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0075 GROVE STREET
F F pv a. a Town of Barnstable , Building ,PoshTh�sCard SosThat,�t.�s Uls�ble From the Street App_rovedaPlans Must be Retained-on lob ands#his Card Must,be Kept s, =RARNSrA .. Posted Until Final Inspection Has Been.Made a E %Where aCertificate`=of Occu 'ancs Re wired;such Bwldmgahall N•otbe Occupted,untd aFinala,lnspect�on hasbeen_made 1 �1 j'l � 4 . , . �,gyp Y ... .q� _a E . � ..., __.. . 6 .... Permit No. B-20-347 Applicant Name: Henry Cassidy Approvals .Date lssuecl: 03/26/2020 Current Use: Structure Permit Type: Building Insulation Residential Expiration Date: 09/26/2020 Foundation; Location: 75 GROVE STREET,COTUIfi Map/Lot 020 107 Zoning District: RF Sheathing: . {" 3 F. Framing: 1 Owner on Record. GRIMES, PAULA P __ Contractor°Name " CAPE COD INSULATION Conttor license: 153567` Address: 75 GROVE ST rac b ,, ? � .. COTUIT;MA 02635 ¢` Est. Protect Cost: $560.00 Chimney: Description:' Insulation/Weatheriiation Permit Fee: $85.00 � ;;: Insulation: Project Review Req: Fee Paid ` S 85.00 ` 3/26/2020 Final: Date Plumbing/Gas "_ Rough,Plumbrng: Building Official Final.Plumbing: This permit shall be deemed abandoned and invalid unless he work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the,approved application and the:approved.construction documentsfor which this permit has been.granted. Rough Gas: All construction,alterations and changes of use of any building and`strucur tes shall be incompliance with the local zoning by laws and.codes. This permit shall be displayed in a iocation.clearlyvisible from access street or.road and shall be maintained open for,public inspection for the entire duration of the Final Gas: work until the completion of the same: ,:«» „ . - - - Electrical The Certificate of occupancy will not be issued until all applicable signatures by the Bu ding a nd Fme Officials areprovided on this',permit. Minimum of Five Call Inspections Required for All Construction Work: _ - Service: 1.Foundation or Footing r ` 1Sheathing Inspection 4E ' Rough: . . 3.All Fireplaces must be inspected at the throat level before firestflue lining is installed' .Final: 4.Wiring&Plumbing Inspections to be completed prior to frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do.not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: %KrL_ IJ Town of Barnstable *Permit# 46-16 dWq 0 Expires 6 months from issue date Regulatory Services FeeSTAB }}►► v� z `0$ Richard V.Scali,Director J V Building Division 4 Tom Perry,CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 R www.town.barnstable.ma.usr `CEP 14 2916 Office: 508-862-4038 1 0VVjV ab ar,�, Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL � MiLt Not Valid without Red X-Press Imprint Map/parcel Number 0 Lp —1 O7 Property Address -75� Srl'. [Residential Value of Work$ 5 1 S q0 — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address � t'n / (A y Gt':rti e SL Contractor's Name ArE 611 ( //t;59/7 Telephone Number (qo 1,) Home Improvement Contractor License#(if applicable) / 73 2 4157 Email: Construction Supervisor's License#(if applicable) ('�Cj' 7 C 7 [�<orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Idm the Homeowner I have Worker's Compensation Insurance Insurance Company Name CQ,17 f'O�A l 41e1 i enn Z—.s [ _n z, Workman's Comp. Policy# Wz�9 3/U116 Le 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-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 . 30 (maximum.32)#of windows 3' #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. d *Where required: Issuance of this permit does not exempt compliance with other town department regulations,,i.e.Historic,Conservation,etc. ***Note: Property wner must sign Property Owner Letter of Permission. A copy the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PI01 DHR\EXPRESS.doc Revised 040215 f dha3 Rmmul By Andersen:4f 5awIrm.Nam kmithad '-Juntm an*d i tauia.Gri► t � rnit+ern� k,Ei�atin ;�a s ilL s�rulfe Si - - - Ciii,93MM,botA 4173249i,CT, M634SSS,ILe�bd:Firm# 1237 0.2635 �a�mse eBaw� Z5 Abco".d I Uncurl,RI 02065 C?55 F�-:26U7 Pto k %5-3-323SOaw e-mm Ciwomb1sy:Nwid-, Justin Grirthirs arttt PoWa Grimes ��itl��.et C]aem 08131,116 01csefatrdEpii�at y:ineia ¢ 4S '11607 !4�idCrE� jiti�at. �uia�3fc Buya6I hev&y oi.nd:y an3is [I1r 'oaf pu 6asc ith ne�du.€t� ndlor ircrts,df +rra rrei.L *. ng and s_ L�d�:d�t h 4E lI By dlti r .a o 3+uuiliaa€1 3w1t La l ti►�9� �'.CB"iaio i lF rI9 36h�rd:u [ai�eiitu aQi wou aiiil cvi.i ie i Ali Jl,C l:7;ii g1ai�r� na w is itta.!id�'uy�nr9br�xT$rrn Lerr�cc �C:n19at�r►.rr�Drl G�e Ir �-e��e. `1" cI m��iloun-6, i ems,flat! ����rer� C ° ►N t 5an�i.i� ! � t SP) !