HomeMy WebLinkAbout0022 HIGHLAND AVENUE e.
V 22 Highland Ave.Coast:MsA'J_ X
G' Q G zillow.com/homedttaits/22-Highland-Ave-Cotuit-MA-o2 63 5/1 08 6 1 09 72_zpkdf t`r
Apes Property icoLup 4* Inspection Dashboa Town o Barnstabte SA Check a profession... Q C51 Verney a Public-View Point.., a GperUero
N
i a
' Z i 11Cw (`�Save �w`Share More
�.i�'
4
\ µ
,
4�r � r $6580,5003bd 3ba 1,864sqft ,
iPrice cut: 1 15K(111)
22 land Ave, tu 02635
__ a_ .... a � � r����w�ir�n,n. � ,a fi f �a� `. r� r-✓��'� �2 Gpre-qualified
High e C it CIA
Est.payment: ,790lmo et
-
a
7
,R
Contact Agent Take a
Overview Facts and features Home value Price and tax his
w .
Overview
Time on Zlilow 8 days Views 539 Saves 10
' Looking for a location with privacy close to the Village of
Cotuit?Tucked away down a long driveway you will find this
3 bedroom Cape.This one owner home has been lovingly
maintained with some nice updates.There is an open
kitchen,dining area,3 season room and spacious
bedrooms.The laundry room is located on the second level
along with a 1 st floor laundry hook up.There is a home
office area and master bedroom.The 2 car garage has a
separate attached apartment and there is an additional
Read more �
f� Type here to searclh
Thursday,Jan 28,2021 11:11 AM
Assessor's map and lot number .........::...................::.... T �� F THE To
�� r PTIC SYSTEM MUST
0
STALLED IN COMPLIANCE
Sewage Permit -number ........... .... ........ . ..'............ . .. . d
j - WITH TITLE 5
✓ .t Z BABHSTADLE, i
House number � ......" =NVIRONMENTAL CODE AND................ .......................... . ........ 9 MA88,
TOWN REGULATIONS '�,�oMpY.tr�em
TOWN OF BARNSTABLE
J BUILDING INSPECTOR
t APPLICATION FOR PERMIT TO ... .�' I ..-,-- L .:.�.►......................................................
n
TYPE OF CONSTRUCTION ........... 1d�:.� ..... ��a : G?1�, .51... i �l....l?Z.. ..5 '
............................ ......� �....19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ............. . ...... a.............. ...... ... ...................................
j L
ProposedUse ............ .,......114,.;1:(. .................................................... .................................................
r
Zoning District ...... s.. �.........................................Fire District //��
.....1..� �� !.. .
Name of Owner A ... . .1.�1 ?.'��...............Address .1.C{.[t� N.C�S. ..........
7r61 i day *- ^Q� GtJ (� rer,ce`ice._1�s`e��v l
td ... l .l .11Address Name of But er_........,. .t..............r....�... .... ....................................................................................
Name of Architect .......................Address .s-0?.� 7.130..5i%. .d(v..ltA...
Number of Rooms .../ ... '.1.....................................Foundation ....Lr.L'Nt:.!` ic. ................................................
W " d jde ql l S i nq,1e_5 f clwPbaa.�
Exterior ........... '9'? ..Roofing �!J 7A }.1,: 7-
.............................................................
Floors .......s. - . ................... .....................Interior ....... . w.y
. ........................................................
Heating •,-` 'tireg ?�f1/ Ti' ��iD4.Plumbing .....fl? '}: .�:.....................:.:...:..:.::....................
�.. __ . . . (... �! .........
Fireplace .... Approximate Cost ......... .........................
Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area ... .. �S!�...........
Diagram of Lot and Building with Dimensions Fee ^^ ��
�Cl. ............ .........
SUBJECT TO APPROVAL OF BOARD OF HEALTHD ISL1/
N
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of thefTown of Barnstable regarding the above
construction.
Name . ..............
Construction Supervisor's License .:.. ......: >........ ......
GIFFORD, JEFFERY W.
