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HomeMy WebLinkAbout0069 OLD TOWN ROAD ��I ,� _�_... r Town of Barnstable *Permit Expires 6 nihs from issue date Regulatory Services FeeHAS s N • s,►FuvsrAar.E, 9Q� 1Q `0� Thomas F. Geiler,Director Building Division Tom Perry,CBO, Building Commissioner. 200 Main Street,Hyannis,MA 02601 www.town barnstable.ma us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel NumberAffin � Property.Address 61 ® Id louind • !S e Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address i e— l l c K�e_y\ 5 0YN Contractor's Name Ne_yi>x c n Rf+ h 14?q 6�" n Telephone Number 0'9 L-4 4 L f 50 Home Improvement Contractor License#(if applicable) 1-7 2- 3 Construction Supervisor's License#(if applicable) 9 2,-7 Z d 4Workman's Compensation Insurance XPRESS P �p C eck one: � �BI�� I am a sole proprietor MAY I am the Homeowner 3 1813 I have Worker's Compensation Insurance Insurance Company Name. me-i d lri TOWN OF 83ARNSTABLe Workman's Comp. Policy# - Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Q ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to V" ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side (r-ca t-a rt,y #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. i SIGNATURE: Q MPFILESTORMS\building permit forms\02RESS.doe Revised 053012 I LEV>!CORPORATION l 1090 Bnsfol Rd,Mountainside,NJ 07092._ Phone:(908)65;0wt.. Fax:(90,8),554 8069 Certifcate of Attendance an Successful Completion Renovator Initial-English ?ei•40 CFR'Part 745.225 HENNING HALVORSEN 27 PINEHURST RD. - EAST FALMOUTH.MA.02536 - Identification Number.R-1-18342-10-057� - Course Date:07C20/10 - - Examination Date:0720110 - Expiration Date:0720115 0728110 ;,•rt _ _ - Date Training Manager/Principal Instructor- -_--_—___—--- -� Massachusetts - Department of Public Safety Board.of Building Regulations and Standards Construction Supenisor License: CS-092720 I HA; HENNING M IjVORSEN III gg6 Canterbury Lane. t�" East Falmouth MA MIXAS_;y J,.`+•� J1 ` ,� r,F Expiration Commissioner 05/02/2015 1 ��ie Voon�naniuea`64 a1C�/�/laadaC1U1dez4 return to: ` License d for or teg!sr Lion date If found use ulation �. Office of Consumer Affairs&Business Regulation before the'exp► r Affairs and Business Rel; — ME IMPROVEMENT CONTRACTOR �> Office of Consu Suite 5170 gistration ;72374 Type: j lOYark?l'aza- piration 6�19E2A14 LLC Boston,MA 02116 j BARNSTABLE HANDYMAWISERVEIFS,LLC. HENNING HALVORSEN 27 PINEHURST RD hOut signature Not valid �``I E.FALMOUTH, MA 02536 Undersecretary I I �.. __.-, 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/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): iQ C n 5 ✓— +iq b Iva ��V� � r y 9 Le 5 (/7��eP7i1 ihY 'NAl vow►) T Address: b C r4hA-e_C Lv•(-V L(I City/State/Zip: 1qr Phone#: 56 1f IL._6 7 77 Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.;Kj am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y p h'• 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.❑Other 5 e a'h 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. i Insurance Company Name: I YY_i /Cm-150 Policy#or Self-ins.Lic. C P' !a� � I Expiration Date: ci& Z Job Site Address: 6 (01A I o yi Y1 KJ • City/State/Zip: 1s � 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 frie 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 of perjury that the information provided above is true and correct Si ature: lrQ^^ �i �^ � g�l�v� Date: 5l ( I Phone#: Official use only. Do not write in this area,to be completed by city or town official h 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#: 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, 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 jowner of a dwelling house having not mI- 1ore than par three atments�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),, ;o 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 constructybuildings 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." X1 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 Inv`estigationahas to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be use&as a'refeience 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: '' "'`'fI � The Commonwealth of Massachusetts f _E• 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 05/31/2013 09:17 5084577660 ALMEIDA & CARLSON PAGE 01/01 DATC 4MINDMNW) ACCMa- CERTIFICATE OF LIABILITY INSURANCE os13112013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS ' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polley(les) must be endorsed. It SUBROGATION IS WAIVED, subject to the terms and condmotm of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the coMficete holder In lieu of such endomment(s). PRODUaER Phone: 808.U"'I61 Fez; 5569-a57-7960 OONTACT BobAll(ette ALMEIDA&CARLSON INSURANCE AGENCY INC. PHONE S08 $8$-0207 ax (508)888-0550 P.O.BOX S54 rallletta@almoidacarlson.com FALMOUTH MA 02S41 _.._... _........ _._.— INSURER(S) AFFORDING COVERAOE NAIL 0 INSURER Western Heritage Insurance Co ------ ... --...--........... .... .. BARNSTABLE HANDYMAN SERVICES LLC INauRER B : Ace American Insurance Co CIO HENNING M HALVORSEN INSURER c 8 CANTERBURY LN MURER D, EAST FA-MOUTH MA 02538 INSURER E weuRFrt F ; COVERAGES CERTIFICATE NUMBER: 24426 REVISION NUMBER: 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO All.THE TERMS, EXCLUSIONS AND CONDITION$OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEN EDUCED BY PAID CLAIMS, INSR. TYPE OF INSURANCE I ADVL SUDR POLICY NUMBER POUCY RFF I POuc►EaP LIMI?9 Lam__....__--_....._. MBR, NIVO - .—_.. ....._ (NMMI)M.Y.n. (nMI off.y. 'J _ _..._._ . A 6214M I �B� SCP0900389 09/28/12 09128M 3 EACH OCCURRENCE R 100,0()0 T COMMERCIAL GENERAL LIABILITY D/wlAaEroRERTEb-"' � 100,000 mmISES Eo ooamanc%) „•.-• CLAIMS-MAOF- I X I OCCUR MED.EXP(Any one person) S 5,000 PERSONAL B ADV INJURY E 100,000 OENERALAGGREGATE R 2,000,000 GENI-AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AG. S 2,000,00. PRO- POLICY "I I._... LOC S AUTOMOBILE UABIUr --- COMINE081NBLEUMrr IEo naeMe� E ANY AUTO BODILY INJURY(Per person) S ALL OWNED —SCHEDULED AUTOS AUTO I BODILY INJURY(Per soddent) E HIREDAUTOS AUTOS NON-OWNED PRtlPEtPrVI ;'__... ---------..... (per eocMnnO $ -----LIAB - - —.._ LA OCCUR —__.—..._.... -•-. UMNIML --- E1CM OCCURRENCE S ExeFas IJAB I CLAILr—MADE AGGREGATE S - DED RETENTIONS g B M10� COA1D LIMU 6862353 09l21112 09l21M3 �"1° YA�-�_- AND ERS CO Ra' ruelurr TCRV UMrts ER S ANY PROPPJBTORIPARTNERIEiECUMT rY/N E.L.EACH ACCIDENT S+ 100,000 OFFICOt(EMBER F•YC=PJ)? (MwMnroyMNH) I NIA E.LDISEASE-EAEMPLOYEE S - 100,000 nws aoeenoaun4o. ..._ _ -- RE(MIMONofOPERATIONSbelow - E,I„DISEASE-POLICY UMR R 500,000 I _ DESCRIP'(ipN OF OPERATIONS/LOCA770NS!VEMCLFS(Aaseh ACORD 107,AdAhlonal Rmnarxs ScnoduM,K more space 16 mqulred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DrSCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BARNSTA13LE BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. AUTNOR�D RF,DREQENTATIVE .. �._r//p—�. ' Attentlon: 508-790-6230 Bob AlIWW ACORD 25(2010/05) 0 1999-2010 ACORD CORPO T1ON, All rignts ra The ACORD name and logo are registered marks of ACORD f PROPOSAL FID# 092720 028 Date:4/16(13 092720 CSL# HIC# 172374 Insurance Agency: Almeida!Carlson 27 Pinehurst Rd. E.Falmouth,MA 02536 508-444-6879 www.barnstablehandyman services.com ame:Mike Dickenson Job Address:69 Old Town Rd. ddress:282 Plains Rd. ity/Town:Hyannis,Ms. ity/Town:Ballston Job Phone: te:N.Y. Other Phone*518-788-7630 ip:12020 MtKG,��cKPSo1 .mail: Estimator: Marty_Halvorsen We hereby submit specifications and estimates for the following work:Vinyl siding. t.Take down shutters and strip cedar siding on front of house and dispose of trash properly. 2.Put half inch backer on front areas to be sided.Put Mastic/Quiet Willow,(which is a shade of green) chosen by customer on front only.All wood trim will be covered in white aluminum trim and 3/4 inch J-channel including windows,door,and fascia.Soffit holes will be drilled between rafters and white vented soffit to be installed.White colonial comers will be installed on two front comers. Black vinyl shutters will be installed over siding.Siding and backer nailed with 1 1/2 inch aluminum roofing nails. "Job will take I to 2 weeks weather permitting. "Contractor will pull permit. abor&Materials: 0,860.00 jWe look forward to working with you. Please call if you have any questions. Sincerely, H.Martin Halvorsen Bamstable.Handyman Services,LLC Accepted By: /%f l� Date:-4A*" J f zcj J l 3 THIS PAGE IS PART O AND IN CONFORMANCE WITH:PROPOSAL#: d FID# 27-0281028 CSC# 172720 Dates-4 HIC# 172374 l � +3 Insurance Agency S Imeida/Carlson 27 Pinehurst Road E.Falmouth,MA 02536 