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HomeMy WebLinkAbout0349 SOUTH MAIN STREET Isom! AK PAN n"Unw,May sum A111 yzgjp ago U. T IX .4i, ly IN, N-1; V 14�12 MEN Ww"MUNMpamw MI. 'ilili, T, 15,10 ftvPi ­qj4% INS M"(10-4 k SAP 14 " ,I.,' �b A 1 st, ,A "I N, x man t tij N, fj 14 t, y"W i �I __ I fo moms �'l -,� `-4�, 11—T,", oiir ROW T Mow 12 OPT R 'A Rp AMDRY'i J,�'Jon, Wt 0;I't it" 4", , I. ,� 'I- VA" 010,11 to If ivory Y_ I 1z wn x , illli'�'4ij""�, - 'VIA, J aj A R"?iT ffiji-j "T 0 a N"My W"MA "U",41 01. v S W—M A PIP in,.1,I q­lj� am A � WAINA .qA this T� 4�i Hlltlalltih M, 'PVt Mt "4 Di W- M yj,y 'Pop ;t !1', 1 w.n, TO— �q OF,' 1,4 0 RR, I to"p 4w4j J jaqqjq QQQ v--ol I & WWW_ If TgA SMAUROPf"fl,",M wow Vot J, Air 1­'1r1'_1A­.RkWEfJ& Ki VMS it _U­W, W-11 Oki MIMI "M P:" Z�4 kii _tt, TH—WIWIt 14 —fie. I V11I v WS THEW"" CIL. AA NA "l. N""',4 _Vii I v, vv it o qgkuw x IQ A Y I jY4 4 S VMS WMAR i,int" Mir P" Maio IN gm Way— WME 41 lik" WIMSAW i74 ,i -W-M . ,ci,lin 4 y VI RIJW2, 10, ,V0 01 'k�Mo­ ­1K h—qw- pi I Jav In I rl_1111i� 11 AN 41,0%19P)4R30 y,j IF N"i "d 1V3 1, ........ I Town of Barnstable Ida r3� Q, Fxpires 6 months from issue date Regulatory Services Fee LJ , � , Thomas F.Geiler,Director IYIA� �►�l�nll� 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 —1 Not Valid without Red X-Press Imprint Map/parcel Number QZ l 0 69 Property Address 3 yq C,;Du+h W-4Oti n S"r Ce-✓rL f V 1( �e �4A [Residential Value of Work___7�n Minimu Z of$2 .00 for work under$6000.00 v Owner's Name&Address n C d�h rl So j'7 r' D�►1�}Vl Contractor's Name TnS2.,r C n n��,r ,r. �n n, L L C Telephone Number Home Improvement'Contractor License#(if applicable) Construction Supervisors License#(if applicable) 8 2rWorkman's Compensation Insurance NJJ1.01r " 9 2011 Check one: ❑ I am a sole proprietor FOWN,OF BARNSTAB E I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 0,41 or-)0.( �.�rl i 0-n R1 r e L n S u ret r\ C C p Workman's Comp.Policy#_ 1n1 C- 669 9 ,40(ob Copy of Insurance Compliance Certificate must accompany each permit., Permit Request(check box) dRe-roof(stripping old shingles) All construction debris will be taken to Sarljw ❑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 required. SIGNATURE: Q:\WPFH,ES\FORMS\building permit forms\EXPRESS.doc Revised 090809 The ConwWnwealth ofmassachusetts Depa tmw 0fjfi&qpqVA ccidents Office ofinvestagadons 600 Washington Sweet Boston,MA 02111 Workers' Com enaction wwrti mass.gov/dJa P Iasuirance Affidavit.-Bwlders/Confractors/Electricians/PIuuabers A Iicant Information Please Print L 'bIV Name(Businessrorgamzation&dividuai): Car�S-k'uL- -�a LL L Address: City/State✓Zip: c; ' 1f`{,c� Q�6 3 Phone#: . a�o- V?8 �� 9a Art: otr an employer?Check the appropriate boar 1. I am a employer with 4 []I am a general contractor and I Type of project(re9ni,*d); employees(full and/or pa time) have hired the sub 6. ' 2.❑ 1 am a sole proprietor or cos []New construction j partner- listed on attached sheet. �7.. Q Remodeling ship and have no employees These sub-contractors have working for me in any cgxtdty employees and have workers- working ❑Demolition. [No workers'camp_insurance comp instnaace t 9.. Q Banding addition r pled 1 5. ❑ We are a corporation and its 10.❑Electrical 3.❑ 1 am a homeowner•doing all work ofl5cers have exercised their repairs or additions myself.[No workers'comp, right of exemption per MGL I LE]Plumbing repairs or,additions insurance required]t ' c 152,§1(4),and we have no 12.