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HomeMy WebLinkAbout0020 HAWTHORNE AVENUE J-=�----- �--.�.,.-v-�----� �,_ � Town of BarnstableBuilding BAJL14STANA Post This Card So That it is Visible From the Street Approved Plans.Must be:Retained ohAob�and:this Card Must;be Kept . ,�" Posted Until final Inspection"Has Been Made Permit Where a Certificate of Occupancy is Required,such Building hall Not'be Occupied until a Final Inspection has been made ? Permit NO. B-20-1087 Applicant Name: Russell Cazeault Approvals Date Issued: 05/15/2020 Current Use: Structure Permit Type: Building-Addition/Alteration- Residential Expiration Date: 11/15/2020 Foundation: Location: 20 HAWTHORNE AVENUE, HYANNIS Map/Lot: 286-016 Zoning District: RF-1 Sheathing: Owner on Record: ANDREWS,CHRISTOPHER B TR Contractor Narne: PAUL J. CAZEAULT&SONS INC. Framing: 1 i Address: 40 SCHOOL ST Contractor License: 103714 2 ANDOVER, MA 01810 Est. Project Cost: $ 24,000.00 Chimney: Description: Replacing rubber roof and cedar sidewall. Permit Fee: $ 172.40 1 Insulation: Project Review Req: Fee Paid:'' $ 172.40 Date: 5/15/2020 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. i' Electrical I' signatures r he Buildin Yard Fire Officials are-provided on this permit. issued until all applicable s atu es b t The Certificate of Occupancy will not be ssue pp g y g P ,P Minimum of Five Call Inspections Required for All Construction Work: Service: P , 1.Foundation or Footing `"� Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 6N`T;06 �iMekyC- S�^y' Tt+e Town of Barnstable *Permit# rres 6 months from issue date �.� Building Department Vee : . MASSY : Brian Florence,CBp v . Building Commissi s639one U ��FD Mld A 200 Main Street,Hyannis,IVZI Alf www.town.barnstable.ma.0 RR a�m�1 �J Office: 508-862-4038 + 8-790-6230 1 AR 07 z©1 EXPRESS PERMIT APPLICATION - L 6NLY /' / Not Valid without Red X-Press Imprint 'r�p C Map/parcel Number ��(o� (.b LC Property Address ^ O p rty � Residential Value of Work$ Cho,o c, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address t=t S L/0 �, �JJ'A Contractor's Name A0,4A�A'3 `V Ate' Telephone Number .5Lg-78!; C.34160 Home Improvement Contractor License#(if applicable) > Email:_— jypcot1 woRKF�\ t1Cet112a�10 Construction Supervisor's License#(if applicable) CS`" 066 so a ❑Workman's Compensation Insurance Check 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 taken to ❑Re-roof(hurricane nailed)(not stripping.-Going over existing layers of roof) - Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *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 p of the Home provement Contractors License&Construction Supervisors License is re r SIGNATURE: QAWHILESTORMSTMESS2017 • The Camuzomveakit oj#•3Iassad iusetfs DVarti► mt ofladus&W Acddem& Vivo Office o,fIn igadens 600 Washington Street Boston,MA 021�11 wnnv mas&govMa Workers' Cumpensation Insurance Affidavit Blmitders/C,ontr'actursMec icians/Plumbers Applies Information Please Print f fe��bIy Name lBasiness�gaaizatirsnfla al}= (�C�A�S W Address: Phone-,40-- S-08 934 t 10o Are you an employer?Checkthe appropriate bow: Type of project(regmi ed): 1.❑ I am a employer with 4 ❑I am a general contractor and I ti. ❑New construction employees(fall andfor part-timed* have hiredthe sub-c=tractors 2.R I am a sole proprietor orpartner- listed onthe attached sheet, 7- 0 wog ship and have no.employees These sub-contractors have g-,❑Demolition wadaag forme in any capacity. employees andhne wodzers' 9. ❑Building addition, vupdaers' comp.insus-m a comp-msuranml req ai red] 5. ❑ We are a corporation and its 10_❑Ele orical repairs or additions 3.