*pora��i hoject Infojou aisn,and any omher dDoo neeie amiched €►this, ceeen 11 l iwnE bEa'eeeaats�.F'Nv:In4rh arY..dl a seal®�'6n�r the Fur m Enid irioaagamtasec➢h�reiim Qeiesrae I(a Wecc'rv�ly,ikais;-r erunrot _T9uuer+(3).FCeri t* ,a�ram,ro sign a coup epon cw.t i�e.aFter'Coiitracbor hai crrmideted,all,remark:wadia olds aneiatont. `I Dmllb iet r�uiisl: '+ atgiri%n c�,gs,�gn m ema yn�t7• n tm f ter:the R m c Cc nm l tilc t mti-Aa Run, 1�na��J1xs� i���yir art �r� Ri k,ii�ig,k�h ;�r�1it��i�,��� ►h. Bares but:- "����94 EsC' Gaged Saaru_ l+eii e�e�C`r,€m-ok �t�¢ei�etail!Fiai� �, Methad of P ryngtent: K i ` �SC,beduk insrd[I''dons bwed-an dw dv of rh afi a0 nuaa and secgd& [y on tEe,jatE in wcliid}u ��e own P i&tl&lffl&bi�8:re���gt�si MEELlb..�iro�eallstiore dabs'thi- et 1Nom paid [1�,ch,et ,21'1;du a ,�ace pi�id at `h- iamc is only�tsai aoe.we kvi11<,mmamQnicat-C an�affkid al}a e Won st€irt/CaaJ%ipk#�on. to clnb a i heee da s eattl6 are dre'w taa3rtitoii Cau-n`cg fire' 'axon.IpaFcI in C'atui# I : 1 13 i1L1).b 1 5 and.undease i$tat 6ks'Ayct.M nErCQi i�ureo-the eat'[fo e W Its iJfalllatLlkC bMil"R thC;oUdM Atli 4haVdiffe ace DO%XIU: iundr tavialia lanit �i nb'ba�ial�3+iioi pity d ili['leiar3s�a�u r Crit[6it..C*[vi�i ero �s ir�a vi J l:wS�i 9cn ra.Wbi l i t11-w ic:wrt3H1 Si d wr trm saarom-lr r„f blrh the B��lad Contrz r r Bux,w(s)b '.adik6i+ It qog t rl's� L 8 I re �a9+�s r� nnnt,uriJersun&d ht,ienw o rhis A m. nt,and has m,viwd a com3pEi:i&fkWa amd da of ul Ar, m at,ina9tifd m tEa two ati:achad,N%t cm a.F Canodllaiaan on the dive @-Sirsa mto en a xwv 26d.29 ivam 6rAh,inf�riai.eaP or 13uNWE r"n:iin-,cincel'`dais: MIMICE°I 1u OVIN.Ek Do nrr a d 4v aeo ee gl-i Ei:'�,u i ��eEel l a p f lW Wilt YOUJHE BUYER,.NMAY CAUNCELTHIS TRANSACTION AT ANYTIME NOTLATIER THAN N-HDNIGHT, IC14E M AtrE 1 S LAT EIL S; cat it!TACH.ED NaY,cio 0r t A v C E L[An0N PO 10R AN M ATI-ON OF T S RIGHT. I.tad'Nzmen Sooifmm.i m En i VuJwm LC CM.46car10 d1 iiir1kr4r �ra, �aal4ix�sir Enrdan�l: Eric Tama. in Grimes Paula Grimes Prima NoneoFsakq'Nrsueu Fria CNI't,mie print,Nb-fire ;Pa4Me 2 1 10 Southern New England windows d.b.a Renewal by Andersen of SNE Massacilusets Department of Pubil safety Soa;d of Suild,ng Regulations and Standards _icense: CS-095707 BRIAN D DENNISON 7 LAMBS POND OIRC CHARLTON MA 01 0 ,;O rt m.s s L; e' 09 09.r'2018 in D2 Office of Consumer Affairs find Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement:Contractor Registration RegWmtlon: 173245 Type: Suppkrmerd Card SOUTHERN NEW ENGLAND WINDOWS LL E>miratbrc Brlfirzols DENNISON BRIAN 26 ALBION RD -. LINCOLN,RI 02865 Update Address and rewrn card.Mark ream for chaw sa,e—riasni-- (']xde.ae L Rene waT Eniployt.rnf p Lane Lira — --—---- ——- 0 mowr>roraD�a�f�IaaranF.oefle of Coasauer Affairs 3 Bashers Reg-Cation License or registration valid for individul am only E IMPROVEMENT CONTRACTOR before the expiration date. if foand.rcturn to. Office,of Consumer Affairs and Business Regulation won: 173245 Type 10 Fork Plaza-Sake 5170 Expiration: 911IMMIS Supplernent:.ard Boston,KA 02116 SOUTHERN NEW ENGLANDWIMDOWS LLC. RENEWAL BY ANIDERSON DENNISON BRIAN 26 ALBION RD 0 LINCOLN.RI 02%5 U.&—rehry Not valid without signature The Cbnlfnonivealtli of Massachusetts Depat-tinert of liidisstrial Accideiits I Congress Street,Suite 100 e.� Boston,1M 02114-2017 ivlvHt inass.j ovIflia * Workers'Compensation InsuranceAffidaitit:Builders/ContractorslElectricians/Plumbers. TO BE FILED«7TH THE PERMITTING AUTHORITY. Applicant Information Please Print Legiblv Name(Business%Organization%Individual): Address: 2(2 �ol-) , City/Slate/Zip: b I� ��io�� Phone:a �: 0/` Are you an employer:Check the apppropriate box: Type of project(required): 1 X i am a employer with 20 a employees(full and/or pan-time).' 7. M New construction 2.17 1 am a soic proprietor orparmership.andbave no employees working forme in 8. Remodeling any capacity.[No worker;'comp.insurance required.) 9_ ❑Demolition 1FQ I am a homeowner doing all work myself.[No workaY comp.insurance requird.l' 10 0 Building addition 4-0 1 am a homeowner and trill!r_•hiring contractors to conduct all trod;on my propsty- t trill ensure thmt all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietor with no employees. ' 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-contractors ltave employees and have vvorlkers comp.insurance,. \ 6.Q we are a corporation and its officers have exercised their right of exemption per'tiGL c_ 1-i..!r I ether w l/)Jpt,� 152,r l(1),and we have no employees.1No trorkers'comp.insumnce requir.-d.l re lACB/rl 5 =Any applicant that checks box r i must also fill out the section belor.