[]Roof repairs. emP1oyee&[No workers' 13. � ❑.other carmP.Insurance required.] Any aPPlic ut that checks box#1 must also fill out the section below showing their workers' 4 Homeowners who submit this atdavit indicatingmPensation Policy information ;Contractors that check this box must ' doing alI work and then hire outside contractors amst saber a new affidavit indicating such. employees If the sub-contractors bave��j an additional sheetshowing the name ofike sub con i emp oyees,they must tractors and state whether or not those entities have pmvide their workers'warp policy,mm�ber. � I am an employer that is provid�ig workers'eo satfon info on buuranceformy employees Belo a the P o j w ley and job site Instaance Company Name Polrcy#or Self-ins.L ic..#: PVC- 0 n Expiration Date: (D Z� 3 Job Site Address: � Attach a copy ofthe workers'compensation policy declaration City/Stat-q P' Cn{- rvl Q ,MA O2632 Failure to secure coverage as r page(showing the policy number and ea equired under Secti pirafion date), crag on 25A ofMGL c 152 can lead to the imposition of.criminal penalties ofa fineof'up upto to$250.00$I,500.00a andayd/oragaiast one-yearthevio imprisonment,as well as civil penalties in the form ofa SIOP WORK ORDER and a fare j lator..Be advised tliat a co of this Investigations of the DIA for•insurance coverage.verification. PY statement may be forwarded to the Office of i !do hereby eertd 'rs dpenaltles o f pe&7 that the lnformad*n provided above is true and sorriest.. Si Dates l I.OJj idal use only. Do"of write in this area,to be coiVieted by city or town o ffciQi City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building]Department 3. P City/Town¢ ,Cleric 4 6.,OtherElectrical Inspector. $.Plumbing Inspector Contact Person: Phone#• � I FRASCON-01 MOSU ACC o DATE(MMIDDIYYYY) CERTIFICATE OF -LIABILITY INSURANCE 9/26/2011 PRODUCER (508)676-0309 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Viveiros Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 376 Airport Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR p Fall River,MA 02720 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. , INSURERS AFFORDING COVERAGE NAIC# INSURED Fraser Construction LLC INSURER A National Union Fire Insurance Company P.O.BOX 1N6 INSURERB: Cotult,MA 02635- 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 ADD` POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONsm E OF INSURANCE LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurenoe $ CLAIMS MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ RO- POUCY P LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN _EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STA ITUS OTH- AND EMPLOYERS'LIABILITY TORY A ANY PROPRIETORIPARTNER/EXECUTIVE YIN N C009930601 9/26/2011 9/26/2012 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? Y (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes describe under 500,00 SPEG�IAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Fraser Construction,LLC DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN PO BOX 1845 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Cotult,MA 02635 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i J(!Nte -60/m�� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 517,0 Boston, Massachusetts 02116 Home Improvement C6ntrhgtofRegistration Registration: 112536 �_ --�--� Type: DBA Expiration: 3/23/2013 Tr# 209024 FRASER CONSTRUCTION CO. Pil DEAN FRASER P.O. BOX 1845 COTUIT, MA 02635 /� 7 `} _ Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CA1 