The URL can be used to link to this page

Home My WebLink About0790 FALMOUTH ROAD/RTE 28 (2) I� YOU WISH TO OPEN A BUSINESS? For Your Information: Business YOU COST (WHICH YOU MUST DO BY $30.00 for 4 at 200 Main U H M.G.L. - it does not give Years. A Business Certificate ONLY REGISTERS YOUR Hyannis. Take the completed form to thepeormission to operate). You must first obtain the n' the Business Certificate that is e the ed.by law. NAME in the Town n Clerks Office, 1' Fi, necessary signatures 3b7 Main St., Hyannis, MA 02b01 on this form (Town Hall),and get 1 Fill in please: APPLICANT'S DATE Y BUSINESS NAME: E ADDRESS:. p TELEPH N# 0S� 7 _ 76 Tna4l k NAME OF NELV BUSINESS '4 �l d IS THIS A HOME OCCUPATION? Telephone Number: r Have you been given a —YES NO 1 TYPE OP BUSINESS � � • '��L approval from the b�ing division? YES ADDRESS OF BUSINESS � p NO rl'1 When starting `MAP/PARCEL NUMBER O1 a new business there are several thins Barnstable. This form is intended to assist you in obtairiin g You must do in order to be in compliance with the rules a Yarmouth Rd. & Main Street) to make sure g the information town. you may need. and regulations of the Town of You have the appropriate permits and licenses required to MUST GO TO Z00 Main St. — (corner of 7• BUILDING COM 510 legally operate your business in R'S OFFICE this This individual has b inf d Y rmi requirements that erta to this in p type of business. COMMENTS: , Auth zed Signature** a ,Pr4 2. BOARD OF HEALTH This individual has been infor �ue e rmit requirements that ertaiAut orized i * p n to this type of business: COMMENTS: 3- CONSUMER AFFAIRS LIC G This individual has in i. , AUTHORITY) en orm of the g re licensing quirements that pertain to this type of business. COMMENTS: .l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q— M A I lea Map �'` ' I Parcel DD I Application # Health Division 13(//L��N�®� Date Issued Conservation Division P-rApplication Fee Planning Dept. 7' FEB l 5 2017 Permit Fee Date Definitive Plan Approved by Planning Board �wN 0158AFZ 1BTAB CF Historic - OKH _ Preservation/ Hyannis Project Street Address '7'� a Village Owner Address 1a ° - Telephone So , `t " 1 6 66 Permit Request R-aIIJ1>,:� 14 r-t-P0-irf dvtl n 6-IV ck—a G - d \/� -� � Aj vn 1f 1�� 1l1 11Pj 11'4 d �Z® a 1Z- 1 Y stMh Gc(+�n�Jtil G/u�j Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �' �-- Telephone Number so Address i 3 3 1Yk,I "�k SA , License # C S - o �9 Lt 9 TV-) Home Improvement Contractor# Email ', ,l, c c� r , A i ,. , c Worker's Compensation # V-'C `2.3Li ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WI,L-L BE TAKEN TO I c SIGNATURE DATE ^"' 3 I Zo 1 7 FOR OFFICIAL USE ONLY -APPLICATION # DATE ISSUED -MAP/ PARCEL NO. �I ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable Regalalory Services yam, _ RiicL"Y:Sc A Director BuildingrDivisioit Pani•B:oma,BuSding Commissioner 200 M&Streak Hymnis,MA 02601 _ www.town.barffftbILmL= Office:.50"62-4038.. Fax 508-790-MO Property Owner Must Complete.and Sign This Section If Using A Builder L Ventas Whiteha11 Estates,LLC. as Ownet of the subject propettp he Lutjiojize Brookdale Senior Living,Inc. to aa bebal� in all matters m]ative to work anillosized by this bufl ag permit appEmdon E= 790_Falmouth Road, Hyannis,MA 02601 (Addiesa of Job) "Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utihed before-fence is installed and all final ks' ecdons are performed and acceptrd. 3 .Vent ite:'all Estates LC lute of chv= S of A t By:Christian N.Cummings PP President Christian N. Cummings n y Pd=Name Priat Nance h. 71 Q:Fo�s:owrmtrt�ror�oois . Scanned by CamScanner OP wig al iil a v p S 1p ® �;I WIN s m it o vi a ro III The Com monwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 wM "� www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMIT"I'ING AUTHOB'TCY. _Aaolicant Information Please Print Let=►bly Name(Business/Orgmizadon/Individual):BELFOR USA GROUP, INC. Address:138 Bartlett Street City/State/Zip:Marlborough, MA 01752 Phone#:508-485-9780 Are you an employer?Check the appropriate boa: 25 Type of project(required): LEI I am a employer with employers(full and/or part-time).• 2.❑I am a sole proprietor or Partnership7. ❑New construction and have no employees working for in any capacity.[No workers'comp.insuranceS. Remodeling required.] ❑ g 3.[]l am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition 4. I am a homeowner and will be 10❑Building addition ❑ hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole Proprietors with no employees. 11.❑Electrical repairs or additions 5.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.msunance.t 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption14.0 Other Repairs 152,§44),and we have no employees. per MGL c. [No workers'comp.insurance regrrired.j Any applicant that checks box#1 must also M out the section below showing their workers'compensation policy information. 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comP•Policy oli number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Insurance Co of the State of Pennsylvania Policy#or Self-ins.Lic.