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Home My WebLink About0037 SEAGATE LANEf Town of Barnstable *Permit# -70 a 1 Fxpires 6 months from issue dale Regulatory Services Fee._ : Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 0260.1 www.town.barmtable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PEPMT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address ec, r 00 [�Residential Value of Work 3 c70 0 - Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address l C C� �}-'L✓ )2..e(-4 fj yar?/I1 Contractor's Name. Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) PE , Wit a ❑Workman's Compensation Insurance )C"'pRESS Check one: DEC 2 6 2007 I am a sole proprietor Ef I am the Homeowner ❑ I have Worker's Compensation Insurance -TOWN OF SARNSTAI Insurance Company Name 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 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side �01 ✓� (" Replacement Windows/doors/sliders. U-Value maximum.44 ( ) ..._,.y,w-�-•--....�.... 'Where required: Issuance of this pemut does not exempt compliance with other town department regulations,i.e.Historic,Conservation,,etc. ***Note: Property Owner must sign Property Owner Letter of Permission 00 :C. j,`j 90 J301001 A copy of the Home Improvement Contractors License is required.. r - 91 sq ry jj 3IGNATURE: �Torms:expmtrg teyise061306 ' The Commonwealth of Massachusetts Department of.Industrial accidents Office of Investigations 600 Washington Street Boston.,MA 02111' wwww.mass gov/dia ' Workers'Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers A.Pplicant Information Please Print Le ' I �- 1121ne(Business/Organizatian/Fndividual):• �/ 'l . Address: -� �� L c U2wi Phone.#: So S6�` y S l city/state/zip:_ �y� 0,11 s , /'1 Are you an employer?Check the appropriate boa: -Type of project(required):. 1,❑ I am a employer with 4. (] I am a general contractor and I 6. ❑New construction . employees (full and/or part time).*• have hired the sub contractors 2.❑ I am a'sole proprietor or parb=- listed on the attached sheet. 7. [✓]Remodeling ship and have no employees . These sub-contractors have 8. ❑Demolition' an for me in capacity. employees and have workers' • working Yapacty. 9. ❑Bui7dmg addition . [NO walkers' comp.insim+nce comp.insurance#' required] 5. [] We are a corporation and its 10.❑Electrical repairs or additions '3.rI am a homeowner doing allwork . officers have exercised their 11.[]Plumbing repairs or additions myself:[No workers'comp. right bf exemption per MGL 12.n Roof repairs insurance.required.]t c. 152, §1(4),and we have no ] employees.[Na workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infu-mation. t Homeownerawho submit this affidavit indicating Qroy are doing aU work and then hire outside contractors must submit a new affidavit indicating such. tConb=tors that check this box mutt aulched an additional sheet showing the name of the sub-contractors and state whether ornat those entities have employees. If the sub-contxactors have employees,theymust provide their workers'comp.policy number. I ant:an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site* information. Insurance Company Nat= Policy#or Self-ins.Lie.#: Expiration Date: Sob Site Address: City/State/Zip: Attach a copy of the Workers'compensation policy deZI afion page'(showing the policy number and expiration date). Fmim-e.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 maybe forwarded to the.Office of Inyestiaatio as of the MA 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• 404L2 Date- /_- Phone P Offuial use only. Don oi write in this area,to be completed by.ciiy. or town•ofjiciaL City or Town: ' Permit/License# Issuing Authority(circle one): J.Board of Health 2.Building Departrnent 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: r THE Town of Barnstable �pF Regulatory Services Thomas F.Geiler,Director BARNSTABLE, MA93. 9q,,,rED 39. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 vt,mv.town.b a rnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 2 2 6,0 JOB LOCATION: number lmber ff nn street village /l "HOMEOWNER': o/ J-eG/rsc. 9 10d--5-// YK SGr- ?—X VS name ^ home phone# work phone# CURRENT MAILING ADDRESS: ma- cT1 Ga ) city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building pemut. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. ignature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a formIcertification for use in your community. Q:forms:homeexempt Town of Barnstable Regulatory Services • saxxsr�sia, • Maas g Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax- 08-790-6230 Property p rty Owner Must Complete and Sign This Sectio If Using A Builder I, /,Is Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by building permit application for. (Add res of Job) I e Signature of Owner / Date i Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&O WNERPERMISSION Town of Barnstable *Permit#�- Ezpir 6 months from issue date -PRESr, PIEPWIT Regulatory Services Fee Thomas F.Geiler,Director ,)UL 3 0 2007 Building Division -TOWN OF BARNSTP'BlT&Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 3 Z Fee 4,et C 1 ,Residential Value of Work `7 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 3 -7, e � &Ae Contractor's Name ALr" COAT /AIC Telephone Number 4 77 6 �,IX Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) oworkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insuranc Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ["e-roof(stripping old shingles) All construction debris will be taken to ��-� UL ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. 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. A co the Home Irovernent Contractors License is required. SIGNATURE: G� �:Forms:expmtrg :vise061306 RightFax H1-1 7/26/2007 4:09: 10 PM PAGE 003/003 Fax Server AC®R®m CERTIFICATE OF INSURANCE DATE(MMMDIYY) 07-26-07 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 021W COMPANY 28Y2K A HARTFORD GROUP INSURED COMPANY B R L T CONS TRUCTI ON INC COMPANY 1 MANNI CIRCLE C CENTERVILLE,MA 02632 COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITI-67ANDING 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 5 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(MMIDDIYY) DATE(MMIDDWY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE S COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY S OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Anyone person) S AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT 5 ALL OWNED AUTOS BODILY INJURY(Per Perscr) $ SCHEDULE AUTOS BODILY INJURY(PerAccident) $ HIREDAUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE UABtLITY ANYAUTOS AU70 ONLY-EAACODEN7 $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'SLIABLITY UB-1051C045-06 12-24-06 12-24-07 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT 4 100,000 PARTNERSrEXECUTIVE X INCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS CON9 COVERAGE. s JOB:RUTHCORREIA, LDO FOXGLOVE RD,CENTERVILLE,MA 02b32 CERTIFICATE HOLDER CANCELLATION SHOLLD ANY OF-HE ABOVE DESCRI3EC POLICIES BE CANCELLED SEFORETHE TOWN OF BARNSTABLE BUILDING DEPT EYPIRA70N CATE THEREO= THE SSUING COM-ANY WILL ENDE4vOR TO MAIL 10 DAYS WRIT7EN NOTICE TOTHE OERTt=ICATE HOLDER NAMED TO THE LEFT BJT FALL PIE TO MAIL SUCH NOT'CE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY 200 MAIN STREET KtND UPON THECOMVANY,ITSAGENTS OR REPRESENTATIVES. HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE Raniani Ayer ACORD 25.5(3193) 1 d 3 ' The Commonwealth of Massachusetts Department of Industrial Accidents s Office of Investigations ' d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation luasurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): . Address: City/State/Zip: Phone.#: F 776 �/ /* o . Are,y u an employer? Check the appropriate bog: Type of project(required):. 1.R I am a employer with Q 4. I am a general contractor and I 6. New construction . 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 -workingfor me in an capacity. employees and have workers' • Y P tY• �$. 9. Building addition comp.insurance. [No workers' comp.insurance required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ officers have exercised their I am a homeowner doing all work 11.❑plumb' ng 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 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. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'com ensation 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 declara on page(showing the policy numb r 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify uTAfflyhepains-anndpenalties ofperjury that the information provided above is true and correct lr&Si afore: CJ • Date• Phone#: ! 771 Ol7 Official use only. Do not write in this area,tb be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.BuiIding bepartment 3.City/Town CIerk 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 i§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 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." McTL 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-contiactor(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 fo 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. Tho Commonwealth ofMassaohu=tts Department of Industrial ACcidcnts Office of Investigations 6.00 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia i c:ul u5� 11'J c "�'.� ✓��LxLbja;Gf��C: ^^' 4 reit�l. .:• i ,icense of.regiatr at► if fS►tzd r rzuf ., "date zrds ti °�'vn+n i�at►on ,rslStand w nrid StlndaroT� Regal ttons, -,xcfore tt• ex e P I d►nr Re$utau of Building BoAro"€ TRACTO ''O-,Ird.. 4 OVEf9ENT CaN. sbt unto"Pl.ceRm 1301 ME,IMPR . bay A 0214 w �4286 �►stuu,b1a �.