N .. 2Q.2.8... Permit for ..........
........S.i.n.g.le..kFa i. .y...nwe1.1.i ag............. f
Location .Lat...3.3.�..
.cA.tui.t..........................................
Owner ......+? �.y....h1,.... .i. 01;G.............
Type of Construction .....k:x:c3me....................... ;
......................................................................
Plot ........................ Lot ................................
r
Permit Granted June 2 8; .....19 88
Datel6f Inspection ....................................19 -
Date' Completed ..... .':,j ..:........19
i
r';00
r
+. rp r-
Assessor's map and lot number ...a o - 3 3
pF T E tp�
Sewage Permit number .. ................:;
a8 �J BA"STAMLE, i
House number ........:................... ........................................ ro M aea
i639. \e
MAY A,.
TOWN, OF BARNSTABLE
r
i BUILDING INSPECTOR � ..
APPLICATION FOR PERMIT TO .....�..�7.7.1' .. ...... . .)........ ....................�.......... .....................
`t TYPE OF CONSTRUCTION ........... ? sD.....1:I... .....................................................................................
............................ ... .....19 �D
TO THE INSPECTOR OF BUILDINGS:
The.undersigned hereby
� (applies fora permit according to the following informationn:.
'Location ............(7 t .Y7.1.C��'1. ... ` ... C�"�L.1.1 ................................... -- :.4.... ..a,� .. ...................................
ProposedUse ........... ......! t5.!?. ............................. ............................... ..........................................
Zoning District Fire District .....1,..0 (•}.1�................ .. ,. ``.�.. ..�'............ '.....................
t
Name of Owner ... . .... .......G.i.�Q.�(5...............Address ................ � .�.�.Nn�S 0..........
. � ►�'� lk��°� . R '-t'+'+'�'� c:> � SIR�i'tA.o�i, ��'}' l� :....... ...................
Name of Buifder ........ � ddress ..........:�.. ........ ............!!D.............. ......A ..... ..........�........ .................:.. .�.. .
Name of Architect .f.�.��.tG!!wx�::. QC.�.i�J nC.......................Address � S����.`'` .-f ....1� 1��C.r.!!P�C�I...4 l: p.r......
Number of Rooms I Ci �v`� Foundation r d��C �� 't..................................................... .............................................................................
Exterior ..... 5.......'VI .................................... ..........................:.:..
t�. ) 7.....Roofing �...............
Floors .......... .. ':�bdi 5...................(.,. Inferior .......�QA. ),.�:'OAI...........:....:......:................................
Heating ��=ate''=........ rc�. .. n .11........y''....... ...4.Plumbing ..... ...1311 .......................................................
Fireplace ...........M-S,40 Approximate. Cost .... !.................
9.9
Definitive Plan Approved by Planningp Board ________-_____________________19________. Area ............................ ...........f.
Diagram of Lot and Building with DimensionI i Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
t
,I
- r
• r
6CCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regu-lations of the Town of Ba'instable regarding the above
construction.
h Name ....... . .....
"`: - Construction Su{�ervo License ,k
GIFFORD, JEFFREY W. A=20-33
No A.20.2.8. Permit for ...One„,SIgry,•••••••••
Sincfle..Family...Dw l .�,
.. g............ - O r
L
�f
Location Lot #3 3,.....,2&...H i,gliland�...Avenue < �-
4, Cr
C
.................COtUlt.............................................. CU
Jeffre W
Owner ....................Y............r�.7..��.Qxd............... �.
Type of Construction ......k:x.ame....................... r -
_ .r
.................................................................................
00
n .
Plot ............................ Lot ................................
� J
T
t
Permit Granted ........J.UZe...2.8.............19 88
Date of Inspection ...................
