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Home My WebLink About0144 HUCKINS NECK ROAD a III �///�//f. //��/� !\'��\�////�/ f .. r .- .. .. - f. " .. (� � � � .'. _ .. ._ .. j. ., ,. 1 Y .. _ �'� Y � .. .. '� O Town of Barnstable *Permit Gb�P S ®nWI # Q M,41RNSrAj3LE I Fires 6 months ro adate Regulatory Services Fee z006 Thomas F.Geiler,Director Building Division 0f o/d G Tom Perry,CBO, Building Commissioner j 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 Imprint Map/parcel Number i i Property Address ,I / Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address c Contractor's Name i AD Telephone Number C I!�—' `"'-1 Home Improvement Contractor License#(if applicable) 1 Construction Supervisor's License#(if applicable) (}2_60 ZS I• XWorkman's Compensation Insurance j Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) . 5kRe-roof(stripping old shingles) All construction debris will be taken to�A ` I La f r ❑Re-roof.(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value i___(maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must(sign Property Owner Letter of Permission. ome Impr vement Contrac ors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 1 I NThe Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations .600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): - + �^ Address: 5� City/State/Zip: Cc, - )`11 l KA Phone #: LAr)�' Ar you an employer?Check the appropriate box: Type of project(required): 1 I am a employer with�Z 4. ❑ I am a general contractor and I 6. ,❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.$ 7• ❑ 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 required.] officers have exercised their 10.❑Electrical repairs or additions 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 12''Roof repairs insurance required.]t 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: - Policy#or Self-ins.Lic.#: �j C� ,�(�� Expiration Date: Job Site Address: IIlY,� /y l\� City/State/Zip:GfAfNJ14_ 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 'y under the payis,and penalt ies of perjury that the information provided above is true and correct Si natur : 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#• vafSHE, Town-of Bainstabie P ti Regulatory Services �wsree�, _ 9 bus& $ Thomas F.Geiler,Director �6�9• �0 �p�fc +• ., Building]Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA b2601 www.town.b arnstabl e.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property owner Must Complete and Sign This Section If Using A.Builder I, s, rO A R S ,as.Owner of the subject property hereby authorize PA u q Z2 v ®� koo t,5to act on my behalf, in all matters relative to work authorized by this building permit application for: t q4 A�ck,,ivs /�gc ?°. �- (2&o, WKu rile, MA (Address of Job) oil nature of Owner Date Print N=e Q:F0RMS:0WNERPERNUSSIO1J * . :•,•:r::..,,;:;r a > DATE(MMIDDIYY) 1 A PRODUCER TKIS CERTIFICATE IS ISSUED AS A, MATTER:OF IPu- :DOWLING 6 0 NE;IL INS AGC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE: 222•FST:t3Alld .STREET. HOLDER. THIS- CERTIFICATE DOES NOT AMEND EXTEND—OR PO;BOX1990 ' ALTER THE COVERAGE AFFORDED BY THE POUCIE.`li 1 ELGW1 . HYANNIS I•iA 02601 COMPANIES AFFORDING COVERAGE 22 LGR' COMPANY, INSURED A TRAVELERS PR.OPF,R.TY CASUALTY COMPANY OF AMFI1.[CA •. COMPANY PAUL J CNZEAULT 6 SONS INC. B 10317MA.IN STREET 05TERVSLLE MA-02655 COMPANY C COMPANY D ;COVE ,>`;<i: ` '::is •..v::�:�,:,y. .. ... .. I J,ro+ ::G;i 1S s TO CERTIFY ..>...Y THAT :k.:>.,.... AT THE �:i > PO 1 L CI E�OF i NSURANCE LIST .+;.;�.": INDICATED; NOTWITHSTANDING R BELOW HAVE BEEN ISSUED TO'THE+'INSURED NAM'D' a ANY REOUIREtdENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER.DOCUME'NT WITH nE PECTETO WHIC14 THIS tr"CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE*INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, "'''EXCLUSIONS AND-CONDITIONS OFSUCH POLICIES.LIMITS*SHOWN MAY-HAVE BEEN REDUCE D'BY PAID CL•AIMS. ' CO - TYPEOFINSURANCE EFFECTIVE POLICY EXPIRATION' VTR ', . ' POLICY NUMBER. POLICY EF LIMITS OATE.(tdtAOII\YY) . OATE(MUXUU%YYI. GENERAL LIABILITY , CUMMtH,1Al G6NEHliLiNyIL11Y• GENEHAL AGGIIEGATE S . MItUUU0!-_;UfdF'9UM M.11;, CLAIMS MADEaOCCUR. S PERSONAL It ADV.IN.IURY y OWNWS A�ONTRACIOR'3 PROT.