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Home My WebLink About0127 SHORT BEACH ROAD ��' ;, �. .� , .� ',f � s .�. ., � a . � � .,. � , :: ,; _ .. .x,�.- t p. k _ r _, ._ ,. 0 0 Town of Barnstable *Permit#��Q(43A9Dg ExpdAp 6 months from issue date Regulatory Services Fe o i 00 Thomas F.Geiler,Director I OVID� Building Division Tom Perry,CBO, Building Commissionx.p 200 Main Street,Hyannis,MA 02601 � � www.town.barnstable.ma.us OCT O office: 508 862.4038 T��`��, 2 508-790-6230 EXPRESS PERMIT APPLICATION - RESII��PVY'L"NLY Not Valid without Red X Press ImprintSTgB L� /parcel Number g2 - � (' ierty Address Usidential Value of Work Minimum fee of$25.00 for work under$6000.00 ier's Name&Address we n tractor's Name T `'(f 7. �/✓�'- Telephone Number fj�Z Z ne Improvement Contractor License#(if applicable)__7 i"ensr-#�ifappht-able) Vorkman's Compensation Insurance Check one: ❑ I am a sole proprietor �the Homeowner e Worker's Compensation Insurance Crane Company Name rkman's Cornp.Policy# )y of Insurance Compliance Certificate must be on file. nit Request(check box) / Re-roof(stripping old shingles) All construction debris will be taken to dxlk1-12LAR o ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. 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: Property Owner must sign Property Owner Letter.of Permission. A co' y of the Home Improvement'Contfactois License is required. :NATURE: )nm:expmtrg ise061306 Department of Industrial Accidents F Office of Investigations z 600 Washington Street Boston,MA 02111 °,M �• www mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plurribers iplicant Information Please Print Legibly me (Business/OrganizatiowTndividual): AL 7— tIfy,- /^-C ([dress: rl 44 .. t r/State/Zip: #: zz� X� you an employer?Check the-appropriate box:. . _ _. - Type of project(required):- am a employer with 4. ❑.I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors I am a sole proprietor or partner- listed on the attached sheet. $ 7• ❑ Remodeling ship and have no employees - -: These sub=contractors have 8...0 Demolition - working for me in any capacity. workers' comp. insurance. 9. [] Building addition [No workers' comp. insurance... . 5. ❑ We area corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions J I am a homeowner doing all work. _-.. right ofexemption per MGL 11.❑ Phimbig repairs or additions myself.:[No workers'. comp. - c.__152, 1 4 ,and we have no §,_O 12: oof repairs insurance required.] t employees. [No workers' 1-3.0 Other comp. insurance required.] applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: `t cowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. actors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy inforrniition. an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site mation. � . :... . ance Company Name: y#or Self-ins.Lie.#: Expiration Date: site Address: J,27DIOL't, &e��ACity/State/Zip: G' . ch a copy of the workers' compensation policy declaration page(showing the policy number a d;expiration date). re to secure coverage as required under-Section 25A of MGL c::.1.52 canlead to the imposition of criminal penalties of a ip to$1,500,00 and/or one-year imprisonment- as well as.-civil penalties irt the form ofa STOP WORD"ORDER and a fine to$250.00 a.day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of atigations of the DIA for insurance coverage verification. hereby certify unde pains and pens ' s of perjury that the information provided above is true and correct; ature: Date: — te#: fficial use only. Do not write in this area,to be completed by city_or town official. ity or Town: Permit/License# suing Authority(circle one): Board of Health 2.Building Department 3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing Inspector Other .ontact Person: Phone#.• x _ --Al k!n Board of BUiduiR / � a iteutattans and StartdarrT HOME IMaROVEMENT.CONTRgCTO1 -•Registration � a � 42 6 Expirataor� r ll a, \ aQRT C�NST INC I �t"ND � RONNIE TAYLpR �V. PING&ROOFIN �r; . 7I MtYf4 GIf�GEE' k s1d"Tiim '•` `' : :: . : ; : :: .....:.... ..:T -] :: .::.:.::: :::::. : .... .. .... ::::::::: E.::: ::::.: :. ::::.:•...:::.:::::.:::::...:::::::::.:.::::. .:::.::.: :.:::::.:::. DATE(MM\DD\ t' :::.:.::::::::.:::: ::....:.::::::::::::.:.:.......:::::.:.:::: m PRODUCER FALTER ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AND CONFERS NO RIGHTS UPON THE CERTIFICATE EDWARD A GRAZUL INS AGCY R. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO BOX 337 THE COVERAGE AFFORDED BY THE POLICIES BELOW. MARSTONS MILLS MA 02648 COMPANIES AFFORDING COVERAGE COMPANY 2BY2K A HARTFORD UNDERWRITERS INSURANCE COMPANY INSURED COMPANY R L T CONSTRUCTION INC g 31 MANNI CIRCLE CENTERVILLE MA 02632 COMPANY C COMPANY D ... ............::.:...:... . ........ 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. .O TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MM\DD\YY) DATE(MM\DD\YY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG. $PERSONAL&ADV.INJURY CLAIMS MADE�OCCUR. OWNER'S&CONTRACTOR'S PROT. $ EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ AUTOMOBILE LIABILITY MED.EXPENSE(Any one person) g ANY AUTO COMBINED SINGLE $ LIMIT ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Per Person) g. HIRED AUTOS NON-OWNED AUTOS. BODILY INJURY (Per Accident) $ PROPERTY DAMAGE g GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT EXCESS LUUlILITY AGGREGATE $ EACH OCCURRENCE g UMBRELLA FORM OTHER THAN UMBRELLA FORM AGGREGATE g WORKER'S COMPENSATION AND EMPLOYER'SUABILITY (US-1051C04-5-05) 12-24-05 12-24-06 STATUTORY LIMITS THE PROPRIETOR/ EACH ACCIDENT :$'>i` PARTNERS/EXECUTNE INCL OFFICERS ARE: EXCL DISEASE—POLICY LIMIT g OTHER DISEASE—EACH EMPLOYEE $ i O 00 ICRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER I AFFECTING WORK.E...R.S. COMP COVERAGE. ......::...... ..: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ARNSOF BA BUILDING DEPARTMENT 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE DON OF BSTREETBLE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 00 MAIN STREET YANNI S MA 02601 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �� Island and w-'-1ofhV A4 ;us4, a division of RLTCowtnxtron,Inc. a July 13, 2006 Peg Hine 127 Short Beach Rd. Centerville, Ma. 02632 We are pleased to submit the following specifications and estimates for reroofing: Strip existing asphalt shingles.and flashings Install new aluminum drip edge and pipe flashings Install 3 ft. Ice & Water Shield to eaves, interwoven w/step flashing on cheeks and skylights Install 15 1b. tat paper to remaining roof Install 30 yr. architectural grade shingles Install continuous ridge vent to all ridges Clean up and haul away all debris to landfill We hereby propose to furnish materials and labor—complete in accordance with the above specification, for the sum of- FOUR THOUSAND EIGHT HUNDRED DOLLARS ($4800.00) PAYMENT TO BE MADE AS FOLLOWS: $4800.00 Upon Completion All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents,or delays beyond our control. Owners to carry fire,wind damage and other necessary insurance. RLT Construction, Inc.carries General Liability and Workers Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: - Signaturel�` Start Date: Signatur SPLSCCLY t)p- VAQe' GAO�- C 31 Manni Circle Centerville, MassacFiusetts 02632 Tefephone 508.42a5243 and 508.833.5249 • fax 508.420.1776 • Email caperoofer@caperoofer.com