Date Completed .....:................................19
_ F
A
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I M A�L'
DATA
„` .w.. TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING'PRN1�1
A=2 0--3.3 'fD'DATE ,. 9 is T 6n 0_1R
s 1 '+ PERMIT NO �'+ 1� ..7 t
APPLICANT I :'�2 ADDRESS -si% JWIt i ,j: x,� a I '1 '013483
.! t�. a
IN0.) (STREET) l'C ONTR'S LICENSE)
PERMIT TO ouJ NUMBER OF
'- (i ) STORY :.L'. l. ,.<�1,t1J. _)�i',:.) .;UDWELLING UNITS
ITV PE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) r 1J T{:.( ;';1.c1 'U "• i:qa,j 1'li . ZONING .
" (NO.) �.F-�•� _ (STREET) DISTRICT,
BETWEEN t' v`
AND
(CROSS STRE
ET)
- ) (CROSS STREET) .
SUBDIVISION LOT ,
LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY F.T. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTII
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
II _ (TYPE)
REMARKS:
liond
AREA OR
VOLUME (.i, {_1t1 PERMIT
(CUBIC/SQUARE FEET) GG
ESTIMATED COST 0 FEE
OWNER
ADDRESS BUILDING DEPT.
BY o
THIS PERMIT CONVEYS t10 RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY C
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE A!
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE 0-STAINE
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIOP
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE SA A”INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN
ELECTRICAL, PLUMBING AND
t. FOUNDATIONS OR FOOTINGS. MADE.. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIREO,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBFINAL INSPECTION
TI TO LATH)BEFORE
FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY. -
POST THIS CAR® SO IT IS VISIBLE FROM STREET
BUI DIN INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS 'ECTP,ICAL INSPECTION APPROVALS
3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
i
OTHER
BOARD OF HEALTH
WOR16tHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'H!LL BECOME NULL AND VOID IF CONSTRUCTION
TOR HAS APPROVED THE VARIODUS-STAGES OF . WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN
CONSTRUCTION. PERMIT iS ISSUED AS NOTED ABOVE, ARRANGED FOR BY TELEPHONE OR WRITTI
NOTIFICATION.
i
Afightand -pad
t
qt t Cape �n i ap a�2y:ee�i.nc
L19 /:lc&bo�t Road
.ltlanni4, ria. 02601
i
i
`�-50
�Ia-te 6-8-88
VI, p
.totA c,
363,982 S
�a 4( CAR
l tot A a4.shown on a ptan
I Z,oz made Jot oeb J G,!jt02C1, doted
3-29-88, and teco2x ed.
J S�
Jhe Foundation ahown on th i 4,
ptan i.4 -foca-ted on the pound
a4. ahown hetcon, and me.P t . -the
4P,tback- tegcwte%aen& o� tJte �
ld l`decrz 44 �I Jown o da&nAtab fie.
�. .\Oad IO t.0 raC7.it O n
:qnc i en t watt /` Ja-te 6-8-88
L
s 156
eot, is
\ SNED
\ \ 33.00 157
I
POWER OF ATTORNEY
I, Lawrence P. Tasney, holder of Construction Supervisor
License #013483 issued by the Department of Public Safety,
Boston, MA, authorize Eugene J. Smith or Patricia Smith
of Holiday Homes Construction Co. , Inc. to use my signature
and license number.
Lawrence P. Tas ey
30 Hunt Street
Quincy, MA 02171
Sworn to and subscribed before me this twenty-eighth day
of June, 1988
Notary Public
. ", �,,..__ „� �::. ,. s,.,.��-...,,x,y_.:rz.. �.�r..Y..�-^.:».:,,,-�F.�..-��.}Tr,Y;.."*r''.,�i'•fF+t� ''�r"'+w^^"y+�w-r�Y.rv^-� «-�-e-s�sr-_" -•,c�-^,.;wM-«s.s r�-;�.n+/w'. ,�,�„�_.
•
,.•ME TOWN OF BARNSTABLE Permit No. ...3. �
BUILDING DEPARTMENT ..
I '�iMa I TOWN OFFICE BUILDING Cash ................
HYANNIS.MASS.02601 Bond ..
CERTIFICATE OF USE AND OCCUPANCY
Issued to Jeffrey W. Gifford
Address Lot #33, 22 Highlands Avenue
Cotuit, Massachusetts
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND,IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
February6, t9 89 �+%.......................... ................. ........ ................
