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Home My WebLink About0102 HARBOR HILLS ROAD Ooq" e n : O � 63 i � Town of Barnstable *Permit Ewba 6 eivu d Regulatory Services` � <� EaRramrears. Thomas F.Ceder,Director. d sb39 PERMIT Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 MAY 14 2013 A www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 TO 8-AF6 XT WERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint = Map/parcel Number)Z y 7G�yi 4h :2 ' Property Address 9 U c� t ", 15 �' 1!�'I e ❑Residential Value of Work `^ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Gk C.enl61A L- AT Contractor's Name Qom, dC �,� ` R Telephone Number 77y 722 O 52Z Home Improvement Contractor License#(if applicable) 1 .73191 Construction Supervisor's License#(if applicable) S `. ❑Workman's ompensation Insurance C�hq&one: I am a sole proprietor ❑ I am the Homeowner 1 ' ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate most accompany each permit. Permit RVq (check box)-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 =r #'of doors ❑ Replacement Windows/doors/sliders.-U-Value (maximuin.35)#of windows ❑ Smoke/Carbon Monoxide`detectors 4 floor plans mnarked with red Sand 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 Pwne'r Letter of Permission: i A copy of the'Home Improvement Contractors License&Construction Supervisors License js require SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012. r ' " The Comnronwvedth ofMa3sachuseft Department oflndust ial Accidents Office o,f'Imgm6gadons . 600 washinvon Street Boston,M4 02111 ..n»lrna.>±nas`xgo�ldia.., • , .y Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r' Please Print Legibly Name(Business/Organizationattdividual): ` (,Gl t' e" eon9fu Vl` Address: a�dWl City/Stat&-zip: O CO 6 77`� �L2_ oS 2 2 Are you an employee Checkthe appropria#e .project(required)- 1_❑ I am a emplol�eruoith 4_ I affi a general Type and l El New(full,and/or pzt•�)-* have bisect the sue ti_ sub-contractors construction . 2_❑ I am a sole p>opaetur or partner listed on the attached sheet I- D ship and have no employees `TUm sub-comb-actors ham S_ []Demolition, , a w for me in any capacity- � worms 9-. El Building addition [No '�- Comp- dditioni required-I 5_❑ We.are a and its l0_❑Elec9r>cal or a 3_❑ I am a homeowner doing all itsork officers have eater theirILEIadditions myself Plo worbaW camp tight,ofemmVtion per IMGL insurancerequ )1 c.152,§1(4�andwe have no 12 Rm:ng employees-[No ems'' l�-❑:Ot1a� Comp-:..suran•roreq 1 *Any applicant that checks boat#1 mast also fill out the section below showing they w+otkets'compensation policy indotmatim Hommwners who submit ibis aff&p h adkofng they are doing all wa*and then hire outside coat mcmrs must submit a new affidavit indicating such TCouuwcmrs that check this box must attached art additional sheet shouting the none of the sib-cantrKtots and suite whether or notthose entities ba,6 employee. If the sub-cone nctots Lace employees,they mast provide their trackers'comp.policy number. I am an employer that is providing workers'.compensation i►Ysurance for my entployeeL Below is the policy acid job site information. Insurance Company Name: ` Policy 4 or Self-ins_Lic_ft: Expiration Date: Job Site Address: city/statelZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to seem coverage as required under Section 25A of MGL c- 152 can lead to the imposition of criminal penalties of a_ fine up to S 1,500.00'andlor 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 Investigati ms of the DIA for ice coverage verification_ I do hereby certify tder tit s e 'ury that the information provided above is true and correct Si tine: � Date: _ _ r Pie f Official use onto,Do not write in dris aim b be cam by city or tsint of{fdat y city or Towne Permidlacense# Issuing Authority(circle ow): 1.Board of Heath 2.Building Department_3:City/Fown C krk 4.Fdechural Inspector S.Plumbing Inverter 6.Other ContactPerson: Phone#-. ' 6 ACORQM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) O1/24/2013 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 CONTACT ME: Joanne Bretton NA Southeastern Insurance Agency, Inc-. alCo"N E,�. 