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Home My WebLink About0035 VALLEY AVENUE 35 ��- l � t� v�. � . � � u, 6 � _ a . : . � �� 4 T '� 0 u I •: ,. a .�. ,, Assessor's map and lot number T.An ll....4..(�7p...Y.0 9X 0— 3e9, OA � /� U y4/6,t01 C 0� Sewage Permit number r � �• �'� ��° 7 � ........................................................ yOFTHETO TOWN OF BARNSTABLE BASH9TADL&. � - "6 q .•� DUhLDIAG INSPECTOR I?HAR APPLICATION FOR PERMIT TO . . . 'L...l �"" \'... .....r.... a ...�!.. ..�Q U/o obi TYPEOF CONSTRUCTION ..............,.........FRAM......................................................................................:....................... TO THE INSPECTOR OF BUILDINGS: rt The undersigned hereby applies for a permit according to the following information: Location L' 4 Y9 ......o....-b 6 ProposedUse .Rl.�u .... Qo K��... S l�p AL 1 G J.................................................................................... Zoning District ........................................................................Fire District Name of OwneCA.R 4�� 5•r HI.l 9`'l WAddress ji iq ............................�V/............. 6 Name of Builder S.�L. ........................................... ...................... .F ...................Address ................. .... ........ ..... ...................................................... Name of Architect 'y 0gf.............................................Address O Number of Rooms �q d Foundation po - 4 ................................................. .............. ........ . ....................... .. Exterior. j5DAR� g O.J6,te" ' �.... Roofin ®. Floors :r : 1 �1•* �!'L .5�. ................. ... ...................... . . ............. ... ....... Interior Heating .............. ....................................................Plumbing ....... ...................................... .... ........................ ffo .........................Approximate Cost ...... 00,0, .................................. Fireplace .............. ................................. ................. Definitive Plan Approved by Planning Board ------------__---_-----------19_______. Area .. .. .. .. ............................ �• Diagram of Lot and Building with Dimensions Fee ....... ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH TS DOOR Tq CA S FM FAI?' dl " 70 0W.S' 6"X 3 b u O?F/q 0 or D DOT, Ll ti Fa I -(c M cJ i c o , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above t construction. Name . ...:'.................... ............:....................................... Whittemore, Carroll & Agnes 17571 ~- remodml- atore - ` �u -----.. Permh for ----- --- -- | ' ' ---------------.----.-~----.- Location --'_..35..Vallmy..Ave^ --------.. --- ."~, ..' � Carroll & Agnes Whittemore � Owner ----------.............-------' . � frame Type of Construction -------------- .............'...,............................................................' Plot ............................ Lot ----------' _ | � Permit G,onn*6 -- ..29.-'-..lg 75 ` Date of Inspection -- �. ------lV ' \ � Data Completed - . . ' ........ _ . . ^ ` ` ^ PERMIT REFUSED � ' . ......................... 19 .-------~...----.-.---------.. ' � .............................................................. � � ....------.---.~—.-------.---, � - ` � -----~---'----'''r--^--^-^-~''^' . � ^ � Approved ................................................ lg . � ---------------....---..--~-.. ' , ^ ----------.--.------.-~~.~..-, . } . 4 Assessor's map and lot number .. ................ .....`�^� Y� Sewage Permit number .... ..... ............ y�FTHErQ�y TOWN OF BARNSTABLE Z 8ARNSTABLE, i "6 9 BUILDING INSPECTOR °CFO MPY of. 9 1�14 .� � ffe � �•APPLICATION FOR PERMIT TOK6 .0 r'..N. t... .............. ....:..............0.:,_..........................;..' .- TYPE OF CONSTRUCTION :.............r� ..........19. `S/ TO THE INSPECTOR OF BUILDINGS: { �f The undersigned hereby applies for ta,� permit according to the following information: J Lacation !;- ..:.....�AA i c��YI.4- � 145.5 . p {}'la .......................... nny .......................................................................... t.............. r Froposed Use `. .f J n 1 P P. /� �f��... •'�, l! G•��.................................................................................. Zoning District .....................:.:................................................Fire District iT `R WAx. L �' • 9OT�... 