❑ I am a homeovnw doing all work officers have exercised their 1L❑Plumbing repairs or additit7ms myself� o wro6mrs' re 17❑Ito of f of exemption per MGL repairs insurance r �&]y c.132,§1(4�and we have no employees-[No worms' 11M Other SEE UM comp_insnraum requued-] J • apgiica �atcbeds'SoaiflnmststafiIla�thesectioabeLowshntdug�eirwo�es'compeasatiaapolicyiafo�aiioa t f€omevarners Wbe sabnxit this mffidniz=dkxtmg they ans doing RUwa*ago ffimbae aumde contcmummst submit a nem affiaaeft iadieabno sadi fCaattscfo�s�2ehecirt}dsbmcn}astaffich�ffiaddiiianalsheershoamgthensmeafthesnb-c�trscta�seuistafe�rLe<hetarnotthasee�tEeshsve emPioyees.IftbeSub•-caabactaeshave employees,dLeymmstpmvide their trorke&c=1%policy numbm I airs an errtglvyer flirrtisgrat�itirrz�tvasicers'con�perssrrfiarz irzsrsrrrrzca fur rrx}*errrgtaS�e¢s $e1`o�v is tihegaficy arui jab s� irzformatiass - Insurance Company Nam: Pflhcy 4 or Self-ins.Iic.4 Expiration Date: Job Site Address: Attach a copy of the workers'compensationpolicy-dedaration page(showing fhe policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL a 1572 can lead to the imxpositim of crimirzai penalties of a fine up to s1,50a 00 andlor one year imwisonmenk as wcll as civil penalties in the form of a STOP WORK ORDER-and a fine of up to$250-00 a clay aaamst the violator. Be advised&at a copy of this sblement maybe forwarded is the Office of Imtestigations ofthe DIA for insurance coverage veFifrcatim A£o hereby cenfffi, t Rgaisrs andgesratties a, perjury thatthe iriformatiorrgrnt W bm h=acid correct Si2nattne: G l% ` Date- l Phomik O rd use only. Do seat ssrke in this urea,€a be comgWad by tafp arto n ofjreral City or Town: Peruddl incense# Issuuing A.nthDrity(cu cle one): L Board of Health 2.Buil mg Department 3.CitpTaim Clerk 4.Electrical Fnspector S.Phxmbing Easpmtor ft.Other Contact Person Phone#: :laformation and 11nstrxctions Massachase#fs General Laws chapter U2 requires all empIoyees tD provide workers'compensation fzrr their euploy=. PMMUM3t to this siatate,an employee is defined as."_.evm:y person in ffie service of another nod=any contract ofhire, express or implied,oral or written." An ernp&yer is dofined.as"an individual,partnexs�,associaiiOn,corporation or 0 er legal entity,or any two or more of the:fi3regomg J in a joint ,and including the legal representatives of a dwzase d employer,or the �e receiver or trustee of an individual,partocrship,association or other Iegal entity',employing employees" However the owner of a dweIlmg house having not more than tbree aparimenis and who resides therein,or the occrTant of 13ie - dweIling house of another who eo.3pIoys pe min to do maim ce,construction or repair woric on such dwelling house or on the groundq or building appanisnautthereto shallnotbecanse of sash employmentbe deemedto be an employer." MGL chapter 152,§25C(6)also stains that aevery state or local licensing agency shall withhold$ze issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for airy aPP licant who has no ith produced roduced acceptable evidence of cdmplianee w the insurance coverage required:' Additionally.MGT-c1aptnr 152,§25CC7)stains-Neither the cammaawrahh nor zly ofits political subdivisions shaI1 carter unto any contract for theperformance ofpubhc work until acceptable evidence of compliancewith the ms**ance. reTlire ents of this chapter have been preseniPd is the contacting aoiiiozity-" Applicants Please fill obt the workers'compensation aidavit completely;by ch=km ib e boxes that apply to your siination and;if neces.SarL Supply sorb-confractor(s)namc(s), address(es)and phone nrmmber(s) along with theircmtificafe(s)of ;,cr mance. Lid Lnbrlity C aipames(LLC)or Limited LiabUity-Pm aenETps(LI P)withno employees other fl3 am tb e members or partners,are not required to cagy workers'compensation inszn n= If an LLC or LLP does have employees,a policy is requb4 Be advised that this a$tdayit maybe submitted to the Department of Industrial Accidents for conf maiion of i osuu� coverage Also Be sure to sign and date;.he affidavit. The affidavit should be reed to th.e city or town that the application for the permit or license is being ru;=siud,no t the DePartaenf of . n al Accidmis- Ohouldyou have