Buil i g Inspector
l
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
2 BARIST U : TOWN OFFICE BUILDING
rua
i6J9' � HYANNIS, MASS. 02601
�o rn�t►.
MEMO TO: Town Clerk
FROM: Building Department
DATE:
An Occupancy Permit has been isssuueed- for the building authorized by
Building Permit #.: t5 r ............ _...... .........._... ......._
issuedto ....��L�Z. .. �1„ .................._.................................._..... ........; ✓� l . �...
Please release the performance bond.
Best Pit #P-S l 36
Made Jdti l�o �3 `----
wit. �. Con-0n j�zo�•i,Ge � I
No wa test encoun te&-e'd No Pab .�
Pete. 4,ate 2 min, pet 1 n
top
_. _ _.. .. .......... - -
3� •
Iqu Cope hank 1500
I �
Barad a9 4adio!i Road 4
/dyam, Ma. 02601 �.5.9. ! _
si
3 S® vi .
I
f� �caLe I'r= 50
9.P. #2 date 12-30-85 i
# 4 s
37 � —
d
top
• '� n 1 -
I -
N 5_eN, F 1_I 7.
r , otd Neck load = 549 cvo o,
i !.'6. ,'� 6 (a p4,op4,i;eto-ra ��-
�� way)
INM40-1 Evi i -
Nk
1
Ct,wa�t i on, a wwn at: bad ed on adunsed datum.
No. 1Jc3G/L(JOM1 ? I !
1) .O
I _ Zeac. ,w, acted __ 267 g s _
O l" LE
_l
L o
- i�e�e.2r�e: . a 267
{ Ll
C
o
apc�ar �� S49 �d ti� �,uEo 6"
1 ..:..
I
,
I
I 7S*ac. i
Sketch /).Canso j, .tand in Cot.�i t, Ma, �1-
O2 r'e� 1Cti �o2d i
'3e�ru pc�,t o d a,. de4a-tZed in deed A. 694 l c�. �62
ap aliowt% on a plan o f Co•tui,t hog Ale--to-t4 dated &q 1903. 3`
I
Z.
A OF
i
I
- --
h L I
VARDIF
To
k ,
t
a..
ti
e�
Town of Barnstable
Regulatory Services
CF TME'1p�
Thomas F.Geiler,Director } �}
Building Division
: BARNSrABLE, + _
MASS j Tom Perry,Building Commissioner-
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 _;*'v�i ��€� Fax: 508-790-6230
Approved:
Fee:
Permit#: CC/2 t
HOME OCCUPATION REGISTRAT ON
Date:
Name: pe r �/ t d`Cl Phone#: CS0S) L128—Rg3y
Address: 2Z Village: � V 1
Name of Business: c e cos � d ` » y�C
<G ( � " ' �
Type of Business: �Z�,n ff�0.C���r e (Rer4r— Map/Lot: Oc>2d /&3,—
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there is
no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have read and agree with the abovp restrictions for my home occupation I am registering.
Applicant: Date:
Homeoc.doc Rev.5130103
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which
you.must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1'FL., 367
Main Street, Hyannis, MA 02601 (Town Hall)
awl DATE: 6, 5-IO44
C�
�r � � Fill in please: r
APPLICANT'S YOUR NAME;-J Gr'�` Ll? ° Cr
M ,�M 1 M
BUSINESS, YOUR OME , DDRESS: 22 1
� .r .TELEPHONE. # Home Telephone Number
NAME OF>NEW'BUSINESS 2'� P IL
e Tree t,, e!e'TYPE.OF BUSINESS
h 4 120 C ►n
IS THIS A.HOME'OCCU_PATION?. -NO
...
a. on
ADDRESSOF BUSINESS MAP%PARCEL NUMBER 0,20
S
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of.Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S.OfFICE
This individual has or ed of an p rmit requirements that pertain to this type of business.
