Loading...
HomeMy WebLinkAbout0032 NATKA DRIVE i o BIKE Town of Barnstable *Perm►t# Expires 6 mon s ro issue e PERMIT Regulatory,Services Fee L v • HARNSTABLE, • f , Mass. �0�� Thomas F.Geiler,Director. � V F i3ARNSTAj3L Building Division TOWN O Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bariistable.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 1 p ❑Residential Value of Wor ,;�,Q. 7 Zy� 5 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name 1 Telephone Number-1 `-( V Home Improvement Contractor.License#(if applicable)'O J� /.KC;44-L iWLQ=` Construction Supervisor's License#(if applicable)Kc,r k- ` 'tr cy- v7n,l ee ❑Workman's Compensation Insurance Check one: ' ❑ I am a sole proprietor ❑ I am the Homeowner Er have Worker's Compensation Insurance Insurance Company Name A A^ { Workman's Comp.Policy# 5b_1 tj Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) ,All construction debris will be taken to E L Aar y-e st u�2 ❑Re-roof(not stripping. Going over' existing layers of roof) NRe-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *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 required.: SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content:Outlook\4STGU5QO\EXPRESS.doc Revised.090809 _ r .,7 t. . rw 111� ` . r lie C,..tttnrevEaltle of Arssachusetts Department of Industrialccrdetits ()fjtce of Itlga�iioru 60011;1!sJt can,fre t . n:- ( : &►stop,,AAA'4Z111 .: »gnu;`'massgav/dia arkers'Campenaat an Ia ce Affidai&I3adersJCri ct�rr lE tr�eaans/Plambe Applicant IBfaraaat�an Please Print ley , . Name p a B( 1 dress.��� ®Zo,.c- -I1.-V-1,�1:1.7:",...,-I"!.I--11�.-:..�,I..I��.��-1.:".,..:�-.-,�]..:,.�vI..�.,ii 1,IX1..,.:.,.:�1.._`.:�......:.::.,�:-I�,..::.I..�:...1�.:...��m-.-::.-,�. CI#yl5tats(Zap Phi#;'t�✓1 �'' ,�UZ� �.�-.1:�.—.;l..,:C:.,.�.,:-.-,i�,::�i��..�'.f..�.<...1.:1'�.:.,�II]-i I:.,,.,,,..l�I2.-..X.:.�,6,��,v.�1�'.�.�...�.,.,..—I-��:.:.�.]1:-.41:=.,....:�-':...—:,,�..�--:I:,,....1.::.:.:��.:i:,.-,1O�II-m-...-1.-.'.-:�.����:�'�-I�.�d1�.-.',.�I—]-.....,..:.,:.-.�-:�:':--]-.1...:.:-..—%�::.....1-.1-,..�-,::..'�.1::���..�-.:..--:.i-.--�I�.:.......,.:., Areti employer?,Check the appropriate boz. Type of PTl { oy�vaftlt 4 ❑ I am a getters!contractor attd I { �s have hired then coagactoss 6 ❑ Ie ! full 2❑ I ara a sole proprietor part�a hated the attached s3ieet 7. ❑ ship aauf love nn employees Theme��'"""'�'d" . .. $ ❑Demohtim wig for me ffi acty c pacrty �P atl+d have worirers 9 ❑Btnhtaag addtttan [Ato ivoalr�s'Coin ice cO 1 5 ❑ We are a en[pizahtm and its 10.0 Etechacal repass or addshons .: 3.❑ I am a houreowner doing all work offtceas have e..... , eti thtnr. 1I;-❑Pl:Initn' fWatrs or adthboYis myself[No vvarkets comp nght of esemph�per ArSGI. 12:_❑Itnof repairs tce l c_152,i 1{4�,and we!rave tin employees [i�Fo vrtuktss l5' 1 Z coanp.mstzree regtnred.] Any a dbm rhxks Gas#1 nest also fill ant the settitm b0*shc-t►g tb&teaa$ecs .�P a pa]icp.�foa�� who snbnut this affidavit indneatffig lEey are rEl woik aaa theta kite c setots mttst svhmit a sll5davtt soci� TCon�ctois that cbeck ibis bmt't�st stfe� M as addniamal suet sh"the nee of the and state whether fs not three emtm have e�pltsyees If the sab cnntisctas Lasela}�es,theF P Fcy n�bet I am ae;ettlppn that u pi wrdu �wvrlFsrs'cot sattiu tnstar�ue for p+y Hslaty is th .: ertd�ob sets 2RfOfYttBhOTt Insurance Ctrmpatry Aiame. Pohcy#or Self ins 11 #l 1� � :"�b l II "' \ -i i Job Site Address '`�CL G. "C �s.. t•► ` Cit /^�tatedZ p. Attach a copy of the waifs'campemcahoa PoLcy declaration Page{shawiag the policy anmber and dated F"ure to secme coverage as rt quired under Section 25A'of t GL;.. I5 cart lead to the ata�asYtlon of cram�l peaaltaes fine up to S 1,5( A 1-1 1-r one-year impr son.m as well as csiiil penalties ffi the foam of a STOP WORK:ORDER and s fie of up to254_0 a day age the viohrtor Be ativtsed that a copy of this stated array forwarded to @Fe:'OfficE.of Investigations m, DIt for coverage v cation I do hsrslsy fy UnAw Oies'ofpsrj U thatthe uifottrt�tonpr�tttR�d.a is!t�ius an4 cnrrait 1 Y Date. t .. f'C7 '�G y Isyhone A U,(ftal oitlp DoRot sortie au thts<�sa,Abe completer!by taip or tnwvl eclat City or Iowa Pet/Ltceuse# Issta>8g Anthoa�ty{circle one) ' L Board of Hearth artment 3 Cityfowa Clerk d Electrical Inspector 5 Phambtag Insbrctor Bna'ldang lleP b:[f#her Contact Person Phone#.. _: .. 