HomeMy WebLinkAbout0005 KEEL WAY s e e4
W flY
Application number.. `
Fee ................................ ..... ... ...............
Z BU�BTABEE. •. � �
Building Inspectors Initials......
3. �(. Date Issued: .............................
OwN OVAO�,
1��o Map/Parcel.............q...I..........1...(a ..............
SEP 11
WNS AM TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION.
ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: o l
NUMBER w E STREET VILLAGE
Owner's Name: 1, Zt Phone Numbers 8 ?T$ 1/2 O lv
Email Address: Cell Phone Number
Project cost$ 1 B a Check one Residential Commercial
OWNER'S AUTHORIZATION
As owner of the above propertyfI hereby authorize Vm�2 m 11a a p �'td `��y� i4� /
to make application f building pe • in dance with 780 CMR
Owner Signature: G Date:
fi TYPE OF WORK
ElSiding IP Windows(no header change)# ❑ Insulation/Weatherization
❑ Doors(no header change)'# Commercial Doors require an inspector's review
❑ Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to YA1"aAW �4 J
CONTRACTOR'S INFORMATION
Contractor's name Vt 16 A �T,
E
Home Improvement Contractorst Registration(if applicable)# ® J7 (attach copy)
t �
` Construction Supervisor's License_# C !S' ®O 0 (attach copy)
s'6Ft��S•T'p fv f�'
Email of Contractor V 1 C roA `i✓!1`y //V 2;A/ Phone numbers o S 3 41 791 D
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEAS OLD OR IF THE SUBJECT PROPERTY-IS IN
A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION.NUMBER..................................................... ......
*For Tents Only*
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides?Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
Fuel source being used LP tank 20 lbs. or>Yes No____, if yes, a gas permit is required.
Natural Gas Yes No ,if yes,a gas permit is required.
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am-9.30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval.
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures, specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANT'S SIGNATURE
v
Signature ��� . � �� Date 0
All permit applications are subject to a building official's approval prior to issuance.
r
f
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street '
Boston,ALL 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information / Please Print Legibly
Name (Business/OrganizatioMndividual): V 1 G7—o x
Address: -1 J C
City/State/Zip: OA/R/Y,.$ '/9 AW/-A MA D� 'Phone#: .5-(3 7 S!O
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ 1 am a general contractor and I
employees(full and/or part-time).* - have hired the sub-contractors ; 6. ❑New construction
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
workingfor me in an capacity. employees and have workers'
Y P tY• $ 9. ❑Building addition
[No workers'comp.insurance comp. insurance.
required.] 5. ❑ We are a corporation and its .10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.Wther W�•
Pa 1VS
comp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct
Sienature• �%6 / 4 �'�� Date:
10
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
�• of
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person ih the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that every state or,local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would 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 Industrial Accidents
Office of Investigations
600 Washington.Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#617-727-7749
www.mass.gov/dia
r
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constpo. bp�,rvisor
CS-000998a.
may;
4 i 5(. ires 09/2912021
VICTOR J WRNIKAINEf+4
PO BOX 69
WEST BARN T,,/►BI E AMA 66�8 -a
Commissioner
•
Office gt-Consumer/tf/airs&Business Regulation
H WE IMPROVEMENT CbNTRACTQR
x` TYIndnnduel
sf a 08/07/2020
VICTOR J.WII ,
x
g`
•� �«m f tI A,
VICTOFE WiINIK�,�J k' -
5i3 CAPE,COD LN
BARNSTABLE,MA 0283Q
lin�ersecretary:
I
Town of Barnstable Building
• - `This Card So:Thaf pis-U�sible�Fromsthe Stceet A roved;Plans`Must be;Retamed on Job and this Card Musi be Ke 4,
Post , t -,
-•AEId$'CAW.E, } ,a ra,�:;. ' —�'�' ..� sa'� r :.`�. m� '\ ? ='v � S._�sI ro k..'�.,. Jai y.tt" p � i -., • 1 ..
MAC Posted Until Final Inspection Has Been Made ., � �� -�• �� � � � a � � � ��� � � � �g�
Wh e a Cert�ficateaf Occupancy�s,Requ�red;�such�Buildmg shall Notbe Occupied unt�ha Final�lnspection has been made
1639.