OCCUPLO ON OME
ut orize Signature**
COMMENTS: p RULES
2. BOARD OF HEALTH
This individual has been informed It mit requirements that pertain to this e of business.
q P type
Auth rized Signature**
COMMENTS: . / c! Z. 81
3. CONSUMER AFFAIRS (LICENSING AUTHORITY]
This individual has0einform tiie licens e, ire that pertain to this type of business.
fr Authorized Signature*
COMMENTS:
�� I
47
,,v ' own (of Barnstable ?l *Permit# ) sd �.
evExpires 6 months from issue date
RtVglll<ktffy StvFAUS Pee 5
,U� 2 9 2dng Thomas F.Geiler,Director Q�
Building Division
o� Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601 -
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION v RESIDENTIAL ONLY
Not Valid without Red Y Press Imprint
Map/parcel Number 0� d (�
Property Address C +L`^d ;Iq A- U ;26 3 S
residential Value of Work �{- 5 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address 'd, o -0
a
C1 MA-
Contractor's Name aAJ- • Ca`y�ba" cJ I Telephone Number
Home Improvement Contractor License#(if applicable) ! 2 5 3�P
Construction Supervisor's License#(if applicable)
[�,Workman's Compensation Insurance.
Checl one:
❑ I am a sole proprietor
❑ I am the Homeowner
0,I have Worker's Compensation Insurance ))
Insurance Company Name T�ZrL Ul
Workman's Comp.Policy# LL f� D 3 q I M$,5 �(� O
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 I
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-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.
***Note: Property Owner must sign Property Owner better of Permission,
- _.A copy the Home ImProvement Contractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise061306
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
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): FA a_dL� L LC,
Address: I J l
City/State/Zip: dj Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1,2�_1 am a employer with 4. ❑ 1 am a general contractor and i
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. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9.. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation'and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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:
Policy#or Self-ins.Lic.#: U ly - 0 3 q I M 56 6 - 0 cl Expiration Date:
Job Site Address: 02 vt ( - City/State/Zip: C_e) n'l D 6_?
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi a nd pe Ides of perjury that the information provided above is true and correct.
Si ature: Date: '12
Phone#:
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#:
i
A
d` g' Ss'IIdOdg -
• �P �Li�'ee�se
MOB
' 0'11• T40 9.7638 '
EAST�AUDtmUJW,IPA,tf�S6 mmS�sionir
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. H found return to:
Registration: 112536 Board of Building Regulations and Standards
Eupiratft -3123/2011 Tr# 281021 One Ashburton Place Rm 1301
Type: DBA: Boston,Ma.02108
FRASER CONSTRUCTION C.O. ;1
DEAN FRASER 31
104 TWINN VIEW LANE
E FALMOUTH,MA 02536 Administrator Not re
i
Boar o �ingla ons an tan ar s
One Ashburton Place. boom 1301, -
Boston. Massachusetts 02108
Dome Improvement Contractor Registration
Registration: 112536
Type: DBA.
Expiration: 3/23/2011 Tr# 281021
FRASER CONSTRUCTION CO.
DEAN FRASER
P.O. BOX 1845
COTUIT, MA 02635
Update Address and return card.Mark reason for change.
Address Renewal Employment Lost Card
Al is 40M-08/08-OBSLIFORMCA108212008
f
I
i
f-
RM
I"•`:m 1
RightFax C2-2 10/1/2008 1 : 00:56 PM PAGE ' 2/002 Fax Server
::.......:::... .....s:..-�:......::.::.. _.. - .. ..::. :....s ------ ISSUE DATE
:•i:::::•::•::::•: ::•: 10/01/08
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES BELOW.
WISE&QUINN INSURANCE AGENCY COM PADS AFFORDING COVERAGE
449 PLEASANT ST
BROCKTON MA 02301AR"Y A IIARTFORD UNDERWRITERS INSURANCE CO
IHM
INSURED COMPANY
FRASER CONSTRUCTION LLC LETTER
PO BOX 1845 �ARNY C
COTUIT MA 02635 CCOOMPANY D
:?:f.ti::•tiav-::•:•:{{: :. ::•::}::ti}ti y:{•}:?::•:v.�: ti•}r v v•:.: E: aS } tiy ?B:K• COMPANY
LETTER
{:: :...: ti:......f:...