6 - - ✓lie C�arrunwozureai.a�✓UGadeccclucoel�4 Ps Board of Building Regulations a r1`laiadar is f{ mo ors or registration valid fcr indiv iduf use only HOME IMPROVEMENT CO14 cTCR bcf r i''e expiration date. if found return to: Bo t d i:f Building Regulations and Standards Registration ,146589 �0urtgn Place Rm„1.3.0.1 '•. Sla 02108 Expttahon .t trjn, . .3Type Supplement Car d r _.NMPRO OPERATING LLC MARK.HOLLETT'y ? t 26 CEDAR ST — WOBURN,MA 01801 — At i tr..,i�u ator � of wnlid without signature . i a 40 Massachusetts- Department of Public Safet-, Board of Building Regulations and Standards i Construction Supervisor License License:.CS 97310 tc Restricted to 00 MARK HOLLETT 2 BROOK STREET WHITINSVILLE, MA 01588 Expiration: 4/22/2012 Commissioner: Tr#: 23738 y MA Reg. #146589 f F-J] Siding Contract CT Reg. #0605216 1W RI Reg. #26463 American classic wall Systems Federal ID#20-2625129 Corporate Headquarters:26 Cedar St,P.O.Box 2696 Woburn,MA 01888 (781P33-4100 1-800-342-2211 THIS CONTRACT MADE THE day.of APRIC20/0— between 539 83 (Home Owners) (Home Phone) (Bus./Cell Phone) (Mr./Mrs.) of (Address) I state) (Zip Code) the"Owner"and NEWPRO Operating, LLC, "NEWPRO". NEWPRO hereby agrees that it will for the consideration hereinafter mentioned, furnish all labor and material necessary to install the following described work at the premises located at (Job address) (E-Mail Address) APPROVED MATERIALS WILL BE FURNISHED AND INSTALLED TO THESE SPECIFICATIONS. Specifications PLEASE READ CAREFULLY:ONLY ITEMS CHECKED`YES"ARE INCLUDED IN YOUR ORDER. YES NO/ YES NO / 1. BAD SOLID VINYL SIDING cover only flatwall areas designated for siding, 15. D ®/BE S/COLUMNS wrap with approved VINYL CLAD ALUMINUM. excep areas d elow� v L �� circular or round columns) Color Size Color�attern Packag 1•� 16. Q GUTTERS/LEADERS remove existing and replace with new custom stom corner posts color_ less gutters and leaders. D White D Brown s 1 A. SIDING will be applied to the following areas only: 17. D SHUTTERS provide&install pair approved polystyrene D Front Elevation D Rear Elevation D Other hutters. Color D Left Elevation D Right Elevation D Other 18. Q MASTER MOUNTS provide&install for exterior light fixtures only. D Par t D Details: 18A.)Lights# 18B.)Water/Elect O tlypt# ffl� tire C3 Details: ABC.)Dryer Vent# Col TA 2. O D INSUL T,ION or my flatwall areas designated for siding with 19, Q�Mj GABLE V NTS v de and install vents. �Y SI inch insulation. _,.-Color� � —No&rcular or triangle vents 3. 91"10 Use approved STARTER STRIP where contractor deems necessary. 20. pry❑LEAN UP property at completion of work. (N t available with Nailite) 21, �NSURANCE All Workman's Compensation and Liability to be maintained. 4. O iding to be applied over EXISTING FOUNDATION. 22. g D ARRANTY Mail to customer after completion&full payment is received. 5. D 9115se approved PERMA TABS AND FINISH STRIP where contractor 23 D PAYMENTS on NON-FINANCED orders installer is authorized to collect deems necessary in same color as siding.(Not available with Nailite) progressive payments. 6. D' D WINDOW OPENINGS 24. D D ADDITIONAL WORK(not specified above) D Custo ap with approved vinyl clad alumiqual � 12p� v Color ��// 7�!!It Q Jump over casings with siding and"J"channel - :. # Color D Channel existing window only(eg.Andersen type or previously 25. D D Work Not to Be Done J wrapped)# Color 1 /Other details 7. ��DAULK all sills with rubberized color coordinated caulking. 8. IIYU DOORS jj custorq wrap with approved VINYL AL(j�A}t�lu 26. CID -Repair or Replace the following woods of Doors ��_ Color f'�' 9. fT D GARAG OOR FRAMES custom wrap wit pppprove 1 YIN LAD ALUMINUM. Color IfTo Ric'm �� Ingle D Double with Mull O Double No Mull � g 10.