Co 50M-04/04-G100�r 1a em ��216 ������� OfficeTf/ s�l; ines�a' on License,or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR ' before the expiration date. If found return to: Registration: f;112536 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza 'Suite 5170 Expiration: .3(23S2,013 DBA Boston,MA 02116 kF R CONSTRICTION CO , DEAN FRASER 104 TWINN VIEW LNE gQP E FALMOUTH,MA 02536,v __ Undersecretary otval► wit ut si re 9 s-Department of Public Saf-ty w` Board of-Bu-Building Regulations and Standards CbftattucUbn Supervisor License` License:-,CS_'97MS I DEAF! MA4Y ,.• - -� E �t, ` 104 TV{!I s. EAST i AL .. t i .; A 6�536 Ex .. ,. piration. W7/2013 . C'onunissioner Tr#: IGM 4 -*CONSTRUCTION -9 . MM Fraser+Co'nstructionLLC.. : P.O. Box 1845, Cotuit MA. 02635 ROOFING Email: fraser_constructio@verizn.n etRECE VED www.fraserroofing.com FAX 1-508-428-0123 911661508-428-2292 HICL#112536 CS#97668 RE-ROOFING PROPOSAL DATE: September 6, 2011 PHONE: 508-775-9139 NAME: Karl Johnson, Eben L Johnson EMAIL: karlandrewjohnson@gmail.com MAIL ADDRESS: 349 South Main St Centerville MA 02632 JOB ADDRESS: Same FRASER CONSTRUCTION hereby proposes to perform the following services in a neat, professional like manner in accordance with the manufacturer's specifications and local building code. -Remove and Haul away all of the old roofing material -Re-nail all plywood sheathing as needed. # 1�an+ . Fraser Construction will include'a 4 Star Upgraded warranty with the. selection of any 30 year shingles or any Lifetime shingles. CertainTeed SureStart Plus- The extra measure of protection when'a credentialed company-installs an Integrity Roof System. 4 Star warranties have a 20 year Non-Prorated Coverage on any 3 tab shingles (XTAR 25 & 30) with a 50 year Non-Prorated Coverage for any lifetime shingles (Landmark Lifetime, Premium, 8s TL), which will cover incase of any in warranty,repair, Labor and Materials, any Tear-Off, and any Disposal Fees. Upgraded wind warranty available on the following products when special application methods are used. See description below and in the .CertainTeed SureStart plus brochure enclosed. Supply and Install - CERTAINTEED LANDMARK: LIFETIME WARRANTY CLASS A FIRE RATED, ALGAE Resistant, Extra Heavy Weight,Self Sealing, Multi- Layered, Architectural Style, Fiberglass Based-Asphalt Shingle with New England's Exclusive, COPPER/CERAMIC-Stones with a Full 10 Year Warranty against ALGAE Containment. . With a SureStart Plus upgrade customer will receive 10 year 130 mph wind-resistance warranty with six nails in common bond area, Fraser construction includes six nails in common bond area at NO additional cost. See actual warranty for specific details and limitations. , MAIN HOUSE Color: -vg Prwo©`-b PRICE- $8,750.00 Initial NOTE: Price based on roofing and installing proper ventilation on vent able attic areas. .All other cathedral areas can be vented, but will be priced at TIME & MATERIAL. . 1 , f GARAGE J Color: PRICE- $4,995.00 Initial Re-flash and re-shingle white cedar on dormer area where nece ary. TIME 8v MATERIAL � Initial Vents for soffit- Smart ve Gutters & Trim- C-)-¢� TRIM- Fascia trim: Remove Old gutter- $295.00 Initial PRICE 8s DESCRIPTION OF GUTTER INSTALLATION 5" Snap Lock seamless gutter system installed. 2x3 downspout(s) installed using zip screws.' Placement is to be determine_ d by the installer and/or customer at time of installation. Downspout to be installed using alcoa clips. Price is for new gutter and downspout at all areas with existing wood gutters and downspouts on both buildings. Areas with existing aluminum,gutters and PVC gutters will remain as is. PRICE- $2,180.00. Initial )?