• EACH OCCURRGNGC f IRE DAMAGE(Any one lire) f f MED..EXPENSE.(Arst ono person) S. -- AUTOMOBILE LIABILITY _ ANY AUTO COMBINED SINGLE f LIMIT ALL OWNED AUTOS SCHEOULED AUTOS HQP16Y INJURY (Per Person) 3 HIRED AUTOS NON-OWNED AUTOS BODILY INJURY i (Per Accident) PROPERTY DAMAGE f GARAGE UABIUTY' 'AUTO ONLY: f' ANY AUTO' l)Tt1ER THAN AUTO bnlY. EACH ACCIUENL g, EXCESS LIABILITY ' AGGREGATE j UMBRELLA FORM EACH OCCURRENCE t OTHER THAN UMURELLA FORM AGGNEGATE f WORKER'S COMPENSATION AND. _- P` EIAPLIIYEEZSLIABwTY (LIB-0095B69-A-06) 08-10-06 08-10-07 STATUTORYLIMITS THE PflOPI'ETOR/ EACH ACCIDENT PARTNERSIEXECUTIVE " INCL s OFFICERS ARE: EXCL DISEASE-POLICYLIMfT i DISEASE-EACH EMPI-OYES g THIS REPLAC.EG ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDEP. AFFECTING (•1oRi:ER,s;:. sfr,:3>i.:.;R :L' COMP COVE+<' :F'7'> %;.4; RAGE. :M, r '��r "__'�—•----.—. Snr..::v..v..•:�oi>n.:.:.i.�.F",v?t.,....:" rfr QN: ..f.:'i: .. -•-�,_,�._ - J.�,...:r. r., ir:. :.!' cL:.::1:..` tt�i::3:az;t:a.t: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED^BEFORE« THfl\` r Paul J.Cazeault$Sons EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENpEAVOR TO MAIL Roofing,l:ic, 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 1031 M.a't:t Street LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIADIUTY OF AMY'KWO UPOU70LCOMVii V,ITS,A"m5-CAR, VFiE+EiiTbTly{Gr,,.• Ostervillo, MA 02655 AUTHORIZED REPRESENTATIVE 'ab,4ryl/'ay?.�i y43':..L;fiE ;%i%1:;,: 55:�,83' ,><:$:R�:• >:<.::E:4�:>:::<.:.f.<.;t , Ofill CCHpC1EiLlT1(�!(1.993°, l�-._... • Irk - Client#•19989 2CAZEAULTPA ACORD- CERTIFICATE OF LIABILITY INSURANCE 0519/os°""YY' " PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling$O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 222 West Main St. PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western World Paul J.Cazeault$Sons Roofing,Inc. INSURERB: 1031 Main Street Osterville,MA 02655 INSURER C: 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,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.AGGREGATE LIMITS SHOWN MAY HAVE,BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE MM/DD LIMITS A GENERAL LIABILITY NPP1012091 04/30/06 04/30/07 EACH OCCURRENCE $1 00O 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPRFM rmrvcel $50 OOO CLAIMS MADE F_x1 OCCUR MED EXP(Any one person) $2 500 X BI/PD Ded:1,000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS.-COMPIOP AGG $1 000 000 POLICY JER 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 EA ACC $ OTHER THAN __HAU10 ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND , WC STATU"MIT- OTH- EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICEMMEMBER 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 I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate of insurance will be issued directly by the insurance carrier. 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 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 90 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 Of 2 #42866 LS1 O ACORD CORPORATION 1988 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. Marl:reason for change. Address ,�� Renewal I Employment ! Lost Card PS-CA1 0 50M-05/06-PC8490 ,,tpom� ✓lze [�arrv�,ta�zcuea/�! o�,✓1�G�4aac�iu4ell6 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: Registrati9rr:.,103714 Board of Building Regulations and Standards Expiration:;'7/9/2008 One Ashburton Place Rm 1301 Boston,Ma.02108 Type:!Private,Corporation PAUL J.CAZEAULT`&*\SONS ,INC Paul Cazeault 1031 MAIN ST ; OSTERVILLE, MA 02658 l Deputy Administrator Not valid without signature FAAA Board of Building egulations One Ashburton Prace, Rm 1301 Boston, Ma;;02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE- Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/200.7.`; . Restricted To: 00 5 PAULJ CAZEAULT , 1034 MAIN ST ' OSTERVILLE, MA 02655 Tr.no: 7696.0 Keep top for receipt and change of address notification. PS-CA1 G 5OM-04/05-PC8698 T1. .._._.-......_._.....-_..... ✓ Vi anvnzoo o�✓vlaaoac��u�Grlta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number:CS, 026325 • B0Pdate 1.0/20/1959 1+ Expires 10/20/2007 Tr.no: 7696.0 Restricted,,;00 PAUL J CAZEAULT, a, 10111 MAIN CT .-.