[J U FASCIA custom wrap with approved {� t $ _Mu Wfefh3 rc yF R INYL CLAD ALUMINUM. Color 7-,� INDICATE FORM OF PAYMENT 11.#I n SOFFIT(eaves/overhangs)cover with approved SO INY QFF Z f Lo YSTEM.Except area noted below.1/3 Vented.Color $ 12.LNCJ R� OTTEN WOOD Will only be repaired or replaced inhere specified on line Deposit With Order 33% item#26 listed below.Any additional areas needing a repair will be Payment on estimated upon their discovery and priced accordingly. Measure or Start 33% $ 71 ` J ` Does not include wood studs,or exterior sheathing.) 13.�LJ REMOVE EXISTING MATERI exterior of house. D Other Balance Due on Q nyl D Aluminum ood Shingle D Wood Siding Substantial Completion 34% $ ,�- - 14.D AARCH CEILINGS cover with approved SOLID VINYL CEILING MATERIAL Total Amount of in the following areas: Balance to be Financed $ It-shall-be the obligation of NEWPRO to obtain any,and all permits necessary.under this agreement,as the Owner's Agent:The Owners who secure their own construction- related-permits; or deal with unregistered Contractors will be excluded from the guaranty fund provisions of MGLC, 142A. All Home Improvement Contractors and Subcontractors shall be registered by the Director and any inquiries about a.Contractor or Subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration,One Ashburton Place,Room 1301,Boston,MA 02108,(617)727-8598. If the Owner is obtaining financing by way of a Retail Installment Sales Agreement,such Agreement shall include a time schedule of payments to be made under said contract and the amount of each payment stated in dollars, including all finance charges.The Retail Installment Sales Agreement.shall be incorporated herein by reference. If-the Owner is obtaining a revolving credit line to pay,in whole or in part,for the contract amount herein,the terms of the revolving line of credit including interest rate and payment terms,shall be clearly set out on the credit application.The portion of the credit application referencing a time schedule of payment,to be made under this contract,and the amount of each payment stated in dollars,including all finance charges,shall be incorporated herein by reference. NEWPRO represents that it carries Workmen's Compensation and Public Liability Insurance in the amount of$100,0004300,000. If the Owner refuses to permit NEWPRO to proceed with the work herein,or in the event of any breach of the Owner of this agreement,for any reason whatsoever shall cause the owner to pay NEWPRO a sum of money equal to thirty-three and one-third percent of-the price agreed to be paid,as fixed,liquidated and ascertained damages,- and not as a penalty,without further proof of loss or damage. NEWPRO shall not be held liable in damages for delays in the performance of this contract due to causes beyond its reasonable control. Owner warrants that he is the owner of the property on which the work is to be performed or that he is otherwise authorized on behalf of the owners to enter into this agreement. This contract represents that entire agreement between the Owner and NEWPRO and cannot be changed except by a writing signed by both the Owner and NEWPRO. You are entitled to a copy of the Contract at the time-you sign. Keep it to protect your legal rights.We,the aforesaid o_w_ners, _ certify that immediately after the signing of the aforesaid agreement,a copy was furnished to us. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office, or branch thereof, provided you notify seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement.(Saturday is a legal business day). See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. The Owner has seen"sample"warranties that will be provided by NEWPRO upon installation. ❑ Sample warranties provided to Owner. IN WITNESS WHER arties have hereunto signed their names this day of �f� 20 ] EO � EIN# Signe ' I MarketiTR-e resenki jr * ed Name O ner AcceptN PR LC By Signed Marketing Representative Signature Owner Wall Systems Branch Office,151-153 Memorial Drive Business Park,Suite B-C,Shrewsbury,MA 01545,Phone 800-456-0555,Fax 508-842-9248 WHITE:Branch Copy YELLOW:Customer's Copy PINK:File Copy GOLD:Finance Copy US-21(Rev 1/07) IACORQ, CERTIFICATE OF LIABILITY INSURANCE 05jo%z 0 PRODUCEfa 508.366.6161 FAX 508.366.5202 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Mackinti re Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 11 West Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Westborough, MA 01581-1931 INSURERS AFFORDING COVERAGE NAIC# INSURED Newpro Operating LLC INSURER Peerless Insurance Co. 24198 26 Cedar St. INSURER B Woburn, MA 01801 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. INSR DD' POLICYEFFECTIVE POLICY EXPIRATION TR DD TYPE OF INSURANCE POLICY NUMBER D TE MMI D D T MIDD LIMITS GENERAL LIABILITY BP8588370 (MA POLICY) 12/31/2009 12/31/2010 EACH OCCURRENCE $ .1,000,000 X COMMERCIAL GENERAL LIABILITY CBP8589577 (RI POLICY) 12/31/2009 12/31_/2010 DAMAGE TO RENTED $ 300,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 15,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY ECT J LOC EC AUTOMOBILE LIABILITY BA 8584174 12/31/2009 12/31/2010, COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS ' BODILY INJURY X SCHEDULED AUTOS (Per person) $ A X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS - (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO -OTHER THAN EA ACC $ AUTO ONLY: - AGG. $ EXCESSNMBRELLALIABILITY CU 8582578 12/31/2009 12/31/2010 EACH OCCURRENCE $ 5,000 000 X OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 A $ RDEDUCTIBLE $ x RETENTION $ 10,000 $ WORKERS COMPENSATION AND WC8645074 - MA POLICY 05/01/2010 05/01/2011 WRYTATus UEMg EMPLOYERS'LIABILITY WC8645974 - RI POLICY 05/01/2010 05/01/2011 E.L.EACH ACCIDENT $ 500,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED', E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes.describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. - Newpro Operating LLC AUTHORIZED REPRESENTATIVE Timothy Mo na h ACORD 25(2001/08) ©ACORD CORPORATION 1988 a BIKE IMMSTABL6, MA SS. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO . Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder h- C'' ' tU ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application'for: (Address of Job) Signature of Owner Date Print ame If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollikWppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 sicJAI oF1KEr o'6 n of Barnstable Permit 1 Expires 6 mouths from issue date Regulatory Services Fee ''. + BARNSTAHT v MAT $ I P Thomas F. Geiler,Director ATED Mph� C� Building Division Tom Perry, CBO, Building Commissioner. 200 Main Street, Hyannis,MA,02601 www.town.barnstable.'nah.us Office: 5.08-862-4038 - Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address v� /�t�2" � /G� 07� ��vll ['Residential Value of Work �� t� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's NameTelephone Number S� 776 Pll' Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) In/workman's Compensation Insurance Check one: " I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation.Insurance Insurance Company Name Workman's Comp.-Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re roof(stripping old shin ),All construction debris will be taken to ��� gles ❑ Re-roof(not stripping. Going over existing layers of roof), ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *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 e uired. SIGNATURE: r1ANxrocn tc\rnDt,nc\ti,.;i l;. P—if f,­\PYPRAS.0 rind ' The Commonwealth of Massachusetts Departrnent of I7idtistrialAccidents Office of Investigations 600 YVashington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,fJ Please Print Le ibl Name (Business/Organization/Individual): P/✓L- /��r C /�iIA., e Address: City/State/Zip: � t�,v, �� 109A Phone #: ' f&T Jf 77(� Are you an employer? Check the a propriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hued the sub-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, [] Demolition working for me in any capacity, employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.