/ Build out Fascia flush with rafter notches to''a commodate }ew gutter. TIME & MATERIAL Initial Product & Installation tails Supply & Install - (Soffit Venting)`hick's Ventilated Drip Edge or S" Aluminum Drip Edge with existing soffit vents. Smart vents over white drip edge. Protection against damage to the roofing materials and structure. The most effective system is-a balance of air intake and exhaust that creates a uniform flow of air through the attic. This system creates a condition in which the roof temperature is equalized from top to bottom, supplying a uniform air flow along the entire underside of the roof deck. Supply 8s Install CertainTeed Minter Guard or Carlisle WIP: (Ice 8a Water shield) (WIP= Water & Ice Protection) Waterproof Underlayment System (3ft: on.eves and valleys, l K on rakes, walls, and skylights) Water and Ice Protection (WIP) is a self-adhering- roofing underlayment used on critical roof areas such as eaves, rakes, ridges, valleys, dormers and skylights to protect roofing structures and interior spaces from water 2 Possible Extra-Any rotted or otherwise deteriorated trim boards, sheathing, lead Clashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$60.00 per hour, plus 10%0,mark-up materials FRASER CONSTRUCTION Warranties the labor for as long as home is owned by current homeowners mentioned above. FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. CERTAINTEED Warranties the shingles and labor 100% through the Sure Start Warranty duration. CERTAINTEED Warranties the shingles to be.ALGAE resistant forthe duration of the Sure Start Warranty depending on the shingle that was purchased. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge,over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should. carry fire, tornado and other,necessary insurance upon the above work., We, if not accepted within thirty,days.may withdraw this'.proposal. FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public . Liability Insurance on the above work, certificate available upon request.. DATE OF ACCEPTANCE: q L WarrgA coorrQc�cs 3�on�a be f���'v G� � Knc1 .'`ohnsan 51ntr.�1 '`hnrsDv\ �SPo tix� Moo omeowner Fraser Co uction, LLC For company use only. Date Received Date Started:_ Date Completed Job estimate: Dean/Mike # of squares:_ Billed Material ordered Extras Paid ,Available Discounts , . 4 a� OFWE� Town of Barnstable •Permit#�� ti Expires 6 months from issue date BMMSTABM : Regulatory Services Feed pi 16.39. � Thomas F.Geiler,Director ; l _ Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERART APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 207 loo Property Address 3y 9 S . (Y)c� i''� S-� C t?►'��e v /°f Residential Value of Work 4 114 yot� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address K iq P_L J,YA,)sclj . Contractor's Name !`$ �ltie0 e f9 C U M i 4 en- Telephone Number 5_0�7/7 7 S- 12,5q Home Improvement Contractor License#(if applicable) 1 35 /7 / Construction Supervisor's License#(if applicable) ,-PRESS PERMIT Workman's Compensation Insurance Check one: - AUG 2 2 2008 ❑ I am a sole proprietor . ❑ amthe Homeowner TOWN OF-BARNSTABLE have Worker's Compensation Insurance Insurance Company Name u4 eas-4 .rn z%s"r41-A L-f_ A • cV\c Workman's Comp.Policy# W C 755 3 7 D q Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ e-side Replacement Windows. U-Value -.35 (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 A1017A (,{/1 C:Form.a:emmtra - - - - - LLI IL ✓2re Tavevevyrareaosa�GE .