508-444-6879 www.barnstablehandymanservices.com Name:Mike Dickenson job Address:69 Old Town Rd. Address:282 Plains Rd. City/Town:Hyannis,Ma. City/Town:Ballston,N.Y. Job Phone: State:Ma. Other Phone:518-788-7630 Zip:12020 Email:mike dick@ Estimator: Marry Halvorsen ."SQ r-400 ri SWX t cC,C N This is the entire agreement of the parties. Any discussions or, verbal agreements are superseded by this agreement. Such agreements, even those of the smallest nature, must be in writing and signed by both parties. This contract price is for standard industry installation procedures and also includes only the specifications attached to this agreement. Any work or product not contained in this agreement would be subject to an additional cost as required or requested. The attached Specifications and Estimates are incorporated herein. CONTRACT TOTAL $3,860.00 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Pursuant to M.G.L.Chap 142A,the parties agree to submit any dispute to a private arbitration service ,approved by the secretary of the Executive Office of Consumer Affairs and Business Regulation,One Ashburton Place,Boston, MA. Signature(s): '"— Date: 3 .A''1 ) 3 This contract is not valid unless signed by company representative: Signature: H. Martin Halvorsen Date: 4/16/13 1 may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof, provided the seller is notified in writing at his main office branch by ordinary mail posted, by telegram sent, or by delivery, not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right job is estimated to commence approximately 2 weeks after deposit is received. Scheduling may be affected by jobs requiring historic approval,which involve ordering materials with more than a five-week lead-time. Total production time to be approximately:' Substantial Completion Date: 6/30/13 If acceptable, initial here: Start and completion times area proximate and subject to change due to, but not limited to,the following circumstances: weather delays, additional work, permitting delays due to town regulatory boards. In the event of rot repairs, roof repairs or work requiring immediate attention where it would be detrimental to delay,we will proceed without customer approval in order to protect the property. BARNSTABLE HANDYMAN SERVICES,LLC provides a five(5)-year unconditional labor warranty against faulty workmanship on all services provided. All warranties will be null and void if account is not current and paid in full. A Warranty Inspection by a BARNSTABLE HANDYMAN SERVICES, LLC representative is required annually in order for all labor and material warranties to remain in effect. BARNSTABLE HANDYMAN SERVICES, LLC warranties labor only for all customer supplied products/ materials. Workmen's Compensation and Public Liability Insurance on above work to be taken out by BARNSTABLE HANDYMAN SERVICES, LLC. All special-order materials must be chosen, ordered and received before start of job. There will be no refund for special-order windows, doors, or any other special order. Special-order materials not received in time to produce job will cause a delay in scheduling and possibly cause job to stop until material is available. BARNSTABLE HANDYMAN SERVICES, LLC will provide construction-related cleanup,and all debris will be removed from the site. Professional interior cleaning is not included in proposal. Owner is solely responsible to move all personal objects,furniture, etc.,from work area. BARNSTABLE HANDYMAN SERVICES, LLC is not responsible for any damages if said items remain in place. In the case of any roofing and/or ridge venting,dust and debris should be expected,and any items in the attic should be removed or covered to prevent damage. Curtains, drapes and window and door treatments may need proper reinstallation or replacement by customer due to sizing on any window or door replacements and is not included in jobs contracted with BARNSTABLE HANDYMAN SERVICES, LLC. BARNSTABLE HANDYMAN SERVICES, LLC is not responsible for any damages that may occur during construction to landscaping or any finish groundwork, plantings,asphalt or stone driveway,etc. Flowers and shrubs-against house may need to be repaired or replaced by homeowner. BARNSTABLE HANDYMAN SERVICES, LLC is not responsible for snow removal from jobsite area or access ways.