# required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself,.[No workers.'_coxnP,... .•_..___......... __-. right of exemption per MGL _...__ _ ......12.❑.Roof.repairs - insurance required.]t J. 152 §1(4),and we have no employees. [No workers' 13:❑ Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 sub-contractors have employees,they most provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy #or Self-ins, Lic.#: Expiration Date: Job Site Address: ' v q�) Ce4474�6111, C" City/State/Zip: 6 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 cer,,;p the pain enalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#• Aa -176 U/ l7 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 Ilealth 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other t l r• �� a to _ Phone#: r 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 certificate(s) of insurance. 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 of LIP`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 Town 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license 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 maybe 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 to any business or commercial venture (i.e. a dog license or permit to bum 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 Commonwealth of Massachusetts Departrnent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia Island Sidin andRoofing a division of ELT Construction, Inc. 31 911anni Or& Centervif[e, YA 02632 Algis Matios4t April 17, 2010 32 Natka Dr. Centerville, Ma. f. r . We are pleased to submit the following specifications and estimates for reroofing.,% Remove existing asphalt shingles and flashings. Install aluminum drip edge and pipe flashings. Install 3 ft. winterguard to eaves, valleys and interwoven with step flashings. Install 15 lb. paper to remaining roof. 1 Install 30 yr. Certainteed Landmark Woodscape architectural grade shingles. 0i, Install ridge vent to all ridges. Clean up and haul away all debris to landfill. We hereby propose to furnish material and labor complete in accordance with the above specification, for the.sum,of: $6,800.00 Terms: No deposit required. Payment in full is 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 ,LGt Start Date: Signature f3ii V" 7efephone 508.420.5243 and 508.776.8914 Tacsimile 508.420.1776 i I,L F 7' tilaj'S c us tta B 'r�artment of Public Safety Bo.brd of Buildrn-RcgouIatio`ns and Stani dl ard+ Constrtiction`Supervisor Specialty License i License: CS`SL 99910 Restricted-to:. .RF,WS. " t RONNIE `TAYLOR I ` 31 MAN NI CIRCLE. CF NTERV I LLE,,MA`02632 I a.i, EXp> ation: 10/26/2011 ' NP _ y F $ t <" ✓lie �a�;xzao���realC� a��/ %zcwa:c:�tiioe�6 ' Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registratio'n`� 1'34286 f I Expirati Tr# 293257 i Type 3ffl d dyu�al— +' +RLT.00NST.ING DBA IS'�LAI- 4SIDING&RO.OFIN RONNIE TAYLOR Xp 4q� ; 31 MANNI'CIRCLE � 4 i CENTERVILLE,MA 02362E Undersecret airy,. x , 'License or registration valid,Ar,individul use only _ ~ before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation r 10 Park Plaza 7 Sui'te 5110 Boston,MA 02116 Not* lid without gnature F. 04/22/2010 09: 05 5084204474 PALUMBO INS COTUIT PAGE 02 II ,4coR F LIABILITY INSURANCE °ATE'MM'°°""Y' ` C? CERTIFICATE O 9�1�2009 PRODUCER (508)428-1943 FAX: (506)420-4474 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION William Palumbo Insurance Agency,. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4527 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Coturt; MA 02635 I INSURERS AFFORDING COVERAGE �NA1C# ---- -- _ _....._.—_.._... _..._—..._... _. ---._. ..._.._ ------ .... _— - -- INSURED INSURER A:Travel era 39337 RLT CONSTRUCTION INC. INSURER 6!Guard Insurance Co 31 MANNI CIRCLE INSURER D; .. .. _.._----_.._..... :. .. .