-showing their umrkers'compensation policy information. y Hntnetntmers who submit this affidavit indicating they are doing Al wort and then hire outside ennrmctors must submit a new affidavit indicating such. ,Contractor that check this box must attached an additional sheet showing the name oCHte sub-contractors and state whether or not those entities have employees. Ifthesub-contnetorshavecinptoyi es,they must provide their tam er,'comp.policy number. d. I ani an employer that is proryiditig rvorA-ers'coiiipettsalion iiisitrattcefor nt) cittplorees Beloit,is the policy and job site0l informatfoit. Insurance Companyllame: Av { �1%C�(fijZ6U �� �u o8� { Policy=or Self-ins.Lic.n: Expiration Date: Job Site Address: 7S 6ro ve, Srl • 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 required under MGL c. 152.j25A is a criminal violation-punishable by a fine up to S1,500.00 and/or one-year imprisonment,as well as cl-6 penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the♦violator.A copy of this statement may be forwarded to the Office of:Investications of the Dik for insurance coverage verification. � I do liereby cer ' older the pre-is aired penalties of peijury chat the information provided above Is true and correct � 9 n / Signature: Date: -1 A ` /61 Phone n: !'� Official use only. Do not rtrite 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 1.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: SOUTNEW-01 UOLLINGER ACOKU' CERTIFICATE OF LIABILITY INSURAN-CE DA-MWAIDDr1�^11') 6/29/2016 THIS CERTIFICATE IS 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 ALTER 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 policy(ies).must be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement. A statement on tMs certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CO ACT NAME: CoBiz Insurance,Inc.-CO PH GNE FAX 821 17th St aC No Ext:(303)988-0446. a No):(303)988-0804 Denver,CO 80202 DRESS:Co.Bizlnsuran .' cobainsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Continental Westem Insurance Company 10804 INSURED INSURERS: Southern New England Windows LLC INSURER C: D/BIA Renewal by Andersen 26 Albion Road INsuRER D Lincoln,RI 02865 INSURER E INSURER.F: 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 OTHERDOCUMENT 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 AbUCED-.BY'PAID CLAIMS. INSR TYPE OF INSURANCE EFF POLI LIMITS LTR INSR.VIVID POLICY NUMBER MMlDD MMID COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE '$ 1,000,00 A IX CLAIMSAAADE OCCUR CPA3136080 i 07/01/2016 07/01/2017 ENTED PREMISES Eaocaurence $ 700,000 I MED EXP(Any one person) $ 10,00 I- — i PERSONAL&ADV INJURY $ 1,000;000 N'L AGGREGATE LI X ES PER: ( GENERAL AGGREGATE $ 2,000,000 GE LIMIT APP PRO LOC PRODUCTS-COMP/OP AGG i$ 2,000,000 POLICY❑JECT OTHER: I EMPLOYEE BENEFI $ 2,000,000 OMB RNED ING_LE U M I T $ 1,000,000 AUTOMOBILE LIABILITY Ee accident A • X gNYgUTp �CPA3136080 10710112016 071011201.7, BODILY IN JURY(PerPerson) $_ ALL OWNED ^SCHEDULED I I BODILY INJURY(Per accident)I$ AUTOS AUTOS NON-OWNED �fP accident) ERY DAMAGE 1$ HIRED AUTOS AUTOS I I $ X UMBRELLA LIM X OCCUR EACH OCCURRENCE $ 5,000,000 I A EXCESS LIAB CLAIMS-MADE CPA3136080 07/0112016 07/01/2017 AGGREGATE $ DED I X I RETENTION$ O Aggregate TH- $ S;0001000 WORKEM COMSATION PEN STATl1TE ER ,• AND EMPLOYERS•LIABILITY Y I N A ANY.PROPRIETOR/PARTNER/EXECUTIVE ❑ CA3136081 07/01'/2016 07/01/2017 E.L EACH-ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A 1,000,000 (Mandatory ht NH) E.L DISEASE-EA EMPLOYE $ If yes,describe under E.L DISEASE-POLICY UMR $ 1,000,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Addlllorgl Remarks Schedule,may be attached If more space.ls.requlred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION .DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE'WrTH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE -- —-' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. . 02o Parcel ' 167 . Application # VG - �1 Health Division Date Issued 411 S Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address &"06 Sr Village 91ro IT Owner �rf l rAr'5 Address S�in'1 Telephone 50t 7U-_� .Permit Request LoNSr"cT N6w 4AL�- PjATH 103 C_Y_1ST1^16r S660Nb 1�100e2 660"M Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District 1 Ur Flood Plain ly Groundwater Overlay to' _a`a Project Valuation �I�t�On00 O0 Construction Type v�00b ,�., ;C-) CD Lot Size Grandfathered: ❑Yes, ❑ No If yes, attacffspporting::docientation. Dwelling Type: Single Family A Two Family ❑ Multi-Family (# units) `; ZZ c� }KJ Age of Existing Structure 1939 Historic House: ❑Yes )d No On Old King' Highway: ❑ s No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other #_ rn Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) ?32 Number of Baths: Full: existing , new Half: existing new j Number of Bedrooms: 3 existing �new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ;I Oil ❑ Electric ❑Other Central Air: ❑Yes )4 No Fireplaces: Existing-New Existing wood/coal stove: ❑Yes No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION ,� (BUILDER OR HOMEOWNER) Name V-0C ,2.SA0Ap � RS. Telephone Number 50$ '47-a 001 Address License# C S - IOZgq� Home Improvement Contractor# 164m Email CTSS a Q06r6Z6A+-bMAeN1�1jguILbR_s.C/O M Worker's Compensation # y6 491� P7s2-6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 600aAZ SIGNATURE DATE r FOR OFFICIAL USE ONLY r APPLICATION# ' DATEISSUED MAP,/PARCEL NO. ,j ADDRESS VILLAGE r OWNER DATE OF INSPECTION: . i ' FOUNDATION a. FRAME INSULATION FIREPLACE C ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i� FINAL BUILDING; DATE-:CLOSED.OUT AUOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A lic• nt Information Please Print Legibly i Name ( 'usiness/Organization/Individual): Address: 44.5 (96—,6"1UX_ / 6A9,NS-r14g1* 1 City/St to/Zip: S'+'rQ,v a c.tg � 01��5' Phone #: 1508 -4ZT6- 00l Are,you an employer? Check the appropriXeb x: Type of project(required): I f am a employer with I am a general contractor and I � 6. ❑ New construction employees(full and/or part-time).