Loading...
HomeMy WebLinkAbout0700 POPONESSETT ROAD �tre �opoaeceT( IZd. �- - -- - J � _ i Of Barnstable � *Permit# 3-63 RGc�� �� ires6months romissue' �P f dote uA NrsrABt.E, : AUG _ g �p��Regulatory Services Fee 9�A 1639 ,0� Thomas F.Geiler,Director 'f0"""` WN OF BARNSTA ildin!�� g Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press I..priu6 Map/parcel Number Q (S "l Property Address't 00 �a p o nJ e 5 S e RA a tv ' Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&AddressDin ipO' 91' 4',k\/aY\ 4`- �GY� l?o_ Do Y)e-'S S; IAA Co . m R o 2 co3 5 Contractor's Name Telephone Number��0 Home Improvement Contractor License#(if applicable)_ Za Construction Supervisor's License#(if applicable)_ A7� Z )K.Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# �, j�DCt 5 "[A05 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) R,Re-roof(stripping old shingles) All construction debris will be taken to__q ;r oy ❑Re-roof.(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement)Wndows. 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 Letter of Permission. Home Im ovement Contractors License is required. SIGNATU Q:Forr s:cxpmtrg Rc visc071405 , rrt � The Commonwealth ol Massachusetts Department of'Industrial Accidents :.r z Office of Investigations 600 Washington Street y` Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elects icians/Plumbers Applicant Information Please Print Lelzibly Name (Business/Organization/Individual): t, SO Ns (� 1A) Address: l(731C�(n S� . City/State/Zip:,04C r\V i D ZbSS Phone#: Are ou an employer? Check the appropriate box: Type of project(required): 1. I am a employer with . �,� 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors . 6• El New construction 2.El am a sole proprietor or parter- listed on the attached sheet. $ 2 Remodeling ship and have no employees 'These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I 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 1?.�Oof repairs insurance required.] t employees. [No workers' 13,0 Other 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. 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 the policy and job site information. TILQ Insurance Company Name: TM J�` -�I(S 5 Policy#or Self-ins.Lic. #: V 0) DU Cj Nj 4 rl y 5 Expiration Date: Job Site Address:_ b®D Q!?SS2A Cck t- City/State/Zip: A A 2, 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 ce under the pains and penalties of perjury that the information provided above is true and correct Si a Date 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: f � �.ZME Jam,_ BARNSrABM = Town of Barnstable y MASS. Regulatory Services �'0rea ram" Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section = If Using A Builder I ,as Owner of the subject property rj hereby authorize o act on my behalf; in all matters relative to work authorized by this building permit application for: 62 ( d ess of Job) Signature of Owner Date Print Name i i Q:ForMS:cxpmtrg Revisc071405 j! _ = Board of Building Regulati ns and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 _..... Update Address and return card. Marls reason for change. Address .� Renewal I Employment Lost Card PS-CA1 0 5OM-05/06-PC8490 OR& '�iomvinoouu� o�/�aaa�ivarlld 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 Expiration: 7/9/2008 One Ashburton Place Rm 1301 lugBoston,Ma.02108 Type: Private Corporation PAUL J.CAZEAULT&,SONS INC Paul Cazeault 1031 MAIN ST OSTERVILLE,MA 02658"! Deputy Administrator Not valid without signature Board of Building egulations One Ashburton Ace, Rm 1301 Boston, Ma.=02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/2007 Restricted To: 00 PAULJ CAZEAULT 1031:MAIN ST r OSTERVILLE, MA 02655 Tr.no: 7696.0 Keep top for receipt and change of address notification. S-CA1 0 50M-04/05-PC8698 + i ✓/ze Pomrmaoou�eal!/ o�✓�aaaac/auaelta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Numb , r:;CS, 026325 ' �' Blrt�date 10/20/1�59 Expires; 10/20/2007 Tr.no: 7696.0 Restricted ,00 PAULJ CAZEAULT 1031 MAIN ST C OSTERVILLE, MA 02655 • Commissloner 1P AC01tIP. C���l�l��`f"� �� ����f iP'9��� OATElMM1D01YY) 1; PRODUCER THIS GERTIFICATE IS iSSd3ED AS A t�iATTEEi:Oir IPiFO�AiATi08t. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DOWLING & 0 NEIL INS AGC HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 222.WEST:MAIN' .STREET. ALTER THE COVERAGE AFFORDED gYTHE POL1ClES�gELf2VIL. PO BOX 1990 HYANNIS mA 02601 COMPANIES AFFORDING COVERAGE COMPANY, 22LGR A TRAVELERS PROPERTY CASUALTY COMPANY OF AMER.ICA INSURED COMPANY PAUL J CAZEAULT & SONS INC. g 1031'NIA.IN STREET COMPANY OSTERVILL$ t4A 02655 C COMPANY D COVERAGES THIS 1S TO CERTIFY THAT THE POLICIES-OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO'THE INSURED NAMED ABOVE FOR THE POLICY PERR7D'Y` INDICATED, NOTV�ITHSTANDING 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.! Co TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTA POLICY NUMBER - DATE.(Md•ADIA.YY) DATE(MrSDD\YY). LIMITS GENERAL LIABILITY GENERALAGGIiLGATE $ CUMMtHCi1AL GtNtHALt1ABILfIY' ' - _ MHUUUCI�3-(;UIVIY/UW AGO. $' CLAIMS MADE�OCCUR. PERSONAL 8 ADV.INJURY $ GwNEfi s a�ON7RAO7OR PR07.- EACH OCCURRENCE $ FIRE DAMAGE(Any one tire) $ M ED..EXPENSE.(Any one person) S. AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE 8 LIMIT ALL OWNED AUTOS 6t]DILV INJURY SCHEDULED AUTOS (Per Person) $ HIRED AUTOS NON•OWNED AUTOS BODILY INJURY 3 (Per Accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY:EA ACCIDENT' S" ANY AUTO OTHER THAN AUTO ONLY:, EACH ACCIDENT, S AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLAFORM AGGREGATE $ OTHER THAN UMBRELLA FORM . A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (LIB-G095369-A-GSj 08-10-05 08-10-OG STATUTORYLUAITS THE PROPRICTORI ' EACH ACCIDENT 8,...,..:...10,0 . 00D,. PARTNERS/EXECUTIVE X INCL DISEASE-POLICY LIMP) $ 500,000 , OFFICERS ARE: EXCL _ _ _ _ _ DISEASE-EACH EMPLOYEE 8 100,000 OTHL Fl D IT THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER' AFFECTING WORKERS COIgF COVERAGE. CaAN6�ELI,Q,TIQid: _ --- -- l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Paul J.Cazeault&Sons I EXPIRATION DATE THEREOF, .THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Roofing,i:Tc• I LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 1031 Mai a Street LIABILITY OF ANY-"11 UPON THLCOM Au'i,US.AGii.'Tsai'iRjpkEsciC AjIVirs.. OStervllle, MA 02655 AUTHORIZED REPRESENTATIVE ,:, « '� .:. RI2 G11<IpdR,A7ldAit993 Client#:19989 2CAZEAU LTPA 06 ACORD,, CERTIFICATE OF LIABILITY INSURANCE 019, °""YY' -, PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling$O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St PO Box 1990 Hyannis,MA-02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western World Paul J.Cazeault$Sons Roofing,Inc. INSURERB: -1031.Main Street INSURER C: Osterville,MA 02655' INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF.ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. LTR NSR TYPE OF INSURANCE - POLICY NUMBER POLICY MMIDD EFFECTIVE Ppq�EXPIRATION TION LIMITS A GENERAL LIABILITY NPP1012091 04/30/06 04/30/07 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDISESF $50 OOO CLAIMS MADE a OCCUR MFA EXP(Any one person) $2 500 X BI/PD Ded:1,000 PERSONAL&ADV INJURY $1 00O 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER., PRODUCTS-COMPIOP AGG $1 000 000 POLICY j�T 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-FA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ - $STATU- 1WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEiIE(ECUTIVE 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 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate of insurance will be issued directly by the insurance carrier. I i i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Informational purposes only DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN 'I NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR j REPRESENTATIVES. AUTHORIZED R€PRESENTATIVE i ACORD 25(2001108), of 2 #42866 LS1 ©ACORD CORPORATION 1988 J - {