#:WCO28415783 7/1/2017 Expiration Date: Job Site Address: `7 9 0 ��, v��„ RA City/State/Zip: pn p O Z6 o i Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 pains and penalties of perjury that the in ormation rovided above is true and.correct j -P _ - . Signature: Phone#•508-485-9780 U Official use only. Do not write in this area,to be completed by city or town offidaL City or Town: Permit/License# Issuing Authority(circle one): -- — — - I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I - 1 CERTIFICATE THIS CERTIFICATE IS ISSUED AS A MATTER � ��L� 1��41�C� YCERTIFICATE DOES NOT AFFIRMATIVELY OREGATIVELY AMEND s/22r1oBELOW. THISCERTIFICATE OF INSURANCE DOES NOT CON EelNO RIGHTUPON THE CERTIFICA;D:ATE(MWDD� HOLDER. HIS . EXTEND OR ALTER THE COVpZgGE AFFORDED BY THE POLICIES e'e DATIVE OR PRODUCER,ANp 77iE nFlCAT.E HOLDER- A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED IMPORTANT;If the certificate holder is an ADDITIONAL INS SUBROGATION IS WAIVED,subject to the Ue�+the a poll (es)must have ADDI710 certificate does not confer rights to the certificateterms and conditions of the oli e�eNn�Provisions or to endorsed.ff p cy,certain policies may require an endorsement A statement on this to PlzooucER holder in lieu of such endorsement(s). Aon Risk services central, Inc. INTACT Southfield MI Office 3000 Town center Pnof1� o Suite 3000 (AIC No.Ext): (866) 283-7122 FAX (B00) 363-0105 DAD�RESS: Southfield MI 48075 USA m a 0 11USL RED INSURE _R(S)AFFORDING COVERAGE Belfor USA Group NAIL# . Inc. INSURERA: National Union Fire ins Co of Pittsburgh 19445 dba Belfor Property Restoration 138 Bartlett street rtusuRlTRe: AIG Specialty insurance Company Marlborough MA 01752 USA INSURERC: The insurance 26883 Co of the State of pq INSURERD: Underwriters at Lloyds 19429 mISUREREe 32727 COVERAGES INsutReR F: THIS IS TO CERTIFY THAT THE POLICIES OFI NSURACATE NNCIE LUSTED BE OW HAVE BEEN ISSUED TO THE INSURED NAMED ABO INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CO REVISION NUMBER: CERTIFICATE MAY;O ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, IXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PA D CLAIMS.CUMENT FOR THE POLICY PERIOD WITH RESPECT TO WHICH THIS LTR TYPE OF INSURANCE A NSD POLICY NUMBER are as uested ww Lbnits shown req X COMMERCIALGEIIERALLIABILITY I GL MMIO CLA1W-MADE X0OCCUR SIR applies per Policy EACH OCCURRENCE LIAAIiS P cY to & condi ions $2,000,000 PREMISES REallon ranee $2,000,000 GENLAGGREGATE UMITAPPLIES PER: MED EXP(Any one person) $10,000 PERSONALBAOVINIURY $2,000,000 m POLICY ��ECT �UOC GENERALAGGREGATE OTHII $4,000,000 N A PRODUCTS_COMp/OpAGG $4,000,000 m AUTOMOBILE LIABILITY CA 3194493 0 07/01/2016 07/01/2017 CORE SINGLE LIMIT 1- A X ANYAUTO AOS aaideM $2,000,000 CA 3194494 _ A X OWNED SCHEDULED 07/01/2016 07/01/2017 BOOILYINJURY(Perpersan) AUTOS ONLY AUTOS Z X IR DUUTOS NON-OWNED CA 31W95 07/01/2016 07/Ol/2017 BODILY INJURY(per accident) AUTOS ONLY VA PROPERTY DAMAGE A or accident 00 X UMBRELLALUIB X occuR 26275184 07/01/2016 07/01/2017 ti EXCESS LLgB CLAIMS MADE Excess Liability EACH OCCURRENCE ar Dm RETENTION $5,000,000 V c VmwDED COa� AGGREGATE $5,000,000 EMPLOYERS.LMBa�irY�N� WCO28415783 07 0 2016 07 Ol 2017 X pFJty C AWPROPRIET0R/PARTNM1 YIN AOS o -ryTUTE 0 (� ry FIBER E7c0LUDEo9CUnvE N NIA WCO28415784 ER IPyas.deap0aunnder FL 07/01/2016 07/01/2017 E.LFacesACCIDENT $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE $1,000,000 E.L.DISEASE-POUCY LIMB S1,000,000 DES Cc OF OPERATONS I LOCATIO Evidenencee of insurance. NS/VEMCLES(ACORD 101,Adddional Remadrs Schedule.may be attached N men! ePace is req,d,eIS) - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE EXPIRATION DATE THEREOF, NOTICE RIB BED CANCELJ ED BEFORE THE Belfor USA GrOU POUCYFROVISroNS. DELIVERED IN ACCORDANCE WITH THE _. _ IJ_=n a:'BE r-Pro art•--..____.__.- "•::—�.-___..,._—_-.:_-_..--__..:-Aur,Fw. 138 Bartlett StreetRestoration — _-__� �RIZFp.W. -RESE g Marlborough, MA 01752 USA �c se ACORD 25(2016/03) The ACORD name and logo are registered marks of A ORDRD CORPORATION.All rights reserved. ` AGENCY CUSTOMER ID: 570000005415 q� p� LOC#. ADDITIONAL REMARKS SCHEDULE Page _ of _AGENCY Aon Risk services central, Inc. NAMEDINSURED PDucr NUIlA9ER Belfor USA Group, Inc. See certificate Number: S70062627367 CARRIER see Certificate Number: 570062627367 NAIC CODE FFECTNEDATE: ADDM0NAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER E URERURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. INSR ADDL SUB& POLICY NUMBER POLICY POLICY LTR TYPE OF PISURANCE OM W,D EFFECrM EXPIRATION LEWM DATE DATE WORKERS COMPENSATION (n'mDD/YYYY) (dR1/DD/YYY]) C N/A WCO28415785 07/01/2016 07/01/2017 MA,ND,OH,WA,WI,WY C N/A WCO28415786 07/01/2016 07/01/2017 CA C N/A WCO28415787 67/01/2016 07/01/2017 AZ, VA C N/A WCO29415788 07/01/2016 07/01/2017 IL,KY,NC,NH,UT C 7/A Wc028415789 07/01/2016 07/01/2017 N],PA ACORD101(2008101) O 2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD public SafetY Massachusetts Department at ono and Standards Board,of Building Reg nd � z �b License: CS-059495 Construction Supervisor _ . GERARD E MC=44GLE,JR v 13 GROVE RD �s MA 01760 t 7 NpTICK Expiration: Commissioner 09/19/2018 Office of Consumer Affairs and Business Regulation L 10 Park]plaza o Suite 5170 Boston, -Massachusetts 02 115 -Home Improvement Co Registration RegisMon: 955902 Type: Prwcft Corporation Expiration: 6/17/2017 7uIl 26556I BELF®R USA GROUP, INC. GERARD MCGGNAGLE 185 OAKLAAND AVE STE 300 BIRMINGHAM, MI 48009 Update AddmesM amd r2WM CErd.MM*reeM®m ffmv&Mg% y 3 2W-esm Address I,, Rawm0 ', lEm pRoymaemi: r] Lot Card � '"'lfe�ri�•irtn�ctter/f�p�^��i�.tiurfu�r://; ®®flee of Comsmm r AQ£sim do S®dnogs 1Lueemse or�¢gmBM[�®m r%isfcra4i®m valid for imaHneradaui use only '®ME Wi3O9lEMENT G®iNTRW R before the eapi on dam. l ff found r•etmo m to* !� islrai= 95.=2 fie: Free of Cousrumer Afffdn and 1Bul new ReB kdom . Expiration: 5147/2 17 Private Corporation 10 Park Dina e Suite 5170 Bosom,KA 02146 ®ELFOP,USA GROUP,1"'C GERARD MCGONAGLE 185 OAKLAND AVE STE 300 ®IFgMiNGi-IAM,Mi 45009 UJmdermiret y Not�ai�d a�iQOu�m�sigmagmtee r I ac}c>Verizon GTE 8 44 AM i00% 3 boss belforeomplfaincesysteirm.doti , . — .. `* r Mom Room - 1,13 Adfv ► ves buie �. • • • PERSONNEL TRACKING BELFOR'Q®D C C O O PROPERTYRESTORATION. FORM VERIFIER IS ON JOB NUMBER-COMPL LOSS CAUSES CODE LOCATION WEATHER RATE CLASS EXAMPLES CODE VEHICLE NAME(TABLE) $k 1 —0 a\ � ❑ FIRE L00 RESIDENTIAL ALL ❑HUMID APM ASSISTANT PROJECT MG 529 PICKUP,SUV OR CAR LINE# INITIALS a U 'It N START DATE +VLE DAY JOB NAME —e (9 TN TECHNICIAN(DRYING) 530 VAN,PASSENGER/CARGO O) M (7 w WA TH ❑ TER/FIOOD LOl{y,-„�.o�� ( „A❑TEMP 3 0 00 l , (, F SA SU "" r J �' ) ❑ WIND L02 ❑SNOW RS RESTORATION SUPERVIS 518 TRUCK-MOVING/BOX/BOARD UP W STOP DATE f- CLE DAY JOB ADDRESS ` 0. i M W TH -I-t C v�1 �y ❑ . MOLD L03 IN RT RESTORATION TECHNIC[ F SA SU 528 TRUCK,3/4 TON PICKUP ElEARTHQUAKE L04 ❑WINDY LF LABOR FOREMAN 527 TRUCK,1 TON 4X4 W/LIFTGATE `i� CREW SHEET# � A 0,,�� ) 0-- Los GL GENERAL LABOR 45j TRUCK,EXTRACTION LAST DIGII50F J05-6 DIGIT DATE-(ADMIN ONLY) ❑ ❑ SAFETY TOPIC TOOL BOX TRAININ E] L06 ❑ DL DAY/TEMP LABOR N/A NO VEHICLE P (? COMPLETED?