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0099 ELLIOTT ROAD
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Richard V.Scali,Director OAs�- U 'ED6�M�a, Building DiVIS101, jj AA PR 05� Z01j Paul Roma,Building Comm'i§slil 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us R" SIAB LE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ? p Property Address 67 ( / Id Residential Value of Work$ j C,/&0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address V), Ad, cokl Contractor's Name ��G C �ii —Telephone Number Home Improvement Contractor License#(if applicable) � Email: ZC'kdQ C� "`�'� Construction Supervisor's License#(if applicable) Ld 7TWorkman's Compensation Insurance Check one: a-I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# ( 14 /A tI/ J 6 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: '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 required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\NetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 The Conir►tonivealth of Massadiusells Department of Industrial Accidents Office of Iniestigatiorts 600 Washington Street Boston,MA 02111 itn nnniass gavIdia Workers' Compensation Insurance Affidavit: Buildeis/Contractors/Electticians/Plumbers Lkpplicant Information Please Print Le gib Name(Busiuess/Organmtion/lndividual). e _ Address: l,F � F�J r 69 t—PI City/State/Zip: CCA142-7-Ae ^r , Phone 9: ,j `� j�►'� dL Are you an employer?Check the appropriate box: I am a general contractor and I Type.of project(eequu-ed): 4. 1-IX I am a employer with U ❑ g employees(full and/or part-time).; have hired the sub-contractors 6. Q New construction 2.Q I am a sole proprietor or partner- listed on the attached sheet. ?. Q Remodeling ship and have no employees These sub-contractors have S. Q Demolition working forme in an capacity. employees and have workers' °�'� Y tY 9. Q Building addition [No workers'comp.insurance comp.insurance..= required.] 5. ❑ We are a corporation and its 10.Q Electrical repairs or additions 3.Q I am a homeowner doing all work officers have exercised their 11.0 Plumbing.repairs or additions tf ri o lion per MGL myself[No workers comp. right. exemption p 12.Q Roof repairs insurance required.]T c. 152,y§1(4),and we have no ��0� employees.[No workers' 13.Q Other comp.insurance required-] *Any applicartthst checks box#1 must also fill out the section below showing their woikers'compensation policy informstion- I Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating stub aContractors that check this box must attached an additinnal sheet shorting the name of the sub•conuatmrs and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant art etltpW6,r that is prot'aditig isrorkers'cougm-itsatio►t ittsrtrance for►ny auiploJpem Below is the policy and job site iltfOrlllati0►t. Insurance Company Name: Policy#or Self-ins.Lie.#: f' ' f+, ! a d5 Expiration Date: / /D Job Site Address: 7 �r l ld City/State/Zip: ��� C ' �� � �; 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 NIGL 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 cartefy under the paints ared eltatties of perjt ,tltat the information provided above is tote a►td correct Si lure: Date: Phone#: �lj/� C/ a2 Offlciat use only. Do not write in this area,to be completed by city or tonrn offl4aL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: � s P.. CA �EA�U UT ROOFING PAIRS PROPOSAL Proposal No. 17-1086 February 24,2017 To: David Downs Work to be performed at 99 Elliot Rd Centerville MA We hereby propose to furnish the materials and perform the labor necessary for the completion of: NEW ROOF 1. Remove existing asphalt roof 2. Install new aluminum drip edge 3. Ice& Water barrier first 2k all skylights and penetrations 4. Cover roof with 15 lb felt T 5. Re-roof with 30 yr architectural shingle 6. Install ridge vent 7. Flash all pipes and penetrations 8. Remove all rubbish from project Labor and Materials $4,400 All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications and completed in a substantial workmanlike manner for the sum of Four Thousand and Four Hundred Dollars$4,400 with payment as follows: Two Thousand and Two Hundred Dollars$2,200 At Closing and Two Thousand and Two Hundred Dollars$2,200 upon-completion Respec Ric d P. C ult,Jr. HIC# 168607 CS1#100393 198 Five Corners Road Workman Comp'and Liability with Centerville,MA 02632 Leonard Ins Ost (508)420-5482 Acceptance of Proposal No. 17-1086 The above prices, specifications and conditions are satisfactory and are hereby accepted. You are au to do the work as specified. Payment is outlined above. Signature Date . � ATE(MMIDD/Yl'Y) C�!F 1_ CERTIFICATE OF LIABILITY INSURANCE D02/13/2017 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 and endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT Leonard Insurance Agency Inc NAME: Berkley Assigned Risk Services 683 Main St B (acNw.Ext.x (888)548-7431 (AAIXa_No.} (866) 215-8118 Osterville,MA02655 ADDS:PolicyServices@berkleydsk.com INSURER(S)AFFORDING COVERAGE NAIC# INSURED INsuRERA.-Acadia Insurance Co 31325 Richard Cazeault Jr INSURER B: 198 Five Corners Road INSURER C: Centerville,MA 02632 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN INSUUED 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. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP INSR WVD (MMIDD/YYYY) (MMIDDIYW`n LIMITS WORKERS COMPENSATION AND. WC STATU- .. EMPLOYERS LIABILITY ®TORY LIMITS ❑OTHER ANY PROPRIETORtPARTNEW E.L.EACH ACCIDENT $500,000 A IXX�UT�(YMICElMEMBER Y� NIA ❑ MAARP300886 02/04/2017 02/04/2018 E.L.DISEASE-EA EMPLOYE E $500,000 (Mandatory In NH) E.L.DISEASE-POLICY LIMIT $500,000 if yes,describe under DESCRIPTION OF OPERATIONS below. - DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,AddiLonal Remaft Schedide.if more space is*utred) - - - Election Category Election Staws Name Effective Eywation AD Insured Entity sole Proprietor ExcTuded Richard Cazeauft Jr .. _ Richard Cazeautt Jr . Risk:Location 198 Five Comers Road,CentervMe MA 02632 COMMENTS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE.DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ignature: ACORD 25(2010/05) BRAG 3139 Off.rce of CoAsurner Affairs&Busyness Reguiatran HOME IMPFtbVEMENT GONTRAC70R ,--- TYPE indnndtt2l Reg�strahon valid for individual use oN before the eirati R istratron on e. and un S1return to dat ,1 --_ nation Office of Consumer Affairs 1 &ill ;-: 03F072C r9 B� Regulation 10 Park Plaza-Suite 51Z0 RICHARD P CAZEAtILJR eo MA 02F:16 s DB/A R Cazeau if-Roofir 8�Re 9 pairs RICHARD CAZEAULT JR t ft ive Comers Rd Centerville,MA 02632 C` Unctersecretary Mot valid wi signature. = � Massachusetts Department of Public Safety - u ions-and Standards . License: CS-100393 Construction Supervisor RICHARD P CAZEAULT JR 198 FIVE CORNERS ROAD CENTERVILLE MA 02632 EXpiratIon -- Oy0312018 + _ „ommisstone w fM �it kA '_ Fsd�l$ pepg(�fnEnt Ot LabQf ©ccupatiana�Safety andtieWth Adm rnstration Rtchrc#9Caueautt s � g 3 4 ?. - � ,wPletPd a 10 hour Occupational Sat�y and Health Gonstructiorr Safe Am, - t y f I