* <ve hired the sub-contractors 2.❑ I am:a sole proprietor or partner- listed on the attached sheet. 7. X Remodeling ship nd have no employees "These sub-contractors have g. ❑ Demolition worb ing for me in an capacity. employees and have workers' Y P' Y• 9. ❑ Building addition [No . orkers' comp. insurance comp. insurance.*- regtl red.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions ❑ g h exercised officers have exercse ter 11. 3. 1 am: homeowner doing all work ❑ Plumbing repairs or additions myse If. [No workers' comp. right of exemption per MGL 12.0 Roof repairs i11SLirance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] ':\ny applican that checks boa#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 it at check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. It' he sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site in fornuatiod Insurance C mpany Narne:jjfQA4XWlX_ JbGUS 1LA &-%-j1 C, Policy# or elf-ins. Lic. #: U6 — 49 77 FO 2.S7_ " Is Expiration Date: I /le- Job Site Ad ress: �� �(1.c�J� �- City/State/Zip: &TOi-T ,r Attach a co y of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to s care coverage as required Linder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$11 ,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$25 .00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigati s of the DIA for insurance coverage verification. I do herehy:certifv and a pains and pen lies of p ury that the information provided above is true and correct. SiUnature: Date: �— Phone #: 60T • 42Z (® Official use only. Do not write in this area, to be completed by city or town official. City or own: Permit/License# Issuing uthority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other' Contact'Person: Phone#: ` _ CERTIFICATE 4F LIABILITY INSURANCE. DATErMng/9019VYv) rCERTIFICATE IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE R PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAM E: ROGERS&GRAY AGCY INC PHONE FAX 434 RTE 134 (A/C,No,Ext): (A/C,No): r ' E-MAIL SOUTH DENNIS,MA 02660 ADDRESS: 727HW y INSURER(S)AFFORDING COVERAGE NAIC l INSURED INSURER A: HARTFORD UNDERWRITERS INSURANCE COMPANY ROGERS&MARNEY INC INSURER B: INSURER C: INSURER D: P O BOX 310 INSURER E: OSTERVILLE,MA 02655 INSURER F: 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 IN SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB I POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DD\YYYY) (MIADD\YYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE Is COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) ' ED EXP(Any one person) Is ERSONAL&AOV INJURY 1$ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE Is POLICY PROJECT❑LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) BODILY INJURY $ HIRED AUTOS � - (per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB []OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATLrORY OTHER EMPLOYER'S LIABILITY Y/N UB-4977P252-15 01/01/2015 01/01/2016 LIMITS ANY PROPERITOPJPARTNER/EXECUTIVE , N/A E.L.EACH ACCIDENT _ $ 500,000 OFFICER/MEMBER EXCLUDED?(Mandatory In NH) E.L.DISEASE LOYEE EA EMP $ 500,000 - It yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 230 MAIN ST IN ACCORDANCE WITH THE POLICY PROVISION97; AUTHORIZED REPRESENTATIVE HYANNIS,MA 02601 ACORD 25(2010/05) The ACORD name and logo are registered marks of'ACORD 1988-2010 ACORD-CORPIS Vvy yts reserved. i i i Q9 Office of Consume r Affairs and Busines s Regulation,atlon g _ _ 10 Park Plaza - Suite 5170 i Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164688 Type: Private Corporation Expiration: 10/30/2015 Tr# 244188 ROGERS AND MARNEY, INC. GARY SOUZA P.O. BOX 310 OSTERVILLE, MA 02655 Update Address and return card.Mark reason for change. t 4 20M..0 Ott LJ Address Renewal-r i Employment Lost Card ((OfILfi[P)t[[P�/�n/.ri,{Y[IJirrr�r�irr//J O. d License or ..,fGec of Consumer Affairs do Busi ess Regulation registration valid for individul use only P before the expiration date. If found return to: :IMPROVEMENT CONTRACTOR P f istratlon: -164688 Type: Office of Consumer Affairs and Business Regulation 01ration:. :10730121115 Private Corporatior 10 Park Plaza-Suite 5170 x Boston,MA 02116 #6 �5.AND MARty�1f VARY $OUZA VI(EST BARNSTAg� `ib. Underseereta ^ 0 ry Not vali hou signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards �U SUM'ft Construction Supervisor License: CS-102999 GARY J SOUZA 7` P.O.BOX 310 = s Osterville MA 01355 )i i,I�`. Expiration 