❑Y N "X" AFTER ANY VEHICLE CODE TO SHIFT- PHASE CODE EXAMPLES:JBC-JOB CHECK&PHOTOS/JSS-308 SUPPORT SUPERVISION/OFF-OFFICE ADMINISTRATIOWOZO-OZONE/SAL-SALES/SBT-STAND BY TIME/SCC-STEAM CLEAN CARPET/TSH-TRASH/TVL-TRAVEUCAB-CABINETRY/CON-CONTENT INDICATE FOR TRANSPORTATION MANIPULATION/CLN{LEANING/DEO-DEODORIZATION/DHU-DEHUMIDIFICATION/ONO-GENERAL DEMOLITION/DOR-DOORS/DRY-DRYWALL/ELE-ELECTRICAL/ENE-EMERGENCY/EST-ESTIMATING/EQP-EQUIPMENT(SET UP-TAKE DOWN)/FNC-FINISH ONLY CARPENTRY&TRIM/FNH-FINISH HARDWARE/FRM-FRAMING/HAU-MAULING/LDS-LANDSCAPING/LIT-UGHT FIXTURES/MDR-MOLD REMEDIATION/PLM-PLUMBING/PNT-PAINTING/PWA-POWERWASH/SEC-SECURITY/SEW-SEWER CLEAN UP/STK-STAIN KILL /TMP-TEMPORARY REPAIRS/WTR-WATER REMOVAL FOR RENTAL CARS: PERSONNEL NAME 24 HOUR CLOCK N SEE GUI E SHEET f SEE TABLE PERSONNEL NAME TOTAL HOURS z p CLEARLY PRINT YOUR NAME HELPS ENSURE THE CORRECT 24 HOUR LUNCH 24 HOUR W PHASE HOURS O w p YOUR 5IGNATURE REPRESENTS THE APPROVAL TO PAY YOUR PERSON I5 BEING PAID FOR HOURS WORKED.AN ILLEGIBLE RATE H O F w w HOTEL HOTEL DOCUMENTED HOURS WORKED.A LACK OF SIGNATURE MAY RESULT OFFICE ID# STARTTIME BY PERSON c O CODE BY J z VEHICLE NAME MAY RESULT IN UNTIMELY OR NO PAY CLASS START U U LL i o NAM E ROOM K IN UNTIMELY OR NO PAY STOP TIME p "WHAT' PHASE a w a CODE PRINT FIRST THEN LAST NAME TIME STOP TIME BY OTHER N a a LL d CODE # SIGNATUR ND OF SHIFT 01 � 3 L't f 3 Y Y Y Y Y Y ;�y� VERIFIER to )O% Zo3c'J� �� 1,Aa� `1Qf+� 1�3o tb3� tj RENTAL❑ 02 Y Y Y Y Y Y VERIFIER REMAI❑ 03 VERIFIER Y Y Y Y Y Y RENTAL❑ 04 VERIFIER Y Y Y Y Y Y RENTAL❑ 05 VERIFIER Y Y Y Y Y Y RENTAL❑ 06 VERIFIER Y Y Y Y Y Y RENTAL❑ 07 VERIFIER Y Y Y Y Y Y RENTAL❑ 08 VERIFIER Y Y Y Y Y Y RENTAL❑ 09 Y Y Y Y Y Y VERIFIER RENTAL❑ 10 VERIFIER Y Y Y Y Y Y RENTAL❑ 11 VERIFIER Y Y Y Y Y Y RENTAL❑ RESPONSIBILITY OF APPROVER:PLEASE COMPLETE ALL REQUESTS BELOW vEwFr TorALnu VERIFY TOTALHu —CATION OF KS DATA "PROVER SIGNATDRE TO VERIFY FORM IS CDMPLETED STEP i-PRINT APPROVER NAME STEP 2-DID THE FORM VERIFIER REVIEW THIS FORM i DY ON ISTEP 3-TOTAL HRS THESE TWO TOTALS ISTEP 4-PHASE HR5 STEP 5-_DOES THE PTS COVER: STEP 6-APPROVER SIGNATURE FOR COMPLETION?IF"N", YOU AS APPROVER MUST VERIFY&COMPLETE ALL MUST MATCH I WHO❑ WHEN❑ WHERE❑ OUTSTANDING ISSUES INCLUDING TOP SECTION OF FORM. WORccK DESCRIPTION:BASED ON LOCATIONS WORKED AND PHASE CODES PLEASE DESCRIBE WHAT WORK THE CREW PERFORMED d�� t: 1✓ate 1�L, vS t .� a }, p I 1. v .` cr � � a Uy-r•/ � b �V iL a✓ __t �. �� v�� c� Itio 1 L�� i{'� pro t >.��x, FORM VERIFIER-PLEASE ENTER QUANTITY or"0"FOR ALL E&C PAGES INCLUDED WITH THIS SHEET- NONE #OF PAGE 3 _*OF PAGE 4 #OF PAGE 5 RECEIPT TRACKING FORMS V091514 PAGE 1 ` GUIDE SHEET-EQUIPMENT-CONSUMABLES-TIME OF DAY BELFOR SERVICE TYPE RESTORATION PROPERTYRESTORATI ON HOTEL LIST 24 HOUR CLOCK CALCULATE TIME STEP STAGE YOUR EQUIPMENT STEP OS JOB PROCESSES STEP06 CLEANING coenNuEo ABV AMERICA'S BEST VALUE 12:00 AM =00:00 Once you have POWER I UOM BOARD UP MATERIALS UOM DEODORIZERS UOM - AHI AMERIH057INN 01:00 AM=01:00 E0447 ❑ ELECTRICAL DIST PANEL(SPIDER BOX) C1248 ❑ FURRING STRIPS,1"x 2" EACH - E0455 ❑ FOGGER,COMMERCIAL AMS AMERISUITES 02:00 AM= 02:00 Converted your hours E0458 ❑ GENERATOR,PORTABLE C1247 ❑ FURRING STRIPS,1"x 3" EACH E0456 ❑ FOGGER,ULV/THERMAL(ELECTRIC) BIS BAYMONT INN 03:00 AM= 03:00 t0 military time, use E0561 ❑ GENERATOR 65KW C0903 ❑ OSB,7/16"X4X8 EACH C0370 ❑ THERMO FOG DEODORIZER GALLON BVI BEST VALUE INN 04:00 AM= 04:00 Your phone or SO451 ❑ CORD,EXTENSION EACH C0899 ❑ OSB,3/8"X4X8 EACH E0488 ❑ GENERATOR,OZONE BWH BEST WESTERN 05:00 AM=05:00 CBICUIatOr: LIGHTS UOM C0384 ❑ OSB,1/2"X4X8 EACH E0473 ❑ ION AIR CLEANING SYSTEM BSA BUDGET SUITES 06:00 AM=06:00 1)Enter End Time E1512 ❑ LIGHT,BALLOON C0901 ❑ PLYWOOD,3/8"X4X8 EACH E0505 ❑ SMOKE MACHINES(SMALL) BGT BUDGETEL 07:00 AM= 07:00 2)Subtract Start Time E0478 ❑ LIGHT,TEMPORARY(DEMO/STAND/STRING) C0900 ❑ PLYWOOD,1/2"X4X8 - EACH E0693 ❑ VAPOR SHARK CWS CANDLEWOOD SUITES 08:00 AM=08:00 3)Subtract Lunch Time E0479 01 LIGHT,TOWER MOBILE(400 WTDIESEL) C0902 ❑ PLYWOOD,3/4"X4X8 EACH C0998 ❑ VAPOR SHARK MEMBRANE EACH CRS CLARION 09:00 AM=09:00 EXAMPLE E1002 ❑1 LIGHT,WOBBLE C0383 ❑ STUDS,2"x 4"x 8" EACH FLOOR CLEANING SYSTEMS TUOM CFU COMFORT INN 10:00 AM= 10:00 DAY SHIFT AIR MACHINES UOM C1217 ❑ CARRIAGE BOLTS EACH E0408 ❑ BUFFER,FLOOR CFS COMFORT SUITES _11:00 AM= 11:00 8AM TO 8PM 1/2H LUNCH E0401 ❑ AIR COMPRESSOR,ELECTRIC/GAS C0369 ❑ TARP(ENTER SQ FT) SQ FT CO293 ❑ FLOOR BUFFER PAD EACH CIS COUNTRY INN 12:00 PM= 12:00 E0402 [I AIR COMPRESSOR,TOW BEHIND - CO290 ❑ LOCKIHASP EACH E0552 [I CARPET CLEANING MACHINE CTH COURTYARD 01:00 PM= 13:00 ZO-H-.5=11.5 E0403 ❑ AIR MOVERS/CARPET BLOWERS C1300 ❑ NAILS/SCREWS LB E0454 ❑ FLOOR CLEANING SYSTEM(WALK BEHIND) CPH CROWNE PLAZA 02:00 PM= 14:00 MIDNIGHT SHIFT E0471 ❑ INJECTIDRY UNIT CONTAINMENT UOM E0511 ❑ STEAM CLEANER DIH DAYS INN 03:00 PM = 15:00 8PM TO 6AM 1/2H LUNCH E0404 ❑ AIR SCRUBBER,HEPA E0416 ❑ CONTAINMENT SYSTEM VACUUMS DTH DOUBLETREE 04:00 PM = 16:00 FOR MIDNIGHT,ALWAYS BEGIN BY CO286 ❑ LAYFLAT,500'(ALL DIAMETERS) ROLL C0914 ❑ ADHESIVE,SPRAY CAN E0523 ❑ VACUUM,HEPA(BACKPACK/CANISTER) DRH DRURY INN 05:00 PM = 17:00 ADDING 24 C0650 ❑ FILTER,PRIMARY(PRE) EACH C0336 ❑ POLY SHEETING-2 MIL/1.5 MIL ROLL C0317 ❑ HEPA VAC COLLECTION BAG&FILTE ELH ECONOLODGE 06:00 PM = 18:00 - C0541 ❑ FILTER,SECONDARY(PLEATED) EACH C0337 ❑ POLY SHEETING-4 MIL ROLL E0524 ❑ VACUUM,UPRIGHT EBS EMBASSY SUITES 07:00 PM= 19:00 24+6-20-.5=9.5 C0303 0I FILTER HEPA(PARTICULATE) EACH C0338 ❑ POLY SHEETING-6 MIL ROLL E0526 ❑ VACUUM WET/DRY ESA EXTENDED STAY 08:00 PM= 20:00 TIME INCREMENTS CO292 []I FILTER,CHARCOAL(ODORIVAPORS) EACH C0367 ❑ TAPE,BLUE(PAINTERS) ROLL