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Home My WebLink About0025 PATRICIA STREET 'H,.� -:..._- .a..:e;Es'.� C ti.'. a .,,>• 3 „ .'„7 .� Ay ,., .ti 'wc .„ ��1'' �`S^" �- '9".a - r � , .r -z..+ ,; A - .� c< ,�, ': KxX_. Y.$• �a � � Y aWo-, t a !r �= ` •. w 001 ' u Will ate: i v • a i 0 • r i 4 i r Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee 73s,6o * MUMSznsi.E, 1 . A $ Richard V.Scali,Interim Director FO MA'I 7/ Building Division Tom Perry,CBO,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 ram)S;f-) Not Valid without Red X-Press Imprint Map/parcel Number V+ IcJ� \\ Property Address 3 PCB { C a 0,R, C,(V� t Residential Value of Work$ bs��i Minimum fee of$35.00 for work under$6000.00 m Owner's Name&Address l)p C-\ r�D\x� lank\vr� dl1R „ Contractor's Name C1001N6_1 Telephone Number 5b�'9�b-030� Home Improvement Contractor License#(if applicable) f 6815 Email: Q 5 r oo P,n� e Cot e CG S`-.,e1' Construction Supervisor's License#(if applicable) 0 99�1 Lf 0 �_I�f�2�(� G�fIPrn1P]nn� E2Workman's Compensation Insurance p Check one: r SE f 02 2014 ❑ I am a sole proprietor ❑ I am the Homeowner TOWN OF BARNSTABLE 9-1—have Worker's Compensation Insurance 3 Insurance Company Name c!�rG( 1 nSvdC n�Q . Workman's Comp.Policy# '1V C Qj 0 1 O'�),0 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) r ORe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders:U-Value (maximum.:35)#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 required.. SIGNATURE: l " T:\KEVIN D\Building Changes\EXPRESS PERMIT\EXPRESS.doc Revised 061313 a The Commonwealth of Massachusetts Department of IndustrialAccidents F Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Cook's Home Improvements, Inc Address: 90 Mendon St, Suite 6 City/State/Zip: Bellingham, MA 02019 Phone#: 508-966-0306 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 6-7 4. ❑ I am a general'contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. T ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. ❑ Building addition 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" I I.❑ Plumbing repairs or additions myself. o workers' comp. right of exemption per MGL Y (N P n 12.0 Roof repairs insurance required.] t ` c. 152, §1(4),and we have no employees. [No workers' 13.0 Other ` comp. insurance required.] *Any applicant that checks box#1 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. $Contractors 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 must provide 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: Star Insurance Company Policy#or Self-ins. Lic. #: WC 0709020 Expiration Date: 11/28/14 Job Site Address' r �101 CSCI G City/State/Zip:Cf►rf VI 11,Q MA 1b�a 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 under the pains and penalties of perjury that the information provided above is true and correct Si afore: Dat e: s Phone#: 5089660306 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#: Information and Ins ructions Massachusetts General Laws chapter 152 requires all employers to pro de workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in t service of another under any contract of hire, ex�ess or implied, oral or written." An employer is defined as"an individual,partnership;association, co oration or other legal entity,'or any two or more of the foregoing engaged in a joint enterprise, and including the legal epresentatives of a deceased employer, or the receiver r trustee of an individual,partnership association or other gal entity, employing employees. However the owner of dwelling house having not more than three apartments an who resides therein, or the occupant of the dwelling h� e of another who employs persons to do maintenance, onstruction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because f such employment be deemed to be an employer." MGL chapter 152, SC(6)also states that"every state or local li using agency shall withhold d the issuance or renewal of a license permit to operate a business or to const ct buildings in the commonwealth for any applicant who has not`p oduced acceptable evidence of compli nce with the insurance coverage required." Additionally, MGL chapter 2, §25C(7)states"Neither the co onwealth nor any of its political subdivisions shall enter into any contract for the p rformance of public work until_a ceptable evidence of compliance with the insurance requirements of this chapte ave b`e`en,.presented to the contract g authority." Applicants Please fill out the workers' compen ation affidavit completel , by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)na e(s), address(es)and hone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited ability Partnerships(LLP)with no employees other than the members'or partners,are not required to carry workers' co pensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised\that this affid vit may be submitted to the Department of Industrial Accidents for confirmation of insurance cove,age. Also a sure to sign and date the affidavit. The affidavit should be returned to the city or town that the applicat on for permit or license is being requested, not the Department of Industrial Accidents. Should you have any quel'ons r garding the law or if you are required to obtain a workers' compensation policy,please call the Department apt th number listed below. Self-insured companies should enter their self-insurance license number on the appropriate lin City or Town Officials Please be sure that the affidavit is complete and priniled le '.bly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the O ce of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number ich will be^,�sed as a reference number. In addition,an applicant that must submit multiple permit/license applicatio s in any giventiyear,need only submit one affidavit indicating current policy information (if necessary) and under"Job ite Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been off Tally stamped or m\noelated by the city or town may be provided to the applicant as proof that a valid affidavit is on fi for future permits orses. A new affidavit must be filled out each year.Where a home owner or citizen is obta' mg a license or permit to any business or commercial venture (i.e.a dog license or permit to burn leaves c.)said person is NOT rd to complete this affidavit. The Office of Investigations would like t thank you in advance for your coo eration 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 lbepartment of Industrial Accidents l "t Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877-NIASSAFE Revised 7-2013 Fax#617-727-7749 www.mass.gov/dia f ub/1-11/21-114 11:JJ Kar l Lrowe l I I nsurance (FAX) P.001/001 CERTIFICATE OF LIABILITY INSURANCE DATE 12014M,DDiYYYY) Eel2201a 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 ALYER 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(Iss) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms end conditions of the policy,certain policies may require an endorsement. A statement on this certiflcate does not confer rights to the Certificate holder In Ileu of such endorsement e. PRODUCER Karl Crowell Ineurence Inc, Karl Crowell Insurance,Inc. rARNJ. ,qJ0B)747-7744 608 747.1730 38 Cordage Park Circle EMAIL , karl Crowell veri:on.net Suite 224 PRooucER .184 Plymouth MA 02360 INSURED iNnumn A Arballa Protection Insurance Co, Cook's Home Improvements Inc. iNsumpm m Star Insurance Company 77 Cross St Bellingham MA 02010 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. IN SR TYP90FINSURANCE ADDLBUBR P LIMITS GENERAL LIABILITY EACH U9R4NC 1000 000 A X MERCIAL GENERAL UABILrrY 0500004228 6/419014 8/412016 DAMAGE TO NTE 850,000 CLAIMS-MADE a]OCCUR M D 9 000 _ - PERSONAL A ADV INJURY 51,000,000 OEN RAL AQQR19&TE s2,000,000 LAOOR LIMITAPPLIEa PER: PRODURT§-COMPIOPAGO s2.000.000 J X 1 POLICY pp LO f AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO S Es accident BODILY INJURY(Pat Person) 6 ALL OWNED AUTOS BODILY INJURY(Peraocldenq S SCHEDULED AUTOS PROPERTY DAMAGE 6 HIRED AUTOS (Per Ooetdent) NON-OWNED AUTOS S i UMBRELLA LIAR HOCCUR CH OCCURRENCE EXCESS LIAa i &MADE EO E DEDUCTIBLE WORKERS COMPENSATION X C STATU- OTH• AND EMPLOYERS'LIABILITYED a ANYPROPRIETOR/PARTNERIEXECUTIV / WC0709020 11/28113 '1'1-12SM4 E:LEACHACCIDENT 10%000 OFFICERIMEMBEREXCLUDED? N N/A (Mandatory In NH) E.L DISEASE-EA EMP Y 100 000 If ee describe under E.L.DISEASE.POLICY LIMIT 600000 DESCRIPTION OF OPiRA110NS I LOCATIONS I VEHICLES(Atfaoh ACORD 101,Additional Remarks schedule,Ornate span Is required) CERTIFICATE HOLDER CANCELLATION INFORMATION ONLY SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NO RIGHTS CONFERRED THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS., AUTHORRED REPREBENTAT:VE'.:, 4CW> 01088-2009 ACORD CORPORATION, All rights-reserved.. ACORD 25(2008109) The ACORD name and logo are registered marks of ACORD Wes. .. 1. .. _ /re orulrrrrrrcealff n 'C�il�rlJJac�lce�lJ ' �. dS��rrifaSSY[ �ep ., + :,; Saf .! t _-L\ Office of ConsumerAffarrs.