08/16/2016 Commissioner } 0*1HF F, Town of Barnstable H� O .. Regulatory Services • BAP-,;SfABLE. v KASS. a Thomas F.Geiier,Director e FOMa Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, ivL-\02601 Office: 608-562-403S Fax: 50S-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 'k � � , as Owner of the subject property-. herebyauthorize ROGERS & MARNEY, INC. to act on my behalf, in all matters relative to work- authorized by this building permit application for(address of job) s C/fa tly ST C c) rU Ss ignature of Omer are &u l a Cr 1 rn eS f d JkSr11V 67rlmeS PrLnt-Name Q FORVS 0';'.N P ',11SS'ON Rk.M ROGERS&MARNEY,iNc. BUILDERS List of Subcontractors performing work at S� %TnRISIDE I-AND CONSXR-UCXIQN (3A&C# -2001 8 %Rn . • SPENCER HALLETT PLUMBING&HEATING (WC#WCA508470011 EXP: 2/22/15) ^_�.-ircln�R n[�u__n[.11i6 �WG#�AAW75�1I3�P:9T�7-T�S� - - -S) . _I PAINT { AFE#GP3999V+*'. RING (V44G-# p. Building Quality Homes Since 1968 • rogersandmarneybuilders.com Post Office Box 310,Osterville,MA 02655 •tel 508,428.6106 • fax 508.420.3550 * email gjs@rogers@enarneybuilders.coni w C err � &,S brA)c" RNSTABLE +' I C-?Gl s-rltjr--f. _ - I'T I aar Cc- lax' 9 r 'Town of Barnstable .� . Expires 6 mn Irs om�te��, Regulatory Services Fee BARkSfABLL � ,�� Thomas Geiler,Director ptED� F. Building Division Tone Perry-,CBO, Building Commissioner .200 Main Street,Hyannis,MA 02601 www.iown b arnstab le.ma.us O$$ce: 508-862-4038 Fax_508-790-6230 EXPRESS ERNIIT"APPLICATTON - 'RESI.DEN TTAT,ONLY. Not Valid wi}Jrorri$ed X-Press Imprint Map/parcelNumber (✓ (i 'ProperryAddress 17S - J 2Nes idential Vahie ofWork S —! �lliv Minimum fee ofS35.00 for worst underS6000.00 W.,Owner's Name&Address Contractor's Namei r Telephone Number—'52L qd P o)a /j Home Improvement ComractorLicewe#(ifapplicable) 1063 Em.-i-k �I� Commiction Supervisor's License 7jr'(ifapplicable) X-PRF Workman's CompensationInsvrance Check one. NOV ❑ I am sole proprietor 52013 F-1 amthe Homeowner J�'I have Worker's mpensation Instcu�a cce�^p 6suravl&?. lnsuranreCompanyName J J �,1 L - �(D I ®F B'�RNSTABLE Workm='s Comp.Policy# W� 00 0 Copy oflusurance Compliance Certi£cate mast accompany each permit: Permit RLqyesT(check box)dddddd ��\��\ `n Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to � K V V� 1 ❑Re-roof(hurricane nailed) not stripping. Goatg over existing layers ofroof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Vahte - (maxamun.35)0 ofwindows n ofdoors: ❑ Smoke/Carbon Monoxide detectors 4 floorplans marked with red S and inspections required. Separate Electrical&Fin Permits required. *Wlere required:Ism=.e ofthis perm$dom not exempt comp]iaace with odrer town departm=regulatbas,ie.Historic,Co=,ava�A etc. ***Note: Property Owner maistsimmProperty OvmerLetterof Permission. A copy of t e Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: CAUsersC&coRk AppDara'LocAPMicrosofE\Windows\Temporary Izrtttna FIts\CoatemOut ookNER76BDt%AIE.3TRESS.doc Revised 061313 r arA .l he Commonwealth 0f Massachu.7etts --+r Depanment of Industrial Accidents O1�ce of Investtga7:lO;Zs y P.. - 1 600 Washington Street Boston, ?t1A 0211.7 _ Www.rna,�s.gov/dia worker•s compensation.Insurance Affidavit:Builders/ConixactoxslElectrieians/Pluanbexs AppUcant Infomation Please Print Legibly Name(Business/Organization/Indiv-dual): e7 f Address: i Phone# Axe you an,employer?Check the appropriate box. Type of project'(reopuired.): 1. [2 1 am a etployer with—L— 4•E] 1 ate,a general contractor and I have C�. employees(full andlor art-time'." hired the eraj New coast=action part-time).- oa,tractors listed on m �. �Rcodeliug 2. the ^bgd�sn -eet : 1 am a sole praprietor or partnership These*snb-cot3tractozs have 8. Q Demolition' and have no employees working for employees and have workers'comp. 9. Building addition me in any capacity.[No 1�jorkers' instuance. comp insurance required.] We are a corporation and ite 10.Q Electrical repairs or additions officers have exercised Theis iglu of 11. Plumbing repairs or additions 3 Q I am a homeowner doing all work exemption per MGL c.152§(4),and 12.❑Roof repairs myself[No workers'comp. we have no employees.[No workers' insurance required.]j comp.insurance regnixed.] 13.Q Other *Any applicunt that checks-aox,=l tnnst also:i1 out me secdaa below showing their wa leers'-com r perdorpoiicy itiorirapor• theHomeowners who sr omit:his af$davit indicating they are dolpg all work and than hire o,:tsid contractors trnrtt subn t E ntviof 6r affidavit indicat ng sub-conzxaxors have=nnployees,teeny nniiastp o idz their workerssl comp policy n mber.OnMae:a and state whethc*or not those entities have—ployces.;f I am an employer that is providing workers compensation insurance far my employees.Below is the policy and job site infor"MUOYL D Insurance Comp any Name: Policy T or Sel ins.Lic.i` v O �J�(/[ I E2pi-adon Dste._ 1 Job Site Address: / � GitylState!Ltp: {"t (�� Attach a copy of flee workers'compensation po)i&declaration page(showing the policy number and expiration date), rai!ure to secure coveraga as required�cer Section 25A of MGL c_152 can lead to t'ne imposition of criminal penal ies of a fine np to1500.