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Home My WebLink About0094 LONG BEACH ROAD v :, 4OW6, L. c� Town of Barnstable *Permit# 0266 Expires 6 months from issue date Regulatory Services Fee IDS: OQ MASS. 0$ Thomas F.Geiler,Director SS PERMIT Building Division Tom Perry,CBO, Building Commissioner JUN 06 2w 200 Main Street,Hyannis,MA 02601 ` ��bN-g8BARNSTASLE w rn ww•town.bastable.ma.us Office: Fax: 508-790-6230 EXPRESS PERMIT APPLICATION -- RESIDENTIAL ONLY Not Valid without Red X-Press Imprint . Map/parcel Number Q(-Q rl Property Address Lo.nPL - r Residential Value of Work 2.S00 7,— Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address , IJ 6(0033 Contractor's Name Pa.,) A-L)( Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) d a(_0 3 DL t!�Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner `KI have Worker's compensation Insurance Insurance Company Name Workman's Comp.Policy# U 0 09 S b Lo 4 A Of; Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) _�KRe-roof(stripping old shingles) All construction debris will be taken to a Y— 0 U AA-� ❑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 required. SIGNATURE: Q:Forms:expmtrg Revise071405 s The Commonwealth of Massachusetts 1 Department of Industrial Accidents i Office of Investigations 600 Washington Street Boston, MA 02111 c www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Pao , Address: �0.?� 1 ACA i tj City/State/Zip: �fi ,r `e MA O aYho e#: Are you an employer?Check the appropriate box: Type of project(required): 1 I am a employer with [Z 4. ❑ I am a general contractor and I 6. .❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp,insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13. Other 1(e comp.insurance required.] _ *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. I 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ,17 Insurance Company Name: Policy#or Self-ins.L,icy.#: U �j �jR> U A A-' Expiration Date: .,'�- 41 10 1 y Job Site Address: LQV'39 PVUC M Cyp�(j\1i&Q`(;,e-ity/State/Zip: l O u�JZ 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 criminal penalties of 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. 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 hereby certi der the pal and enalties of perjury that the information provided above is true and correct. Signature* 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:_ Phone#: �oFTME TOw Town of Barnstable y*. Regulatory Services ' Thomas F. Geiler,Director XAM Fo;9.�A�O� Building Division TomPerry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstab1c.ma.us Office: 508-862-403 8 Fax. 508-790-6230 Property Owner Must Complete-and Sign Thus Section If Using ABuilder 1, //// A��i /la,l0- i`S ,as Owner of the subject property hereby authorize. 1�� `(�,• S', � � %�(�_ a -lU�-to act on mybehalf, - J in all rriatters relative to work authorized by this building permit application for, LOY11 ; � C; �� C-en der vIuiaress of job) Signature of Owne . Date Print Name • p:FORMS:OWNI:ItPEF�vIISSION fie � BoVard 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 f�r Expiration: 7/9/2006 PAUL J. CAZEAULT & SONS, INC*** NC ;.•.::,.: Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 Ij Update Address and return card.Mark reason for diang DP8-CAI Co :,OM-04/04-G701216 Address M Renewal Employment 0 Lost Card ./ItC O-U09JNROOff!/CR.GUL �✓VGQddCLGtlL�1P.u4 ---- Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Licellse or registration valid fur individrll use unh` Registration; 103714 before.Ilic expiration dale. If found rehire lu: Board of Building Ite illalious and Sl:nrdarQs Expiration:. � P 7/9/2006 Oui Ashlrul Uw 1 l.11l Kul 1301 'TPrivate Corporation ypo: BuMoll,Ala.02108 I PAUL J.CAZEAULT,&.SONS,.INC:; -. ..... ,- Paul Cazeault �ie o�nmzaJuu a o/ 1031 MAIN ST OSTERVILLE,MA 0265t) BOARD OF BUILDING REGULATIONS OS -.