1/I iG. Name of OwnrA..RRai- ... ...4 . ..�X .....� 'A I6rr/.,.44,4..41 ..... ........... -............... .....� �� , ddress .. .� , ,7s'ir Name of Builder ........S4.. ,......................-....................................Address .. . ......................... ......................................................... Name -of Architect ........Address a Number of Rooms d Foundation �' �j �� ...a{ �.. ............................................... h......................................... ..�. ... OF Exterior .... Roofing .................................�.. ..� .... ..�.. .a •vim••-• .,. f Floors .., �.Rl 'S ` ....... .....................Interior .Y •%�J f?I,'CT?'r. G� :r �............... r .. ............ - ,r Jr Heating . ...........................................Plumbing :�rl`... ............... ........r.. . ..........c.......................... .................. ...........................................................�> Fireplace .. .Approximate Cost ......... Definitive Plan Approved by Planning Board ________________________________19________. Area ................................... ,A) Diagram of Lot and Building with Dimensions Fee SUBJECT TOAPPROVAL OF BOARD OF HEALTH ). „,.._...� .._. � 1 ,4.40 � a Out 60 _fa 1 l(� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....................................................................... Whittemore, Carroll & Agnes ~ 17571 No Permit for ...remodel store ............................................................................... Location 35 Valley Ave./`,, Owner Carroll �& Agnes Wlfiittemore ................... Type of Construction ........frame . ....................... Plot .................... ....... Lot ................................ Permit Granted January 29 . 19 75 ..... ........................... . t Date of Inspection ....................................19 Date Completed .........:...... 19 .PERMIT REFUSED ........................................... ................ 19 ............................................................................... ...................... ..V................ ................................. Approved ............................................... 19 ............................................................................... ............................................................................... o VE Town of Barnstable *Pa�# p Expires 6 months fro issue date + + Regulatory,Services Fee + BARN3rABLE, • ` NAM .0 9 Richard.V.Scali,Director s639 �� Building Division -PRESS Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 PERMIT www.town.bamstable.ma.us AUG 17 2015 Office: 508-862-4038 TOWN ' ax: 550'8-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL Ulf"L"Y'°STABLE Not Valid without Red X-Press Imprint Map/parcel Number Prope Address -9S VA lL Ev A O C esidential r Value of Work$ �i ®�.ac� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �� Dy OLwoQ nk s.5 V,kLLv--y Aoc c P. 6vlu_G %&4d, 4 Contractor's Name EJ 1518 5 Telephone Number !J- d8`4E8'Q`1(2c( Home Improvement Contractor License#(if applicable) ®aQ Q Email: �,4JAV 4a(—P �5202.�`- Construction,Supervisor's License#(if applicable) O_583 7b ❑Workman's C pensation Insurance E Che 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 accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be to El -side (hurricane nailed)(not stripping. Going over existing layers of roof) -side Replacement Windows/doors/sliders.U-Value (maxim_ um.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and 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 Owner Letter of Permission. A copy of the iloy6e Improvement Contractors License&Construction Supervisors License is requir d. SIGNATURE Q MPFILEST �img t forms\EXPRESS.doe Revised 040215 27ze Corral:ornwealth of-Vassachusetts w ' Departrnivit ofIndustrial Acciderats - - a ce of In stigations r 600 Washington Street y Baston,3M 2111 n-%nv mass gtrv1dia ""Tarkers' Compensation Insurance Affidavit:Bmldex-slContractGrs/EIecEr cianslPlu nbers Applicant Inf inn.ation Please Print Le gib NafYliP(BusmessA)zZmiifzafim adiMual}: Address: Q1. y 10& City/StateiMp f�"��` ; s"t� ol�`��1, P}rane �J� LO��`�Zl A21am n lover?Check the appropriate boi: Type of project{regnirerl)_ 4. I am a general contract x and I �. �New construction 1_ a employer with ❑ oyees(full anNor part-time),* 'have hired the sub-contractors 2. a sole prqpri P3 etor or rtaer- listed on the attached sheet. 