any questions regarding the law or if you are required to obtain a workers' . compensation policy,please call the Deparimeot at the number listed below. Self insured companies should eTtfi-r their s elf-n+Snrn ce license number on the appropriate Imo. City or Torn Officials t - Please be store that the;affidavit is complete and praded.legibly. The DeparSnenthas provided a space at the bottom of the affidavit for you tD f01 out in the event the Office of Iuvestigations has to contact you.regarding the applicant Please;be sure to fill in the pen l; iccwe,nvnbes which will be used as a reference number. In addition,an applicant that must SabMt multiple p=If fficwsa 2011tmiious in any given year,need only submit one affidavit indicaimg cmreat olicy infomation(if necessary)and under`Job Site Ad&ms*tie applicat dn shoul rouet aaIl Iocaimns n �5'( or p town)"A copy of the affidavit that has been officially stamped or marked by the city or tows may be provided to the applicant as proof tbzt a valid affidavit is on file for futme'pennip or licenses A new affidayitmust be filled out each year.Where a home owner or citizen is obtaining a license or permit not related in any business or commmLial vent= (ie. a dog license or p=k to burn leaves eta.)said person is NOT regnaed to complete this affidavit The Office of Invesiigafrons would like to thank you nor 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 er: ' Ca mmawe -th of aChUsEtts ' Delta d meat cif ludmidal Aocidenta �Q4� Qn t BaderM&02111 Tf,-L.4 617-727-4900 cxt 4,06 car Fax 617 727-7749 revised 4 24-D7 W W W..rn C Town of Barnstable Building Department Brian Florence,CBO Via`` Building Commissioner 200 Main Street,Hyannis,MA 02601 www town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete'and Sign This.Section If Using A Builder I L-VRl �.�� as Owner of the subject,l property . hereby authorize A3 t _ to act on my beh4 in all matters relative to Work authorized by this building pettnit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final. inspections are performed and accepted. Signature of Owner wig"'Mnaq�=e Applicant Lem D � rc.,;�f ✓Jr� �l��C'l; • Print Name Print Name Date , QTORMS:OWMMPERI MS10NPOOLS Rev:10/17 t �e. dffice o onsime[= air &�e ness g&tion Registration valid for individual use only HOME MP before Flegistrati expiration date. If found return to: 'tYPE'LLC Office of Consumer Affairs and Business Regulation Re sftation :EXGlration is Park Plaza-Suite 5170 1 277 i 1 2172019 gostan,MA 02116 - ORKER'LLC. THOMAS OM.THAS C.W rHI[ — a1:5A MA Not 111 id without signature CENTERVILLE,MA'o2632 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards L License:'CS-066582 € `) Construction Supervisor THOMAS C WHITE y 415A MAIN ST CENTERVILLE MA 02632 r�i=" Expiration: / /Commissioher 03/1412019 I Construction Supervisor Restricted to: use group which contain Unrestricted-Buildings of any cubic meters)of less than 35,000 cubic feet enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit:yWVW.MASS.GOVIDPS i ' Town of Barnstable *Permit# Expires 6U onths from issue date Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 1 L- li�QS www.town.barnstable.ma.us Office: 508-862-4038 TOWN OiFA A50r8��IpBLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY l/ Not Valid without Red X-Press Imprint Map/parcel Number ® lP! Property Address otj(Z. Av(? r r J XResidential Value of Worker Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 0YrS D be j'` �-J��_ .PA) ,A,"s Contractor's Name &l ( ;A Telephone Number W—y 2_?