� -- ---- J Board or Bulldiog Regulafior�is and St�nd�rd UCccse or re0stm(lon valid for zdal tree only - HOME IMP OYEMENTCONTRACTOR before the exp(ration datt. If pun d rvturato:. �� 135174 BoardofB�cildinLRegalptia andStmdsrds _ 9f2010 Trl 263353 One Ashburton Place Rio y Boston,Die.02108 BEN MACPHERS Q ! 1921YAlVOEJG!-i HYA►NIS,MA 02601 Admroistrator Not valid without signature W — — - - - m e . 00 w 00 - LO m _ .. lf7 co . .i N N ..._ 00 .S7. jr7 RG3 € €ir; rna# c �,a.� rsfrr% girl [a rttl� 6,f114Sa�1 SC3n :n).0 eIY'l�sot'�43�* [c��:'j1 PF�flL .. .. .. .RsPt.YCI i,Y WS ::BEN MCPHERSONI k O. $ X 674 . SAP NtTAKE,:MA.02630 e ai irt, 9 kT2012092 r' A �.�Liil'N ts.gF,x .'i9�q :. k`. v sw- f �F8ti3,S` N`1�8 �`s p i i". #w3 d" { sas x g xx I f 54°iY.t4 + r tau' J � � XX F s r � � a� � ..�x f3 All Cape Aluminum Estimate 192 Iyannough Road Hyannis, MA 02601-2018 Date Estimate# 508-775-4299/fax: 508-778-8999 8/12/2008 081208A Name/Address Ship To KARL,EBEN&SARA JOHNSON 349 S MAIN ST CENTERVILLE,MA 02632 I Customer Phone P.O. No. Terms Project 508-775-9139 REPLACE WINDOW Description Qty Cost Total HARVEY CLASSIC VINYL WINDOW(S)-ALMOND 1 893.00 893.00T FACTORY MULLED DOUBLE HUNG,FOAM FILLED FRAME AND SASHES,LOW-E/ARGON GLASS,FULL SCREEN(S) AZEK-REPLACEMENT OF EXTERIOR TRIM 1X4 60.00 60.00T Subtotal 953.00 Permits&Dump Fees 50.00 50.00 INSTALLATION 350.00 350.00 ANY ADDITIONAL WORK TO BE DONE WILL BE BILLED 0.00 0.00 OUT ON A TIME PLUS MATERIALS BASIS(LABOR RATE $90/HOUR) Subtotal $1,353.00 A 50%deposit is required to bind this estimate. o This estimate is valid for 30 days. Sales Tax (5.0 ) $47.65 Custom orders are non-refundable Signature [ J Total $1,400.65 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 • www.mass.gov%die, , Workers' Compensation Insurance Affidavit: Builders/Contractors[EIectri�c' Pei luzunt Legibly A licant Information Please Pri Name: (Business/Organiz idbu udividual): ICcqe. . Address: 1 2 ct v:V\-uu S 1., City/State/Zip: ilict►nA i' -me,I e, CIZ60� Phone.#: A,ree,you an employer? Check the appropriate box. Type of pioject(required): 1. am a employer with t0 4- ❑ 1 am a general contractor and 1 6 ❑New construction and/or part-time).* have hire,d the Sub-contractors employers(full. 2.❑ listed on th I am a sole proprietor or partnrr- e attached&hart 7. ❑Remodeling r. ship and have uo employees These sub contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 Building addition [No worker' c mp'.-myurance comp.insurance.x rbquired] 5. [j We arc a corporation and its 10_❑Electrical repairs or additions 3.❑ I am a homnowner doing all work officers have exercised tbeir 11.0 Plmmbing repairs or additions myself[No workers' tromp. right df exemption per MGL 12 ❑Roof repairs inccr re t c. 152, §1(4), and we nran havt no employees. [No workers' 13�dOthcr '►ti tl wS comp.insurance required.) Ij *Any applicant that checks box#1 must also fiA out the section below showing their workers'ec)rnpmsation policy information- t Homeowners who submit this affidavit indicating tbey arc doing all work and then biro outside contractors must submit e.new affidavit indicating such. 1{ontractnrs that check this box must attaclrcd an additional sheet showing the name of the sub�antraLtma and rtatn wbcther ur not those entities have employers. Nthr.sub-contractors have urployces,tbcy mustpruvidb their workers'comp.pobcy number. I