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SEP-13-2001 15;30 BRRNSTRBLE HOUSING 150B7739312 P.01
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a"a ; Lci;,ed Housing Dept. (50)77'-7N_
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.e3a I ousin� Authority 7, 1
�h South�tre%t H tnniti. !�4a�,.t)_6{)
ZONING VERIFICATION
TO: Gloria Urenas
FROM: Robert Hooper, leased Housing Coordinator
RE: legal Rental Unit Verification
Date: --yZ 9/LL--__ -__-�_-_------
Address: 141 -T����� C Ne_ --
Village: G ✓ I le—
Unit Type: Skl e_ �."-9 L_— — Bedroom Size: nz
Map & Parcel No.: 27d - o-,3.L
The owner of the above listed property is entering into a
contract with us for the rental of the property as listed
above.
Please verify by signing below that the unit is legal and
meets all zoning requirements for a rental in the town-of
Barnstable. If it does not, please list reason here:
- --------------d--------------------------------
--'-----------W---------------- ------------r... ---
_Trff ou f r your assistance 9n this rna /
S/- n ture �s 'Print name
t I
VIA FAX: 790-6230 - MRVP section 8
Rev, 9/98
Equal Housirt� Aoetw
TOTAL P.01
, ��...... ......-Application numberq?.....I.q......36......
Fee............................................................ ...............
SEP 6 291
Building Inspectors Initials.... .................
MINN 0� bAHNSTABLE ryko�
Date Issued......." J......L J- .q....... .. ....I...........
Map/Parcel........ ..................
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SID ING/WINDOWS/DOORS/TENTS/STOVESAVEATHERIZATION
PROPERTY INFORMATION
Address of Project: ILA V)It1AhQ Cna P41 C9-AAew%U,,
ER aTREET VILLAGE
Owner's Name: Phone Number ;kn 4
w
Email Address: lh&Cell Phone Number
Project cost$ Check one Residential Commercial
OWNER'S AUTHORIZATION
As owner of the above propeirty I'hereby'authorize
to make application for a building permit in accordance with 780 CMR
Owner Signature: bate:
TYPE OF WORK
0 Siding D Windows'(no header change)4 hisulationfWcdtherization
Doors(no header change)# Commercial Doors require an inspector's review
Roof(not applying more than I laver of shingles)
Construction Debris will be going to oj-xLouA4
&
CONTRACTOR'S INFORMATION
Irk— Nplrl VQ1.
Contractor's name__UWL
Home'
frftprbvem ent Contractors Registration.(if applicable) (attach copy)
Construction Supervisor's License # (attach copy)
Email of Contractor PAC—LQ45.) CtIWhone number
ALL PROPERTIES THAT HAVE STAfTUA-6 OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORICAPPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NUMBER............................................................
*For Tents Only*
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides' Yes No (If yes please attach floor plan with exits marked)
Dimensions'of each'Pent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a:for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
I ood is being served at our event lease obtain a Health Department approval between the hours
.ff g y P P PP
of 8:00am 9.30 am or 3.30 pm-4.30pna,Commercial events may require Fire Department approval.
*WOOD/COAL/PELLET STOVES X
Manufacturer# Model/I.D.
Fuel Type Testing Lab '
Offsets from combustibles:"front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures, specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANT'S SIGNATURE
Signature , Date Oil
All All permit applications are subject to a building official's approval prior to issuance.
i
.%G CERTIFICATE OF LIABILI rY INSURANCE
�,
09r19119
THIS CERTIFICATE.IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MG14TS UPON THE CERTIFCATE HOLUM TM
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AWMD,E=X0 OR ALTER TNE.COVERAGE AFFORD BY THE pOUCYCS
DIELOW.TNS CERTIFICATE OF INSURANCE DOES NOTCONSTIME A CONTRACT 199TWMN THE ISSt11NG INSURENSA AU7HORM
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLMR
1 TANT: If the CesetiWte h0IZ Rs an ADDITIONAL INSURED,ttte poltcy(ios)muttt I a"ADDITIONAL INSURED provisions or be aWorse&
It SUBROGATTIDII 15 WAIVED,sub}od to tha tatrmaatld condt Iona of tho I,oUty,c"t lin policies may require an erx1amn.mvL A statamme on
this callDcate does n*4 confer►iljNs 10 We certirrate h0hier in lieu of aocM endorsernertlK
PROOUCER
Iweu PAUL SCMLE"L
Phoenix Ices LLC 781-4384024 -M 436A6TB4
8 WYMAN STREET noatrssa: CERflFeC TAnsuraruaLLC cen�
STOUGIRON.FAA 020rZ
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NtauRfO INstiamo: TOMON INSURANCE
LEWIS WA CONSTRUCTION talc INiURHR C
34 MAAKC-T ST Ile>df�st n:
BROCKTON.IAA 0ZW1
COVERAGES CERTIFICATE NUMBER REVISION NUfTW-R
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LIN. `IYPEOF'INO{NtANCE put MY Wm= aftwor " unrr-s
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rat"a jr T ❑raI Ms'fj"r..mueernir� 'S 2.000.000
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FOR OPEIFtATIDNS COVERED ON WSUtEm:S POUCtEs.
