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HomeMy WebLinkAbout0044 CHAPPAQUIDDICK ROAD I I a Town of Barnstable Pennit 6-14, 3s E7 Regulatory Services ate: s 2_/6/!4 Richard.V.Scab, Director ee. Building Division 3 S, Paul Roma, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstablemaas Office: 508-862-4038 "; Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT -a7S 7 /L Owner: � d 4 4 Phone- �� -�� 0 Ins at: 14y}fP 14( u W)I CK Viliage: L I Map/Parcel: `1 '� Date: Stove ew Used B. Type: Radiant Circulatin , - C. Manufacturer. C3 V Lab.No. �dvl �) 1���IC�d�- D. Model No. Chimney A. New if existing please note date of last cleaning) B. Flue Size C. Are other appliances attached to Flue? N D. Pre-fab Type and c a 6 s� `in e-✓ E. asonry: unlined Hearth . � A. Materials: B. Sub Floor Construction- W 01:> Installer- C ,P --���- rc4kmbul ctt�9 Name: Address: r Phone: Z( C�> (� Location of InstaUation: C ,ot D <1 H.I.0 Registration#��1 Construction Supervisor# C S� .t- 10 S0 � BUILDING DEFT. OR check Homeowner bnstalling,no license required LICENSED INSTALLERS SIGN DEC 2016 APPLICANTS SIG i QP RARNISTABLE APPROVED BY: 4n Please make checks payable to the Town of B le *This constitutes an official stove permit after inspection,"photographed and approved by the Building Inspector Q:forms:stove , Rev:06W16 f IMG jpg(JPEG Image,2549 x 3299 pixels)-Scaled(19%) https://web.mail.comcast.net(service/home/—/?audr=co&loc=en US&i... i The Commonwealth of Massachusetts + Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 wwn.massgov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Aoalicant Information Please Print Leeibly' Business/Organization Name:Chimney Care Address:PO Box 202 City/State/Zip:Centerville MA 02632 Phone#:508-420-9261 Are you an employer?Check the appropriate box: Business Type(required): 1.❑✓ i am a employer with 2 employees(full and/ 5. ❑Retail orpart-time).' 6. Restaurant/Bar/EatingEstablishment 2.❑ I am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(Intl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] g• ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c.152,§1(4),and we have 10.0 Manufacturing no employees.[No workers'comp.insurance required]` 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, Service with no employees.[No workers'comp.insurance req.] 12.❑Other 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the cotpomtion has other employees.a workers compensation policy is required and such an organization should check box#l. I am an employer that is providing workers'compensation insurance for my employees Below is the polity information. Insurance Company Name:AIM Mutual Insurer's Address:54 3rd Ave City/State/Zip:Burlington MA 01803 " Policy#or Self-ins.Lic.#AWC400-7024208-216 Expiration Date:4/16/2017 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 c ,and he pains and penaldes of perjury that the information provided abZ,1171 ' fnd correct Signature: G;L / Date: (� Phone# Q facial 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#• " www.mass.gov/dia - 1 of 1 12/1/2016 1:23 PM )etatls nup:iieacense.cns.state.ma.usi veruicanonilietaus.aspx ragency_ta=t&t... The Official Website of the Executive Office of Public Safety and Security(EOPSS) r Mass.GovHome State Agencies Licensee Details Demographic Information Full Name: SCOTT B SMITH Owner Name: License Address Information City: Centerville State: MA ipcode: 02632 ' Country: United States License Information License No: CSSL-105026 License Type: Construction Supervisor Specialty Profession: Building Licenses . Date of Last Renewal: 9/15/2015 Issue Date: Expiration Date: 8/12/2017 License Status: Active Today's Date: 11/29/2016 Secondary License Type: Doing Business As: Status Change Reason: License Renewal Prerequisite Information E censee: SMITH, SCOTT B Relationship: Attribute Of cense No: CSSL-105026 Glose,,Window ©2011 Commonwealth of Massachusetts• Site Policies Contact Us . of 1 11/29/2016 6:28 PM �� �� i . ��� a ��� _.� t k i IMG jpg(JPEG Image,2549 x 3299 pixels)-Scaled(20%) https:Hweb.mail.comcast.net/service/home/—/?auth--co&loc=en US&i... d l-'X f. 0/9�jJ/fzcko'e,m Office of Consumer Affairs and Business Regulation ` f 10 Park Plaza-Suite 5170 Boston, Massachusetts 02116 Home Improvement,Contractor Registration Type: Individual F z� Registration: 161642 Scott Smith Expiration: 11/11/2018 P.O. Box 202 -! Marstons Mills, MA 02632 _ f�r . ••`� ems.-. .r - - Update Address and return card. Mark reason for change. SCAI Ei 20:'i-MIJ Q - 4.+.t.eec fl D.. et 7F.n..t..