__ CENTERV ISLE MA 02 632 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED"NAM ED 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, TNSRADD' POLICY NUMBER I POLICYEFFECTIV6 PT OLIGV EXPIRATION E_OF_ILV°iIIfl NC- _ _ .GATE IMMIBOIYYYY�-D, YY LIMITS IGENERAL LIABILITY EACH OCCURRENCE S •,1•'000,000 'X 07�T0'A'M t0 RENTf ...._.. COMMERCIAL GENERAL LIABILITY PREMISES,.(Es xcurrence)•,-_-$_._._„ 300,r•000 -_ A I CLAIMS MADE I X OCCUR 6608476N705 8/1/2009 0/1/2010 MED EXP(Any onep?r.an) a—_ 5,000. -— - -- PERSONAL&A_DV INJURY 5 Y--__— GENERAL AGGREGATE OEN'I.AGGREGATE LIMIT APPLIES PER; PRODUCTS_,COMPIOP A00 s.... 2 r_000,000 X POUCY PECT L L._. .I OC AUTOMOBILE LIAMUTY --,_. I COMBINED SINGLE LIMIT (Ea Eccldent) .-- ANY AUTO ....----.._...._.._.... ------- ALL OWNED AUT06 BODILY INJURY S SCHEDULED AUTOS (Par parson) --- - - ----- HIRED AUTOS BODILY INJURY NON-OWNEDAUTOs (Per Eccldan.. S - ----...- PROPERTY DAMAGE $ (Per eOddnnt) GARAGE LIABILITY AUTOONLY-F.AACCIDENT I S ----- - ANY AUTO OTHER THAN FA ACC 9 -- AUTO ONLY: AGO $ EXCLSS/UMBRELLA LIABILITY EACH OCCURRENCE 5 OCCUR 1^ CLAIMS MADE - AGGREGATE S - S DEDUCTIBLE ------__-•-• _ -__. -- RETENTION S $ B WORKERS COMPENSATION -7 p TAMITS I ER -.. ATU AND EMPLOYERS'LIABILITY -- ANY PROPRIPTORIPARTNERIEXECUTIVE YIN F,,L,EACFIAIDENT 6 �500,000 CC FNI OFFICERIM<MBER EXCLUDED9 (Mandmary In NM) D0pQ19137 12/24/2009 12/24/2010 E.L.DISEASE•EA EMPLOYEE 000 IfP as describe un0er SI-. IAL PROVISIONS below E.L.DISEASE,-POLICY LIMIT S 500,000 OTHER 0EOCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS M JOB at 25 Huokins Neck Rd. Caritarville, MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE 0E9CRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town, Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEN .367 Main St=ae't NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,13UT FAILURE TO DO SO SHALL Hyannis, MA 02 601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR _REDRESENTATIVES. AUTMORIZPb RMPRBBCNTATNE N` - J LaRocca., Sr/SROGZR ACORD 25(2009101) ®1988-2009 ACORD CORPORATION. All rights reserved. INS025(200901) The ACORD name and logo are registered marks of ACORD rt ofTME�o TOWN OF BARNSTABLE � Permit No.�M.0....... BUILDING DEPARTMENT -, TOWN OFFICE BUILDING Cash 4 9. .. s HYANNIS,MASS.02601 Bond ..... . ....V CERTIFICATE OF USE AND OCCUPANCY Issued to R. Manni Address Lot 464 . 32 Natka Drive Centerville. Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .... ...ma"..2n ....... 19.....R..7........ s':1.�... � . / , Building Inspector ���°•.ew TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING » HYANNIS, MASS. 02601 �OIUY M. w MEMO TO: Town Clerk FROM: Building Department DATE: '17/v/T 2 D f P�7 y An Occupancy Permit has been issued for the building authorized by BuildingPermit $k.....-2.�� il' ........................................................................................................._......._................. .. .....»» issuedto v _... . . .........»...».........._... ...................... ,. _ .»............��.......... ..�.. ......................»......»..... »... »» ..... ._...... — Il , ...... ....... ........ 4 i Please release the performance bond. • TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING. PERMIT A=lb9-U11-OU1 - DATE SE'_1?1:l'.CC1bL.T 1g 36 PERMIT APPLICANT R. Ma mil ADDRESS 800 Oi.lk Stre''e , W. BarT1 t 0101 407 (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO build Dwelling ( ) STORY Jiilj.le FC11[tily NUMBERNG UNITS OF (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) LOt 1:(64, .j:: iVuClCia !J'L'1Vr.. (,tti;Ct.?=V i liC ZONING cDISTRICT IN0.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: �i�4dcic_' jFcSU-nlU - '011d. AREA Off VOLUME l..St�i3 6q s 'f-"Y• � 4U UUU•�\) PERMIT ESTIMATED COST ► �<.•l�li )CUBIC/SQUARE FEET) " FEE OWNER n• f':c3t1t i dUO Oak SC�t.�Lr W. barasLablG BUILDING DEPT. .