am an employer that is providing workers' compensation insurance for my empCoyees BeLow is the policy'and job site ' inforrrtation. lns zamcc Company Name: W`'� ( �'�Q'C�� I ✓1Sv1 v r,•�C �. Policy#or Sc1f--ins. Lic. #: �- 5 J 3 O Expiration Datc: - /U 1 Job Site Address: 34 ` J 'YA c^'nS4 e� �y i 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 rcquirrd tmder Section 25A of MGL c. l 52 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 statemrdt may be forwarded to the Office of Iuvesti ations of the DIA for incttraacc coy r-rag e verification. I do hereby certi r the pains-and pe of perjury that the information provided above is true and correr-t Si store: Datr: 2Z IU�S Phone# �� /7- S 'L(29� Official use only. Do not write to this area, tb be completed by city or town offtciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing.Inspector 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees: Pursuant to this statate, an ernplayee 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 anindividual,Partnership, association or other legal entity, employing employccs. However the owner of a dwelling house having not more than tbrcc apartments and who resides thcrcin, or the occupant of the Jwclling house of another who employs persons to do maintenance, contraction or repair work on such dwelling house )r on tbs grounds or building appurtenant thereto shall not becaust of such employment be deemed to be an employer." vIGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or enewal 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 bf compliance with the insurance coverage required." VdditiDnally,MGL ohapter 152, §25C(7) states `Neither the commonwealth nor any of its political subdivisions shall Inter into any contract for the performance of public work until acceptable cvidenec of compliance R'ith the inL.�nce cquircments of this chapter have been presented to the contracting authority. applicants lease fill out the workers' compensation affidavit completely, by checking the boxes that apply to.your situation and, if ccessary,supply svlr�ntractor(s)uame(s), address(cs) and phone numbers) along with their certificate(s)of mnance. Limited Liability Companies(LLC) or Limited Liability Partnerships (LLP)with no-eraployces other than the icrnb= or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have mployecs, a policy is required. Be advised that this affidavit may be submitted to the Dcpa-tmcnt of Industrial ccidcnts for confimiation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should :retuned to the city or town that the application for the permit or license is being requested,not the Department of idushial Accidents. Should you leave any questions regarding the law or if you are required to obtain a workers' )mpcnsation policy,please call the Department at the nurgber listed below. Sclf-insured companies should enter their if i as uranro license number on the appropriate,line. ity or Town Officials case be sore that the affidavit is complete and printed legibly. The D epartment has provided a space at the bottom 'tiro affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant case be sure to fill in the permit/license number which will be used as a reference number. •In addition, an applicant it must submit multiple permitllicene applications in any given year, need only submit onp affidavit indicating c=cnt lacy information(if necessary) and under"Job Site Address" the applicant should write"a11 locations in (city or Nn)."A copy of