7. ❑Remodeling ship and have no employees. These sib-confractors have 8. ❑Demolition wo dnQ forme in any capacity_ employees and bit, woricers' Building addition' [No�v orScers'comp.insl�„ce comp_i1sur2nce-1 r ed_ 5: ❑ We are a corporation and its 10'-❑Electrical repairs or additions ecF& ] 3.❑ I am.a homeommer doing all work officers have exercised their 11-❑Plumbingrepairs or'additiorn set€ o workers' right of exemption per MGL my � gyp- § {� 17.❑Roof repairs insurance required-]6 c.152, 1 andwe have no employees.[No woscus' 13_❑Other WL-0060S comp.insurance required_] *Any apphc=&at checks box Al :'also fill out the section below showing their wodere ca®pEnsation policy information. I Homeavaaers who submit this afBdatit indirzong they are doing all wc*ami duen lie outside rAmtmaom amst submit a new affidavit indicatiag such. fCantractors ffW check This boar must attached su additioaa2 sheet showing The name of the sob-con twA m and state whether or nottbnse en2itiesbn�e erp4oyees. If the sal-coatmamshave employees,they n:rsr provide.their workers'camp.policy number. lam an Below is the policy and job site infornzatiall. Insurance Company Name: _ y Policy 4 or Self--ins.Lic_9: RxpiratiionDate: Job Site Address: S5 Y P `� F�`�E;l '`�U� CityJStatelzsp: Attach a copy of the workers'compensationpolicy declaration page(shoving the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c 152 can lead to the iraposition 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$250-Oil a day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the D1A.for mi suranc=coverage vacation. I do hers l-tder perrahYes afpe�urp that the information prm-z&d abm�a is true and correct Date: 17-2 d 12 Phone `T Z r Q q ZL Official use only. Do not write in this area,to be coompWad by city ar town o f j�iczat II� City or To.mn: PermitMkense# Issuing authority(tdrele one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions �nf � Y Massachusetts Geheral Laws chapter 152 requires ail employers to provide workers'compensation for their employees. Pnrsuantto this stat UL-,an.errPZa3'e--is d$tmed as."-.every person in the service of another under any contact of hire, express or implied,oral or writ" An ezrTroyer is defined as"an individnal,parinai ip,association,corporation or other legal entity,or any two or more of the:foregoing engaged in a joint enterprise,and including the legal represenfativves of a deceased employer,or the receiver or trustee of as individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apaitments and who resides therein,or the occupant of the - dvi,eIIing house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or bnl�appurtenant thereto.shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C Q also st3 Es that"every state or local licensing agency shall withhold the issaance or reuewaI of a license or permit to operate a business or to construct bufldings in the commonwealth for any applicantwho has not produced acceptable evidence of compliance with the insurance.covearage required." AdditionaIly,MGL chapter 152, §25C(7)states"Neither the commanwealth nor iay ofits political subdivisions shall enter mto an contract for the erfoimaace of ublic wmkuntil acceptable evidence of compliance with the asuranc0._ . Y P P requirements of this chapter have Been presented to the contacting author" Applicants Please fill out the workers' compensation affidavit completely,by checlang the boxes that apply to your situation and,if necessary,supply sob-contractor(s)name(s), addresses)and phone numbers) along with their certificates)of sn c=ce. Limitrd Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not rupEae to cairy workers' compensation insurance. If an LLC or LLP does have emp_loYees,a �� Be advised that this a.ffidayit may be submitted to time Department of Industrial Polic Yis Accidents for conffimatioa of fimance coverage. Also be sure to sign and date-tine affidavit The affidavit should be retumed to the city or town that the application for time pem it or license is being requested,not the Department of Loil T t i l Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-ins=d companies should enter their s eif-fi s rrm ce license number on the appropriate line. City or Town Officials . f . 