(X?amd ar one-y ear impdso=- =E,as wen as civii penalties itt the form of a STOP WORK ORDER ,nd a fine of up n aj Pena a day a fmr-u to violator. 0 advised that a copy of this stamment may be forwarded to the Office o`Investigations of the DIA for insurance coverage v=Mcado, 16 hereby certify the pe rallies of perjury that trxe information r Rded above is true and correct. Signature: Date: Phone#: a Official use only.Do not write in this area,to be completed b3 it or tvxm c' ffrciaT I o City or Town: Permit/License n Issuing Atrthority(circle one): l 1.Board of health 2.Building pepzrtsnent 3.City/Town Cleric 4.Electrical 7 J 6.Other Vector 5.Plumbing inspector Contact Verson: Phone : z , FRASCON-01 PAAS CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOfY1'YY) 9/1912013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELdW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 508 676-0309 CONTACT Viveiros Insurance Agency,Inc. { NAME: AshleyPaiva PHONE Airport Road A/C Ex': 5 -676-0309 127 (ac,Nol: 508-324-9147 Fall River,MA02720 ADDRESS:APaiva Viveirosinsurance.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Granite State Insurance CO INSURED Fraser Construction LLC INSURERS: PO BOX 1845 INSURER C: Cotult,MA 02635 INSURER D INSURER E: INSURER F: 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. INSR LTR TYPE OF INSURANCE 1N^R WVD POLICYNUMBER MOD MMfDD EXP LIMITS GENERAL LIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED FRCP(Anyone person) $ PERSONAL&ADV INdiJRY $ GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIO^.AGG $ POLICY I PRO• LOC AUTOMOBILE LIABILITY $ COMBINED ANY AUTO (Ea accident) IN UMI $ BODILY INJURY Per person) $ AUTOS NED SCHEDULED I AUTOS BODILYINJURY(Peraccident) $ HIREDAUr05 NON-OWNED AUTOS PROPERTYDPeraccidea)A A $ S UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED REYENTION $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WC STATU• OTH. YIN TORYLIMITS I ER A ANY PROPRETORIPARTNERfEXECUTIVE WCOO9930601 9/26/2013 9/26/2014 OFFICERWEMBEREXCLUDED,/ NIA E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) It yes,describe under E.L.DISEASE-EA EMPLOYEE $' 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCAMONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more s ace'p is required) i I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable Building Division THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Nyari n is,MA 02601- AUTHORIZED REPRESENTATIVE y O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201D/05) TheACORD name and logo are registered marks of ACORD Massach setts -DepeNtrnent of Public Safety ! 802(d of Building ReclWat'ions and Standards I .CnnstTGetlnn$Gi)CI'1"1fipY ' i License: CS-097668 DEAN C FRASRR-` 104 TWMN vmw I BAST T11L14�0YJAT�TS _ Commissioner. 0 610 7/2 0 1 5 4 .�r' r t1 Office of Consumer Affairs and Business Regulation I O.Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 112536 Type: DBA Expiration. 3f23l2015 TrR 237059 FRASER CONSTRUCTION CO. DEAN FRASER P.O. BOX 1845 COTUIT, MA 02635 YJpdateAddress and return cared_Mark reason for change. sc.n> tot, rr n Q Address ❑ Renewal Q Employment F7 Lost Card , �iUfficc of Consumer Affairs&Strsi$CCt 1Zesulation License or registration valid for indMdul use ouly �1OME IMPROVEMENT CO FZACTaR before the expiration date, Iffound return to_ t2egistration_ 112536 Type: Office of Consumer Affairs and Business -�„ Regulation ,_ :Expiration: 323/2015 DBA 10ParkPla=-Suite5170 FRASER CONSTP,UCTION CO. Boston,MA 02116 DEAN FRASER 104 TWINN VIEW LAME / E FALMOUTH,MA 02536 "`--" Undersecretary Not valid without signature ` i �`: - � ° 1 Fraser Construction,. LLC CONSTRUCTION P.O. Box 1845, CoWit NIA. 02635 ROOFING Email: info@fraserconstructionca:pecod.corn ✓ www.fraserconstructioncapecod.com v 508-428-2292 FAX 1-508-428-0123 HILL#1.12536 CS#97668 OPFING 'PROPOSAL ADDE DATE: October 29, 2013A PHONE: 508-428-2607 NAME: Justin Grimes EMAIL: MAIL ADDRESS: JOB ADDRESS: 75 Grove'St. Cotuit MA 02635 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. 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 50 year Non-Prorated Coverage for any lifetime shingles, 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. ASK US ABOUT QVR OVERHEAD CARE CLUB! Below Roof Prices are for Main House only E Supply and Install - CERTAINTEED LAND : 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 1..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. Color. PRICE-$4,400 Initial a * Price includes fixing coil trim on right side and re-shingling around chimney on right side of house. u 0 S! �� i i J� P !'