TOOLS LARGE FFI FAIRFIELD INN 09:00 PM= 21:00 15 Minutes 0.25 WATER REMOVAL UOM C0366 ❑ TAPE,DUCT-SMALL 2"X 60' ROLL E0411 ❑ CART,DEMO FPH FOUR POINTS 10:00 PM= 22:00 30 Minutes 0.50 E0452 ❑ EXTRACTION UNIT(PORTABLE) C03651❑ITAPE,CLEAN ROOM(GLOBAL) ROLL E0444 ❑ DOLLY/WHEELBARROW HPH HAMPTON INN 11:00 PM= 23:00 45 Minutes 0.75 E0421 ❑ DEHUMIDIFER 100-140AHAM PINTS C0916 10 ZIPPERS EACH E0477 ❑ LADDER-4',6',8',10',12' HSH HAWTHORN SUITES 12:00 AM=24:00 60 Minutes 1.00 XM8DH ❑ DEHUMIDIFER XM8<100 AHAM PINTS BLASTERS&POWER WASHERS UOM E0476 ❑ LADDER-EXTENSION HGI HILTON GARDEN INN _ C0589 ❑ CAN,GARBAGE(45 GALLON) EACH E0446 ❑ BLASTER DRY ICE W ACCESSORIES E0481 ❑ MECHANICAL GANG BOX HIH HOLIDAY INN STEPOI ARRIVE AT LOSS CO291 ❑ FILTER MATERIAL ROLL E0498 ❑ BLASTER SAND E0499 ❑ SANDER,DUSTLESS HIE HOLIDAY INN EXPRESS VEHICLES&STORAGE CONTAINERS C0740 ❑ HOSE,GARDEN/DEHU EACH E0506 ❑ BLASTER SODA E0500 ❑ SAW,DEMO H2S HOME2 SUITES E12411❑ BELFOR STORAGE,12'-NEED FREIGHT RECEIPT E0492 ❑ PUMP,SUMP/FLOOD C0354 ❑ BLASTING MATERIAL-SODA I BAG CO249 ❑ BLADES(DEMO,GRINDER) EACH HWS HOMEWOOD SUITES E1215 ❑ MOBILE WAREHOUSE 53'-NEED FREIGHT RECEIPT E0493 ❑ PUMP,TRASH WITH HOSE 2" E0507 ❑ BLASTER,SPONGE JET E0512 ❑ TOOL BOX(PORTABLE) HIH HOWARD JOHNSON'S E1528 ❑ TRUCK,DUMP-NEED FUEL&LANDFILL RECEIPTS E0420 ❑ DESICCANT-1 TON SPOT COOLER E0508 ❑ SPONGE JET MEDIA CLASSIFIER E05141❑ITOOL SET,FRAME/DEMO HTH HYATT E0517 10 TRUCK/TRAILER-NEED FUEL RECEIPTS E0426 ❑ DESICCANT-500/600 CFM C0359 ❑ BLASTING MATERIAL-SPONGE I BAG ICH INTERCONTINENTAL _ - E0423 ❑ DESICCANT-2000/2250 CFM E0406 ❑ BLASTING UNIT AGRI SODA WHAT YOU SHOULD BE HANDING IN JWM JW MARRIOTT STEP 02 PROTECTION-PERSON&AREA ` E0424 ❑ DESICCANT-3500 CFM E0531 ❑IWASHER,HIGH PRESSURE COLD NAME OF FORM -'BOX KIH KNIGHTS INN SAFETY WEAR UOM E0425 ❑ DESICCANT-4500->5000 CFM E0532 DI WASHER HIGH PRESSURE HOT PERSONNEL TRACKING SHEET ❑ LQI LA QUINTA CO287 ❑ DUST MASK(CLEANING) EACH E0427 ❑ DESICCANT-9000/10000 CFM EQUIPMENT&CONSUMABLE TRACKING ❑ MHR MARRIOTT HOTELS C0349 ❑ N95 MASK EACH E0422 ❑ DESICCANT-15000 CFM STEP 06 CLEANING COMPLETED MOISTURE MAPS ❑ MCT MICROTEL C0347 ❑ RESPIRATOR,HEPA P100 EACH E0429 ❑ DESICCANT-DX UNIT-20/30 TON CHEMICALS R.T.U. UOM EQUIPMENT RENTAL AGREEMENTS ❑ M6H MOTEL 6 C0352 ❑ PRP-FILTER,HEPA PANCAKE EACH E0430 ❑I DESICCANT-DX UNIT-60 TON - CO214 ❑ ALL PURPOSE CLEANER GALLON WORK AUTHORIZATION ❑ QIH QUALITY INN C0348 ❑ PRP-FILTER,HEPA PARTICULATE EACH E0428 ❑ CHILLER-100 TO 400 TONS-ENTERTONS CO269 ❑ DISINFECTANT/ANTIMICROBIAL GALLON PHOTOS BY LOCATION ❑ RDH RADISSON CO297 ❑ GLOVES,COTTON PAIR HEATERS CO226 ❑ GLASS CLEANER GALLON SUBCONTRACTOR NAMES&HEADCOUNTS # RMH RAMADA CO299 ❑ GLOVES,LATEX(SURGICAL) PAIR - E0459 ❑ HEATER,ELECTRIC CO223 ❑ HEAVY DUTY DEGREASER GALLON NAME RCI RED CARPET INN C0300 ❑ GLOVES,LEATHER PAIR - E0460 ❑ HEATER,PROPANE/TORPEDO CO220 ❑ ODOR/SMOKE ELIMINATOR GALLON NAME RLH RED LION HOTELS C0301 [IGLOVES,NITRILE(SLEEVED) PAIR E0437 ❑ HEATER-20 KW E0484 ❑ MOP BUCKET EPD - NAME RRI RED ROOF INN C0345 [IPROTECTIVE SUITS-TYVEK EACH E0440 ❑ HEATER-50 KW C0362 ❑ SPRAY BOTTLE EACH NAME RIH RESIDENCE INN C0344 [I PROTECTIVE SUITS-SARANEX EACH E0434 ❑ HEATER-100 KW C0563 1❑ISPRAYER,PUMP(HUDSON) EACH RECEIPT TRACKING FORMS $ STI SHERATON FLOOR PROTECTION UOM E0436 ❑ HEATER-150 KW CLEANING TOOLS&SUPPLIES UOM NAME SHI SHONEY'S INN C0340 ❑1 CARPET PROTECT ROLL E0438 ❑ HEATER-200 KW CO209 ❑ BAGS,ENVIRONMENTAL EACH NAME SIH SLEEP INN C0346 ❑ RED ROSIN PAPER ROLL E04391 0I HEATER-400 KW CO208 ❑ BAGS,TRASH EACH NAME SHS SPRINGHILL SUITES C1238 I❑I LAYOUT BOARD(TEMP PROTECrN) ROLL E04411❑1 HEATER-600 KW CO260 ❑ BRUSH-SCRUB,LONG HANDLE EACH MATERIAL SUPPLIERS $ SSH STAYBRIDGE SUITES - E04351❑1 HEATER-1000 KW CO262 ❑ BRUSH-WIRE,LARGE EACH NAME S6H STUDIO 6 STEP03 DOCUMENT THE LOSS SPECIALTY EQUIPMENT CO263 ❑ BRUSH-WIRE,SMALL EACH NAME S8H SUPERB DOCUMENTATION TOOLS E0501 ❑ SCAFFOLDING BAKER C0330 ❑ MOP HEAD EACH NAME TPS TOWNEPLACE SUITES E0400 ❑ ACCOUNTING PACKAGE E0407 ❑ SMALL BOBCAT -. CO296 ❑ SCRUBBERS-FOAM PADS PACK ✓BOX TLH TRAVELODGE E0409 ❑ CAMERA,IR CODE -ADDED ITEMS `" 'UOM C1021 ❑ SCRUB PAD,GREEN EACH ❑ RENTAL CAR RECEIPT "r" ' # `t WHR WYNDHAM HOTELS E0443 ❑ DOCUMENTATION KIT(DIGTIAL CAMERA) ❑ C0360 [I SPONGES,CHEM 1.5"X3"X6" EACH ❑ HOTEL FOLIOS TV OT E0483 ❑ MOISTURE METER ❑ C0363 ❑ STEEL WOOL EACH ❑ TOLLS/TAXIS ETC H 00 E0480 ❑ MANOMETER ❑ C0372 ❑ WIPES-COTTON CLOTH/TERRY POUND ❑ a U) E0534 ❑ WORKSTATION(TABLE,CHAIRS,ESD) ❑ ❑C0378 WIPES-WORKSHOP RAGS POUND ❑ V091514 PAGE 2 Town of Barnstable �i 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-263 Date Recieved: 1/31/2017 Job Location: 790 FALMOUTH ROAD/RTE 28,HYANNIS Permit For: Building-Alteration INTERIOR Work Only-Commercial Contractor's Name: GERARD E MCGONAGLE,JR State Lic. No: CS-059495 Address: • NATICK, MA 01760 Applicant Phone: (Home)Owner's Name: VENTAS WHITEHALL ESTATES LLC Phone: (Home)Owner's Address: 21001 N TATUM BLVD, PHOENIX,AZ 85050 Work Description: building permit to do repairs to water damage. re insulate,drywall, paint,flooring and reset toilets andvanities units 116, 117, 118, 119, 120, 121,&some common areas. Total Value Of Work To Be Performed: $100,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the . Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. . All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: GERARD E MCGONAGLE,JR 1/31/2017 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $100,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $1,010.00 znsi2oi7 $t oto 0o t927 Check ............................... .............................. ....... ........... .......... Total,Permit Fee Paid: $1,010.00 ��- YAK' INTHII " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0 0I Application # Oqd Health Division Date Issued a �- Conservation Division Application Planning Dept. Perrnit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address �'"toLu �fl Village Owner �Z�Me�rt-c1�1' S:bu1,L _ �_W��- . Address Telephone Permit Request C)FJ-6- S44J6t& Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation l-06 — Construction Type -- t Lot Size Grandfathered: ❑Yes ❑ No If yes, attach�supportinga ocui lentation. Dwelling Type: Single Family 0 Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway Pb Yes_: ❑ No �n Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name'5G IJINPQA '2� �� GQP= e-u-0 Telephone Number S24" - Z5!!7" 35QZ, Address 1 t l �- 1'r' ''e �� License # C,S1— 1 a 4� P Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �Gl v.Gs F �L�uC xl� c2 \?