TIES IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTW nIFSTANDINO MY REQUIREMEN•C.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W TM 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
CO TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LIMITS
LTR EFFECTIVE DATE E"IRATION DATE
(MMIDD M/DD/YY)
GENERAL LIABIdTY OEN RALAGOREOATE $
PRODUCTS-COMPIOPAGG. $
❑COMMERCIAL.GENERAL LIABILITY
❑ CLAIMS MADE ❑ OCCUR. PERSONAL&ADV.INJURY $
EACH OCCURRENCE $
❑OWNERS&CONTRACTOR'S PROS. -
v FIRE DAMAGE(Any One Fire) $
MED.EXPENSE(Any one person $
AUTOMOBILE LIABUATY comn;IN®SINGE¢LIMIT $
❑ ANY AUTO .
BODILY INJURY $.
❑ ALL OWNED AUTOS (Pcr PersotQ
❑ SCH MULED AUTOS
BODILY INJURY $
❑ )BRED AUTOS (Pcr Accident)
❑ NON-OWNEDAUTOS
PROPERTY DAMAGE
❑ GARAGE LIABILITY
- $
EXCESS LIABILITY
❑ UMBRELLA FORM EACH OCCURRENCE $
-- AOOREOATE $
❑ OTHER THAN UMBRELLA FORM .
STATUTORY,LIMITS X
A WORKER'S COMPENSATION EACH ACCIDENT $500,000
AND UB- 09/26/08 09/26/09 DISEASE•POLICYunur $500,000
0341NB56-08
EMPLOYER'S LIABILITY DJSRASEEACH8AUWYEE $500,000
OTHER THE
PROPRIETOR/PARTNERSIERECUTIVE
OFFICERS ARE INCLUDED.
DESCRIPTION OF OPERATIONS/IACATIONS(VEMCLESISFECIAL ITRMB
TIM INSURRD*S MA WORKERS COMPE(MTION POLICY AND ITS LIMITED OTHER STATES INSURANCE RNDORSRMRNT AUTHORIM THE PAYMIPU OFBIINBPITB FOR CLAWS
MADE BY TM INSURED',MA ES PLOYNES INSTAT890MER THAN MA.NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENEFITS IN ANY STATE OTBER THAN KA IF THR
DISUSED HUM,OR HAS HME%KNIPWYERS OUTSIDE OF MA.TM POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTTIER THAN MA.
THEE REPLACES ANYPRMR CERTIFICATE ISSURDTO THB CERTIBICA'IR HOIAER AnWnNG WORKERS COMP COVERAGE
'•1L1V.'...t:11:V.•:1{•:r.r•••:••••• ::1::•:.••L::{1•r:1.1::1y�'Y :.i}•llhl.•.rl:ll:r::.'f:.`r: :'11{:{1::{•:fhY L•.Vr f::L•.1M11.{•.•:
jj•L•1V.4.•. •:{•:r:.:::•::N.V:N{L:::1-•:•.'.Y A:V.•:.S•LL••y:•:• .A•_VX_LS:::::11C::L:L:{❖:':�•A•:•:1LV.Y_JSlAV •.VJ.1
:..........................................{........i.::..V:: -
FRASM ENIEWIVAPMES LLC SHOUID ANY OF TIM ABOVE DESCRIBED POLICIES HR CANCRIMM BZFMTHR
PO BOX 180 RIIPRiATION DATE THEREOF,THE L99UIM COMPANY WILL E NDRAVORTO MAEL
COYM MA 02435 IO DAYS WRITIEIV NOTICE TO TNR CKRTIFICATR HOTAffit NAB TO THB LRFr,
BUT FMLIJRRTOMAMSUCHNOTICRSNALL HOMNOOBLIGATMOR
ILUHZffOFANY KIND UPON TBRCOBWANY ITSAGENTSORRBPMENTATIVIS1
ASPRE51BVi'ATIYE -
�4�C�
• - •.vr.:vr ~:1-:•-'-l:ti:•• }'y'{{{1:1�•ti-'••t`• '':
'•:{•---•{_•:'•11-e�v:y k.}r .•'•.•k :�}'.:t titi��:•.v'•"�r '
. ....+Y:}..k4{:::.vh.t�.:........?h;.r]:::{•-:-:::::•.: {4.�f{t+r• :a•Yr.}�+M.,.'�+.4A+•:4 '•hTi�:�:fi}..::..:.:.:t:•:i ..