(If snow removal is required for access to the site by contractor or its subcontractors, additional charges will be in rred). Accepted by: Date: 43 �1�`i -3 Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. All agreements contingent upon Acts of God, accidents or delays beyond our control. Owner to carry Home Owner's and other necessary insurance upon above work. Contractor shall obtain any and all necessary permits. Owners who secure their own construction- related permits or deal with unregistered contractors will be excluded from access to the Guaranty Fund provisions of 14 GL c. 142A. Any further changes to proposal will be referred to as additional work authorizations and can be authorized by either one or both of the original authorized signers on proposal by fax,email,or original signature. TERMS OF PAYMENT Down Payment: $2,560.00 At Start of job: $650.00 Upon Completion: S 650.00 "Customer may retain the value of any remaining minor items until they are completed. ALL PROGRESS AND FINAL PAYMENTS TO BE MADE TO BARNSTABLE HANDYMAN SERVICES LLC AFTER NOTIFICATION THAT PAYMENT IS DUE. LATE PAYMENTS ARE ASSESSED A MONTHLY FINANCE CHARGE OF 1 16%PER MONTH. IN THE EVENT OF AN ACTION FOR COLLECTION CUSTOMER IS RESPONSIBLE ALL COSTS OF COLLECTION INCLUDING REASONABLE ATTORNEYS FEES AND COSTS. CANCELLATION OF AGREEMENT:Should Owner cancel this Agreement for any reason prior to the Rescission Date of this Agreement,Company shall return to Owner all payments made under this Agreement within ten (10)days of receipt of the Notice of Cancellation of this Agreement,which is incorporated herein and made a part hereof. If the Agreement is breached thereafter without consent of the Company, liquidated damages of 20%of the cash price of the Work, plus a proportionate share of all Work and costs already performed will be due the Company. To cancel this Agreement, mail or deliver a signed and dated copy of the Cancellation Notice or other written notice to the Company at its address noted on this Agreement no later than midnight of the third business day from the date of this Agreement. Accepted by: Date: 4f 1 i T,.. a 1 1 3 NOTICE ALL CONTRACTORS AND SUBCONTRACTORS MUST BE REGISTERED WITH THE COMMONWEALTH OF MASSACHUSETTS. INQUIRIES SHOULD BE DIRECTED TO: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, MA 02108 (617-727-8598). THE INTENT OF THIS PROJECT IS NOT TO PERFORM ANY TYPE OF ENVIRONMENTAL REMEDIATION. IF YOUR PROPERTY WAS BUILT PRIOR TO 1978,YOU WILL BE GIVEN A PAMPHLET"PROTECT YOUR FAMILY FROM LEAD IN YOUR HOME"AND ASKED TO SIGN AN ACKNOWLEDGEMENT OF RECEIPT BEFORE THE COMMENCEMENT OF ANY WORK. ACCEPTED BY: '^- DATE: a 1� 46 3 >�')-i NOTICE OF CANCELLATION This notice refers to a proposed sale to be made by the creditor named below: To: Mike Dickenson (Name) Of: 69 Old Town Rd. Hyannis,Ma. (Address) Date of Transaction:A4_1" . l"may I_:3 You may cancel this transaction,without any penalty or obligation,within three business day from the above date. If you cancel,any property traded in,any payments made by you under the contract or sale, and any negotiable instrument executed by you will be refunded within ten business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel,you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this contract or sale, or you may, if you wish,comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty days of the date of notice of cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller, or if you agree to return the goods to the seller and fail to do so,then you remain liable for performance of all obligations under the contract. Any job cancelled after the 3-day rescission period will have costs incurred that will be reduced from the deposit. The amount depends on the time and related costs associated at time of cancellation. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice,or send a telegram to: Barnstable Handyman Services LLC, 27 Pinehurst Rd, E. Falmouth, MA 02536. NO LATER THAN MIDNIGHT OF(Date) 4/21/13 I hereby cancel this transaction Date: Buyer's Signature: Acknowledgement of Receipt The undersigned customer acknowledges receipt of two copies of this No ' f RRi .0 Cancel (Date) d/- ; }-/ t1 3 (Customer's Signature) (Date) (Customer's Signature) t FID# 27-0281028 5L# 092720 Date:4/16/13 HIC# 172374 Insurance Agency: Imeida/Carlson _ 27 Pinehurst Rd. E.Falmouth,MA 02536 ,508-444-6879 Ba rn stab)eh andyma n se rvi ce s.com Name:Mike Dickenson job Address:69 Old Town Rd. Address:282 Plains Rd. City/Town:Hyannis,Ma. City/Town:Ballston job Phone: Late:N.Y. Other Phone:518-788-7630 Zip:12020 . Email mikes 1 Estimator: Marty Halvorsen yN lt<'�. D. STATEMENT: J The intent of this project is to perform renovation and remodeling work in accordance with the scope of work in this proposal. The intent of this project is not to perform any type of environmental remediation. The U.S. Environmental Protection Agency requires that we, as professional remodelers, distribute the pamphlet, Protect Your Family From Lead in Your Home,to owners and tenants of pre-1978 housing before starting any remodeling activities. Please read the acknowledgment statement and sign below. This form must be kept in our company files for three years after completion of the remodeling project. I have received a copy of the pamphlet entitled Protect Your Family From Lead in Your Horne informing m'a of the potential risk of lead hazard exposure from renovation activity to be performed in mywyeyll+ig un' feceived this pamphlet before the work began. H. Martin Halvorsen Signature df Owner(s)/Occupant(s) Company Representative i 1- Date STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT WE, Mike Dickenson, , OWN THE PROPERTY LOCATED AT:69 Old Town Rd. Hyannis,Ma. I HAVE AUTHORIZED BARNSTABLE HANDYMAN SERVICES LLC TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR; THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHU S STATE BUILDING CODE. SIGNATURE OF OWNER: _-=✓�-- OWNER'S ADDRESS: 69 Old Town Rd. Hyannis,Ma. OWNER'S TELEPHONE: 518A88-7630 APPLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 6 Canterbury Ln.E.Falmouth,Ma.02536 APPLICANT'S TELEPHONE: 508-444-6879 RESPONSIBLE OFFICER: H.Martin Halvorsen RESPONSIBLE OFFICER ADDRESS: 6 Canterbury Ln.E.Falmouth,Ma.02536 RESPONSIBLE OFFICER TELEPHONE: 508-444-6879 DATE: 4/16/13 . I oF� row own of Barnstable *1,��,r� � l � 7 ' ' � . �K. gn Kvp res 6 monihs from issue date sr tr Regulatory Services Fee - -,, {�A Y a..9. 0 - Thomas F.Geiler, Director Building )Division TO.WN OF 13ARNST Tom Perry,C130, I3uildiug Commissioner P/ �� 200 Main Street, Hyannis, MA 02601 www.town.barnstablc.ma.us Office: 508-862-4038 tar: 508-790-6230 EXPRESS PERMIT APPLICA'TiON - RF,SIDENTIAL ONLY / Not Valid wilhoul Red V-Press Imprint. Map/parcel Number Gy G ,19 Propc Address _ �i � ��� ,/ ir'l�,i� � 'p�� ( �• ZResidential Value of Work L� Miuimunn'fee of$25.00 for work raider$6000.00 Owner's Name&Address �y c ltl.; Contractor's Name_ i� I s2�z' /` Telephone Number_, Home Improvement Contractor License f6(if applicable) Construction Supervisor's License ti(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I a e Homeowner El_ have Worker's Compensation Insurance Insurance Company Namely �_� •j U/Y�i i Workman's Comp:Policy 1k ,z(-7 Copy of Insurance Compliance Certificate must be on file. Permit Request(chec box) Re-roof st( ripping old shingles) Al(construction debris will be taken to ❑ Rc-roof(not stripping. Going over existing layers of roof) El IZc-side ElReplacement Windows. U-Value (maximum .44) 'Whcrc rcyuircd`. Issuance of this permit does not exempt compliance with other town department regulations,i.e.11istoric,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Per Home Improvement Contractors Li cnsc is required. ' SIGNATURE: Q.f6rms:cxpmtig Rcyisc071405 i Boar of . ul mg egula on*an a n ar s One Ashburton Place - Room 1301 Boston_ Massachusetts 02108 Home lmprovement Contractor Registration Registration: 103714 _ _ _-=- Type: Private Corporation & SONS INC. Expiration: 7/9/2010 Tr# 269847 PAUL J. CAZEAULT Paul Cazeault _ 1031 MAIN ST - _ — OSTERVILL-E, MA 02658 _ Update Address and return card.IMark reason for change. cn, a soon-o7iw-Pcaaso Address Renewal Employment ❑ Lost Card ✓�ze >°rnn�nw�wed�i a�✓uLab.