_Ook4. SIGNATURE O� c� DATE 4 j C. FOR OFFICIAL USE ONLY s APPLICATION# .I DATE ISSUED: 't MAP./.PARCEL NO.. ,I ADDRESS VILLAGE i� i OWNER DATE OF INSPECTION: :. FOUNDATION FRAME INSULATION.` FIREPLACE r ELECTRICAL: ROUGH FINAL f h PLUMBING: ROUGH FINAL "CiAS'. " :'su`' ROUGH FINAL z "IFINAL BUILDING" t s DATE CLOSED OUT ASSOCIATION,PLAN NO: } Tfie Cot-nmonwealth of Massachusetts - Department of1lidustrialAccidents Office of In vestigatio Ks' 600 Washington Street Boston, MA 02111 lvww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _A,ppUcant Information Please Print Le9i.bly Name (Business/Organiza6on/lndividual): Address: V\.\ 06A-. `c City/State/Zip: w �l4, rJZS� \ Phone.#: �'�3�-A 5- 7S Are you an employer? Check the appropriate box: Type of prof Ect(required): I. I am a employer with . 4• ❑ l am-a general contractor and I 6 Q New construction employees(full and/or part-:time).* have hired the stab-contractors 2.Q I am a sole proprietor or'partner-' listed on the'attached sheet 7.. Q Remodeling ship and have no employees These sub-contractors have 8. f]Demolition employees and have workers' working for the in any capacity. 9. Q Building addition . [No workers'•comp.-insurance comp. insurance.$ 10.Q Electrical repairs or additions required] 5, FV We are a corporation and its 3.Q 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.Q Roof repairs insurance d ire u re t c, 152, §1(4), and we have no q ] 13.®Other employees. [No workers' J comp.insurance required-] Any applicant,thatehecks 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 e new affidavit indicating such. rContractors 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 providb their workers'comp.policy number. .ham an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name:.: " 7f10!-j<-L-e L S Policy#or Self-ins.Lic. #: p��Q%N-1 L. 4 " gr \l Expiration Date: ZO\L Job Site Address: �D - �� c`�� City/StarelZip: �(�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 rip 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 IDVE:StjgatiDas of the DIA for insurance coverage verification. Ido hereby certify under thepains andpenalties ofperjury that the info rmationprovided above is true and correct. LL Signature —1� �`'ls�� Date Phone #: Ofj-xial use only., Do not write In this area, to be completed by city or town offeciaL City or Town: Permit/License # Issuing Authority (circle*one):, I. Board of Health 2.Building Department 3. City/Town Clerk 4, Electrical Inspector S. Plumbing Inspector 6. Other s . Information an 11St 'actions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their ernpjDYees. 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 o receiver or hirstee of an individual, partnership, association or other legal entity, employing employees-P Yees. However the ccu an tofthe owner of a dwelling house having not more than three apartments and who resides therein, or the o p dwelling bouse 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." AdditionaIly,MGL chapter 152, §25CO states "Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for the performance of public work untu acceptable,evidence of compliznce with the insurance requirements of this chapter have been presented to the contracting authority." Ap p li cants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-Conti-actors)name(s),•addiess(es) and phone number(s) along with their certificates)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 afLdavit 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. fi 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 underob`J Site Addre ss" fhe 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 (Le% a dog license or permit to burn 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 Commonwealth of Massachusetts ' Department of ladustrial Accidents Office of flay csfigations., 600 Washington 5treet. . n Boston, MA 02111 „ Tel. # 6177727-4900 ext 406 or 1-877-MAS.SAFE Fax # 617-727-7749 Zeviscd l 1-22-06 www.mass.gov/dia i i 00/17/2011 14;21 FAX j ESTIMATGIbrI)ESIRED ORrCfrom; • nPltnlh,cvr •, ,lltudbu, CAS s rtNG�s1u;n(1 500-1344663 fI+K 5US-Z91-48Z5 UOUr T$lb ywir" CURTIFILII)-APROVI;p INSTALLERS FOR MO$T ROOF, (;SYSTEMS and ACC)F)SOR]lt5 Iblonsod ha MA5SACP[USP`I"T8 tvw,v,cl pgcotlrvuGcom )1 HOAAr ISLAND HICNO;IiZZSOC;SLNO:)0Io6l "sarvin6'u11offtivEnglaild" MO.IV0IMum I I t MLIUMtvuy Sla:el,Nwohunt,MA 04i71 lluvnsdd-Ineurdd 114 8.Anpal SI.,Suite I,Prov.,RI 0290G MddOttCNSptI'C'AIiUp,tCt'L'P'i'I;u 471ITIPIMAYPAI. IIINMONGAVAILAU1,11 RRSIDUNTiAL ' COMMERCaI.AL " iNDMT11111AL a IMSTITUTIONA1, aamploro roofs,Sid(Age 11OV,Lrlt 10,000If mpulrethroughdulNotvMIAldlld P—+ATAQ0 ale I J�Li1'S: CPDM-4U11gER PVC MRTALC,OATINCtS'i'OSLALANTS W8URL1NCH W PitopUlITY ItOCIp INSflRCT(ONS FULLY INHURED BfNANCING AVAKAbLL WISAIMC.AMSRrCANxxpr425s.p)SICOv131t VIND US 10'ri-tt YItLI.GW I+Annq, THn 111,111; 1)tN)h ,&'fNt; IN'I'iYttihrl' ER BMAiUPNOTMOAX DATe EIVISAi1'US UNIOR 41WHU;eld Mt•.M UlSechotm Nqu Mr.19U•7606 S_YidttbnU MB aminm Irue cant 17adombur 17,3010 MAILTNO ADDMOS M4)AUOItR;.S A131)1.10: 3I81 RIIInR Avegultaloo 19h IVIMnuuh,Avnd,Hynnnin,MA 02461 TOWN Whltvbudl 091`tFry ROOK Soaltta,WA 98121 6TARTPROP08ltDI TDll COMP1IrflON17ATBPRO1'0911D: 1'l1U PROJECT DESCRIPTJONt RM•ROOFAIJ+SLC)PRD and?t A 1'(oveopl ruegntly 4v1m)R00GSRCYIQN4 OWNER has choice of ST1lIPPiNQ Or001N('.0VLR thr oxhling.rooQngshingk9&EPDM (MIATAINTEG'D Asphalt Rvnr 5hinglos1 30,An or 1,IpIt'j'IftII+,uplivns. 