508-775-5154 FA"0:508-790-0557 641 Main Street - E-MAIL ADDRESS: Hyannis, MA 02601 PRODUCER u - INSURER(S)AFFORDING COVERAGE - NAIC# INSURED INSURER A: Arbella Mutual Ins Co 17000 All Cape Exterior Remodeling LLC INSURERS: AEIC Insurance INSURER C: - 67 SEA STREET APT A4 INSURERD: Hyannis, MA 02601 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 2013 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. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS LTR INSR WND POLICY NUMBER MMIDD MIDDIYYYY - ' GENERAL LIABILITY 8500041933 01114/2013 01/14/2014 EACH OCCURRENCE $ 1,000,000 X k MERCIAL GENERAL LIABILITY - PR EM SES DA GE TOEa oxu ence $ 100,000 CLAIMS-MADE �OCCUR MED FRCP(Any one person) $ - 5,000 A PERSONAL&ADV INJURY . $ 1,000,000 GENERAL AGGREGATE $ „2,.,000,0.0 ^ GEN'L AGGREGATE LIMIT APPLIES PER: - - PRODUCTS-COMP/OP AGG $ f 2,000,000 POLICY PROT- LOC - $ - AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ - - (Ea accident) - ANY AUTO BODILY INJURY(Per person) $ALL OWNED AUTOS - - BODILY INJURY(Per accident) $ SCHEDULED AUTOS - - PROPERTY DAMAGE $ HIREDAUTOS (Per accident) NO"WNED AUTOS $ - $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ - $ AND EMPLOYERS'LIABILWORKERS OITY _ YIN WCC500789601201 01/14/2013 01/14/2014 X TORY LIMlrs °ER ANY PROPRIETORIPARTNER/EXECUTIVE - E.L.EACH ACCIDENT - $ 1,000,000 B OFFICER/MEMBER EXCLUDED? El N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 Dyes,describe under DESCRIPTION OF OPERATIONS below OWNER INCLUDED E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,ti more space Is required) 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 - -display purposes only Joanne Bretton ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD A CORQM AGENCY CUSTOMER ID: t LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Southeastern Insurance Agency, Inc. All Cape Exterior Remodeling LLC POLICY NUMBER 67 SEA STREET APT A4 Hyannis, MA 02601 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: ACORD Certificate of Liability Insurance Garage Liability INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDDNY) LIMITS AUTO ONLY-EA ACCIDENT $ ANY AUTO - EA ACC $ OTHER THAN AUTO ONLY: AGG $ Automobile Liability INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE(MMIDDNY) DATE(MMIDDIYY) Excess/Umbrella Liability . INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR.INSRD POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDDIYY) LIMITS Other Liability INSR - POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE(MM/DDIYY) DATE(MMIDDIYY) LIMITS t I s ACORD 101(2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i C U _. COREY' CONSTRUCTION 1694 FALMOUTH RD #115, CENTERVILLE, MA 02632 PHOjN E` 1-5S Qk4 -73151,!-8,Z4'4 CE: RTANTEED L.AND; MjAR.K LT{ FETIMjE -ALGAE° RESI`S°TANT ARCHITECTURAL. STYLE R.E - R.. 0QFI: Ns0 P Rk 01 P0SA. L February 6, 2013 ROBERT DEYO EM: rdeyo421@gmail.com 102 HARBkZ HILLS RD Tel: 315-449-0554 CENTERVILLE,MA Tel: 315-446-1524 COREY & COREY hereby proposes to perform the.following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles and the Gutters and Downspouts. Re Nail All Plywood Sheathing as needed. Supply and Install CERTAINTEED LANDMARK AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION, CLASS A FIRE RATED, COPPER/ CERAMIC STONES for a FULL 15YEAR WARRANTY AGAINST ALGAE I CONTAMINENT,250 POUND,EXTRA HEAVY WEIGHT, 110 MPH WIND WARRANTY,CATEGORY H HURRICANE, STORM 41MCANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED,LAMINATED ARCHITECTURAL STYLE,FIB MG BASED ASPHALT SHINGLES. COLOR Supply and Install HICK'S.VENTED ALUMINUNM DRIP EDGE . After Cutting an Opening at the Top of the Fascia Boards. Supply and Install CERTAINTEED WINTER-GUARD(Ice& Water Shield) WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves& Under the Step Flashing on the Chimney. Supply and Install #15 BLACK SATURATED FELT ROOFING PAPER Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Entire.Main Ridge.. Supply and Install ALUMINUM&NEOPRENE SOIL PIPE FLASHINGS 'Clean and Remove Debris from work area after job is completed. i TOTAL INVESTMENT ------------- $ 5450.00 4-- 5,)9 C, L r S o Sb 4-- 0� �''IJ�/: -S�i9 r�✓L.