HYTECH ROOFING SOLUTIONS IS LISTED AS AN ADOITI0II:4L INSURED:
CERTIFICATE HOLDER
CANCELLATION
SHOULD AMY OF THE ABOVE DES008ED POLtaE9 BE CANCE11m BEFORE
T►E E MIRATION DATE THEIIEOF,NOTICE WILL 13E DELIVER®IN
HYTECH ROOFING SOLUTIONS AOOORDAMCE WITH THE POLICY PROVISIONS,
12 BALDVIIN RD
D€TNIS KA 02638'. artrte REOaE!izESENgtTT�E
HYTECH ROOFING SOLUTIONS , OLAnA.eLIS
47 19811-2015 ACORD CORPORATION Ain rlgTNa raMftV40d.
AOORD 25(2016)09) The ACORD name and logo are registered marks of ACORD
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c nweelth of Massachusetts
Divtvon of Protessional lacensure
Board of Building Reegulatiorm and Standards
7 n.tructio =, ii agr 5pccialty.
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Commission
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Office of Consumer Affairs and Business Regulation
One Ashburton Place ,Suite 1301
Roston, Massachusetts 02108
Home It`mprovemeni�C ontractor Registration
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4 LLC
184383
HYTEcH ROOFhNG SOLUTIONS LLC. "� R �iration: 01M4r2
• 1Q41202Q
12 6ALD`W IM RD uailon_ 01
DENNK,MA 02638
Updaee Address anq Raflfrn Card.
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OffMe of 06mumerAffairs A'tluslness R09UU CM
HOME IMPROVEMENT CONTRAOTOA Aogistrntlon'valfd forWivldual use awy
TYPE LLC bofore the.expirslion date Il lound return to:
Rrscrwtratio ExnlrMfon OMCG of Cooewrter Affairs and Qusinea Regulsfion
1FiA3B3+� ^`U1Y ►) 10ParkMam-Suite sm `
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PATS CUFF0RD `•" � i
DENNIS,MA Ct2E3t' Not valid without Signature
Wndamocrcta y
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5--0- 8—
L— 717
12 Baldwin Rd. Dennis, MA 02638
ROOF REPLACEMENT PROPOSAL
Provided on: 8/29/2019
Customer:
NAME: Matthew P,ernick 0 `'" , ' 'TEL: (508) 737-2784
STREET: 14 Johnny Cake Rd-. CELL:
_Centerville-;10IE1, 02632 EMAIL. -roper lick@comcast net a_
HyTech Roofing Solutions hereby proposes to perform the following services m a neat and
professional.manner,and-,i-n_aceor-danee-with.the�rnanufacturer's.specificati:ons-and-local-bui-lding codes
_.._. � V .1.. ,'fib\•y._
Remove and haul away all layers of existing roofing materials from the entire roof deck area of
the house.
Supply and Install Inspect and Re-Nail Any loose or popped plywood or boards on the
Entire Roof Deck Area of the House '
Supply and Install CERTAINTEED LANDMARK SERIES LIFETIME WARRANTY,
CLASS A FIRE RATED, COPPER/ CERAMIC STONES for
PROTECTION AGAINST ALGAE CONTAMINENT, 235-300
POUND, EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY,
CATEGORY III HUR.RjCANE, STORM/HUa?ICANE NAILED (6
NAILS PER SHINGLE), MULTI-LAYERED, LAMINATED
ARCHITECTURAL STYLE, FIBERGLAxSS BASED ASPHALT
SHINGLES. COLOR:
Supply and Install HICKS VENTILATED ALUMINUM DRIP EDGE on the entire roof
eaves.
r
Supply and Install 8" WHITE ALUMINUM DRIP EDGE on the entire gable end rakes of
the roof.
Supply and Install CERTAINTEED WINTER-GUARD (Ice & Water Shield )
WATERPROOF UNDERLAYMENT SYSTEM 3 feet coverage on the
entire roof eaves, on top of soil.pipes and vents,and running up the
walls of the chimney
Supply and Install CERTAINTEED ROOF-RUNNER synthetic underlayment paper on
the entire roof deck area of the house as required per manufacturers
specifications.
Supply and Install CERTAINTEED SWIFT START adhesive asphalt starter strips on all
eves and Rakes with a 1/2 inch overhang.
Supply and Install CERTAINTEED FILTER RIDGE (SHINGLE VENT 11) ridge vent on
the entire ridge area of.-the roof using the 3" hand nailing method.