Permit
Permit No. B-19-2208 Applicant Name: VICTOR J. WIINIKAINEN Approvals
Date Issued: 07/10/2019 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/10/2020 Foundation:
Location: 5 KEEL WAY, HYANNIS Map/Lot 247-165 Zoning District: RB Sheathing:
Owner on Record: MILLER,JACK L&CONNIE J + a Confractor.�Narne , VICTOR J WIINIKAINEN Framing: 1
Address: 5 KEEL WAY � ' Conractor License€ CS 000998 2
HYANNIS, MA 02601 Est Project Cost: $1,980.00 Chimney:
Description: replace 3 windows-Yarmouth disposal a� Permit Fee: $35.00_ _ ._ -
a= - - Insulation: _
+ Fee Paid.` $35 00
Project Review Req: k. 7/10/2019 Final:
Date
.- Plumbing/Gas
Rough Plumbing:
Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorize by this permit is commenced within siz months a0,,1ssuance.
All work authorized by this permit shall conform to the approved applicatio-and the approved construction document0or wfii6,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�Snd 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. Ee
f R
Electrical
The Certificate of Occupancy will not be issued until all applicable sign Lures by the B�usldmg and,Fere Off�e ass are p'to ded mn L�s;permit.
Minimum of Five Call Inspections Required for All Construction Work. ' Service:
1.Foundation or Footings ` Rough:
2.Sheathing Inspection , ,.�� _, -
3.All Fireplaces must be inspected at the throat level before firest flue lining is installedq 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
Application number.. ..� �....1..-.. .
Fee .........................3..S.........................................
BARM
JUL
f+� Building Inspectors Initials..................
o%M
DateIssued.............................L........1........................
Map/Parcel............:......!....�l..ln..5.......................
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/V7EAT-MRIZATION
PROPERTY INFORMATION
Address of Project: ��-�— (,o AY lT c5 �j. ouin
NUMBER STREET VILLAGE
Owner's Name: -: 6Ky— Phone Number_-9D& 1'?K r 426
Email Address: Cell Phone Number
Project cost$ Check one Residential �� Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize NJ i cto P4- L) i`0"OK Q Q#J
to make application Bo a building p ccordance with 780 CMRn In
Owner Signature: Date: ! �
TYPE OF WORK
Q Siding 'Windows no header change)# Insulation/Weatherizati
( g ) � on
0 Doors(no header change) # Commercial Doors require an inspector's review
Roof(not applying more than 1 layer of shingles) 2
Construction Debris will be going to YA A/yfQ I E&A��� 44IV
CONTRACTOR'S INFORMATION
Contractor's name 7'0 To I �I t
l
Home Improvement Contractors Registration(if applicable)# 8 D o (attach copy)
Construction Supervisor's License# C,5' 060 � �� (attach copy)'_
� o
Email of Contractorke<-7°QR VYd�nr i�S�i�lr�Sl Q7Lft`lGl� P�hone number,?,44.-Z 78/0
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NUMBER.....................................................F.....
*For Tents Only*
Date Tent(s) will be erected Removed on number of tents total
Does the tent have sides? Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent
Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required.
Natural Gas Yes No ,if yes, a gas permit is required.
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval,
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type . Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures, specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANT'S SIGNATURE
Signature Date --
All permit applications are subject to a building official's approval prior to issuance.
•s -
`„nf fix(Uy
a//Cf' rJI1/lY✓)2O/t/lP.(1L!/!!�,�7�(!)r.(!!.✓/ll���.l
Office of Consumer Affairs&Business Regulation:
HOME fMPRO MENT CONTRACTOR
TY E��nciividiet
Exgiraticm - �;
R J.MIN
VI 1I
VI
CTOR O ..
} VICTOR J.W IINIi�lii�tE4�"'
58 CAPE COD LN a<
BARNSTAB LE,'MA 02630 Undet'secreta
ry M,
Cotnrrmonwealth.:of Massachusetts
1511vlglon of Professionail Lnsure
r, Board of B,uii fcng Reguiations aid Standards
Construe ri sVisor
CS-000998
j E' 'res 49/2912019
~ { � ,
VICTOR J WNIVIKAINEN:! "
PO BOX 69 r
WEST$ARNSTABLE fVl'A`02668
Commissioner
The Commonwealth of Massachusetts
Department of Industrial Accidents
— — Office of Investigations
_ 600 Washington Street
Boston,MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers
Applicant Information ,{� a Please Print Legibly
Name(Business/Organization/Indivi dual): GLO/� �'//y!