-wn fl yat l ne�r;Mr.i ... Office of Consumer Affairs 6 Business Regulation D HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type: Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 161642 11/11/2018 10 Park Plaza•Suite 5170 Boston,MA 02116 Scott Smith D/B/A Chimney Care Scott SmithGG -- 7 Captain Lumbert Ln Centerville,MA 02632 Undersecretary Not valid without Signature 1 of 1 11/29/2016 1:37 PM { Town of Barnstable Regulatory Services KAM Richard V.Scary Director Building Division. Paul Roma,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. Z1 so rC (:CJ/Y , as Owner of the subject property hereby authorize / r0bk-e Ca42e to act on my behalf in all matters relative to work authorized by this building permit application for. l Ile, Oo7� (Address of Job) , **Pool fences and-alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. : - �L • �Si�gnature of Owner Signature of Applicant Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOI S Town of Barnstable Regulatory Services oxTHE Richard V.Scali,Director Building Division • &4RNSTAEM • Paul Roma,Building Commissioner KAM 639• M�� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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. DEFINITION 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 permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules 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 requirements. Signature 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 person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of 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 he/she understands the responsibilities of a Supervisor. On the last page this.issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 I ;aco� CERTIFICATE'OF LIABILITY INSURANCE DATE(MM'DD"YYY) 0712012016 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 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 04220-001 N2AJACT Branch 4220-1 Twinbrook Insurance Brokerage rAH18NNo,Ext:(800)469-6604 AA .IXC.No: (781)848-6100 � -400 A Franklin Street i ) - - ---- --- --- Braintree,MA 02184 08IR s: INSURER • A.I.M.Mutual Insurance Company 33758 INSURED NSURERB:- . Scott. Smith Chimney Care of Cape Cod INSURER P O Box 202 Marstons Mills, MA 02646 NS ERE: 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. ILTR i TYPE OF INSURANCE POLICY NUMBER POLLC PO LIMITS -(MM/DD!YYi r1._..(.MMIYYYYI} - I GENERAL LIABILITY $EACH OCCURRENCE DAMAGETO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIM&MADE OCCUR _ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPiOPAGO $ _..COMBINED SI AUTOMOBILE LIABILITY NGLE LN11T $ � 4(Ea_acciden�) i ANY AUTO' f BODILY INJURY(Per person) $ ALL OWNED SCHEDULED �............ AUTOS AUTOS' BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED I PROP2TV DAMAGE AUTOS $ i_(Per accident)................._....... . __..............................._- - . I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ).-.-.__-------_ EXCESS LIAR CLAIMS MADE AGG REGATE DED RETENTION $ _.................._ . yy�pKERg��M '- AND EMPLOYERS ...................... .... E�gpnoN g 7�{. $ 'LIABILITYAUTIVE��'jXT RY LIMITS ERA PP C E.L EACH ACCIDENT' $ 600 OQ0 O.9A o Ic M tAx�Za�E AWC-400-7024208.2016A 4/27/2016 4127/201T -- -- . ,.f('Manddatory in NH) E.L.DISEASE•EA EMPLOYEE $ I d9s�i:r I'MObN O OPERATIONS be I E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Attach ACORD 1CI,Addltional Remarks Schedule,If more space Is requited) Scott B Smith is covered by the workers compensation policy. . CERTIFICATE HOLDER CANCELLATION Peter Kennedy 444 Mystic.Drive. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Marstons Mills,MA 02648 THE. EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE y C 1888-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD r Town of Barnstable. . �#1 ti Expires 6 months jrom issue dates Regulatory Services Fee 3ARIMABLE v ass'1639. $ Richard V.Scalk Director Building Division 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 - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number !� Z Property-Address l 6K esidential. Value of Work$ 0,06 Minimum fee of$35.00 for work under$6000.00 Owner's Name,&Address W�V Contractor's Name �Ae C ('(. Telephone Number, Home Improvement Contractor License#(if applicable) " l �� Email: Construction Supervisor's License#(if applicable) �i 3 nor-&a ncoRaT ❑Workman's Compensation Insurance Check one: NOV $ 2014 ❑ I am a sole proprietor []'I/have Worker's Compensation Insurance e Homeowner T��� OF �AR���ABLE Insurance Company Name Workman's Comp.Policy# d p._ 4'rzurance Compliance Certificate must accompany each permit. Permit Reques -check box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to cc�1� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers.of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders:U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required., Separate Electrical&Fire Permits required. *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. A copy of the Home Improvement Contractors License&Construction Supervisors License is require -- SIGNATURE: .,,,_. Q:\WPFILES\FORMS\building permit forms\EXPRESS.dg Revised 061313 The Commonwealth of Massachusetts . Department of Industrial Accidents Office of Investigations 600 Washington Street. _ Boston,AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApOlicant Information (, Please Print Legibly Name(Business/Organization/Individual). C(�'Vl.ij►v �"1��' Address: �C City/State/Zip: 1� /`� Phone#: JG f Are you an employer?Check the appropriate box: Type of project(required). 