-/17—7 Home Improvement Contractor License#(if applicable) m37I Construction Supervisor's License#(if applicable) 'Workman's Compensation Insurance Check one: ❑ I am a sole proprietor QI am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Tr,&/e e TN 5 Workman's Comp.Policy# U LJ —002 5)3 tp q A o -5 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) IV Re-roof(stripping ohs) All construction debris will be taken to CkY ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 { P�oFTMETo�ti Town of Barnstable ' Regulatory Servzees ' qk,�'" Thomas F. Geiler,Director E10 F. Building Division Tom Perry, Building Commissioner 200 Main Strcet, $yannis,MA 02601 www.town.barnstab1c.ma.us Office: 508-862-4038 Fax: 508 790-6230 Property Owner Must Complete'and Sign This Section. If Using ABuilder , I) Ve_ AtAreuos as Owner of the subject property herebyauthorize. . JCAQDf <2_ to act on my behalf, in all matters relative to work authorized by this building permit application for, C� 4or k) AV .(S ir' (Address of Job) .ignature of Owner . D Ee skv�,erj * W , ANAre.,os Print N 0TORMS;OWNERPER&SION f C_ Town of Barnstable *Permit#a �06. Expires 6 months from issue date X-PRESS PERMIT Regulatory Services Fee 4as.66 APR 2 5 2006 Thomas F.Geiler,Director Building Division TOWN OF F BARNSTABLE Tom Perry,CBO, Building Commissioner C) 200 Main Street,Hyannis,MA 02601 www.townbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address r J 'e, 4u Ak)62 �s `--Residential Value of Work _?Cno Minimum fee,of$25.00 for work under$6000.00 V /i_ L Owner's Name&Address (\Y-�5� Df -e r � AmC ,r4ws U N1 ,� m I o Contractor's Name C A�r� � t� Telephone Number Home Improvement Contractor License#(if applicable) �(1),2E ~ Construction Supervisor's License#(if applicable) ®2_U 3 0� �,,MWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Com ens ation Insurance Insurance Company Name Workman's Comp.Policy# ` J)0-F J V L D "I A-0 S Copy of Insurance Compliance Certificate must be on file. Permit Request check box) R -roof(stripping old shingles) All construction debris will be taken to oA LA 11) ❑Re-roof(not stripping. Going over existing layers of roof) i ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) 'Where requved: 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. &I H7., vement Contrac r icense-is required. SIGNATURE: ' ,` Q:Forms:expmtrg Revist071405 E! Department ofIr dustrial Accidents ' Office.of Investigations ' a 600 Washington Street • Boston, AM 02111 www.mass-gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/P lumbers Applicant Information Please Print Leeibly Name (Business/organization/individual): 'l _ �� A, �j C­ Address: City/State/Zip: f`y\ 11 � Phone#: "— Are you an employer? Check the appropriate box:. Type of project(required):- 1 I am a employer w --ith �2 . 4. ❑ I am a general contractor and I 6. ❑New cotstraction employees (full'and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. [] Demolition working for mein any'capacity. workers' comp.insurance. g. ❑ Building addition [No workers' comp.insurance 5. ❑ We'are a corporation.and its 10.❑ Electrical r airs or.additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL T 1'1.❑ Plumbing repairs or additions myself.-[No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers comp.insurance required.] 1.3. they . . � 4 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: �F t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new a$idkvit indicating such r tContrictors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infonrnation. I am an employer that is providing workers'compensation insurance for my employees-'Below is the policy and job site ' information. 1 �� Insurance.Company Name: AN- I•-e r� �' k S Policy#or Self-ins.Lic. #: , 1?22,Doq 5[( 0 q J T Q-5 Expiration Date: . - Job Site Address: o oft'cv-- e City/State/Zip: s ' Y\A 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 pen' ' in the form of a STOP"WORK ORDER and a.fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ee d r the 'ains and penal'es of perjury that the information provided Bove is true and correct Siena e:. Date: r Phone#: 24—— Official use only. Do not write.in this area,to be completed by city,or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4..Electrical In 5.Plumbing Inspector 6. Other