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 time event the Office of Investigations ions has to contact you regarding the applicant Please be sure to fill in the pemiit/liceuse number which will be used as a reference number. In addition,an applicant that must submit multiple pma itlIicense applications in any given year,need only submit one affidavit indicating cture t p olicy mifbrmation(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 or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file,for future permits or licenses Anew affidavit must be tilled out Bads 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 Time 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 numbm: Tit C-G-=10awealth-of Mrs chusf--tts Departramt of lradnstdal Accideut% C��e of�.ve�iig�tZops �Q�-�`ashingtan t Rasto-zl MA G2111 Tf,-L A 617;727-4900 406 or I-9 MA-SSSAFE Fax#617-727 7749 Revised 4-244)7 .mas�_gcvfdia f K y a �oirmiir {€#° ,; s+`- Ist1(IEilll Tim"ierr,.; r tt0340"x bA;;z c FsIlzltl r r I;a rlq—at#F't111� r .rS/A V�d S�AS�Gtny t myL �i>#1 txw iY++,.s:.t.' :10'+ul .r�'..r,;>; .�.3;�:I t e'rJLa x_��t4r '�? ti oi: a i i t� 35 411el AV. , Craigv�Ka, FFAtJPool �r1 - ��2€'.��t3�,+AY Of a.F ii3L. t're E'{il#.tJ �?e'_Y 1', �A�t"�,ili•IYTe,��;�,tC�.'�"iA"flt.L;�"i:Iis�3.�.�t� 3 � t t`" � i� r � `1L�"d:��-.liC,J�t..�S y �{'� •-..rr�.».�Ji'�t'�+ 'lif."i7s.'I :5 ��M e(R f} vck�oflt� iU Massachusetts -Department of Public Safety +" Board of Building Regulations and Standards Construction Supervisor a License: CS-058376 DAVID P SHASTAft , 12 V7STA CIR MASHPEE MA Q644 n W _ Expiration Commissioner. 08/19/2015 Unrestricted- cOnn less than S��s°f an use group enclosed space. 0 cubic feet gro p which m )of Failure to � State Building a current wilding Cod edition of e Is cause for the Massac For DPS licensin revocation Of husetts g information visit: this license. e. w•Mass.Gov/DPS e Tpomvnzoozcuea `�C�/�"°�`r�'"°ei License or registration valid for individul use only Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR i before the expiration date. If found return to: i fregistration: ,�'08901 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 piration- 8/27/20-1— Private Corporation Boston,MA 02116 �=- REVISIONS, INC. ��,:'�" � David Shastany Y =-'" i �: I_-; 12 VISTA CIR "K";�•. :=.==;::<�=� g��-�n,.Pr / i MASHPEE,MA 02649 Undersecretary Not valid without signature i 6 ^7 y �P 'Town of Barnstable *Permit# y F lam" � Expires 6 monthsftonj issue date Regulatory Services Fee snxxsrAsis, 163Q. ,0� Richard V.Scali, Director ATED MP'1 A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Z Property Address `� Vf, //�ti ❑Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ,�, �1� � ��, G`r >a.� s �'4- , Contractor's Name- ;t C 6) —Telephone Number —7 Home Improvement Contractor License#(if applicable) 1 G -1 3 4 Email:.'jk�rfle/)y,/i a </k� < u L �� Construction Supervisor's License#(if applicable) Work Compensation Insurance Check one: © �� / ❑ I am a sole proprietor ❑ I am the Homeowner OCT 27 2014 I have Worker's Compensation Insurance Insurance Company Name LJ ,✓ w�L- TOWN F ARNSTABLE Workman's Comp.Policy 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-35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and 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 YOwner must sign Property YOwner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 The Commonwealth of Massachusetts Department of IndustrialAccidents K. 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): C. Cr9- _K c, e- Address: City/State/Zip: Phone #: Are you an employer?Check th a ropriate bog: Type of project(required): 1. I am a employer with_ 4. ❑ I am a general contractor and I ❑ have hired the sub-contractors 6 New construction employees(full and/or part-time).* 2..❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees, These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑Other employees. [No workers' comp:insurance required.] *Any applicant that checks box 41 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the_policy and job site information. l y" G �1 (� r L Insurance Company Name: t � hn,, r Policy#or Self-ins.Lic.#: bi L �� ` 3?-7 Y`9 r s / `� 5� Expiration Date: � Job Site Address: � ( Ci /State/Zi : L-1 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 certify and the p and pJ alties offperjury that the information provided above is true and correct Si ature: l� Date: ® 7 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#: i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant 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,partnership,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 three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." 