� ��tlr� '' rj ADDRESS BY _ ^' f THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC .PROPERTY, NOT SPECIFICALLY® PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CE/RTIFICA'FE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBFINAL INSPECTION TI 70 BEFORE FINAL INSPECTION HAS-BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. - POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS r I,�VV Z 2 2 d ,�sl� ) G 3 3 HEATING I PECTION APPROVALS ENGINEERING DEPARTMENT 1 OTH -- BOAR OF H •j TH WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!L'L BECOME NULL AND VOID IF CONSTRUCTION INSPkTIONS INDICATED ON-THIS CARD CAN BE i TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. - ),.PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. c .. ............. < i ON✓ 1VLA� Ag WIL AM M. c WARW 41�— Assesso" mm p� lot . ...1.......:/....-.. �.��-.fir 0 /.... . ...... aa , o U JEPTIC SYSTEM MUST BE �QyQ f ET Sewage Permit. num er ........... ........................................... COMPLIANCE INSTALLED IN � " INS Z BABa9TADLE, i '�.�...........................:.. WITH TITLES House number .......................: .... CODE AN q°o,,�039•� ENVIRONMENTAL o yaY TOWN * OF BA1F -1-ABTE i BUILDING INSPECTOR — . f / ���! .... .. ...... .. .APPLICATION FOR PERMIT TO ... .�4.a✓.S.Y..r u�......:�nls.<....... .............. s�..� !:� , .,�.... TYPE OF CONSTRUCTION. .......4�10 c)...... 4^.`4�'�'P.............................................. ..... V. ............................19P.G TO THE INSPECTOR OF BUILDINGS: The undersigned hereby appcliiees for�a/permit according to the following information: " Location .........�.�.4...L......../Y�.' ...... �...................ce`V...L.............................. .......................... .... ProposedUse ......$5/.!:✓,c,/f .......... .!zz...... .5................. ................................. ......................... Zoning District .......... . ...................................................... Fire District .......nIF ® 5/..................................... Name of Owner ....Address � t�L$ .................... Nameof Builder ....................................................................Address ..................................................................................... Nameof Architect ...................................................................Address .................................................................................... a , (Q .....................Foundation ` �DF✓G Number of Rooms ...:..... .... .................. ..................................................... Exierior .....................:.`�! l(�..,.......................................,.....Roofing ... ....................................................... Floorse .�"�...P. .......................................................interior ............. .!. Heating ...........ep ...................................................Plumbing ......CP14x. v'..................................................... Fireplace ......... ...................................................Approximate. Cost ........ ................................... .. /`� Definitive Plan Approved by Planning Board ______�1_Zo a f. ?__ _______19._Q Are . .. ............... Diagram of Lot and Building with Dimensions Fee r..6^^�� �' !" ,..1. .......... SUBJECT TO APPROVAL OF BOARD OF HEALTH (� %kP OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding thg above construction. lozName .............................................. o /yo 7 Construction Supervisor's License ...O.............................. iR. NHANNI ``No ..2988 ... Permit for ...1} StorY............... Single Family Dwelling Location .......Lot #64, 32 Natka Drive ................................................... Centerville ............................................................................... Owner ..... ....lnni .................................................... Type of Construction .......Frame ............................. ................................................................................ Plot ............................ Lot ................................ Permit Granted ..... September 10, 19 86 Date of Inspection .........�..� 5..........19�� Date Completed .... ..,�...1'�...............1