HomeMy WebLinkAbout0119 PARK AVENUE 0
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Air Town of Barnstable *Permit "
Regulatory Services wee 6 mo " s from issue date
t an MASS, Richard V.Scali,Director� s
g
Building Division
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Map/parcel Number -f'
�7 Not Valid without Red X-Press Imprint
(f,/rj'� � ,,d� /_
Property Address /�� l`t�C� d-�Q. C.rcyvl3•c.J yi&
esidential Value of Work$l r Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address/-v7Cl(J,1 � (n,v�L C.,r-�- t�1 pal-k CA14-�?Y1, L
Contractor's Name����,� Qd�S() Telephone Number
Home Improvement Contractor License#(if applicable) ?1 3 j Email:
Cons ction Supervisor's License#(if applicable) 6Q 4 O
orkman's Compensation Insurance
Check one: ® gin bt❑ I am a sole proprietor
❑ 1.4m the Homeowner NOV 10 2016 I have Worker's Compensation Insurance
Insurance Company Name L, / Q ���� �BARN
STABLE
P Y (/t('tsLC.0 1 r� /�n S(�✓Ge ti t,C�
Workman's Comp.Policy# A-Ma
Copy of Insurance Compliance Certifica a must accompany each permit.
Permit Requ t(check box)
Ln Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 0 UUJ
❑ 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. r
A-copy of the Home Improv ment Contractors License&Construction Supervisors License is
f quired.
SIGNATURE:
Q:\WPFILES\FO S uilding permit forms\EXPRESS.doC
06/20/16
Herbst Home Improvements LLC
35 PEEP TOAD ROAD
CENTERVILLE MA 02632
774238-2937
www.herbsthomeimprovements.com
PROPOSAL SUBMITTED TO: WORK PERFORMED AT
Maura Stanard 119 park ave Centerville ma 02632
We herby propose to furnish the materials and perform the labor necessary for the completion of:
New roof
Remove one laver of shingles
Inspect roofing deck for loose plvwood
Install ice and water shield
Install new drip edge
Install certainteed diamond deck paper
Install Certain Teed Landmark shingles$9,600.00 �J L)V-11-
Install Certain Teed Landmark PRO shingles$10,125.00
�+ Replace all plumbing boots
Install ridge vent and Certain Teed cap shingles
Clean all debris daily
All material is guaranteed to be as specified. The above work will be performed in accordance with the specifications submitted
And completed in a substantial workman-like manner for the sum of: choose from job price above
Dollars($ )with payments as follows: deposit of 3,500 and remainder upon completion
*Any alterations from above proposal involving extra costs will be added under a separate written agreement and become an extra
charge over and above said proposal.
R5�§ CTFULY SUB OT
Gr'f�h — 9/20/2016
Jason Herbs
ACCEPTANCE OF PROPOSAL
The above price,specifications and conditions are satisfactory.I herby accept this proposal. You are authorized to do the work anc
payments a as specified above.
SIGNATURE.
*This proposal may be withdrawn by said company if not accepted within 30 days.
17m Commompeafth ofMasyadlinsetfs
Deparbnent rrfrr shirt AccideT&
- Office of�a&OM.
600 Was?hLoon Street t
-- Bowton,M4 02HI
IPrvw ma-qFgvv1dia
Wnrlmrs' Caffipensation.Iusu>nce MEavatr B,mlder-./CtmtractGm EIectdcian-.(Fhunbers
AppUcant Infwmiafign Please Print
I&Al2- �d-�� ►��� LAG
Adams
.Cftw ti n a'� 0 �=� 17 � q 3
AreTu an emplo}er?:Qpeckthe appropriate box: Type of project(required):
red):
I.L'I I=a employer i,, cL, 4 ❑I am a general contractor and I 6. New c im d _
employees(fu]I andfor part-timed* have hirers flee sub contractors ❑
2.❑ I am a sole proptietor orpartner- listed outhe attached sheet. I ❑Rento&Hng.