10,.SO year,purkntnu Ali d,iurnnuy nvnUaDlu wlcn 1 IRi','fiM I;MA'PRItInL tVnrranq ASAP.,CtPYr•Q�()h'_Sy;fllhll'TTaD x; 9T1tIP rutVTTR�RUO�' �—' . tc Gtalull Iwow nephuluroui'eyermll IN,vivgs tIWMbud ubuvu 14OTE::9NINQGE4aCysRTI►INx1t1i1)1,AN))MARK/WOODSCAPE ARCHITECIIMA'L dlylo 6p'ori,IITgTiM, aho;thlhgIDAlobousod 1) FRZVI Omer hog the vbolo of sttipping oraU exiSMIS loofmp tnuforlola dovrn io Wooden roof dock 0rg01nb over the WWII g 011M MUt for thgdeellon(n)hired obowr.Cloan&ohook oxlslrng tooRngbowds nod tInshinpa:NOTE:onyTnImIng,broken or roUod will bu ra)shicad ui un alum roayonuGio nau, 1) FI,AIVOT!$iYtemdYvullvcgtplp6tlungos:uudrapincowidlne5v. I 2) 81CYLITRS:01a411.U45IIIIj 011 all,'A 140 If any, NOTEI any floahlug kits naoavpnry W bvu(d.,jplvwood chat raquiro sapleaamaot duotu b410g br0'Od,ndSSing or toltod efinll br un nxuv ntuvonabla aaal, S) FELTV�Pk iyDBRLAYMENPtASPERBUMDrty<3C:0TJVAyr,MA:NUFACTURER'S SPECS:lnmtall ice&Walar Rf,lalll tu.T;jV1'111R i166f ilud o11 vngvye Iutd prnWrAINw. 4) V1INTILtiTIOlV1.A$!01)Et lOU11 VINO CODM 6 MANUFACTURER'S 9PSCSt install rfd@u mowteddopabla ridgo want S) I)Itq�1rUOL)I A11iM11ium drlpldgo shall ba Inslol ldd tvhgro n0'Sveduty n10t1g no linofa bounl araue,.Yonlud dllpdtlg0 le 0ddltlomd, 6) tGP.$tWATG+Et6tf1BLD;torte!ilcq&:WatorShleldrnENTtRER00Nitndollvaticysand penerPatlOnS, 7) 9HTNCGEx:lnstdli CortAlutaad ARCftI'p);Q1tJFtAI. Styto(3n,Rh m'Llir[f1'IMit YEAR 1VARRANPY•)nxphnit booed ! rpotlog aMngloa to elm anrrq yapf ddok Aree,'lhdav ahln;tlw asc tvdnanmd by)hu mNIDNeNrer,All lleahings ra bo properly woven.Color Isbullding owrtal'O ahOlcO.Or marol)OXisting,roofing rnoteriala 8) •IYARRitN1'YI CHiITAI F, 1 R-p S)d1Ntilrlta�oN1 V PI•lls ROOF OI+FNI1319Its IltfS'f WARRANTY I]N'LlIO IytAItK61' H Y T11i3 MANUI+ACTUA6R;WORKMATIHHU)pUARANTY IS FYRST 20 YQARS OP THE 301 50'I(EAR SII1N(It,g$ And..50 YBAiiS FQR TAit LIn1;9•Yivl2 YEAR WARRANTY AIM NON f rlO.AATxo FOR PULL LABOR & MA!rk AL R$PLACEMENT.WE WILL.MIMI)Y01 W11'll COLOR.BI;LECTION PR10R TO p11016C1',it0of muot bu etrlpyedto.racdtvowarrtiaty, 7) TRASN/DiIERrSI Romovs Ali dubi'lu dully&upon epn)p(atleA tv alnitnl daatlnnllon,NOTBI A,ty laiv."rdouswuttty Gush W Asbrstor,oto.,,but not oxaluslvotn mane,stay teqult0 SP4,41 handling and additional oosli To 4u0dlag osynol.Pleusv notify ua QfaryOnSilaha 04113MOM N0'1U I oa1010Adt14W110uI ofuhluglud in d16au mdae May out Mtch tpa rgdt0f nYufIl'doao In scollans. NOTE;Oo•oyarondmly omkt.gtpAalbl parts Of the above nunleriosi numbale s9 WO deem ncccosory.NO dtripping,;vlatarlat Wai9tnityymtlY p1Yp wa "I"," ap title raofd))alnat Innkhtg duo to dnhadvo wtirlTmnnebbt only for 10 yaura, i . tN6Wi160J)UILDINI}pERMlTtyo-T."I te" Il1pSi beep to du MATF,RiAL&LA)IOR COSTA PORTI, AbOVL+13P11C1 PIED PROJT3CT C 11O09B YOUR OPTION 11EL0W M0 CUtoL[1IN1T1AL A) 9TRIP'IT�LImFC1t7Ob "a0Year!'e1tnintaedArebiteotmrnl5tyloR90tSz311000.00 I XAN1'R LONONR W.4RWY,6D ROOFSifINQi r,1 A THIMR LOOK,,,Jost add marerta!OATI$hdlotv,,. AGI.$I11NCtI,t1R MllOi'Nt35Y MAgB,tCFI11FfsT"f3(•11011 W1Nflllpl,il''I'CUR1?S, I i $) kf MCI'11`uPgrddo.19 SO.your odd$13,00n.0 G� I1110T aupprndotaLWIMMM dt")W.:109.00 iJ) 6 STAR CEd%WT&ED tvorinnupdhip gunrAnty buokcd by CERTATNTIIRA.,:Add SFIIEE ...1"Za yoers are For Or SD pur shinglu and SO yonre for LIPUTiM13 MIngles, GO—OVER RMS'1INCv 0PT70iVryUL LIFETIME SHlNCiL >~5 ONLY S184t000,00 5 1 00/17r2011 14;22 FAX SCHI,DULING ARRANGEMENTS,: CALL,SIGN,DATE&1113TURN YC4 OW COPY ONLY PORSCIM-DULNO. PAYNALNTWOBeMAiOSASVOL1 M8t hupon day Ofsmly halt'mmainder upon mldpnlnt,balawae Upon completion. gpualnl0rdur molOrild fs NUN RtIiUNDADI,11JRPTURNA➢i,E. AUTHORIZED SIONATURE X. .. CvE CO.DA 06rum&mzimay Flit)1A:447911dB8 All Work to be camplulod In a tvarkmlmliko nit anor uouording to standard,trceoplgd,NvOgnlmd pmocluas.ADIVI'IONAL COA1'81COA7'8; COW 14 shalt pormistloll to do unforeseen necosshey Wotk only 10 keep pro)eot progrereing In order to motngdn Ilt4 Inlvgrlty of piyiaet ONLY TO$400,00.CCR&Stu provide pholos or any iiacamury/roquecicd additionnl'work done IP Invotcod. CONTRACPI All ngroammncs are canibigant.upon strlkas,acoldouts or dolaye,altd Ootut IACwred bsyund.our control Inoiudhig weather Ora wldioul ' penalty orloss to CCR&S.All material is guorantoed equal to or boher to that whicilt Is tpeolftod above,WARRAIITYIGUARANTY: All,If oily pruvidad ad Hlntod ubuvo,donto uro an optional oapuim.dapuhdldg op ny8tpin or mununici trur,whluh urd only vhlld lowl take effaot ottly upon pay!natttor ilia 00111taat in till tvidilti fivu days or completud pro)eor.All svarrantlas antUor guarandan atatdd nbavo are null and Vold if CCR&S not noilficd In writing of dro notupl daillU90 0901WO1109 within Sd hours with plcturot, i'n UNTS:To.bo meld as outlined above.Mlasdd or dolayad paymaals,IasufHolunt AIMS,oondtimm o braueh erconhaol.prof act j shall Cehse lamn0lattly If ongoing nod tesumvd at our eoavahtonoe Whoa eat pr*ymduis era collected.Owner Is responslbta for all coHiH incufrod for dolny,Wo rwasva the i4ghfto W1111itdd Ihd brc aahad unnditd whhnul ppnnhy,cost or ronind.Ir Wit S roturm:in it , breached conoact And anotherpoymaot 1s missod,Owntf 011.1511Sadsly lho pivinaels to data andpul nomahthig balance In a joint escrow account within thrva days for the prgiuol to be completed.OPERATiONt h IS atittmed rind accepted by Ova ovnior that damngo iihs oeourmd wlUiln lira building and that Is tits rauson At,din spoalllad work tabOvd being dead lard CCR&S Is Indars allied air ull puss, pr4a01 and 1111ta4 damage,ROOK&un occuplod/undmuptad building It a tick to ilia elements.We Shall weuthor tight Os best possible pay*Of a40110113 torn off,May dil m lty tlbAv.howovat Inoltlanlnlhtwidanud uH it recut(of our opomllonw la ilia rasppndlblllty orllia homeowner who Amain till alike opvning ti roof tO tho wuo1hr,Including any further darunga to existing dontage,frtOpBR'rYt Underground floras most be marked or stated