Contact Person: Phone#: .4 Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. (Please return this form with your signed contract, thank you) I (print) mil^r A, as Owner of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. To act on my behalf, in all matters relative to worts authorized by this building permit application for: (Address of Job) �4^ Signature of Owner Date H ( 't71° 6 Tel# C 8$, ,q )n Quo Pro p osal R O O F I N G 1031 Main Street Osterville, MA 02655 www.cazeault.com 22 Giddiah Hill Road Orleans, MA 02653 Mr. Steve & Chris Andrews DATE ESTIMATE NO. 40 School St. Andover, MA 01810 4/13/2006 1859 Phone# Estimated by: 508-775-3161 kevin Description of work to be perfromed Total Re: 20 Hawthorn Ave. Hyannis Port Remove existing shingle roof. (selected areas only) Re-nail any loose boarding. Install 30 lb. underlayment felt. Install No. 1 18"grade A red cedar wood shingles. Shingles to be fastened with stainless steel nails. All flashings to be 16 oz. red copper. Install 1 x 6 red cedar board on ridge. All roofing related rubbish to be removed from premise. All workmanship guaranteed for five years. COST-Remove chimney and shingle part of roof 1/3 due with signed contract, 1/3 due when job is half done, 1/3 due Total upon completion Customer Signature The above prices,specifications,and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified.Payment to be made as outlined above. Date of Acceptance Toll-free in MA: (800) 698-5569 Osterville: (508) 428-1177 Orleans: (508) 255-5569 Falmouth: (508) 457-1141 Fax: (50 Q gxe v IUDBoard of Building Regulat ons/an an ar s One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement':Contractor Registration Registration: 103714 Type: Private Corporation i , Ir Expiration: 7/9/2006 PAUL J. CAZEAULT & SONS, INC Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 ' I Update Address and return card.Mark reason for chang OPS-CAT Q SOM-04/04-G101216 Address D.Rcucwal El Employment 0 Lost Card C�LC V/00lL7Ji0•lttlll.a"', 0�✓l2QAdQGLUdC�4 hoard of Iluilding Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individlll use yuh. Roflisiratiort:. 103714 before the expiration dale. If found rclurn Ur: Expiration-:7/9/2006 Board of lluildiul;Rel orations:utd yl:uul:u ds Ouc Ashburton Place RIn 1301 :;Typo:"Private Corporation Itostun,Ala.01108 ' PAUL J.CAZEAULT;B,SONS.INC.: Paul Cazeault 071 1031 MAIN ST OSTERVILLE,MA 0265a BOARD OF BUILDING REGULATIONS V OS Administrator License: CONSTRUCTION SUPERVISOR - Plt Number ,CS- 026325 B i rth d ate: 10/2011959 Expires 10/20/2007 Tr.no: 7696.0 • Restricted .00:` PAUL J CAZEAULT' 1031 MAIN ST OSTERVILLE, MA 02655 �-- Commissloner , VJ 1 CMV ILLC, {YIN 0 uLo0 - __-- — _ - - .._Administrator--. 6771 Board of Buildin egulations y u One Ashburton Pipace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires; 10/20/2007 Restricted To: 00 PAUL J CAZEAULT 1031 MAIN ST ` 'E OSTERVILLE, MA 02655 Tr.no: 7696.0 DPS-CAI 0 SOM•04/OS-PC8698 Keep top for receipt and change of address notification. j , L,IILIIIli: 'IllJt)'J A--CORD)M CERTIF '4UA/-I=AU ►'A ICATE .OF LIABILITY INSURANCE DATE(MM%0Myy) PRODUCER ,{-j Dowling & O' Neil lnsurancc THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION. Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 222 West Main St. PO Box 1990 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis, MA 02601 I NSURED INSURERS AFFORDING COVERAGE J. Cazeault 8, Sons Roofing, Inc. 