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Town of Barnstable *PermitM20& 03
Expires 6 mo MAW date
�T Regulatory Services Fee
saitxsMLF, FT
MASI
9 1 ,0� Richard V.Scali,Interim Director
Building Division
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
0 Not Valid without Red X-Press Imprint
- Map/parcel Number 702�
Property Address 3 6 f M 41 A S S /� R w y-/1
❑Residential Value of Work$ ?: 0 C) Minimum fee of$35.00 for work under$6000.00
Owner'.s Name&Address
Contractor's Name 16 G — �zn% � Telephone Number -o r �PL_--A/ 3.5-Y/
Home Improvement Contractor License#(if applicable) &17 ;�?l Email:
Construction Supervisor's License#(if applicable) ,
❑Workman's Compensation Insurance
Check one: DEC 18 2013
❑ I am a sole proprietor
❑ I am the Homeowner
OA-Tave Worker's Compensation Insurance TOWN OF BARNSTABLE
Insurance Company Name 7 y
Workman's Comp.Policy# G Z (J - - b 7 Y 5 y 7 /3
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Reque check box)
L�TRe-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)
Pr Re-side- f
❑ Replacement Windows/doors/sliders.U-Value - (maximum.35)#of windows f dw. v
4
#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 Home Improvement Contractors License&Construction Supervisors License is
required.
SIGNATURE: /EGG
QAWPFRM\FORMS\building permit forms\EXPRESS.doc
Revised 061313
L�
control of the Contractor. All employees of the Contractor performing Work under this Contract
shall be and remain the Contractor's employees.
a. The Contractor shall supervise and direct the Work, using its best skills.
Job Safety.Contractor shall be responsible for initiating, maintaining and supervising all safety
precautions in connection with the Work.
i
Permits. Fees and Notices. The Contractor shall secure and pay for all permits and
governmental fees,licenses and inspections necessary for the proper execution and
completion of the Work. Such permits and licenses shall be the property of the Customer and
shall be delivered to the Customer upon request.The Contractor shall give all notices and
comply with all applicable codes, laws, ordinances, rules, regulations and orders of any public
authority in connection with the performance of the Work and the Contractor's obligations
hereunder.
Insurance. Contractor acknowledges and agrees that Customer or Owner shall not be
obligated to carry any insurance in connection with the Work for the benefit of the Contractor.
Contractor's Insurance. Contractor shall at all times maintain and keep in full force and effect,
at its expense, any and all insurance coverage which is prudent, necessary or desirable for the
protection of the interests of Contractor. Contractor shall furnish to Customer certificates of
insurance for the following types of insurance.
a. Commercial General Liability Insurance;
b. Workers'Compensation Insurance to cover full liability under the Workers'
Compensation
IN WITNESS WHEREOF, the parties hereto have executed this Contract as of the day and year first
above written.
i
Customer - � ,� Contractor Company i
By: ll ivw By:
Print : Dell Friedline Mark Mullin Mullin Roofing &Siding, Inc.
Randall Friedline(Legal Representative) 7 Connemara Way,W.Yarmouth MA
02673 508 2218591
Address: 53 Chappaquiddick Rd.
Centerville, MA
Date: 11-9-13 Date: 11-9-13
Phone number: 508-688-4819(R. Friedline) License No. CSL#104076 HIC# 167281
(508)771-0572 (D. Friedline)
Email address mullinroofing@gmail.com
Email address: rfriedline@gmail.com