-� Administrator w License: CONSTRUCTION SUPERVISOR k-> PI1 N umber;.,CS 026325 Blrthdate 10/20/1959 Expires 10/20/2007 Tr.no: 7696.0 Restricted+ 00 j PAUL J CAZEAULT' Il 1031 MAIN ST ? OSTERVILLE, MA 02655 yw' Commissioner - VJ 1 CMVILLM, IVIJ1 ULbJD -- - .._Administrator �� Board of Buildin e ulations 0 n- eA g shburton Pace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/2007 Restricted To: 00 PAULJ CAZEAULT 1031 MAIN ST f OSTERVILLE; MA 02655 si . T .no: 7696.0 Keep top for receipt and change of address notification. DPS-CA1 aJ 5OM-04/05-PC8698 �. a M\OD\Y7) ,•.:...::. :.:.:. .... a DATE(M` a nu-z3 n5 PRODUCER TKIS GcFTIFiCATE IS iSSalED.twS R.1AA.TTER,:QF�NFOLiiia.TL= BOWLING c o IJEIL INS AGC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR PQ OX C 1111I I'i STREET, (ALTER THE COVERAGE AFFORDED flYTHE POLICIES aELQW_ PU LiO:{ 1990 HYANNIS MA 02601 COMPANIES AFFORDING COVERAGE COMPANY, 22LGR A TRAVELERS PROPE INSURED RT'f CASUALTY COMPANY OF At4ERICA COMPANY PAUL.J' CAZEAULT 6 SONS INC. B 1031'NIA.IN STREET OSTERVILLE, MA 02655 COMPANY C COMPANY ;:COVERAGES THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO'THE INSURED NAMEC'ABOVE FOR THE POLICY PERtOU'�t INDICATED, NOTY BE'TH' ANY REOUIREAAENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT V41TH 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 OP SUCH POLICIES.LIMITS*SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS.: T TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTR � POLICY NUMUER DATE.iV=DZYY) DATL-(MfA%QDIYY). LIMITS GENERAL LIABILITY t GENLIIAL r,GGHGGATE g COMMERCIAL GENERAL LIAUILII Y ' 1'Y)000C1:�-CUMYiUW AUG. _ , CLAIMS MADE OCCUR. PERSONAL R ADV.INJURY 3 -- OYYNt✓H'S a�ifN7RAt TuH PR67. EACH OCCURRGNCC y FIRE DAMAGE(Any one fire) g AUTOMOBILE LIABILITY - MED..EXP!NSE(Any one person) g, ANY AUTO COMBINED SINGLE g LIMIT ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per Person) g HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per Acciocni) S PROPERI Y DAMAGE g GARAGE UADIDTY ANY AUTO. A010 ONLY'EA ACCIDENT' g OTHER i!iAN AUTO ONLY. LACH ACCIDENT, g ECCE99lIABIUTY AGGHEGATE _ UMDRELIA FORfd EACH OCCURRENCE g ; OTHER THAN UMBRELLA FORM AGGREGA E - A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (LID-0095B69—A-05) 03-10-05 08-10-OG SThiUTORYIIMITS THE PRGPRIETOR! EACH ACC:IDFNT PARTNERS/EXECUTIVE X INCL Qon -OFFICERS ARE: EXCL DISEASE••POLICY LIMIT $ 500 ,000 , OFTH ET? - - DISEASL•EACbI PM TOYEF. g 100,000 t I Fill T P L IKIAS.. THIS REPLACC3 ANY PRIOR CERTIFICATC ISSUED TO Tt1E.CCRTIFICATE HOLDER AFFECTING WORKL1135 COP i ' F1117,. > ; Cs'A : ':KOL f >":;.:s ; : COVERAGE..,....,..>...... .,.:......... . :..: C+ANC£LI.DTIQN SHOULD ANY OF THE ABOVE DESCRIBED OLICIB- BE CANCELLED BEFORE THE Paul J.CaZeaUlt&Sons EXPIRATION DATE THEREOF, THE ISSUI14G COMPANY WILL ENDEAVOR TO MAIL Roofing,inc. 10 DAYS WRITTEN NOTICE 70IHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUT FAILURE TO MAIL SUCH NOTICZ SHALL IMPOSE NO OBLIGATION OR 1031 Mai"i Street WAWLITY OF ANY,KjN i UPON THECOMPAJL'f,%15.AR,jAj5.QriRrIPRE,wF"AjIV" . Ostervill:;, MA 02655 AUTHORIZED REPRESENTATIVE n -Ad 00 ;<� O�n•cnl3pn�uiriax 933 ACQHD' CERTIFICATE IFICATE OF LIABILITY INSURANCE 05/1 MM/,JUi;�YY) I 05/18/06 DOW.PRODUCE ..! THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dow'ng &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 8r Sons Roofing, Inc. INSURER B: 1031 Main Street Osterville, MA 02655 INSURER C: 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DD/YY DATE MM/DD/YY LIMITS A GENERAL LIABILITY NPP1012091 04/30/06 04/30/07 EACH OCCURRENCE $1 OOO OOO MIS A X COMMERCIAL GENERAL LIABILITY NPP925580 04/30/05. 04/30/06 DAMAGE TO RENTED $50 OOO CLAIMS MADE a OCCUR MED EXP(Any one person) $2 5OO X BI/PD Ded:1,000 PERSONAL BADVINJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1 000 000 POLICY PRO- _ JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $(Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $NY AUTO A OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYEkV LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $ SPECIAL PROVISIONS below _T E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OPOPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Insurance coverage is limited to the terms,conditions, exclusions, other limitations'and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions.Certificate of insurance for workers (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL If) 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 REPRESENTATIVE 1-7 E. LS1 0 ACORD CORPORATION 1988