-�s Sr,ram C io u- 'r i CONSTRUCTION POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$80.00 per Hour. Chimney repair is Materials Plus Labor at the Rate of$ 120.00 per Hour. CENTER CHIMNEYS: COREY & COREY cannot Warrant your chimney against leakage or to be water tight to any degree because a properly installed PAN FLASHING or CHATHAM PAN FLASHING was not installed by.the Mason when your chimney was built. PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 45 Days of Acceptance and Receipt, of Deposit providing the Materials are Available. Please Make Checks Payable to: COREY & COREY COREY & COREY Warranties the Shingles and Labor for 10 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and the Shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the Shingles up to a CATEGORY II HURRICANE-110 MPH WIND WARRANTY . CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. COREY & COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: t _ ACCEPTED BY: SUBMITTED BY: RO ERT DEYQ CHARLES CO Y, C NT HOMEOWNE COREY & COREY C NST CTION �acccLcuaeG License or registration, valid"for individul use dnly ��ie rPornmc°vccaea �a�� j, before the exp►rat►oii date. If found return to: { Office of Cousumer Affairs&Busi ess Regulatiou OME IMPROVEMENT CONTRACTOR. f' Office of Consumer Affairs and Business Regulation ' 1 egistration: e73192 Type 10 Park Plaza-Suite 5170 xpirati4n 9111/2p14 DBA Boston;MA 02116_ t y , J COREY AND COREY`CONSTRUc.T IC)N PATRICK CLIFFORD r j" 12 BALDWIN'RD i gam— Not valid vvitho signature DENNIS,MA 02638 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards t jiciult isor it Contitru.,Ctioti.Super` S - #'I j 'License: CSSL _T—r r pATRICK CLIFF 4RD i it 12BALD�'IN.RAD mnnis Rjn Expiration `J,.G.� J1 06102/2016 Commissioner r II I i e o�y�naruuea�Cf a �` QCGC L►cense or registratio►,val►d for individul use only y Office of Consumer Affair &Busi zess Regulation before the expiration`date. If found return to: OME IMPROVEMENT`CONTRACTOR Type office of Consumer Affairs and Business Regulat►on egistrat�on 73192 10 Park Plaza-Suite 5170 DBA o ; 11 xpiration 9/11/2014 Bost MA 02 6 COREY AND COREY'CON$TRULTION �y PATRICK CLIFFORD\� �< s� G gay , = .12:BALDWIN RD = —. Not valid wiiho signature ; DENNIS,MA 02638 ^`:; �- -" . Undersecretary . - aitment of Public Safety �. i Massachusetts -Dep Board of ding Regulations and Standards Contitr►achoin..Supervisor S �cislty` j. License: CSSL-10595 - i' I I a PAMCK CLIFFQ" ,, s 12 BALDW IN ROAD 4 I _ I I Dennis I Expiration 0610y2016 i' Commissioner i _. � 1 Town of Barnstable *Permit# Fxpires months rom isue date Regulatory Services Fee O Thomas F.Geiler,Director r Building Division Tom Perry,CBO, Building Commissioner �g rn 200 Main Street,Hyannis,MA 02601 �tl www.town.ba05 stable.ma.us ��` ZN C,,�- W�_ Office: 508-862-4038a : S0-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work�� 3SU�,� ,per Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ---e C3v,) Contractor's Name_ ' ! ( �` �n A� - • - • -- _ Home Improvement Contractor License#(if applicable) / i96 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance R Check one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name_l (.J� ' (4, t1!v 3`v Workman's Comp.Policy# G L Ong og B Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) RT Re-side ❑ Replacement Windows. 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: operiy Own m t sign Property Owner Letter of Per ' me Impro men Contractors License is required. AIGNATURE:' Q:Forms:expmlrgF Revise071405 + ' Board of Building Regulations and Standards. HOME IMP OVEMENT CONTRACTOR, ff Registc 136206 4 _ AJ2006 4 r ual 't MARCOS VIERA MA RCOS CASTI � 337 OCEAN ST. hiYANNIS,MA 02601 \ Administrator s t 4 Town of Barnstable -Re lato Services gu. rY Thomas F.Geiler,Director Building Division Tom Perry, 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 Q1�Q r r ,as Owner of the subject property I, - G hereby authorize f V Lars U(; V1 0 • _.to act on my behalf, in all matters relative to work authorized by this building permit application for: k-av-6- Hills Q aj WAr H �� (Address of Job) � P Signature of Owner Date A Print Name U Q:FORMS:OWNERPERMIS SIGN