&BusinessRegulahoo° �-- Board of Building Regulations and Standard.' h OM ve"'4, � E IMPROVEMENT CONTRACTOR. Construction Supers nor Specialh• Iy (Registration 116815 Type:,, -S cznse: CSSL-099140 Expiration 7/24/2016 DBA KENNETH L COOK COOK'S HOME IMPROV€M€NTS WC. 5• 77 CROSS STRE'f KENNETH COOK BELLINGHA:M MA 02019; 77 CROSS ST BELLINGHAM,MA 02019 - �"' r.rrl�:. xe31,afii-ems' - Undersecretary 1.1111/2015 t a o A YKUYUSAL 8/18/2014 COOK'S 1-508-966-0306 Home Improvements,Inc. Email:CooksRoofing@comcast.net 1-508-966-2233 FAX 90 Mendon Street,Suite 6 Bellingham,MA 02019 www.CooksRoofing.com Proposal Submitted To: Work to be Performed At: Name...............................Donald Paxton r . Street...............................22 Brook St , 25 Patricia St City&State................Franklin,MA 02038 Centerville,MA 02632 Phone..............................508-528-9196 The contractor agrees to do the following work for the Homeowner: • Remove shingles from all roofs on house,renail all loose boards. • 8"Aluminum drip edge on all edges of roof,brown drip on on rake gable....Replace all vent pipe flanges with aluminum based and E.P.D.M.rubber flanges • Counterflash chimney/Change lead on chimney/Point and seal chimney/Coat chimney with Geocell 2315 masonry coating/Install stainless steel top with screen.We will build a cricket behind chimney. • Replace any existing roll flashing or step flashing that needs to be replaced Install CertainTeed WinterGuard Ice&Water Shield(with up to`a 50 yr.warranty,the longest in the industry) Bottom 6'of all roofs, in valleys,around chimney,and against walls where shingles meet siding • Install CertainTeed"DiamondDeck"High Performance Synthetic Roofing Underlayment • Install AirVent ShingleVent II ridgevent from gable end to gable end. (Lifetime warranty)ShingleVent 11 is the best performing ridgevent on the market proven through testing.See test results brochure provided- • We will install appx 26-8"x16"brown soffit vents to balance the soffit to ridge airflow.The ridge vent and soffit vents that I have proposed will meet Federal Housing Authority minimum requirements and all shingle manufacturers requirements for warranty. • Install bathroom fan vent in back roof for future use ' • Their will be at least 6- 1 & 1/4 inch galvanized roof nails per shingle.................We will Remove all exterior debris at end of each day • CertainTeed LandMark Lifetime Warranty Class A,10 yr StreakFighter,110MPH Wind Resistant,Architectural Shingles-------------------- $ 6,292 Optional Shingle Upgrades ; Max DefHeather Blend • CertainTeed LandMark Pro Lifetime Warranty Class A,15 yr StreakFighter,116MPH Wind Resistant,Architectural Shingles------------- $ 6,571 • To replace any Ix8 roof boards-$3.10 per foot For additional Optional Upgrades--see page 2 Sure Start Protection on Lifetime Shingles,Coverage 10 yr Material and Labor Manufacturers'Warranty 10 yr.guarantee on my workmanship with a FREE 5 yr roof inspection upon request Certified CertainTeed Quality Master / CertainTeed SELECT Shingle Roofer / CertainTeed Master Shingle Applicator 21 yr.Member of Mass.Better Business Bureau /.Member CertainTeed Professional Roofers Advisory Council for 17 years, Price for the permit is included. All material will be installed according to CertainTeed specifications and Mass.Building Codes.All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of.......With payments to be made as follows:.....1/3 upon signing contract and balance due upon completion of the contract.Invoice will be sent out for the balance due. Any alteration or deviation from 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.Owner to carry fire,tomado and other necessary insurance upon above work.Workmen's Compensation and Public Liability Insurance on above work to be taken out by..... Cook's Home Improvements,Inc....MA CS SL 99140 MA.Reg.116815;R.I.Reg.9058 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies of the contract should go to the homeowner and the contractor. ' Subcontractors-The contractor agrees to be soley responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor.The contractor further agrees to be soley responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance Upon signing,this document becomes a binding contract under law.Unless otherwise noted withing this document,the contact shall not imply that any lien or other security interest has been placed on the residence.Review the cautions an otices on page 2 carefully re si ing this contract. _Homeowner's Signature Contractor's Signature �4 62�& Date of acceptance: Date: 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 the 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 the agreement. ' See attached noticeof cancellation for an explanation of this right. Page 1 TNe tq, I snnxsrns , * ` '""W Town of Barnstable �fD MA'I s Regulatory Services Richard V.Scali,Interim 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 as,Owner of the'Subject property hereby authorize 1�Qv1�1¢ Cox icca ,S- TrrbrO 40 act on my behalf, :fin C in all matters relative to work authorized by this building permit application for: " (Address of Job)„ Signature of Ow er Date Print Name 4 If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. ; TAKEVIN Muilding Changes\EXPRESS PERWREXPRESS.doc Revised 061313