'NsuliER n: Western World NA S. 31 Main Street INSURER n: Osterville, MA 02655 TlrLwlt,r:It �IrJ.t�r;l?r_Y..yns. r , INSURER C: � r INSUrir_ri D: COVERAGES INSURER E; THE POLICIES OF INSURANCE LISTED QELOW RAVE BEEN ISSUED TO THE INSURED NAMED AUOVE FOR THE P ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT ES OTHER DOCUMENT WITH RESPECT 70 WHICH THIS CERTIFICATE MAY BE ISSUED P LI PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$SUQJECT TO ALL THE TEfiM$,EXCLUSIONS AND CONDITIONS POLICIES.AGGREGATE LIMITS SHOWN MAY I�IAVE BEEN REDUCED BY PAID CLAIMS. OLICY PERIOD INDICATED.NOTWITHSTANDING 0 S ITR NSR TYPE OF INSURANCE OF SUCH -- POLICY NUMBL•li P011c—;Y -FFr C7IVE POLICY.f_XPIRATION A GGNERAL LIAUILITY DATE MMlUUlYY UATL(Mi M/UDIIy,.) LIMITS NPP92.X COMMERCIAL GENERA{-LIABILITY 04/30/05 04/3OIOG CLAIM;;MAUL EACH OCCURRENCE f hnMAGI,ToRLNILI) 1 000 000 a OGCUIi I•IiFMI;��� r• r X .BI/PD Ded:1 000 '�'--�� ' ' $50 000 MED EXP(Any ono pafsuN S2 500 PERSONAL 6 ADV INJURY S1 OOO OOO GEN'L AGGREGATE LIMIT APPLIES 1'Lri: cENr_rinL nccriecnTE Q 000 000 POLICY PRO. lOC PRooucis-coMP/ornGG s1 000 000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT ALL OWNED AUTOS (En accident) $ SCHEDULED AUTOS HIRED �r Person) /AUTOS ( s ) NON-OWNED AUTOS BODILY INJURY (Peraccldont)------------ S GARAGE LIABILITY PROPERTY DAMAGE (Par accident) S t. ANY AUTO AUTO ONLY-EA ACCIDENT S OTHER THAN EA ACC S EXCESSIUMBRELLA LIABILTY AUTO ONLY;. OCCUR AGG S -EICLAIMS MADE EACH OCCURRENCE S AGGREGATE S DL"OUCTIULE RETENTION S WORKERS COMPENSATION AND _ s --- LMPt.OYER'S lIA0llllY (Uu-0095BG.j_"_u,S• _ 711E PRomit-TOR! / Da`1D-OS Oa-10-OG STATIITORY1.PdITS 1...2>.•:r....:,,.a: PARTNERSlCXCClI71YCn I"CL s;r:.i;1.... L I ' f:r,:;:; L' I F.ACII ACCIDENT OrrICLII3 NIL 3.::.-^'•�� CXCL OISL'ASC-POLICY LPJII OTHER - t 500 000 - DIRFA.IF-rACIi fMP1.0YFf- .S 100�000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES IF XCLUSIONS ADDED BY NDOR ESEMENT I SPECIAL Operations 12crtormed by the named insured subject to Policy Conditions PROVISIONS and exclusions. CERTIFICATE HOLDER CANCELLATION Paul J.Cazeault& Sons SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIME ROOfing,lnc. DATE TIIEREOF,THE ISSUING INSURER WILL ENOEAVORTOMAIL DAYWRITTEN 1031 Main Street NOTICE To THE CERTIFICATE HOLDER NAMED TO THE LEFT,OUT FAILURE TO DOS WRITTEN Os t"Ville, MA 02655 IMPOSE NO OBLIGATION Oil LIABILITY OF ANY KIND UPON THE INSURER;ITS AGENTS SHALL "CPUESENTATIVr-s. - S OR AUTHORIZE;/REPRESENTATIVE ACORD 25(2001/08) 1 OU2 - #M381 GG `�"--- LS1 0 ACORn Cnrn�r�nTlna Engineering Dept. (3rd floor) Map 2�� Parcel 66 li!�' 11 Y' Permit# 239910 J ,/� House# Z y ISL-- Date Issued T Board of Health(3rd floor)-(8:15-9:30/1:00-4:30) Fee -� Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Plan ni Dept.(1st floor/SchoolAdmin. Bldg.) `o,114E, � act ' Plan Approved by Planning Board 19 - � BARNSTABLE, TOWN OF BARNSTABLE Building Permit Application eet Address S)Q f61.62 1%02A ie Village 6 CA AA I .„_° pen p Owner mWe, P(kJCbe,4,aJs Address Telephone Permit Request &�p gs . Jp � First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ ;3 I `"— Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 10- 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 No. 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 0 Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name Qg,C,m Cr Telephone Number Address `�� l t�fLG�'� C°�� License# Home Improvement Contracto ULNAS 4/A363 016 Compensation# . Worker's Com r &D15--�3 v NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO V& SIGNATURE .-ems-- DATE Ah:27 BU ,T QQA�FOLLOWING REASON(S) vj FOR OFFICIAL USE ONLY PERMIT NO. e DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION " FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. EVE t . .� The Town of Barnstable 9eHASS �0 Department of Health Safety and Environmental Services rEn Is Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no.. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures w I.hich are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: 1 /e_ Est.Cost Address of Work: c3 U ii'ya'"A'-'O'v f�"�e_ l Gt.HniO e l& Owner's Name {�yyu a4 Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY /I hereby apply for a permit as the agent of the owner: (� �.�/ %) ��cv✓1 C' /.