Supply and Install CERTAINTEEDMIP AND RIDGE CAPS on the entire ridge/hip area
of the roof using the 3"larid nailing meihod
Supply and Install ALUMINUM & NEOPRENE SOIL PIPE FLASHINGS, and black
- _ __ _
�, i aluminum n a ,vents -
Clean andjRemove :'Debris fromjhe/work a,rea'after,th6A is complete
Pr-ic :ng_:�...=._ .Good - - Better-:_ ._B-est-
_ .. . _w .. .
Brand: Landmark Landmark-PRO Landmark Premium
Recommended for Inland Inland High Wind On the Water
Weight: 235 Lbs.. 250 Lbs. 300 Lbs.
Warranty Period: 40 years 50 years 50 years
Algae Protection: 10 years 15 years 15 years
Max-Def Colors: NO YES YES
TOTAL Investment: $59060 0 $5MOj$ $6,160.00
Please Check
Selection
s�
boy
I
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
$ 60.00 per hour.
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 30 days of
acceptance and receipt of deposit providing the materials are available.
Please Make Checks Payable to:
HyTech Roofing Solutions
HyTech Roofing SOlUUt arranties,the,Shingles and Labor for 20 years.
CERTAINTEED Warranties the shingles and'labor 100`% for the First 10 Years
and the Shingl s yourXIFETIME,i-f the shingles bec(;rieesW_ddeefective.
4`
CERTAINTEED Warrants the Shingles up to a
7 CATEG0_-RY_1TII H URR CAi+1E=1301iI H�'6� D WARRANT Y.
CERTAINTEED°Warrants the Shingles to be Algae Resistant: . ?
HyTech, Roofing Solutions-.-....-. _ _
�-Carries Workman's Compens Insurance on the above work
-Handles all permitting and planning involved with the above proposed work 4 ri
_Is certified directlyTMby Certainteed., and processes all warranty,paperwork involved
TOTAL INVESTMENT:
(Enter Total Amount Including All Selected Options
DATE OF ACCEPTANCE: qfj
ACCEPTED BY- SUBMITTED BY:
att ew Pernic R Patrick Clifford —Alex Yaskavets
MA CSL license 105951
MA HIC license 184383
The Commonwealth of Massachusetts
Deparfinent of pndust W Accidents
Office of Investigations
600 Washington Street
Boston,.MA 02111
www mass g"Ma
Workers' Compensation Insurance Affidavit:Balders/Contractors/Electiicians/Plumbers
Applicant Information f� Please Print Legibly
Name(Business/Organization/Individual):
Address:
City/Stat lzip: �,1 S �,.�D Phone#: $
Are you an employer?Check the appropria box: Type of project(required):
1.❑ I am a employer with- 4. I a general contractor and I 6. ❑New constriction
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 S. ❑Demolition-
working for mein aci employees and have workers',
�'capacity. 9. ❑Building addition
[No workers'comp.ftmrraace comp.insruanoe.Z
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.El officers have exercised their I am a homeowner doing all work 11.❑Plumbing repairs or additions
myself[No workers'comp. right of exemption per MGL / Roof repairs
insurance; ]t c.152,§1(4),and we have no
employe=.[No workers' 13.❑:01her
comp inswance required.]
*Any applicant that checks box#1 must also IM out the section below showing their workers'coon policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then bae outside contractors most submit a new afdevit indicating such.
=Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state wbedw or not those entities ban,
employees. If the sub-wnt:actors have employees,they mast provide their workers'comp.policy number.
lam an employer that is providing workers'compensation.insurance for my employees Below is thepolky and job site
Information.
Instn mee Company Name:
Policy#or Self-ins.Lie.M Expiration Date:
Job Site Address: ` City/State/Zip: `'"�
Attach a copy of the worken("compensadm4olicy declaration page(showing the policy number and expiration date).
Failure to severe 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 certify under the pairs of perjury that the information provided above b true and correct
Si Date:
Phone#:
OfiScial use only. Do not write in this area;to be completed by city or town of kld
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CityrTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
0
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pumuent 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,partoership,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
owner of a dwelling house having not more than throe apartments and who resides therein,or the oc apaai of the
dwelling house of another who employs parsons io do maintenance,construction or repair work on such dwelling house
or on the grounds of building-appurtenant thereto`shall not because of such employ_ment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or 10c111 licenslmg agency shall withhold the issuance or
renews!of a license or permit to operate a business or to consh ct buildings in the commonwealth for any
applicant wtio has-not produced acceptable evidence of compliance with the insurance coverage regrind."
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 alk)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to cant'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 brat the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regardmg the law or if you are required to obtain a workers'
compensation policy,please call the Department at the mmrber 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_oi 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 bum 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.
The CommimF 9 l of MassVkuseM w
D%mtmwt of I1ldtlSi!W AccioM'tk
Offim of Lavestiat ions
660 Wa6in&a Save
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877 MASSAFE
Revised 4-24-07 Fax#617-727-7749
wwwxaaw.gov/dia