ac to thoir prrAaneo for avohlano,We hue not rwponslbla far any unmarked, Unlddatlnod hales,Owner to pup ramovo dooms hay vatdahlo+111111 may Ito vwlncrobtu io Winging, thlllng hdma mid general OanstwWon opetation,All Inside and oulsido mutt ba propesly stared and secured priorto any work being done. I WD tiro not raaparidbiq flay doningod,fnilon or broken A. ualg,i kwrer lit dhrry NO,10madu nod 01110r hCONAary Inaaranaa to inilura 111emsolvdl mid 04forthetrpropbttyandOtus.PL1NET1tANONS All cai60.dral;Vaulted,(InlslitdurAerwlratypeilelling that may be pbnelraWd by a still Or straw longer than 11t W,—0"or an aid-:out for ventilation purpmes must be slated aboHr.We Anil not be ro4paq@lbl4 Ibr ponoinitians Or amrliuus not nalud.NOTRt 11)(10118 at•Id,ba.indhlll0d,Rat oil(bof ponolrnllOmt darlcus,olthur tat llto root;above it,below it or brilda it,or dirough 14 grany eoncelvdble Shope,opiimtion,or fomt,or ditntlon(including aillilleis)which 1 tnolhde walls,skylights,wlnduwrr,decks&.doors,ate.,Ora nnl tonoldomd"tor Voe'HOW end cony in podorby lh autolvos orosto 0 rouling problem,(I.a.,Iuaking,aquti urid).'1lmsalteul,may trognfrA sstvico,Yopulrar rapNoamunl,ill an added aoit avdn after a now roorlastgllalivn:TWO itolas tao not oovgred under Any watrialiy.or guaranty provldad by CCR&S,Ito lean or problera does oeaur Whlotl Involvei mir real,pod Caft&S td9nI1110 lho prcW m,it mysf(tv oatroolad to CCR&S'a haUuraadnit la rohdn whrrbnty at I;VdraOty(wo f0341Ve IN figbi to teJe4t any OpIAIOA,servlCV,rephlr,or reptaeamcnt that we feet will not correct No problem am)d we rosorvq tbo ttghr to rorus0 to warronty.or guaranty sold Arcola ulitil Omtaoted To.our svtinoA Wisllidlon),CCR&S teacrvcs oxchislvit rights in all ramodlos.1t40LD/t4ILDR%VthU01t Alta Roolit,attid0 Dart oilier ldtallot tied oxlvrlore tuyuiro conskaiil Indpdatlon for ilia i prasoncts.of mold,WO.ma:not rospoosiblo.tegardlesr of reason.far oxisdng or Aicnro tirosones,Or Ihold,A psapsrly Idsoomil and ltinlnteinail bulkting anvolopo dadj not tiNmale.Alold.You inti-it indinii,moimnin and Ina uet soffit lonvors, „ d louvaA n Miter pplas arvadr atlon y ugrly to maintain ropot airi►ow; 1Sk ua quAYAond,uv a l Accaplantaorprg e i _Pit,Ag0 41ofypdppin'altylu;0ply I YOu uro nulitnrized to do tsork be 110MGOWAIS R ' A1�11,p1N4WY hll� f ONLY Apeolbod.Pgymaarvdg be made u oudIned above,including all legal,live, AUTHORIZEDAGENr pAdhrbllra�lmt(boS.nowsSnry Ibr Ilia co11ap11anorroHolullan.of rat oulHhnidhig � d6l or dls OW.both puttlus up,A016 91q olvil wvsuits butrudiovstale 1 on diappiels)by 011410n in itodiht4ly(9U day nollo0 to schcdi lo) undur MO L Chujaiir 251 rdlav,Arblinaton omnpliny is CMCI,➢I aoidn,MA or Small Claims Court. I x , ,. i7A'rr�.•� y�.C�OC� NOTE!Ownar,hosthe legal rightitatancollialon oflillsiolitraol WI Any hiqulrlos about ds shnuldba divactod tar WRoliNtrithm,i AIIIbUflOA Yl„Itm 1 1,Doelon,kdA 02IOB,617-727-8598 NOT&IF r IS A OURSTLON,COMMENT or CONCRRN RE,GADINGM MATERIALS trIBTRT)r VROCRT}I)t2R,•LANGTIAG R,COST WITUTN'tEn CONTRACT.,. please foal free to eAH➢s for all ogI4ngrjan. IINU i I I The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 zs The Commonwealth of Massachusetts ,.�a..� William Francis Galvin r lI Secretary of the Commonwealth, Corporations Division One Ashburton Place, 17th floor Boston,MA 02108-1512 Telephone: (617)727-9640 VENTAS WHITEHALL ESTATES, LLC Summary Screen Help with this form T,,Request'a:7rlificate;;°tad The exact name of the Foreign Limited Liability Company(LLC): VENTAS WHITEHALL ESTATES,LLC Entity Type: Foreign Limited Liability Company(LLCM identification Number: 202106156 Old Federal Employer Identification Number(Old FEIN): 000885082 Date of Registration in Massachusetts: 01/05/2005 The is organized under the laws of: State:DE Country: USA on: 10/21/2004 The location of its principal office: No. and Street: 10350 ORMSBY PARK PLACE, STE. 300 City or Town: LOUISVILLE State:KY Zip: 40223 Country: USA The location of.its Massachusetts office, if any: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: C T CORPORATION SYSTEM No. and Street: 155 FEDERAL STREET STE 700 City or Town: BOSTON State: MA Zip: 02110 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER :RICHARD A.SCHWEINHART� 10350 ORMSBY PARK PL.,STE.300 LOUISVILLE,KY 40223 USA MANAGER —T.RICH ARD RINEY � x��J 10350 ORMSBY PARK PL.,STE.300 LOUISVILLE,KY 40223 USA MANAGER C--O.RLANDCFIGUEROA"` —_ _ 10350 ORMSBY PARK PL.,STE.300 �- LOUISVILLE,KY 40223 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code http://corp.sec.state.ma.us/corp/corpsearch/Corp SearchSumthary.asp?ReadFromDB=True... 8/15/2011 u� Massachusetts - Department of Pulflic SJCIL `: Board of Building-, Re�gulatiobs anc'•:!tand, Construction Supervisor Specialtv�' icens License: CS SL 101061 S Restricted to: RF,WS EMO SHIAPPA 111 HATHAWAY STREET WAREHAM, MA 02571 I c�,.G_ i• �J� Expiration: 10/f 5/201 f (luun,i..ciun,�. Tr#: 101091 i Ventas Whitehall Estate, LLC c/o Ventas,Inc. 10350 Ormsby Park Place, Suite 300 Louisville,Kentucky 40220 August 22,2011 Emeritus Senior Living 3131 Elliott Avenue; Suite 500 Seattle, Washington 98121 Re: Master Lease Agreement — Whitehall, dated April 14, 2005 (the "Lease"), between Ventas Whitehall Estate, LLC ("Landlord") and Summerville 4, LLC ("Tenant'), a Delaware limited liability company and affiliate of Emeritus Senior Living Dear Sir or Madam: Tenant currently leases from Landlord the assisted living facility (the "Facility") known as "Whitehall Estate" and located at 790 Falmouth Road, Hyannis, Massachusetts 02601, pursuant to the terms of the Lease. Under Section 9 of the Lease,Tenant is required to maintain the Facility in good and safe order and repair, including roof repairs or replacements. Tenant has submitted to Landlord, and Landlord has approved, certain plans for roof repairs and replacement,which are to be.completed pursuant to the Work Estimate e p at between Tenant and Cape Cod Roofing & Siding attached to this