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Home My WebLink About1045 MAIN STREET (COTUIT) l0�5 Mein/ vn of Barnstable *hermititc�00 ,� � -- Is�pircr 6 n(hs r 'sue rla(c• s I una�M .b lee�e� d� ltor Serviees .� 9cb i639 `0�' �� flto iF.Geiler, Director prat mpc° ® °� �� `� 5 illding Division NN ®�. Tom Perry,CBO, Building Commissioner `w \\,,\0� 260 Main Street,Hyannis,MA 02601 1 www.town.barnstabl c.nia.us Office: SU8-862-4038 Fax: 508-790-C230 EXPRESS PERMIT APPLICATION - RESMENTIAI; INLY Not Valid without Red X-Press huprint Map/parcelNumber��l�/7� _ ,•� . . • i Property AddressC, Residential Value of Work Minimum fee of$25.00 for work under :000.00 Owner's Name&Address Contractor's Name .. 1�%` lei Telephone Number i. -� Home Improvement Contractor License It(if applicable) Construction Supervisor's License#(if applicabic)_�� _ t C' ❑Workman's Compensation Insurance A N Check one: ❑ I am a sole proprietor ❑ I a ie Homeowner y' have Worker's Compensation Insurance Insurance Company Name i Workman's Comp.Policy Copy of Insurance Compliance Certificate must be on file. Pern�it Request(check box) alre-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.U-Vakie (m,aximum.44) 'Where required:`Issuance of this permit does not exempt compliance with other town department regulations,i.c i listoric„Conservation,etc. *"Note: Property Owner must sign Property Owner Letter of Permission. Home rovemmee t Co tractors License is required.. SIGNATURE: Q:forms:cxpmtrg u Revisc071405 The Commonwealth of Massachusetts Page 10 of 10 in,^ 4 Department of Industrial Accidents Office of Investigations 600 Washington Street t tt► �. . I rrii \'U4/ Boston,MA 02111 r�~ www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant'Information Please Print (Legibly Name (Business/Organizati.on/Individual): PA U L_ �T- L2 a e aU'+ E O n S 00 f—tA J Address: (O 3 M a l Y1 s City/State/Zip: a5�.e c y j 11 M AO2(o Sr.Phone#: So a 9 2-8 - 1 l 1-7 Are you an employer?Check the appropriate box: Type of project(required): 1Z 1 am a employer with 12.. 4. Q I am a general contractor.and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling ship and have no employees These sub-contractors have 8_ ❑Demolition workingfor me in an capacity. workers' comp.insurance. Y P �'� 9. ❑Building addition 5. We are a corporation and its o workers' .insurance ❑ork rs com rpo . . pME]Electrical repass or additions required.] � officers have exercised their _. 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself..[No workers.'comp. c. 152, §1(4),and we have no 12,IR Roof repairs insurance required.]t employees,[No workers' comp, insurance required.] 13.❑ Other Any applicant that checks box#I 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an.employer that is providing workers'compensation insurance for my employees. Below is tine policy and job site. information. Insurance Company Name: Policy#or Self-ins Lie.#: Expiration Date: aG� Job Site Address: _,,01 I— 4_2 City/State/Zip:.' �re 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 certify r the pains and p ties of perj that the information provided above is true and correct Si ` ature Date: , �y 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#• Boar o u1 m e ula Eons an an �rs g g One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement'Contractor Registration - = Registration: 103714 t Type: Private Corporation w Expiration. 7/9/2010 Tr# 269847 PAUL J. CAZEAULT & SONS, INC: ' Paul Cazeault =- 1031 MAIN ST r -------— — - - OSTERVILLE, MA 02658 • - M5e Update Address and return card.Mark reason for change. S-CA7 0 SOM-07/07-PC8490 Address Renewal 0 Employment Lost Card ./�tC U/G!'7L�)z0'IZclIP.LLGG/Z pL✓l�GQ40Q�ZCL6P.�6 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 103714 Board of Building Regulations and Standards Expirations.;,7'/9/2010 Tr# 269847 One Ashburton Place Rm 1301 -Type,"-Private Corporation Boston,Ma.02108 PAUL J.CAZEAULT&;SONS, Paul Cazeault Boar o ui din e ulatlons an g g tan arils One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Construction Supervisor License :_-: License CS: 26325 Restriction: 00 L, Birthdaie: 10/20/1959 Expiration: 10/20/2009 Tr# 6311 PAUL J CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 0. Update Address and return card.Mark reason for change. DPS-CAI v 5OM-07107-PC8490 -- —.