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HomeMy WebLinkAbout0113 LINCOLN ROAD //�3 )- i r) cc e n a�o�. I I �ETHE Tp� 1 own 0f Barnsta le ermlt# ti�P� ti� Ecpires 6 mon from is,sucdafe Regulatory Services Fee .. * BARNSTABLE, Thomas F. Geiler, Director Alb MAy A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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-�7 17 J Property Address --_j—� /rl Ld /�� �TG _ 1 Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address ��Zu � Q-fiW., _— Contractor's Name___ t- Caly,f'% Telephone Number 4 �� Home Improvement Contractor License tl(if applicable)__ __-L-? 6C4 _ Construction.Supervisor's License#(if applicable) [Woorkman's Compensation Insurance Check onc: fis` ❑ I am a sole proprietor Q�� VI❑ I �m the Homeowner 20O8 ave Worker's Compensation Insurance f TO�/!V OF �fit�iVSTq�L� Insurance Company Name t...- p_ Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request (check box) Re-roof(stripping old shingles) All construction debris will be taken to f/ /Ull � rT ❑ Re-roof(not stripping. Going over existing layers of roof) ''' ; ❑ Re-side CD7 ❑ Replacement Windows/doors/sliders. U-Value (maximum .44.) M t a" *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,C nservation;7e c. 1 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of e Home Im rovement Contractors License is required. SIGNA"fUfZN;: Q:'.WPFIL.ESTORMS\huildingpennit forms\EXPRESS.doc Revised 100608 i s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,MA 02111' ��. Www.mass.gov/dia Workers' Compensation InsurAnce. davit: Builders/Contractors/Electricians/Plumbers Applicant Information // Please Print Legibly Name (Business/Organization/Individual): City/State/Zip: 6 • ��" Ph #: 776" g'71 Y S�dv��l� Phone.#: 7 Are.you an employer? Check the appropriate box: .Type of project(required):, 1.L'1 I am a employer with 4. [] I am a general contractor and I * have hired the stab-contractors 6. ❑New construction . employees (full and/or part-time). 7. Remodeling 2.❑ I am a'sole proprietor or partner- listed on the attached sheet. ❑ g ship and have no employees These sub-contractors have g, []Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp,insurance comp,insurance.t' required.] 5. [] We are a corporation and its 10.❑•Blectrical repairs or additions 3.❑ I am a homeowner doing all work . officers have exercised their It.E]Plumbing repairs or additions myself.[No workers' comp. right o£exemption per MGL 12.[]Roof repairs insurance.required.)t c. 152, §1(4), and we have no employees. [No workers' 13.F] Other 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, lContractors that check this box must attached an additional sheet sbowing 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. r 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: /V, Allgn,-7 City/State/Zip: Attach a copy of the workers' compensation policy declara ion page'(shoWWg the policy number and expiration date). Failure,.to secure coverage as.required under Section 25A of MGL G. 152 can lead to the imposition of criminal penalties of a fine tip 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 maybe forwarded to the Office of Investi ations of the IDIA for insurance coverage verification. I do,hereby certi u er a pains a e I ' of perjury that the in provided above is true and correct. Si ature: Date: OK Phone# 77 b � , Official use only. Do not write in this area, tb be completed by city or town officiat 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 Phone Contact Person: #: Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." « nor other le al enti or any or more .. associatio co oratio g ty, ed as an individual artnershi , n, rp An employer is defin ,p P 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 ersons to do maintenance construction or repair work on such dwelling house dwelling house of another who employs p , 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 pro.dueediacceptable 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 eo npliariee with the insurance have been resented•to the co authority." of this chapter g requirementsp P Applicants Please.fill out the workers' compensation affidavit completely,by checking the boxes that apply to,your situation and,if necessary,supply sub-conti•actor(s)name(s),address(es) and phone number(s) along with their certificate(s)of insurance. Limited Liabil.i.tyCompanies�(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 maybe 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. no 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:. `fhe,C0.