1.El 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. ❑New construction- 2.❑ I am a sole proprietor or partner- listed on the attached sheet. T ❑Remodeling ' These sub-contractors have ship and have no employees " 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. l 1.❑Plumbing repairs or additions. myself [No workers'comp right of exemption per 1VIGL 12.❑Roof repairs ` insurance required.]t s 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. 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. I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: -- k 'Expiration Dater Job Site Address: City/State/Zip:- ULl Attach a copy of the workers'compensatiL policy declaration page(showing the policy number and expiration date). Failure to secure coverage_as required under Section 25A of MGL a 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 maybe forwarded to the Office of Investigations of the DIA for insurance.coverage verification. I do hereby certify under t ![ri'r and" es of perjury that the information provided above i' ue and co ect Si mature: -' . N., 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): 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 . 'd therein or th e occupant of the owner of a-dwelling house having not more than three apartments and who resides p maintenance construction or repair work on such dwelling house employs ersons to do g d dwelling house of another whoP w g � P 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-contractor(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/license 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: a The Commonwealth of Massachusetts . Department of Industrial Accidents Office of:Investigations 600 Washington Street Boston,MA 02111 Tel.:#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia e EMM,anu,el ,Construction All New EnlRoofing, Emmanuel construction.com Allnewenglandroofing.com Name: Address: ,51 L11cv � �aC , o( J L; 1 C. Phone/fax: 6? 7 7 'Email TO Job #: Date: Licenses: Construction Supervisor #css1-099382 Dome improvement #145356 Fully insurer Liability, workers comp and auto. Roof description: a 1.Strip entire roof. (Ash (Tile)(Rubber)(Wood) 2.Check for-rooted wood if needed to change, it will be,extra cost. 3.A11 loose boards will be nail back with 1"3/4 nails. 4.Install 8 drip edge. 5.Full 3' ice and water,:on first course and all valleys. 6.Rest of roof we will cover with Deck armor for paper. , v ��V +ju,E --9E` 7.Install 30-year architectural shingle color of your choice. ------ --""=--� Eck 8.A11 roofing shingles will be nailed with 6 nails, l 1/4 9.Change all pipe boots, and install new. 10.Chimney will.install new flashing, and cover with ice and water.Then caulk with clear caulking. 11.All skylights will take apart and Install new flashing, and rap skylights with Ice and water. 12. Install ridge vent on house. 13.We will use shadow ridge cap, matching color of roof shingle. 14.Entire house will be cover,with tarp and plants, protecting house paint, screen etc. t. f , 15.Use magnets to pick up nails and metals from debris of roof. 16.AI1 debris will be dump ona 15 yard dumpster. 17.Price includes permit from the town. 18. If wanted to add Smart vent ventilation will be extra. Total for Labor and Material. $ f; IOC = Pay Y2 down then pay when job is complete. Please sign below if agree: -----------------_--_ __---- -- --- -- -_�-�-___----:-Date- --- --- --.-- - -��-�� --=-Date-----�' S -� ------ ---- Warranty: The Shingle is a 30 years shingle. . 110 miles per hour wind. . 10 years on Algae resistant. .Warranty also can transfer to next home owner if house gets sold. Warranty on installation 5 years. Please keep a close eye on your family,and pets during the install process. The project foremen will be available for any question during installation of roof or myself. References available Any question please contacts me directlyat'508-367-1679 or 781-559 007. .Thank You for your business: Please ask for-our windows ,gutters and trim work. f DATE® (MMfDDIYYYY) /ate R® CERTIFICATE ®F LIABILITY INSURANCE11114/2014 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 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 02806-001 - CONTACT - NAME: Renaissance Alliance Insurance Services - AIC. . (T81)431-9800 aC.No.: Worce St DDWellesley,MA 02482 EMAIL Policies@renaissanceins.com INSURERS FORDING COVERAGE NAIC INSURER A: A.I.M:Mutual Insurance Company 33758 INSURED INSURER B: Hector Sanchez Emmanuel Construction - - INSURER C• - 286 Strawberry Hill Road IN§URERD Centerville, MA.02632 INSURER E: - - 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 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. ILTR TYPE OF INSURANCE ADD POLICY SCR POLICY NUMBER _ MM�DDNYY MM/DD/YYIXYY LIMITS- - GENERAL LIABILITY EACH OCCURRENCE.. $ COMMERCIAL GENERAL LIABILITY - - - - - DAMAGE To $ - PREMISES