These sab-�cantractors have ship and have no etnpla�yees ' � 8. ❑Demalitioa
wod-ng fnr=in any rapacity_ employees and hnre wo&ess' 9..❑B.uildmg addition
[N4 ems'Camp_fiL=ance COOP-*nervan I
required-] 5_ ❑ W-e area corpasafion.an�dd iittss 1a❑Electrical repairs ez a difions
Officers rive exercised flie
3_❑ I am.a homeowner doing all v�ork 1L❑I' - g repairs or$tiditiOns ,
o workers' right of exempfion per M(M 7 r
€� gip- 1... l�o -
insurancerequiregT c.152,§1(4).andwe have no of
employees.(No workers' l3_❑'other
cam-irmMM Z Mqu�]
*Any a ppHcznt&atchedmbaaPlmn- dLsa compensafioa policy iafnrMsuolL,
T 9ZMeDWners WbD sabnat dais 3ffid2V4 iudbuting they axe chin MU Wadi sn4 then]rise=tside caTtIctors mst submit gum af&davk mdicctiao sad
fcaat<ac' tbst chect t ds bax must sttarhed sa sddifianal sheet sbnxing thenme of the sub-caotmcbm and state whether ar not fbnse evfities have
employees 7fthe en try coxa r+is be employes,dheynnu t pMvide ifiumir uorltea'amp.pGlky number
I cam arc erripi'�r t7iat is prcruiciircg yoark¢rs'corrtp¢res�ort irtstcrarree fur�e}s¢nrpfn}�e¢s $eIoav it fit¢paTi�ar�3 jab rrte
inforraadom
Insurance Company Dame: /�/Lc/�1 — /!/�S jjl�(A-✓tiC-t/
Po•&cy 4 or-Reif-ins.Lis t /7-1/yj P':?6z e) ExpirafiouDate: //"/ )-,o �6
Job Site.flddse= G�/'b� Ct Citpf5#ate1 Q: '�`e �/lL� �i 6 32
Attach a,copy of fhe workers'compensationpoHey declaration page(shatving the policy,number and expiration date).
Failure,to serum coverage as required under Section 25A a€MGI,m 157 can lead to the imipositioa of criminal penaldes of a
$ire up#a$1,54QOU sad car one-yearit�mpfisoumeut,as'vrell as zivil penalties im the form of a STOP WORK ORDER and s fsme
of np to$250-00 a day against the violator_.13e a ised did a copy of this statement maybe f xwarded to the Office of
Investigations of the DIA for inssumnee covera -mrificatirm
Fafa tt- tp tlrsPrans Pam! a. FlY fhatfJte inL-rmatyorrpntrtdabote is trug artd correct
Date /6
OBWid am arrIy. Da jwt writs in fps area,€cr be=mpleted by tidy artewn 00rcb:t:
City or'Tawn: Pernzit1T;cense
IssningAuffivi-ity(carte one):
L Board of$ealth :r..Bw1i ing Department 3.( Town Qerk 4 Mectrical Fuspector 5.Plumbing Inspector
6.Other
Comtoct Person: Phone#-
laformation and lastructions
hfrme�C fs CTC0=_9 Laws chap M regtores all employers to provide wades'compensation for fbeg CMPICY=.
this statote,an Moyne is defined as-�. f
$vmypmsoninthe service of airy conract ofhury
or' H04 oral or writs
An.=nFIOYEr is as"an bsrwidm'rl,parta=bip,associaH n;anporation or other I entfty,or any two or mare
of the foregoing is a Joint eafmTrise,and inchuEng the legal representatives of ed emp th loyer,or e
receives•or trastee of m.dividal,pattomsliip,association or otherlegal enfitY,cap employees. However the
owner of a.dwelling a havingnot more than tbrw apartments and who resides - or the occupant oft he -
dWPMa hozrse of employs persons tD do mamfeamce,ca3sivric on or air wolk.on such dwelling house
or on the grotmds or app�.ua�thereto shallnotbecanse of such empl be deemed to be an employer."