=QUWQaM ofMUS-3Ghusl*s �aaz at of kdus al Accidmts Office of lavestigatioas 600 Washingtai Strce B.ostar2,-l�iA Q211 TO. 617-727-4500 ext 406 or 1-�77-MASSAFE Fax# 617-727-77-49 Revised 11-22-06 W.ITtavSs.�E"�v�di� Is la nd s iding a nd Ro.ofing a division of RL7Const,=tion,Inc. October 28,2009 Proposal To: Elizabeth Savoia Re: 113 Lincoln Rd. Hyannis 50 Saddleback Rd. Mashpee,Ma. We are pleased to submit the following specifications and estimates for re-roof Remove existing shingles and flashings. Install aluminum drip edge and pipe flashings. Install 3 ft. ice shield to eaves, valleys and chimneys. Install 15 lb. paper to remaining roof. Install 30 yr. Certainteed architectural shingles. Clean up and haul away debris. We hereby propose to furnish material and labor complete in accordance with the above specification, for the sum of: $1,900.00 PAYMENT TO BE MADE AS FOLLOWS: Payment in full due upon completion All material is guaranteed to be as specified. rationsl work to be completed ina or deviations from the above specifications involving according to standard practices. Any extra costs will be executed only upon wrin strikes tten rs,and will accidents,or become delays beyond ouront ol. owne s to estimate. All agreements contingent upo > insurance.. RLT Construction,Inc.carries General Liability carry fire,wind damage andother necessary and WorkmaWs Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above price specifications s pec ficonditions are satisfactory and hereby accepted. You are authorized to do the workas d. Payment will be made as outlined above. Date of Acceptance: Signature -� i Start Date: Signature 31 Manni Circle Centerville, Massachusetts 02632 7ele hone 508.420.5243 and 508.833.5249 fax 508.420.1776 Email caperoofer@caperoofer.com p 1 (5/7z Mlissachusetts- Depai-tment of Public Sat'et-, Board ot4Buil8ing Regina u s and Stagy �, r. Board of B'i iid ng Reg-ulations and Standards = HOME IMPROVEMENT,CONTRACTOR Construction'Supervisor Specialty License Registration, 134286 License CS SL 99910 _ Ex- irati- Restricted to RF,WS }i P # -10/22/20b9 Tr# 133426 TYPe DBA RONNIE TAYLOR 71 RLT CONST. INC!D�A IS7 ` ,-O SIDING& 31 MANNL CIRC LE CLE RONNIE TAYLOR `I ?> CENTERVILLE, MA 02632 31`MANNGCIRCLE f/Z' i. CENTEkVILLE MA 02362 " Administrator. f' 1(A _ Expii' t on• 10/26/20 1 Cuiumissiuner 1 A trt License or registration.validf for.individul use only;.' ? before the expiration date:-.4f:found return,io: Board'of Bu►Ming Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 DILIk M wts� A ' ` of valid without signature F 1 03113-AM tiARTFORD .\ 2420 LAKEMONT AVE STE 100 ORLANDO FL 32814 C.P 01 6640 G6640POS 08278 03113 P1 TOWN OF BARNSTABLE ATTN: BUILDING DEPARTMENT 200 MAIN STREET HYANNIS MA 0260.1 REINSTATEMENT NOTICE Please take notice that the Policy designated below has been reinstated as of the effective date of the reinstatement stated below,notice of cancellation heretofore issued being hereby withdrawn as null and void. { POLICY NUMBER:(GS60UB-1 051 C04-5-07) ISSUE DATE: 10-03-08 - NAME AND ADDRESS OF INSURED PRODUCER OR AGENT - R L T CONSTRUCTION INC EDWARD A GRAZUL INS Qy 38Y2K 31 MANNI CIRCLE ISSUING OFFICE CENTERVILLE MA 02632 ORLANDO DA HTFD 05G EFFECTIVE DATE OF THIS NOTICE VEHICLE IDENTIFICATION 10-20-08 (Comp'ete for,htto Policies or&verages Only) LOCATION (Comp'ete)br Fire_Policies or Fire Coverages ONLY) WRITTEN NOTICE IS HEREBY GIVEN TO YOU AS: ❑X THE PERSON TO WHOM AN INSURANCE CERTIFICATE WAS ORIGINALLY ISSUED OR A BANK OR FINANCE COMPANY; AN ADDITIONAL INSURED UNDER THE TERMS OF THE POLICY; El A MORTGAGEE THIS NOTICE IS GIVEN ONLY BY THE COMPANY OR COMPANIES WHICH ISSUED THE POLICY DESIGNATED ABOVE. Page 1 of 1 CN 00 3C 03 94 RightFax C1-2 4/23/2008 8 : 58 : 36 AM PAGE . 