�ac�uae� - _ .. - . .. . Board of Building Regulations and Standards License or registration valid for indi'vidul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 103714 Board of Building,Regulations and Standards Expiration_,77/9/2010 Tr# 269847 One Ashburton Place Rm 1301 _TypePnvate Corporaiion Boston, fVla. 02108 'AUL J.CAZEAlJL1.kS9NS,1NE. r_l J�o *� iINlassachusetts - Department of Public SafetN Board of Building Regulations and Standards Construction Supervisor License License: CS 26325 Restricted to: 00 i PAULJ CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 i I Expiration: 10/20/2011 ('ummissi mer Tr#: 7088 .. EIG Fax Server 8/11/2009 12 : 59 : 08 PM PAGE 2/003 Fax Server Kf AI�QRD- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/11/2009 PRODUCER-(800)666-0200 FAX (781)261-1111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 77 Accord Park Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Unit 131 Norwell , MA 02061 INSURERS AFFORDING COVERAGE NAIC# INSURED Paul 3 Cazeaul t & Sons Inc. INSURER A: National Union Fire Ins Co PA 1031 Main Street INSURER.6: Ostervil l e, MA 02655 INSURER C: INSURER D: INSURER E. COVERAGES 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 BY THE POLICIES.DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE-MMIDDIYY- DATE MMIDDIYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY _ DAMAGE TO RENTED y CLAIMS MADE ❑OCCUR - MED EXP(Any one person) $ PERSONAL&ADV INJURY $ f - GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLELIMfT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS - _ - 80DILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY • - EACH OCCURRENCE $ OCCUR CLAIMSMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND W0009757764 09/10/2009. 08/10/2010 X rolzv LIAM TS OT EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 10000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 10000 It yes,describe under SPECIAL PROVISIONS belay - E.L.DISEASE-POLICY LIMIT $ 50000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 03O_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. For Your Information AUTHORIZED REPRESENTATIVE Ronald Cleaves/REF1 C " ACORD 25(2001108) ©ACORD CORPORATION 1988 d� The Commonwealth of Massachusetts Page 10 of 10 Department of Industrial Accidents [ '+ Office of Investigations t i r U- 1 600 Washington Street Boston,,NIA 02111 wivw.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly P }uL - �2Zeav��` Sons I� A a0 A-) U�iVL Name (Business/Organization/Individual : Address: a 1 Yl s City/State/Zip: (`�5 T�I 1_�e— M 87()2(o SS Phone#: S I -1-7 o�— - 1 Are you an emp;proprietor r?Check the appropriate box: Ty;E] of project(required): with [2 4. ❑ I am a general contractor and I 6. New construction 1.,� Iamaemployer employeesl and/or art-time .* have hired the sub-contractors p ) listed on the attached sheet x ❑Remodeling 2.❑ I am a sole or partner- Demolition ship and have no employees These sub-contractors have 8- ❑ working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their ri ht of exemption er MGL 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work c g152, §1(4),and.a have no 12.0 Roof repairs myself.[No workers comp. insurance required.]t employees.[No workers' 13.❑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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: .���l/�6✓�—,CT�� �i1 r l> Policy#'or Self-ins.Lic.#: U/C Qd 'l1"7�� Expiration Date: �1D V 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 prisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine fine up to$1,500.00 and/or one-year im sed that a copy of this statement may be forwarded to the Office of of up to$250.00 a day against the violator. Be advi Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature'- Date: Phone#: r2Og ' 2 - t—1 FLssuingAuthority only. Do not write in this area,to be completed by city or town officiaL n: Permit/License# y(circle one):health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector rson- Phone#- ' 3/31/2010 08:5G^gFAX 15084204555 CAZEAULTROOFINGCOMPANV fa 001/001 ,7 propoty Owner Must Complete & Sign This Form if Using'' a'Roofer/ Builder. I r�►�� L s Owner Agent of tht� subject property hereby aufhorizes Pain J. eazeault& Sons Roofing Inc. to act` on.my behalf, in aN matters relative to work authorized by this building permit*p- Mcadon for: Address of Job X. 44 oen � , I Sig�stbre of Own - 1�lalld ng Addmss'of der i I' Te146hone# DatO_ 1; (Please return this form to Cazeault rooting along Wb your signed contract;.It is n®eded for us-to obtain the "br bind ng erm r 'rred:by your town, to complete your roaing Project,th2llk you)fax#508-42-0-4555 II f I V 1 :6 141 I E DIN y u'v 31MR, A Il i.