the affidavit that has br',en officially stamped or marked,by,the city,or town may be provided to the p ir=nt as proof that a valid affidavit is on file for future permits or licenses. A new affidavit.must be filled out each ir.Where a home owner or citizen is obta''ning a license or permit not related fo any business or commercial venture IL dog license or permit to born leaves etc.) said person is NOT required to complete this affidavit. c Office of Investigations would Mm to thank you in advance for your cooperation and should you have any questions, ase do not hesitate to give us a call Department's address, tcicphonc•and fax number. Tha C6mmonwe alth of Ma ssaGhusoits , Departmmt of I.udustrial Accidcmts ` Office of Investigations , 6.00 Was gbn Street Boston, MA 02111 TeI. # 617-727-49-0.0 cxt 4.06 or 1-M-IvMASSAFE Fax# 617-727-7749 11-22-06 www.masR.gov/dia 2(I;;8- 2: 14PV N). 1...�roD n", A0v - CERTIFICATE OF LIABILITY INSURANCE 02 i4/2008 PRODUCER (508)997-6061 FAX (508)990-2731 7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 439 State Rd. l ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC## INSURED Macpres Holdings Inc ItzL;P-P.'a Central Insurance Companies 20230 DBA: All Cape Aluminum t01PERa Merchants Mutual Insurance Com 23329 192 Iyannough Road 1 J*JPEFc Hyannis, MA 02601 UrE�E COVERAGES i THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATFD.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 D LI I PRATE(MINDOrM POLICY BXPIRATON LIMITS T TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY CLP7533703j 01/08;2008 01/08/2009 EA,:, ?REr,E 1,000,00 �r :.� F: _IAEI I r D tr [y NTEo --- 300,000 N4CF I Il nCC.JR i MF E,Ita rA a fsrs:.r 5,000 A L- � R, r,�L&A V . $ 1,000,000 l G ENEPA, AGGREGATE $ _ 2,000,000 2,000,00 ' FEST AUTOMOBILELIABILTTY 7AM0277013760 01/10/2008 01/10/2009 tde�WFr";INf,I F J'-A,JTQ ea ao:ner:' 1,000,000 WNE,40TOS k Bf 01 r X ,IE I,LE_�AUTO-, g G AIJ,`S - _� X N)a,EC nl''i n a.idw li S GRQF E%277 lwv,++i;t ,$ rera:iae Inel .GARAGE LIABILITY _ AL^V i`ra,.ti-E�. .cC:G='.' i -- riTHE=TH+NN, EX:ESSAAeRELLALIABILITY I g *ORKERS COMPENSATION AND K7553704 01/08/2008 01/07 /2009 1*`c-,L EMPLOYERTLIABILTTY E_.EA-7,41:r.;ir!i- - 100,00 A I-w. ::-�1Pr1.,.E Fr:IFN.9ER >�c�JoeO> E alsFA.= Fes.Fti•= s 100,00 — PAL' S00,000 OTHER - _ - - _ i i DCOCRIr'TION OF OPERATION$li.O,CAT'D!"e '+'c'+�w:`ta.'EXCi.:StJNS ADDBD BY ENDORSEMENTf SPECIAL PRltu1S.;"at5 ; For any and all operat -s performed during policy period CANCELLATION y SWAAL.D JVV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE SXPVRATCh DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 WO^S VMJTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FI&LSE 70 NAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF V rl`K 4D LPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHOR=RIEr RESEN'l ATIVE Karen Bernier (508)896-8089 ACORD CORPORATION 1988 PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT _ - 200 MAIN STREET HYANNIS, MA 02601 DATE: 08/22/08 TIME: 11 :36 � --------------------TOTALS-------:----------- PERMIT $ PAID 25.00 AMT TENDERED: 25.00 AMT APPLIED: 25.00 CHANGE: , .00 APPLICATION NUMBER: 200804518 PAYMENT METH: CHECK PAYMENT REF: 4322 .Saks -7S0-6 2 36 8/22/2008 All Cape Aluminum 192 Iyanough Road, Hyannis MA 02601 508-775-4299 Fax 508-778-8999 Town of Barnstable Building Department Attn: Ernestine Via fax: 508-790-6230 . Jason/hasmission to sign documents on my behalf pursuant to building permir Since Ben W President 1 C5 3 i . TO/TO 