— (� Address Renewal .Lost Card .Board of Building Regulation and Standards Construction Supervisor License. µ License: CS 26325 Birthdate:' Ezpirafioi -`0/20L2009 Tr# 6311 ' FtestcictioIr 00= PAUL.J CAZEAl1LT� Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. I (print) �dwu. C. C.�a �"� , as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for. Address of Job ;Z oar as Signature of Owner err Mailing Address of OwnerD. Telephone# Date (Please return this form to Cazeault roofing along with your signed contract;.It is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you) fax#508-420-4555 ACORD CERTIFICATE OF LIABILITY INSURANCE CP:zSR RF DAoBilz oe) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE M-acIntyre Fay S Thayer Ins Agy HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR . 77 Accord Park Drive Unit B-1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW: Norwell MA 02061 Phone: 781-261-2000 Fax:781-261-2099 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: American International Co. Paul J Caxeault & 1NSURERs: 1 Sons Roofing. Inc. 1 INSURER C: 1031 Main Street I—INSURER D: Osterville MA 02655 _—� — .INSURER.E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOWHAVE 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 RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ) . ......_-. .... ..._. :POLICY EFF_ ., E._....�_.OL IC . .P__ TIO LTR INSRD TYPE OF INSURANCE POLICY NUMBER ; pgTE pARAFECTI PATE MNI10 LIMITS ( GENERAL LIABILITY I EACH OCCURRENCE IS. .COMMERCIAL GENERAL LIABILITY ( -R,EMI$ES-(Ea occurence) S i CLAIMS MADE OCCUR. MEO EXP(Any one,person) $ I 1 ,PERSONAL 8 ADV INJURY GENERAL AGGREGATE 3 GEN'L AGGREGATE LIMIT APPLIES PER: I !PRODUCTS-COMPIOP AGG i 5 POLICY I £a I I I LOC j •.AUTOMOBILE LIABILITY ( j ! I COMBINED.SINGLE E LIMIT ANY AUTO 1 (Ea accident) ALL OWNED AUTOS i BODILY INJURY g ��-SCHEDULEDAIJTOs 1 ,(Per person) HIRED AUTOS ( i i ti=J 1 I BODILY INJURY i . 1 NON-OWNEDAUTOS I ' ((Pereccidenl) j I PROYERTYOAMAGE I ! ) (Peracdcard) $ ' I�ANY AO-ITY O Eh ACC '$ z AUTO ONLY-EA ACCIDENT i$ ' I i OTHER THAN j AUTO ONLY: AGG $ , EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $. 1 OC-UR CLAIMS MADE ! .I AGGREGATE S i ! i $ DEDUCTIBLE F I ! I E I$ RETENTION $ I S- WORKERS COMPENSATION AND I x TORY LIMITS j EMPLOYERS'LIABILITY1 — - — A I.I 6978565 08/10/08 08 ANYPROPRIEI'ORIPARTNERIEXECUTIVE - /10/09 i E.L.EACH ACCIDENT $SQQQQQ OFF!CEPiMEMBER€xuLIDEO? I EL DIS€AS€-EA€MPLOYEEI 3 1 0:0.0C j It yes desabe under SPEC IAL-PROVIStONS Wow I E.!DISEASE-POLICY LIMIT I$500000 I OTHER j I E DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CER71F1CATE.HOl06R CANCELLATION FOR REC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR.-TO.MAIL. O30 .DAYS-WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL For -information -Purposes IMPOSE NOOBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,IY5 AGENTS OR , REPRESENTATIVES: AU 0&►lEDREP 'S TATi}�:.. ACORD 25(2001108) /�� ©ACORD CORPORATION 1988 Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. 973 lyanough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA Western World Paul J.Cazeault&Sons, Inc. INSURER B: 1031 Main Street INSURER C: Osterville,MA 02655 INSURER D: INSURER E: - COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDIT(oN OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POI..ICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR_NSR >__ - - __D_M M1DD•�:l -_DA7:MMlDD �LIMITS A GENERAL LIABILITY NPP1145484 04/30108 04/30/09 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY _.DAMAGE TO RENTED A ISES(Fa gWWrrencel $50 QUQ CLAIMS MADE a:OCCUR MED EXP(Any:one person) $5 000 X BI/PD Ded:1,000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 OOO OOO GEN'LAGGREGATE-LIMIT APPLIES.:PERs:::. PRODUCTS-COMP/OP AGG $1 000;000 POLICY J ROT- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident). . GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AND T I EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE .. E.L EACH ACCIDENT OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE-$ If yes,describe under - SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES t EXCLUSIONS ADDED 13Y ENbORSEMENT.I-SPECIAL.PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Paul J.Caz+eault&Sons DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _._.1.n DAYS WRITTEN Roofing,lnc. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1031 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Osterv.ille,MA 02655 REPRESENTATIVES. AUTHORIZED R RESENTATNE ` '07 G ACORD 25(2001108)1 of 2 #52027 ✓ LS1 0 ACORD CORPORATION 1988