i
!' Fraser Construction, LLC
CONSTRUCTION
P.O. Box 1845, Cotuit MA. 02635
ROOFING & SIDINGEmail: fraser construction&verizon.net
www.fraserroofing.com FAX 1-508-428-0123
508-428-2292 MCL#112536 CS#97668
RE-ROOFING PROPOSAL
DATE: June 15, 2009 PHONE: 508-364-2874
NAME: Jeff Gifford
MAIL ADDRESS: P O Box 543 Cotuit, MA 02635
JOB ADDRESS: 22 Highland Ave. Cotuit, MA 02635
FRASER CONSTRUCTION hereby proposes to perform the following services in a neat
and professional like manner and 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.
Supply and Install - CERTAINTEED LANDMARK /WOODSCAPE AR 30: 30 - Year
Warranty, 5 year Sure Start Protection, 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. 5 year 110 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- $7,695 House Initial
PRICE- $1,275 Shed Initial
Supply and Install - CERTAINTEED LANDMARK /WOODSCAPE PREMIUM:
Limited Lifetime Warranty, 10 year sure start protection, CLASS A FIRE RATED,
ALGAE Resistant, Extra Heavy Weight, Self Sealing, Multi-Layered, Laminated
Architectural Style, Fiberglass Based Asphalt Shingle with New England's Exclusive
COPPER/CERAMIC Stones with a Full 10-year Warranty against ALGAE
Containment. 10 year 110 mph wind-resistance warranty Wind warranty upgrade
to 130 mph when CertainTeed starter & CertainTeed hip & ridge are used. See
actual warranty for specific details and limitations. Fraser construction includes six
nails in common bond area at NO additional cost.
Color: ` PRICE- $9,000 House Initial ei-
-Sa,-,vx skak�e
PRICE- $1,475 Shed Initiaf
Supply 8s Install- CertainTeed Winter- Guard: (ice & water shield)
Waterproof Underlayment System (3ft. on eves and
valleys, 18" on rakes, walls, and skylights)
Supply & Install - Roofer's Select Underlayment Paper (as recommended
by CertainTeed)
Supply & Install - Hick's Ventilated Drip Edge or 8" Aluminum Drip Edge
Supply & Install- Aluminum & Neoprene Soil Pipe Flashing
Supply & Install-Air Vent Ridge Vent (as recommended by CertainTeed)
Clean & Remove - Debris from work area daily.
TRIM WORK:
Remove & replace all rakes on main house with PVC trim 1x6 1x2
(except the section where the power is - we'll piece it in as best we can)
PRICE- $1,195 house Initial
PRICE- $375 shed Initial
X4 Star Warranty Upgrade will be applied if proposal is signed and
returned within 10 days. (see enclosed brochure)
NO MONEY DOWN - NO Payment at the start or part way thru
Payments accepted are:
CASH- CHECK- MASTERCARD -VISA-AMERICAN EXPRESS
*Any payments not made within 30 days of completion will be charged 1.5%for every 30 days the
payment is late.
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$60.00 per hour, plus 15% mark-up materials
FRASER CONSTRUCTION Warranties the labor for 12 years
FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years.
I
m;
CERTAINTEED Warranties the shingles and labor 100/o through the Sure Start
Warranty duration.
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.
DATE OF ACCEPTANCE: 1', ((C? L0 C'
omeowne Fras onst c ' n LC
�.-S o 1 rNQ- v Yls�e on