letter as Exhibit A. Tenant is also authorized to proceed with obtaining in its name any governmental authorizations required.to complete such work. Please contact Landlord with any questions or comments. Sincerely, I Ventas Whitehall Estate,LLC i i f By: ` Name: T. Richard 6ey I Title: Executive Vice President and Associate Secretary I h M { 0/ Office of Consumer Affairs and 14usiness Regulation 10 Park Plaza - Suite 5170 " Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 112280 — "� rf, Type: Private Corporation Expiration: 2/10/2013 Tr# 208052 TRADE .CONSULTANTS/CAPE COD EMO SCHIAPPA 111 HATHAWAY STD == WAREHAM, MA 02571 1; ` Update Address and return card.Mark reason for change. )PS-CAISOM-O4/ Address Renewal (� Employment E Lost Card %r 04-G101216 Office ot` o�m°"e A irs siness egu a o License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 1:,;112280 Type: Office of Consumer Affairs and Business Regulation Expiration: 2la,OI2013- Private Corporation 10 Park Plaza-Suite 5170 = -� Boston,MA 0211ti T CONSULTANT.S[CAFE_CQD ROOFING EMO SCHIAPPAi�s 111 HATHAWAY STy 1 � Y WAREHAM, MA 02571 4 Undersecretary L y Not valid without signature NOTICE N W NOTICE TO 4 a TO . EMPLOYEES EMPLOYEES � y The Commonwealth ea1t of Massachusetts , DEPARTMENT OF INDUSTRIAL ACCIDENTS 600. Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152,Sections 21, 22&30, this will give you notice that I(we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-0499N66-8-11 ) 05-14-11 TO 05-14-12 POLICY NUMBER EFFECTIVE DATES m MORSE INS AGENCY INC 285 WASHINGTON STREET NORTH EASTON MA 02356 NAME OF INSURANCE AGENT ADDRESS PHONE# 0 SCHIAPPA ENTERPRISES INC DBA 111 HATHAWAY STREET 0 CAPE COD ROOFING & SIDING 0 WAREHAM MA 02571 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE o= MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment`.is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS oo,93e W20PIG02 TO BE POSTED BY EMPLOYER ESTIMATE for DESIRED WORK from: " SCHIAPPA Enterprises,Inc.dba, CAPE COD ROOFING & SIDING 800434-7663 fax 508-291-4825 "our 28' year" CERTIFIED-APROVED INSTALLERS FOR MOST ROOFING SYSTEMS and;ACCESSORIES . licensed in: -MASSACHUSETTS www.capecodroof.com RHODE ISLAND HIC NO: 112280 CSL NO: 101061 "serving all of New England" REG.NO:26816 I I I Hathaway Street,Wareham,MA 02571 licensed-insured 114 S.Angel St.,Suite 1,Prov.,RI 02906 MAJOR CREDIT CARDS ACCEPTED CERTIFIED PAY PAL FINANCING AVAILABLE RESIDENTIAL * COMMERCIAL * INDUSTRIAL * INSTITUTIONAL complete roofs, sidings < "OVER 10,000" repairs throughout New England FLAT ROOF SPECIALISTS: EPDM-RUBBER PVC METAL COATINGS&SEALANTS INSURANCE & PROPERTY ROOF INSPECTIONS ' FULLY INSURED FINANCING AVAILABLE VISA/MC- AMERICAN EXPRESS-DISCOVER FIND US IN THE YELLOW PAGES, THE BLUE BOOK & THE.INTERNET`. OWNER EMAIL/PHONE/FAX DATE EMERITUS SENIOR LIVING c/o Mr.M Blanchette Fac Dir. 790-7666 Whitehall-MDna,emeritus.com December 17,2010 MAILING ADDRESS JOB ADDRESS. REF NO: .'3131 Elliott Ave Suite 500 790 Falmouth Road,Hyannis,'MA 02601 Whitehall 69 NEW ROOF TOWN Seattle,WA 98121; - START PROPOSED: TBD COMPLETION DATE PROPOSED: TBD PROJECT DESCRIPTION: RE-ROOF ALL,SLOPED and FLAT(except recently done)ROOF SECTIONS OWNER has choice of STRIPPING or GOING-OVER the existing roofing shingles&EPDM CERTAI.NTEED Asphalt Roof Shingles:30,50 or LIT ETIME options 10—50 year workmanship guaranty,available with LIFETIME MATERIAL Warranty SPECIFICATIONS SUBMITTED FOR: STRIP ENTIRE ROOF to install a new asphalt roof system the areas described above NOTE:SHINGLES>CERTAINTEED LANDMARKIWOODSCAPE ARCHITECTURAL style *30,50 or LIFETIME year shingles to be used `1) PREP: Owner has the choice of stripping of all existing roofing materials down to wooden roof deck or going over the existing entire roof for the section(s)listed above.Clean&check existing roofing boards and flashings.NOTE:any missing,broken or rotted. will be replaced at an extra reasonable cost. 1) FLANGES:Remove all vent pipe flanges and replace with new. °2) SKYLITES: Clean flashings on all skylites if any. NOTE: any flashing kits necessary or boards/plywood that require replacement due to being broken,missing or rotted shall be an extra reasonable cost. 3)_ FELT PAPER/UNDERLAYMENT:AS PER BUILDING CODE/ALL MANUFACTURER'S SPECS: Install lee&Water. Shield to ENTIRE ROOF and all valleys and penetrations, A) VENTILATION: AS PER BUILDING CODE/ALL MANUFACTURER'S SPECS:install ridge mounted capable ridge-vent and/or louvers ventilation. 5) DRIPEDGE:Aluminum dripedge shall be installed where necessary along all fascia board areas.Vented_dripedge is additional. 6) ICE&WATER SHIELD: Install lee&Water Shield to ENTIRE ROOF and all valleys and penetrations. 7), SHINGLES: Install Certainteed ARCHITECTURAL Style (30, 50 or LIFETIME YEAR WARRANTY*) asphalt based roofing shingles to the entire roof deck area."`These shingles are warranted by the manufacturer. All flashings to be properly woven.Color is building owner's choice or match existing roofing materials 8)T*WARRANTY:CERTAINTEED SHINGLES ONLY,THIS ROOF OFFERS THE BEST WARRANTY ON THEMARKET _ BY THE MANUFACT R: WORKMANSI�P G�TARANTY-S Rl� YEARS OF THE 30,g 1 EA�SrHNGLES and 50.YEARS FOR,THE LIFETIME YEAR .WARRANTY ARE NON PRO-RATED FOR FULL LABOR & MATERIAL REPLACEMENT. WE WILL HELP YOU WITH COLOR SELECTION PRIOR TO PROJECT. Roof:must be stripped to receive warranty. 9) TRASH/DEBRIS:Remove all debris daily&upon completion to a legal destination.NOTE:Any hazardous waste such as Asbestos,etc...but not exclusive to same,may require special handling and additional costs to:building owner.Please notify us of any on site hazardous waste: NOTE color and newness of shingles in these areas may not match the rest of roof if done in sections. NOTE-Go=over entirely omits or partial parts'of the above numerical numbers as we deem necessary.NO stripping.Material warranty only plus we Guarantee this roof aeainst leakine due to defective workmanshin.nnly for 16 vearg: