of MGL c. 152 can lead to the imposition of crimifial penalties of a fine tip 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 herebycerii un a pains and allies of perjury that the information provided above is true and correct: Signature: Date: Phone# 776 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#' 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 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 certificates)of in mance. 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 Towu 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 permitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permiVlicense 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 fo any business or commercial venture (Le, a dog license or.permit to brim 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 C6mmonwWth of Massachusetts Department of Industdal Accidents Office of Lavestigatim 600 Washington Street, Boston,MA 02111 TO. #617-727-490.0 ext 406 or 1-977-MASSAFE Fax# 617-727-770 Revised 11-22-06 www.mass.gov/dia l Oar d Regula • Re t MPR pVFMF hOns a pd Stand 9iStrati ! NT Cp ards on NT Exp�ratio 1342g6 CTpR ` n 10i RCT >T 22/20 CONST �N ype DgA 09 T R�NN1E13,3426 31 CENmmAi ERVi CIRS(D/NG&R p pFiN ICE,MA'o2362.. J A47- fsfrator i . i License or registration v before the ex 'valid for iAdividul h use only . Board of Bui din on date. If found return to: ' One Ashburto g Regulations and Standards n Place Rm 1301. f Boston,Ma,02108 of valid With Signature - - ' Island Sid' and Roofing ...... ...... tt +Wa M w a division of RLTConstruction,Inc. April 24,2008 Christian Camp Meeting Association Re: CCMA cottages. 39 Prospect Ave. Craigville Village Centerville, Ma. 02632 We are pleased to submit the following specifications and estimates for re-roofing. Remove existing asphalt shingles and flashings. Install aluminum drip edge on all exposed edges and new pipe flashings.. Install 31. ice shield to eaves, valleys, chimneys. Install 15 lb. paper to remaining roof. Install 30 yr. Certainteed Woodscape architectural grade shingles.(Birchwood) -pew4Y Clean up and haul away debris to landfill. We hereby propose to furnish materials and labor- complete in accordance with the above specification, for the sum of. Yale 198 Lake Elizabeth Dr. $6,100.00. Andover 202 Lake Elizabeth Dr. $5,800.00. Yale is in need of replacement 1'. These prices are for removal of 1 layer of shingles only. It appears Andover might have 2 layers on some areas. PAYMENT TO BE MADE AS WILLOWS: Payment in full due upon completion All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the 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. Owners to carry fire,wind damage and other necessary insurance. RLT Construction#Inc.carries General Liability and Workman's Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby.accepted. You are authorized to do the work as specified. Payment will be.made as'outlined above. Date of Acceptance: Signature 'o'c; L)-/1- Startt Date: S.igna6urAl w/ W14V? L000Dr0-,Y (5oj) 7)S'- 1?L1!> (lQ� � 0 31 Manni Circle • Centerville, Massachusetts 02632 Te hone 5" . 2 9 a 1 ca eroo r eroo er.com. OB 420 5243 and 508 833 5 4 .� x.�08 420. 776 Eanail e @ca �' F f P f i OM :DOUG WILLIAMS FAX NO. :508 775 1503 Nov. 05 2007 02:00PM P1 Doug Williams Custom Building Co. P.O. Box 1069 Centerville, Massachusetts 02632-1069 508-775-1500 866-524-0070 fax 508-775-1503 www.capecodhomebu ilden com email homebuilda@comcast.net Town of Barnstable Building Commissioner 200 Main Street Hyannis, Mass 02601 Monday, November 5, 2007 Sir, I am currently doing emergency repairs to several building in the Craig'ille Conference Center to protect property. I will be taking permits to do the permanent repairs. The addresses are 22219_8,�194,196,198 Lake Elizabeth . drive, 125 Ocean Ave, and the headquarters at 45 Prospect St., The repairs are to stop roof leaks, broken windows and storm damage. Respectfully, Douglas L. Williams Sr. President f FROM :DOUG WILLIAMS FAX NO. :508 775 1503 Nov. 05 2007 02:01PM P2 Douglas L. Williams Custom Building Co. P.O: Box 1069, Centerville, Massachusetts 02632 Since 1972 Centerville, 508-775-1500 www.capecodhomebuilder.com e-mail homebuilda@comcast.net FACSIMILE TRANSMISSION SHEET >~AX# DATE l c Or _ NO.PGS. TO SUBJECT �t e �• �t3�rlc FROM . Douglas L. Williams_ This transmission is intended only for the use of the individual or entity to which it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this transmission is not the intended recipient or employee or agent responsible for.the transmittal to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. if you have received this communication in erg or, please notify us by phone, (collect) and immediately return the original through the 'U,S.Mail, Thank You. New Homcs & Additions Second Stories Construction Supervision Kitchens & 'Bathrooms Window Replacement & Trim coverage Remodeling-Roofing & Siding SINCE 1974 Licensed Construction Supervisor Licensed Hume Improvement Contractor visit wvvw..capecodhousesforsale.com www.capecodhomcinspeetor.com r Parcel Lookup Page 1 of 1 Y Logged In As: Pa t"Ce I Lookup Wednesday, Septem LamedNancy Laed Road Lookup Condo Lookup Multiple Address Lookup Search Options Search By Map Block Lot PEI 097 r77 ruea�Gll�'; <Prev Next> Page 1 of 1 :9 Rows/Page Parcel Location Owner Village 226- §204 AKE ELIZABETH DRIVE-Multiple Address CHRISTIAN CAMP MEETNG CEN 097 8`CAKE`EL'IZABETH'DRIVE=YALE'COTTAGE) ASSOC 226- 204 LAKE ELIZABETH DRIVE- Multiple Address CHRISTIAN CAMP MEETNG CEN 097 (204 LAKE ELIZABETH DRIVE -ANDOVER COTTAGE) ASSOC 226- 204 LAKE ELIZABETH DRIVE- Multiple Address CHRISTIAN CAMP MEETNG CEN 097 (222 LAKE ELIZABETH DRIVE - UNION COTTAGE) ASSOC 226- 204 LAKE ELIZABETH DRIVE- Multiple Address CHRISTIAN CAMP MEETNG 097 (20 8 AKE ELIZABETH DRIVE-CRAIG. CONF. CEN CENTER INN) ASSOC 226- 204 AKE ELIZABETH DRIVE - Multiple Address CHRISTIAN CAMP MEETNG CEN 097 194 LAKE ELIZABETH DRIVE- BOSTON COTTAGE) ASSOC http://issql/intranet/propdata/lookup.aspx 9/6/2006