The URL can be used to link to this page

Home My WebLink About0989 MAIN STREET (COTUIT) �8p /J'Jfli,J ST. - - �. /� - � � i i Town of Barnstable *Permit# �.C�� 5 y� Expires 6 months from issue date Regulatory Services Fee P�RM' 1 Thomas F.Geiler,Director Y G_PRESS 1�� Building Division — 4 2007 Tom Perry,CBO, Building Commissioner �UN 200 Main Street,Hyannis,MA 02601 � � o PARNSTABLE www.town.barnstable.ma.us T e: 0 -862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint V Map/parcel Number A3q O Q 9 Property Address —(7 g�q X"' , esidential Value of Work Minimum fee of 25.00 for work under$6000.00 Owner's Name&Address t. Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) JF If Construction Supervisor's License#(if applicable) ❑workman's ompensation Insurance Ch k one: Kam a sole proprietor I I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) -roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope Owner must sign Property Owner Letter ofi�ermission. o of 0 e Improv ent Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 ' The Commonwealth of Massachusetts Department of Industrial Accidents z Office of Investigations 600 Washington Street W= Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance. davit: Builders/Contractors/Electricians/Plumbers Applicant Information A I Please Print Ise 'blv Name(Business/Organization/Individual): . A Address: /7 City/State/Zip: Phone.#: Are you an employer.? Check the approp ate bog: Type of project(required):. 1.❑ �Ioyees mplo er with 4. I am a general contractor and I Y 6. El New construction . (full and/or part-time). have hired the sub-contractors 2. ole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. �Building addition [No workers' comp.insurance comp. insurance.$" 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.❑roof PIing repairs or additions myself. o workers' com . right of exemption per MGL Y � p c. 152, 1(4),and we have no 12. epairs insurance required.]t § 1 Other employees. [No workers' comp. insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam 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.#: Expiration Date: Job Site Address: 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or ne-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a ag • t the violator. Be advised that a copy of this statement may be forwarded to the Office of Investieations of e for insurance covera e verificedon. I do he certi n er the p ns n penalties o erjury that the information provided bov .cs true d correct: Signafore: Date: Phone k Official us only. Do not write in this area,to be completed by city or town of ecial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee 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 an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal 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 of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 'The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/hcense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits.or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e, a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. ti The.Commonwealth of Massachusetts Department of Industrial accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.4� 617-727-4900 ext 4.06 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.go-v/dia Town of Barnstable. Regulatory Services 9EAxrtsrass,E,XAM $ Thomas F.Geller,Director $AIED�w'�b1 Building Division Tom?erry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town,barnstzb1e.rnz.us Office: 508-862-4038 Fax: 508-790-62.30 Properly 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) Signature of Owner Date Print Nark - OFOP MS:O�T!�T�RPF,R�SISSION _ Board of Buil a� ..._.... ding Re �aacl�cQe _.� HpME iMpno gutations and gf EMENT andards. j Registration: coWRACTpR Expiration; 114813 10/27/2007 �. DAMES p rYPe:. DSA ,TAMES ANFORTH REMOD 1p5 OLD P D,4!,,,IF 1 ORTH COTUIT,M,q 0263RD' )r 5 Adrrunicfrator ESTIMATE James Danforth - P.O. BOX 973 COTUIT, MA. 02635 (508) 420-5131 Mrs. Twitchell 989 Main Street Y, Cotuit, MA. , May 19, 2007 Work to be completed on sections of house roof as follows. Remove the existing roofing material from the flat roof located at the front of the house. Install 8" aluminum drip edge on the front and right sides of the roof. Install polyglass base sheet over the existing roof sheathing. Install Elastoflex Membrane over the base sheet. Remove the existing roof shingles from the upper dormer roof located in the front of the house. Remove the existing shingles from the rear doorway roof; also a section of the roof above the doorway roof. Install 8" aluminum drip edge on all roof edges. Install ice and water shield 3ft. up onto the roof. j Install 151b. felt paper over the roof sheathing. Install a Certainteed three tab roofing shingle. Install new roof caps. House and shrubs will be covered with tarps while work is in.progress. Removal of rubbish. Material and labor$1,930.00 Acceptance of Proposal: 61 Signature: Date of Acceptance: Signature: A