3/003 Fax Server ACORD. CERTIFICATE OF INSURANCE DATE(MM\DD\YY) 04-23-08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EDWARD A GRAZUL INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO BOX 337 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE MARSTONS MILLS,MA 02648 COMPANY 28Y2K A 14ARTFORDGROUP INSURED COMPANY B R L T CONSTRUCTION INC COMPANY 31 MANNI CIRCLE C CENTERVILLE,MA 02632 COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED-BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - -- CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM\DD\YY) DATE(MM\DD\YY) LIMITS GENERAL LIABILITY. GENERAL AGGREGATE $ . COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY. $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS . BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH`ACCIDENT_$ AGREGATE-i EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE OTHER THAN UMBRELLA FORM AGGREGATE - $, WORKER'S COMPENSATION AND A EMPOLYER'SLIABILITY UB-1051CO45-07 12-24-07 12-24-08 STATUTORY LIMITS THE PROPRIETOR/ EACH ACCIDENT 4 r i $ 100,000 PARTNERS/EXECUTIVE X INCL. DISEASE-POLICY LI�IT $ 500,000 OFFICERS ARE: EXCL DISEASE-EACKEMP OYEE _.$ 100,000 OTHER c-D- I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE THEREOF,THE ISSUING COMPANY W ILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT ATTN:BUILDING DEPARTMENT - FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OFANY 200 MAIN STREET KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE - -ACORD 25-5(3/93) Ramani Ayer ona ..-- Expirn �0�1;► Fee (�/�/ .,..; Regulatory Services �pT & ►v°e'� Thomas F.Ge&x I)h* or xP �Qg� Building Division �Es Peter F.DiNfatteo, BuildingCommissioner g m,02601w_ BAR PERMIT 367 l�iam Street, yams. fob ZOQl Office: 508-562--038 N OFBARNS Fax: 508-790-62.0 EXPRESS PERATIT APPLICaT'ION - RESIDENTIAL ONLY TABtE Not YkUd widaut Fad X-Pmsb"PrW Vlap.,parcel Nurnber 2 C�6 2 Property Address M Residential Valtu of Work Owner s Name&Address Xe-9 c S 7a�rS /'���L5 -S r 3� Conaactor's Name me / , ,1.� Telephone Number Home improvement Coaaactor license#(if applicable) r s © 3 Construction Supervisors License=(if applicable) i C • 9 QWorkman's Compensation Insurance Cluck one: Q I am a sole propriewr I am the Homeonmer I have Worker's Compensation Insurance Insurance Company Fame Worianan's Comp.Policv Permit Request(check box) Q Re-roof(snipping old shingles) Re-roof(not stripping. Going over existing iayots ofroof) Re-sidaly e- . Replacement Windo«s. U Value (Imaxintm-44) /Pvot_ Other.(specify) *Wh=required: Issuance of this permit does not examt compliance with other town deParane:st regulations,i.e Historic.Conscn anon.::-. Signature Q:Forms:eapmtres:rev-4);0601 M�1 1-ti?�\��►�1t �! ` t _ �lltf b JAOfINu/rv....--..----- ��� Re Services Regulatory Svices Fee =�asaxsT/►et�f•., b � 9c� t� �e°% Thomas F.Geiler,Dlreetor i pTEO1A"iav Building Division Peter F.DiNIatteo, Building Commissioner 367 Main Sores, Hyazrms,MA 02601w Office: 508-562-038 Fax: 508-7 90-6?_0 E 'PRESS PERATIT APPLICA1TON - RESIDENTIAL ONLY Not Yalid without BidX-Prat,[zpnW Maprparcei.Nurnber _,� L4 S' Property Address 15' L.! nD a. ane. J4� q nn i s,. M ck- o z&g / ER/Residenrial Value ofWork H1060 , Owner's:Fame B:address f_ C CL K►J M A!v.''�n C 0 4 e. eLa 1, an-e, e nnI`s Contractor's Name 0 l /V C B d Ud 0-Gy _Telephone Number 0 613 Home improvement Contractor license (if applicable) o 7 3 Construction Supervisor's License=(if applicable) Z-2 V _ t zwor,kman's Compensation Insurance E k one.- am a sole'proprietor Q I am the Homeonner &*I have Worker's Compensation Insurance Insurance Company Name I R A V t_l-e v-S tv S UR a n C e L-0 4,1 Workman's Comp.Policy `j p U - 7 I cJ ?0 S"®'2- Permit Request(check box) X-PRESS PER T Q Re-roof(stripping old shingles) MAR 1 12002 Q Re-roof(not stripping., Going over existing layers ofroof) TOWN OF BARNSTAB rE Q Re-side LI s 31 U_ i Cq,e rn ZKReplacetnent W indotitis. U-Value (=xh=-44) �2 LI CL Pt c.-e Pe d e ra C u M I) ,3 rJ y Q'Other(specif,) S t A.Q l� R e. 19L t4 rn.e/V T Ai ;L C Felt � ('All d4 son Porat-j ,S'Q.,,JtonAL •When:required: Issuance of this emit does not exenspt compliance with other town depattrnatt regulations.i.e.Historic.Consen-4tion.em Signature Q:Forms:a xpmrrg:res-070601 s lv. ra t � r 61 g �_ �enseQ3{Vo�F�t10�Ay�Sll� k 128,NADYSIPPER LN ►�` n - j s � MARuTOMS Po11LLS: MA:Q284$ Admr�tr�toi�� ti v ,