� X� * Above price includes all discounts and coupons ' F Roofing Product & Installation Details;',.., Supply & Install - (Soffit Tenting) Hick's Ventilated Drip Edge o S" AluminumDrip Edge with existing soffit vents. Smart vents over white drip edge. Protection against.damage to the roofing material's 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 alongkthe entire underside of the roof deck. Supply & Install, Ice & rater shield R 2 Waterproof Underlayment System (3ft. on eves and valleys, 18" on rakes, walls, and skylights) Ice and Water'Shield is a self-adhering roofing.underlayment used on critical roof areas such as eaves, rakes, ridges, valleys, dormers and skylights to i protect roofing structures.and interior spaces from water penetration caused by wind-driven rain and ice dams. WIP may also be used as covering for the entire roof to prevent moisture or water entry. Supply & Install - Surround Underlayment (A Typar Brand) A smart alternative to felt, it is water's toughest opponent, creating a secondary water barrier that reduces the incidence of leaks caused by.storm damage, wind-driven rain, ice dams and worn roofing materials. It is a waterproof, synthetic polymer material that will protect your home against moisture intrusion. Supply & Install-CertainTeed Swift-Start' ` With self adhering asphalt starter course on all eves, and rake edges. CertainTeed requires this product for Integrity Roof Systems and upgraded wind warranties. Supply & Install -Aluminum & Neoprene Soil Pape Flashing Supply & Install -Ridge Vent - Shingle `lent II High performance ridge vent with external baffle. (As recommended by CertainTeed) 3 Supply & Install —Pre-Cut CertainTeed Hip & Ridge shingles Shingle Ridge meets the hip and ridge accessory requirements for the CertainTeed Integrity Roof System which is comprised of underlayment, shingles, accessory products and.ventilation all working together. The Integrity Roof System is designed to provide optimum performance--no matter how bad the.weather conditions are: (As recommended by CertainTeed) Clean & Remove -Debris from work area daily. PAYMENTS ARE DUE IMMEDIATELY AFTER JOB COMPLETION. 1/3 initial payment; remainder to be paid upon completion Payments accepted are: CASH CHECK -MASTERCARD-VISA-AMERICAN EXPRESS *Any payments not immediately paid upon job completion will be charged 0.005%for every day after the given 5 day grace period upon day of job completion. Possible Extra-After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation is not up against the plywood sheathing preventing ventilation from the eaves to the-ridge. If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then,re-installing.the plywood. If needed, this would be charged for as an extra at the rate of$6.00 per panel including Materials & Labor. There are 6 Panels per sheet of plywood. Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$75.00'per hour, plus 20% mark-up materials. .4 FRASER CONSTRUCTION Warranties the labor for LIFETIME of roof: FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 15 years. CERTAINTEED Warranties the shingles and labor 100% through the Sure Start Warranty duration. a , CERTAINTEED Warranties the shingles to be ALGAE resistant for the 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. t DATE OF ACCEPTANCE: - G G >2 Homeowner Fraser Constr n, LLC 5 Town of Barnstable .*Permit42;%MzC� �QY .1 Expires 6 month from issu ate Regulatory Services Fee BA"E8rABLE; : Thomas F. Geiler, Director v ttass g 16.9• a Building Division PTFb�,t Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis, MA 02601 12 www•town.barnstable.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 �� �� D y esidential Value of Work « 1)Oe) Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address "p- Al G el Telephone Number Contractor's Name T P Home Improvement Contractor License# (if applicable) - ❑Workman's Compensation Insurance p �`i' Check one: Al A� P'"®RESS dF—® R ❑ I am a sole proprietor JUL 2 5 Z008 FN--T a the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# 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/doors/sliders. U-Value (maximum.44) . *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc, *'F*Note: . Pro-perty Owner must sign Property Owner Letter of Permissiop����� A copy of the Home Improvement Contractors License R-T-Mn se Inr az SIGNATURE: Q:\WPFILESTORMS\building permit fOrrns\EXPRESS.doC y n The.Comrnonwealfh'of Massachusetts Department of Industrial Accidents Office of hnvestigafions 600 Washington Street Bostorr,AM 02111 www.mass.gov/dies Workers' Compensation Insnrance Affidavit: Builders/Contractors/Blectricians/Plumbers APpucant Information p / please Print Let--MV Namt; (Business/Organiration/Individual): City/State/Zip: Phone.#,:, Are you an employer?Check the appropriate boYc Type of project(required)_ 1.❑ I am a employer with . 4- ❑ I am a general contractor and I 6. ❑New coustr=tion employees (full and/or part-time).* have hired the shb-contractors 2❑ T am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-confractors have g, []Demolition employees and have workers'. wor3ang for me in any capacity- 9. ❑Building addition [No workers' cpmp.