Address: v-5�—,g
City/State/Zipmtl�—l52�911,� MQzb,90 Phone#: 7914
Are you an employer?Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. I am a general contractor and I
mployees(full and/or part-time).* have hired the sub-contractors 6. New construction
2.JrI am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, []Demolition
working for me in any capacity. employees and have workers'
[No workers'comp.insurance comp.insurance$ 9. ❑Building addition
required.] 5. We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no � �,�
employees. [No workers' 13.�Other Iry//y�c3�S
comp,insurance required.]
*Any applicant that checks 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 a new affidavit indicating such
xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. .
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi under the airs andpenaltles of perjury that the information provided above is true and correct
Si afore: ` ' Date: C7
Phone#: �
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees•'
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
t-:
express or implied,oral or written•"
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs'persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced'acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C( )states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to-your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)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 affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
• 9
C1,�.,ld VM3_b9,VB_anv arnestions regarding the 1aw or if you-are_regtured to obtain a wo ers
compensation policy,please�call thaDepariment at the number listed below. Self-insured companies shouta enter taerr -
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit1license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out.each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum 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 Comm.Qnwealth of Massachusdts
Dgwtmennnt of Tndustdat Aeddents
Office Of Investigatious
600 Washington Street
Dostan,MA Q 1 I.1
Tel. 617-727-4404 ext 406 or 1-977-MASSAFE
Fax#it 6.17-727-7749
Revised 4-24-07 ��� a
oFINE r Town of Barnstable *Permit# 1 J 3
Expires 6 months from issue date
,,STABBAR Regulatory Services Fee '
v� Mass. Thomas F.Geiler,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 X-PRESS PERMIT
Office: 508-862-4038
Fax: 508-790-6230 JUL 15 2003
EXPRESS PERMIT APPLICATION - RESIDENTIA16QNLY
r Not Valid without Red X-Press Imprint OF BARNSTABLE
Map/parcel Number 4% 7,16:5--
Property Address
10 Residential Value of Work ®�
Owner's Name&Address7'g"�/� J/�/'�
AIAJ .S
Contractor's Name L� Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
Etworkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name ;'�� /
P Y
Workman's Comp.Policy# 7 I` / 910 f
Permit Request(check box) 14
Re-roof(stripping old shingles) All construction debris will be taken to &��
❑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: roperty O er must sign rty Owner Letter of Permission.
Ho e r men ntrac License is required.
Signature
Q:Forms:expmtrg
Revise053003
1
Fraser Construction
Roofing & Siding Specialists
FRASER CONSTRUCTION Warranties the shingles and labor for 10 years.
FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years.
CERTAINTEED Warranties the shingles and labor 100%for the first 5 years,
and then on a pro rated'basis for 30 years total if the shingles become defective.
CERTAINTEED Warranties the shingles to be ALGAE resistant for a full 10
years.
Any deviation or alteration from above specification will be executed upon
written`orders and will become an extra charge over and above the estimate. All
agreements contingent upon strikes, accidents or delays are beyond our
control. Owner should carry fire, tornado and other necessary insurance upon
the above work. We, if not accepted within thirty days may withdraw this
proposal.
FRASER CONSTRUCTION: Carries Workman's Compensation and Public
Liability Insurance on the above work.
DATE OF ACCEPTANCE: l2 (63-
t
SUBMITTED BY:
L
Homeov ner Fraser Construction
u
Board of Building Regula ions and Standards
One Ashburton P?ace - Room 1301
Boston. Massa, usetts 02108
Home Improvement ,o �tractor Registration
r=_ Registration: 112536
Type: DBA
59 Expiration: 3/23/2005
FRASER CONSTRUCTION Co
DEAN FRASER
71 TARRAGON CIR
COTUIT, MA 02635 `
✓r-t��7 a L*
Update Address and return card.Mark reason for change.
Address [:] Renewal 0 Employment Lost Card
,p� ✓fie >°ammwvuuea/,C�i `�'✓�aaae��xraetl4
�\ Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR befori.the expiration date. If found return to:
Registraioo 2536 Board of Building Regulations and Standards
9r - j One A,�hburton Place Rm 1301
-Expiration 3f23/2005
Boston,Ma.02108
TYPe _DBA
FRASER CONSTRUC-T—IR
DEAN FRASER ''' ' <'`''•'T
71 TARRAGON
COTUIT,MA 02635 Administrator Not valid without signature
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