39dd wnNIvin-Id 3dd3 -nd 66688LL805T 65:TT 800Z/ZZ/80 .d7 i 2x(a KrmGE CXPosED AAfti -it IZ1,966 ✓eA)r PL1I b+pc/ 2t 10 �f Zx (v coccaeS /6"oC , 1 �y Ib 0.14 f r �• 1 f V F,6, 1A) UL a/3KtA1eOA'r u PLYwa® s I 2.,ILL Tw/rDj '' --- 2� 1- -� AuCNOo- /3ocrs-� i METAL (3Rl7Dl iLJU- Come WA6C 00 1(o%I0' Coin FOOT/AJ4- K1�IlEll �" calve 5Lab ov lT'L/N �i:.. SjbftY r WINOOM/ LOW- i I ti '' IA• JJ a t• / 9 - t' 3► Q �� � 5r��r , zgu Couc, ENrny /g' <io" COAJCI Ll i CE��4►e GDwC. SLRi3 Z T27lD GILL ,4tiJCNe2 /3OLTS C n ► a r r� ,Fo u fi Sl-k -T �a�•cs_ Ga��x' i3OSTON, 3\1/LSSAC13 USif-S 0213 3 'WOCI_RS COMPENSATION 13 ; fIDLAVI3' _ j, //ff •with prindpal plUocofbusincsslresidcnast: do hcrcby ccr=ifj;undcr chc ins and <=iuj tath2r: p2 pa�lrx:s ofpayur�;z�ut~ l :m an cmplovcrprov;aing the follow;nsworkcrs- mpcnazioncvclormycploycc KY: injob_ gC b on this - • Ci6,va �vo �� Z - Insura ncc Company Policy Numbcr z soft proariaorsnd h:vc nooncworking forme () I sm s soft proprietor, K�o hz.rc chc followiagw cnccnraor oihomcownv(cirdo in e) nd hvc hum�c�ntraQonJm con o ctinn=ncr poliacr d bclo.� Insus_ncc Comp:nylr'olicr Number ?�amc ofConzr<ror lnsurrncc Co:np.nyjjpol;cyNurnbcr r.:cofCor.;._gor InsuranccQrnp ayfpol;cyNumba I ern = hoz:co��crper:or-- rny:dL �<c<c•` t 1 _ <r:w'o cr-pLo''P< C:rsCr to Zo t`zcttctiJ!{,tctrVVC..cc ct tc^sit`•c�.c-on= 1�-cl::��crtroc rrcr<Lc:.t_r«<c�tr icJ-%C L<bccxc�- t' <cr�::Zc�<L to cc��t<siLcs of oc L�<�rcuclr=pp =xct dct<co act ooc Lrco<f=J'Tj' be ee`Flev<tr c Z<r tx del<rr'Cer`pccr:tioc Act(Cl-C.152,«cz I c (5)).=pp�:e.t:et by t bet�ee�-act fot= i:eee:< ar Fcrr':c r:y<ri1< « i<1ct ? <r__lcvcr cc'cr tl<�or�<rr-Cor�pccrac�ccf.<t j cr_< �•cr'! <y-:-cnr c(lcZc:rr�cJ f<cZ<rc-Ofr.«c!J-ac:=:cc for.u.�<r�< �•<ux<ca��.ti<`,<cc uZ vr.Lcr tcct cr.=Sf,c(ldGL]51<_;Jul<c u ir..per: n c! ni._! �acc�<: c<SlStt.GG�.Lac;i—=r`<rr..cccfr� tocrcyc��.lc -�;c c.c pc f,o<c(<i GG_OG: L-v per._ i.tS<(cr-c.c$<cprlc&ovecr=a= Si�nc(' ibis xJe 62y0f �( 1Llr{/+ . l9 Lic�n_cc/Pcrm;z;c Liccn:or�Pcrrnitto; Assessor's office(1st Floor): Assessor's map and lot number, d' � � .S fu ? *THE >o y V w Conservation(4th Floor): Board of Health(3id floor): p • Sewage Permit number =" �� _ � ' Sepri _ C yo rua t639- Engineering Department(3rd floor):. / 1, 11V SrAQe® SrIe l MljS °mac r�r House number �" ���® �� Definitive Plan Approved by Planning Board r 19 WSr,4-ri iteMPL.dAN � APPLICATIONS PROCESSED 8:30'9:30 A.M.'and 1:00-2:00 P.M.only r®� �1A IL { TOWNOF BARNSA °L � � 'BUILDING INSPECTOR APPLICATION:FOR PERMIT TO TYPE OF CONSTRUCTION I Uj 00 - 2-2- Nn MA,2a Q 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 3I/9 -5' M.41A) 677. CS;VAW_ V/GGAer0*' Proposed Use -4f -Zoning District Fire District Name of Owner aDJ4AJSAddress Name of Builder l_7 46 D 1AV4t4r Address '4 6O2 M')V`a5 PW4' Name of Architect Address !%ZA . Number of Rooms l Foundation 00`;;Y4Ce_7 Jr Exterior ab I Roofing Floors, Interior Heating 1576". • Plumbing � E� -SAVe, L� Fireplace Approximate Cost �d� 000 • , eo Area �`f"o Diagram of Lot and Building with Dimensions Fee C�. �O. Zt OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above i Name QSS7 Construction Supervisor's License JOHNSON, EBEN 55 Build Addition No Permit For Single Family Dwelling , Location 349 S•. •Main Street Centerville ) ` • r Owner •,Eben .Johnson Type of Construction Frame _ Plot' Lot R ° Permit Granted March 22 , 19 94 Date of Inspection: ;) Frame 19 - insulation 19 _ Fireplace 19 q _ Date Com�plefed 19 F• s..r1:�� � E • • • - . 1, •