Ea occurrence CLAIMS-MADE ❑OCCUR - MED EXP(Any one person) $ - - - PERSONAL 8 ADV INJURY $ - - ' - GENERAL AGGREGATE - $ EN'L AGGREGATE LIMIT APPLIES PER: .. - PRODUCTS-COMP/OP AGG $ - OLICY ECT AUTOMOBILE LIABILITY - COMBINED SINGLE UMIT $ - Ea accident ANY AUTO - BODILY INJURY(Per person) $ AU TOSS ALL OWNED AUTOS D _ - _ -' - BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED - - _ PROPERTY DAMAGE AUTOS - Per accident $ UMBRELLA LIAB HOCCUR _ EACH OCCURRENCE. $ EXCESS LIAB CLAIMS MADE . AGGREGATE $ yypRKDEERD pry ERNETgENNTIIONN$ - $ AND EMPLOYERPS LIABI�ITY - X T RY LIMITS OER A P R/PARTNER/RECUTIVE Y IN- f - - - E.L.EACH ACCIDENT $ - 100,000.00 A (Mandatory in NH) � NIA AWC-400-7024M-2014A 4/6/2014 4/5/2015 (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $ 100,000.00 ,.RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD-101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Barnstable 200 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Hyannis,MA 02601 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS: AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved: ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety C�✓ear�unioasruen,�C�o/�CcLiaCrc/%c�cGGt Office of Consumer Affairs&Business Regulation Board of Building Regulations and Standards ME IMPROVEMENT CONTRACTOR. I Construction Superi isor Specialty _ aegistration 145356 Type License: CSSL-099382 i - xplratlon 1/12/2015 { DBA r HECTOR R SANCfUZ F�lVIMANUEL CONSTRUCTION- ' r i ` 286 STRAWBERRY HIL�OAD' CENTERVI LLE VIA 02632 'HECTOR SANCHEZ` , 286 STRAWBERRY HILL RD CENTERVILLE, MA 02632 -- Undersecretary t J..(,..: J1/.51� '� "� Expiration j Commissioner 09/14/2015 r License or cegistration.valid for ind►vidul use onlyji ' before the expiration date. If found return to.: Office of Consumer Affairs and Business Regulation, 1 10 Park Plaza-Suite 5170 ... Boston,MA 01116 Not valid without si nature i i t THE Y TOWN OF BARNSTABLE EARNSTAEL$ i a pYa . BUILDING - INSPECTOR APPLICATION FOR PERMIT TO ... 6.. - .................................................................................... TYPE OF CONSTRUCTION ......... ......... ........................19 z`2.1✓ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... .... ...... . Proposed Use ..... ................ . ......... ......... . .............................................................................................................................. ZoningDistrict ......................................� ...............................Fire District .......... ............... ................................................ Nameof Owner ...........:.......:.....;, .......................................Address ............. .. ...................:........................... Name of Builder ......./.�..................... Address .......... .................................................................................... Nameof Architect ...................................................................Address .................................................................................... Numberof Rooms ...........................................Foundation ...... ....... ... ...... ................................................... . s Exterior ...... ......... .. ....... ...................................................Roofing .. ....... . . ..................... .............. :........ Floors ...........G% !....... .:.......................................................Interior ... ........................d' �� ................................. Heating .......�...l.'al....:.A.V..........................................Plumbing ...... ......... .......................... I Fireplace' .................Approximate Cost , ! ............................ .................... .. ....... ,/''////7v'' Difinitive Plan Approved by Planning Board __________________________ /7' 3./7 Diagram of Lot and Building with Dimensions z J O 'Z LL! W W O L3] Q C) 0 z � Ztl W ' z (D < Y Lt LU ,� f� LL O O $ Lo O 0] Q ►— (� W Z) W ~ � W 'Q W v \y ►Q ® 1 0 n. 7. 0- z < _ \\ w �— � Wi— Cal ' D -- < _J 1 " ® a Q Q' 4 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name/A5� i°:.. ..........�� ........... / 8oaaII JQ��� ' * WV "�� J � A. Fa^ ~ No —. . Permit for ..... --- ........... ................... Location ...... k..Lane_____.. ......................ge ................................. �Ownero�or --.—,.�=�a�..SoaII....... Type of Construction .......frame............—......... -----^-----'----'' -----'' Plot ............................ Lot .-T^ ______ Feb Permit Granted —.. .IO---]p70 Dote of Inspection lQ 740 Dote Completed ...................................... � / PERMIT REFUSEQ_ -----_------.--------- 19 ` l --------------------~----.— . \ --~—'~---^—''~^'------'-^'------'' � .—.—.—.----------.—..—..—~--.—,.. � ------`'-----^'--^---`—'~^~^'~-- i Approved ................................................. lg . � ' -------------.-------~.—.,.—. ( - --------------------.--..—.., � |