�1 t; RegistratLQ 1 7 22 200 &ROOF W d4il} . .f r x" 3r at}!3� I�tGL 4 td"4 k . RightFax H1-3 7/26/2007 3 : 50 : 59 PM PAGE 003/003 Fax Server ACORD. CERTIFICATE OF INSURANCE DATE(MMIDDIYY) 07-26-07 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 02649 COMPANY 28Y2K A HARTFORD GROUP 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE 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(MMIDDWY) DATE(MMIDDIYY) 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(Anyone person) $ AUTOMOBILE LIABILITY ANYAUTO 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 $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-1051CO45-06 12-24-06 12-24-07 STATUTORYLIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 100,000 PARTNERS/EXECUTIVE X INCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIRESTR ICTIONS/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 BUILDING DEPT JOB:MR MILK EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURETOMAIL 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 Ramani Ayer ACORD 25-5(3/93) i Island Sid' and.hoof ing a division of RL7Consmxtion,Inc. Proposal to: July 26, 2007 Robert Bearse 37 Seagate Ln. Hyanni, Ma. We are pleased to submit the following specifications and estimates for roof replacement Remove existing shingles and flashings. Install aluminum drip edge and pipe flashings. Install 3ft. Ice shield to eaves and valleys. Install 30yr. Architectural grade shingles Install ridge vent. 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: FOUR THOUSAND FIVE HUNDRED DOLLARS. $4500.00 PAYMENT TO BE MADE AS FOLLOWS: Payment in full due upon completion. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents,or delays beyond our control. Owners to carry fire,wind damage and other necessary insurance. RLT Construction,Inc. carries General Liability and Workman's Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature Start Date: Signature 31 Manni Circle • Centerville, Massachusetts 02632 7elenhone 508.420.5243 and 508.833.5249 • Fax 508.420.1776 • Emaifcaperoofer@caperoofer.com e�PyoF7NETo�°� TOWN OF BARNSTABLE i BAHB9TSBLE, i "6 9 BUILDING INSPECTOR •�`�MPY A• APPLICATION FOR PERMIT TO ........ Q �... .......................:...................................................... TYPE OF CONSTRUCTION ..........SA T�.!;4.g....... M.l. ... ..... ....... . ?, .5. ......... ........................ .. .. '...19.. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..�r> T... .... .........s7� 1. ... ..� ............... : ProposedUse ......''`.1:.. .�....Q. .". ��........................................................................................................................ j + Zoning District ....... 1.. ....t. +A.�5. Fire District � t-� O.S.... .. :ss............ Name of Owner ...... Address ...... ......... Name of Builder ..................... . ..........................Address ................ ....... Name of Architect .........,f(�...�....5.1. ......�..®.....�......................Address ..: �.S..F.... � ...... Number of Rooms ............ ......... .........................................Foundation ......1.0........... Exterior ........................4.. ..D..AY.......................................Roofing` .................AV.S f.: ................................. Floors ........ .& ... ` .. ...0 ip.! . I n t e r i a r .............. .� �" t .� ................... . .............. . Heating ............�. 1 ...... ...........Plumbing ........... !�t.P?.�.<r4 �,3.... .� ... I�TLC. Fireplace ...........y .......................................Approximate Cost .............z. I Definitive Plan Approved by Planning Board ---------------—_--________19 Diagram of Lot and Building with Dimensions 0 0 SUBJECT TO APPROVAL OF BOARD OF HEALTHY 1691 Y 40 rye�y� t J ib341 4L1 U y m ¢ � � �. A 2 U O L) � ciE�- � C7 I 3.0 e I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .....> .. ................................................... Cataloni, R. J. i No ..15806... Permit for .....1..1�2. 5.. ............ d single family dwelling Location U�.[...Seagate Lane............................ ........................... annis.................................... Owner ..............R:^...J. Cataloni..................... Type of Construction ...............frame........................... ................................ ............................ Plot ............................ Lot ........fit*..................... Permit Granted Janua 2 Date of Inspection .?. ... ... ...$, 4 , Date Completed 19 O�t,®G Etc PERMIT REFUSED' ................................................................ 19 t ............................................................................... t ............................................................................... Approved ................................................. 19 .......................................... ................................ , ............................................................................... i