�ca�-lam �/�� Da Contractor Name Registration No. OR Date Owner's Name The Conintonive llth of Massachusetts Department of Illdllstrial.9ccidc»ts ` !F Office a/MFOW9171/ons 600 11'ashing tan Street X Boston. Maas. 02111 Workers' Compensation Insurance Affidavit �pPI1C'tnt information• Please 1'RIIVT lebi�I�V .---�� _.•.•. , name: z.QG✓t/1 C �� location• �� //4GLG�GM �//? city ��� �/� nhone# 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working_ in any capacity _-..•. ..,....- �,e-...-_.....__..�.�._.you.s.,-ti..s¢rK,.-...,.T- 7�+++':�....n...�.......-..�•-S.-.�+.�...�.+�..w.,,.,......_,..._•.,--•-...,.�,�..-,,.w.,..._ ..,.,.,•__••__.....:. L� ..-.._:,:...:,,,.;�..a_.._,....... .tom-- _.,,,,,,;,__.:=.., .._..._. ...��.. - . - .. ,�... . :.,.. - �.�. �� ._--•-__._-_._ II am an employer providing workers' compensation for my employees working on this job. cnmp•tnv name: address: city: ) / phnne#: insor•tnce cn pniiev 3 6/•A I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comnanv name: address: city: Phone#: insurance ro nniicv# ._...-._.... .._ ...�-_........ _I.L.-��i,.—_:.. .�i+:Ylr'.-+r_Jr•�-__ _ .II.—_ ~� ._ _ 1�- _ �—_ __r—i..✓:Y_Y`.... .L_—.� company nimv: address: rite: phnne#- incurnnee co noiicy# Attach additional sheet if neccSEAry, �'� :� - ^ iF:'�"''''"" �~�^ T`^_ ^" � :.•r�.:.�_.......�r�.r�.:a..:i.l'►. •��� _....;��_••�. ._. _..y0aa-...w.._....�.• �'---`-- 'yY!•�:.L'�it..hfic'w...tL Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 andior one cars' imprisonment as well as civii pcnaitics in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a Copy of this statement ma% be forwarded to the Office of investigations of the DIA for coverage verification. !do hereby cerri • the pains and •tallies of perjuq•that the information provided above is true and correct. Si`nature Date a`— 7 Print name -hex" s [� 14:zqcAo� Phone# rcil�.cise onlydo not write in this areato be completed bycinortownofticial or town npermit/liccnsc# R13uiiding Department Licensing Board 0 check if immediate response is required c3SclectmeWs UfOc. C311ealth Department contact person: phone#: r Othcr s • tip\ . I Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' ciintpeltsation for the employees. As quoted from the "law". an enzpluree is defined as every person in the service of another under anv contract of hire, express or implied. oral or written. An etnplorer is defined as an individual, partnership, association. corporation or other legal entity, or any two or mor the foreuoing engaged in a joint enterprise, and including the legal representatives of a deceased emplover, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However tll; owner of a dwellin�a, 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 ho or oil tite `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe: MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or. renewal ol'a license or permit to operate a business or to construct buildings in the comnionyealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionaliv, 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 i been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits 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 requires to obtain a workers' compensation policy. please call the Department at the number listed below. City or towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o. the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned ; the Department by mail or FAX unless other arrangements have been made. The Office of Investi=atioils would like to thank you in advance for you cooperation and should you have any questior. please do not hesitate to give us a call. . r•-y.v-,+. -. ....-.— ..�........•.•r•..•. _,.�.�•...-.......,�_rrw..w�.�a....-.,.ws. w=-.�...�+�...•.�w•r�a.wavr_r.•_r.•vw_..•wss..���..- The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations -- 600 «'ashington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone 9: (617) 727-4900 ext. 406, 409 or 375 r s \ i� j'A°4 el Y i