MGL chapter 152.§25C(6� sbr3es that"everysfafe or local licensing agen sTiall withhold$ae issuance ar
renewal of a license or permit operate a bus:imess or to construct bid in the commonwealth for any
applicantwho has notproduced ptable evidence of comphan.m With insurance coverage required,"
Additionally,MGL chapter 152,§25 sb±cs aNeif erthe ca,n,�can any ofits political snbdivi_sions shall
enter min any contract for the p c6 nfpnblic woIkUata acceptable 'dense of compliancewith the msm-mm..
rC qai em easfs of this cbapfer have been eked fn the contracting
Applicants
Please fill oirt the workers' oomperlsatian affida ' completely,by fire boxes that apply to yo=situation and,if
necessary,supply sub-- r(s)name(s), (es)andphone el(s) along with their certificate(s) of
insurance. Lmmited Liability Companies(LLC)or Liability P ips(LIP)withno employees other than the
members or parta=s,are,not rbqui ed to corny workers' P,
- M��ce If m LLC or LLI?does have
employees,apolicyisregnntd. Beadvi`sed.that this aff may esobmittedtothe Department oflndustrial
Accidents for conE=afion of insraance coverage Also be a sign and date the affidavit. The affidavit should
be retumed to the city or town that the application for the p license is being req not the Department of
Exb2stap,__ dam. Should you ba4e any gnestions reg�dmg a law or- you ate req�dfo obtain a Wozi=,
compensation policy,please call rite Department at the number below Self-mscned companies should enter their
self-i*+surance license number am the appropriate line.
City ar Town Of c a s
f _
Please be sore that the affidavit is complete:and printed I ly. The Departm has provided a space at the bottom
of the affidavit for you to fiIl oirt in the event the Office v firras has too ' atact yoaregaz ding the applicant_
Please be sure to fill in the pen titMcense mrubes will be used as a refer bear. In-addition,an applicant
that mast submit mtrltrple perm license apglit:aliam' any given Year.need only one affidavit indicating cm ent
policy mfi:)rm.ation Cif necessary)and Hader`Job S' 1a s"the applicant should "all locations in (sky or
town)--A copy of the•affidavit that has been.offi ' sbimped or marked by the city or may be provided to fhe
applicant as proof that a valid affidavit is on file furore permits or licenses Anew offi imxst$e filled out each
year.Where a home owner or citizen.is n a license or permit not related t4 any b commercial vie
a dog license or peunit to bran leaves etc.) person is 1QOTreq3iedtn complete this offi t
The Office of InvestigH&W would HM to. your in advance for your cooperation and sbovl d Yon. any qu o�>
please do not hesitatr to give us a call.
The Department's addr$ss,telephone and nambea:
�c}f ltrd�i�l A�.ent�
f �of� tia� •
-
Bwtma.,MA Ed11F
Ta
�-- it
617 727 7749
Revised 4-24-07 7-mas vfdia.
-- - -- j._. - � •
pi �llbe tpanznzwruuecr�l/z a�C�/�/CaQoac�uateCCa.
�\ Office of Consumer Affairs&Business Regulation i
uHOME IMPROVEMENT CONTRACTOR
Registration: 171331 Type:
Expiration `/�=?[20a8 LLC y
HERBST HOME 1Mf..'_' l=NT1L C j
r
JASON -HERBSTr4
35 PEEP TOAD RD
CENTER VILLE,MA 02632Undersecretary
Massachusetts Department of Public Safety. -
YJ Board of Building.Regulations and Standards
License: CSSL-106051 "
.Construction Supervisor Specialty
JASON HERBST
36 PEEP TOAD ROADk
CENTERVILLE MA 02632jf4 = {"
nn ,,' r'
( „ten l._ Expiration:
Commissioner 10/01/2018'1
License or registration valid for individual use only
before the expiration date. If found return to:
'3 Office of Consumer Affairs and Business Regulation
j 10 Park Plaza-Suite 5170
j Boston,MA.02116 j
a
Not valid wit out signatu
Construction Supervisor Specialty
Restricted to
CSSL-RF-Roofing
CSSL-WS-Windows and Siding
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation oPhis license.
DPS Licensing information visit: WWW.MASS.GOV/DPS
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