•i anuanr_C comp.r71SLT2anCG. 5. [] We arc a corporation and its 10.❑Electrical repairs or additior �] 3. am a homeawnci doing all work officers have cx�rcised tbcix 11.[]Plumbing repairs or addition myself [No workers' comp. right of exemption per MGL 12.0 goof repairs insurance r t _ c. 152, §1(4),.and we havc no ��) employees. [No workers' 13.[] Other Comp, insurance required] *Any appli=t that cheeks b.r#1 must also M ont the station below sb—ing their wm+='corop¢vsa4on poliicy inf—ti— ° t Homrnwners who subarit the d5davit indicating fey arc doing all work and then hire outride contractors must eubmit anew affidavit indicating such r--mtracbx%that cbcck this box aunt attached an additional sheet showing the name of the sub--C;ontracturs and stafn whcthcr or not those entities have employers. if the sub—.ontraeturs have=-oployces,they must pxvvi&their vmricc-s'camp.policy number. Iam an employer then is providing work-ars'compensulzor_insurance for my employees. $elav is the policy and job site information. Innn-a icc Company Nap=- Policy#or Self-ins.Lic.#: Expiration Date: rob site address: City/statc/zip: Aftach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date, Failure to secure coverage as require under Section 25A of MGL c. 152 can lead to the imposition of crir�nal penalties of tint;rip to'$1,500.00 andlor one-year mprisonmcnt, as wcIl as civil penalties in the form of a STOP WORK ORDER and a f of up to$250.00 a day against the violator. Be advised that a copy of this statcm t may be forwarded to the Office of Invcstigatims of the DIA for insurance,covcra o verification. I do hereby cer*under the pains-and penalties ofperjury that the information provided above js dzte tired'correrL $i c: `j Date: Phone# �� �'� • a 15/�' - O cial use only. Do not write in this area, to be completed by city or town official fi City or Towu: Permit/License Issvang-Authority.(circle one): 1.Board of Health 2.Building Department. 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other qA, Town of Barnstable of'cHt: Regulatory Services Thomas F.Geller,Director = BARNSTABLB, . M` Building Division E .o��ago n g Tom Perry,Building Commissioner . 200 Main Street, Hyannis,MA 02601 www.town.barnsi2ble.mia.us e.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:_ qf O S !OB LOCATION: S� ��� ✓�—S�r CfJ 7`�r - number street village "HOMEOWNER": K / name home phone# work phone# CURRENT MAILING ADDRESS: �� �4"O V,20— Co 7`� /'7— yy ct S S •� 14, J^ city/town state zip code The"current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. " DEFT MON OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to- be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner shall submit to the Building Official on a form acceptable to the Building Official,.that he/she shall be responsible for all such work performed under the building perrnA (Section 109.1.1} The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,riles and regulations: The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she.will comply with said procedures and re irements. t , Si turc of Homeowner Approval of Building Official „ Note: Three-family dwellings containing 35,000 cubic feet or larger will be,required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a parsons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption sic unaware that they arc assuming the responsibilities is a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2,15) This lack of awareness often results in serious problems,particularly . when the homeowner hires unlicensed.persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately,responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that hc/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. I °FYH�Ty Town of Barnstable Regulatory Services R ; 5mx ASS. . Thomas F. Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 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) Si ature of Owner Date Print Name If Property Owner is applying for permit please complete the Plomeovmers License Exemption Form on th:e reverse side. The Town of Barnstable 07/ Permit Massachusetts R&RIMABIZ 's Date ,/,� _a 7 — 9S MASS A B' SOLID FUEL ST VE PERMIT Feeav /1 This constitutes an official stove permit ter inspec n and approval by the building inspector. /Owner u 5 f� P tt 1cz G r i nq F s ephone no. So 8 � s"3 - 9 9 z /Address of Property '7.5 6 r o s 7` llage �o Liu, Zl v. Location and Stove Type /� v, o w a s ��v e �► v la /zZ 7 s- Building Inspector The solid fuel burning stove at the above location passed: failed: inspection. JUSTIN P. {GRIMES ter`. µ PAULA P: GRIMES �j s 5,4 5 10. DRURY LANE NATICK, MA 01760351113 r• y { ' . .. . _ ,'£" 'rw�•sr, q.°a e- ''.r;:M' a s Ewa-.: ' . AY:T:O THE ORDE a DZPIN., y �O R OP C� k c!— DOLLARS j M1a Yi .£ .M it ...i BayBanFOR K � n r .. k• Y" rFtl y •Yj i 1:0113023S71: `378 .028.3211' 1,S45 �w -