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(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry 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 that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number 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 or 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel, # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www-mass.gov/dia 1{ Estimate Date Aug 2I 2014 . a Cape & Islands Construction Co. PO :Terms 4 - Po Box 210 Centerville Ma. 02632 Ship Via 508:775.7663 A • : 1 r Ship Date log o Gingy Duckworth 35 Valley i�f;AVb Craigville 0 ' . . �r 7,870.00 MW CERTAINTEED Certainteed Shingle Roof Strip existing shingles from roof. Secure any loose sheathing. Install Hicks brand vented aluminum drip edge. Install Wip brand ice&Water Shield to all eves,rakes,valleys and all protrusions. Install Surround brand Synthetic Felt Underiayment. Install Certainteed Quick Start starter,shingles to all rakes&eves. Instail.Certainteed LIFETIME architectural shingles. .. Storm nail all shingles. (State.building code requires 4 nails,we use;6) Re-flash all vent pipes with new boots. Install Rigid Vent II ridge venting. Remove and dispose of all job related waste: leave your property looking like we were never there) Provide all manufactures warranties and LIFETIME warranty on our labor, if it.ever fails due to our- workmanship we fix it,forever! It's The Best In The Business. Please note our wind warranty is also the best And longest available ANYWHERE! —Structural repairs may be needed*** Total $7,870.00 Signature .Y - na `^� A`oo CERTIFICATE OF LIABILITY INSURANCE T°ATE`MM�°°"YY,' 5I7/2014 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 POLICI_S 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 endorsements . CONTACT PRODUCER FRANK L HORGAN INSURANCE AGENCY INC NAME: 44 BARNSTABLE ROAD P"DIVE FA't AIC No PO BOX 250 EMAIL HYANNIS, MA 02601 ADDRESS: INSURERS AFFORDING COVERAGE NAIC A wsURERA: LM Insurance Corporation 33600 INSURED - INSURER S - CAPE& ISLANDS CONSTRUCTION COMPANY INC INSURERC: PO BOX 210 CENTERVILLE MA 02632 INSURERD: . INSURERE:: . - INSURER F: - - COVERAGES CERTIFICATE NUMBER: 20102526 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 MAYBE 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 PO - LICY EFF POLICY EXP Limn _ LTR TYPE OF INSURANCE INSD D POLICY NUMBER MMIDD MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENT CLAIMS-MADE OCCUR PREMIS MED EXP(Any one person) $ PERSONAL&ADV INJURY $ r GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ADDL SUER $ POLICY PRO- ❑LOC PRODUCTS-COMP/OP AGG $$ JECT OTHER: -E5991 IN I AUTOMOBILE LIABILITY Es accident $ BODILY INJURY(Per pawn) $ ANY AUTO - - - - - - - ALL OWNED SCHEDULED - BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED - _ - ,. Per RTYl ,. HIRED AUTOS AUTOS _. UMBRELLAUAB OCCUR EACH OCCURRENCE $`. EXCESS UAB CLAIMS-MADE .ME.L.EACHACCIDENT GGREGATE $ DED RETENTION A WOR►�ERSCOMPENSAnON WC5-31S-377540-014 577/2014 577/2015 PER oR AND EMPLOYERS'LIABILITY Y 1 N T $- - 100001ANY PROPRIETORIPARTNERIEXECUTNE N/A - 1 OOOOIOFFICERIMEMBER EXCLUDED? - MPLOYE $(Mandatory in NH) 50000IIf yes,describe under CY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA.; This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'-compensation coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF; NOTICE WILL -BE DELIVERED IN ZOO MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS, HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 6_ CERT No.: 20102526 Lucy Garfield 5/7/201E 7:38:38 AM (PDT) Page 1 of 1 U Massachusetts - Department of Public Safety avelation Board of Building Regulations and Standards Office of Consumer Affairs&,Business Regulation OME,,IMPROVEMENT CONTRACTOR "l Construction Supervisor � ` egistration y165936 .. Type:. License: CS-074660 r'',, * x0irati6n419/2016 + `. Private Corporatiorf JOSHUA X KOUR CAPE,&ISLAND'..CONSTRU3FCTIffl;CO INC. PO BOX 210 s ^@ .` CENTERVILLE A 702G3 s � r � pi 1�I JOSHUA'KOURI 55'ELM AVE: ,^,c HYANNIS�,MA 02601 Expiration Undersecretary Commissioner 02/12/2015 i -- ...... .. ,.... .. License or registration valid for individul use only 7 before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza;.=Suite 51-70 I Boston,MA 02116 I v id w hout sY g'nature