Loading...
HomeMy WebLinkAbout0039 TOWER HILL ROAD (9) �3q -7-owe--,c- x _ �i • ii � _ f.� �- '.I �� � �� �� F) � � i� ti i1 �� i M j (� �9 � 11 1 9 - - j i� �� �� 3 �: ,. 11 ;� ;i i f? +: 7 f +�'. (t +i! i !. #. s `. � r t y } { .j I 0 I I i ,, Tow Barnstable n of Building r Post This Card.So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept v M iPosted Until Final Inspection Has Been Made. Permit 'Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-3323 Applicant Name: JOHN T STRUMSKI Approvals Date Issued: 10/18/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 04/18/2020 Foundation: Commercial Map/Lot: 117-072-OOA Zoning District: SPLIT Sheathing: Location: 39 BLDG 1 UNIT 1A TOWER HILL ROAD,OSTERVILLE Contractor Name: JOHN T STRUMSKI Framing: 1 Owner on Record: BATES, EARL& MCDONOUGH, MARY Contractor License: CS-064817 2 Address: 39 TOWER HILL ROAD#1A Est. Project Cost: $30,000.00 Chimney: OSTERVILLE, MA 02655 Permit Fee: $373.00 Description: replace insulation and ceiling in unit. Ceiling 3"-r-21 cloverd cell Insulation: Fee Paid: $373.00 foam insulation ceilings to be sound Beading sheetrock 3'8 sheetrock wallboard Date: !! 10/18/2019 Final: Project Review Req: FIRE RATING OF CEILING TO BE MAINTAINED. INSPECTION ri`K��. �f� Plumbing/Gas y--- REQUIRED. Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection __. Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed - — " Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: i v r sCA i r' IP //tI/IA/NpP /InI�^•`�'t'tlll{�UJC�J � consumer rs Bus ness egu lilauon Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. It found to: TYPE:Supplement Card o Office of Consumer Affairs and Business Regulation Business Reprom �Exniro one burton Place-Suite 1301 100740 • 06/22/2020 sto ,MA 02108 CAPIZZI HOME IMPROVEMENT,INC. JACK STRUNSKI - gyp{Valm without signature 1645 NEWTON RD. COTUIT,MA 02635 Undersecretary Construction Supervisor J Commonwealth of Massachusetts Unrestricted-Buildings of any use group which contain of Professional Licensure less than 35,000 cubic feet(991 cubic meters)of enclosed Board of Building Regulations and Standards space. Const!,o arl tbogrvisor CS-064817 P E ir es:06118120 JOHN T STR( MSKI 16 ALDEN AVE BUZZARDS BWY,,tAA'02832 Failure to possess a current edition of the Massachusetts :71L�� State Building Code is cause for revocation of this license. For Inforrnation about this license The Commenwea&h of Mamchuseas Deparftent of ladusbid Accidents Office ofInvesfiga ions 600 WasUngton Shea Boston MA 02111 www�mas&gov,6fia a Workers'Compensation Insurance Affidavit Bidders/ContrncWn ectnoans/Plumbers ApjLheant biformadon Please Print � Name(Bas&ess,'Org=izatjon adivi&w): CAPIZZI HOME IMPROVEMENT Address: 1645 NEWrOWROAD - C' / : C TUiT MA•42635 Phone#: 28 9518 Are you an employer?Che&the appropriate boa: 1.✓ I am a employer with 4� 4• I am a feral contractor and I 6°f PCo��(� = employees(full auftr part-time) have hired the sub-contractors h New construction 2. I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling shiip and have no=Vloyees These sub-contractors have 8. D mohdon woAcing forme in any capacity. employees and have workers' 9. Building addition (No W01IMs'Comp.inset ee comp.insurance.: -] 5. We are a corporation and its 10. Electrical repairs or additions 3. I an a homeowner doing all work officers have exercised their 11. Plcmzbi ag repairs or additions myself[No wo*='Comp_ right;of exemption per MGL 12. f repairs insnr dnce ]t f c. 152,§1(4),and we have no . employees-[Zito workers' l3.✓ Other comp_ilasivance requbed-J aAW applicagdw chmb bm#t mnst also M=Ibc be3a�v shoes ttsQir:r s' dry an t HOmwwu aswtao subn2d Ens a rate fky me dmg aU wac mtd*m late omside s�rsubmit a�2TIdavit such d=cbmk his box Est stun l shed g tt a same of the and s+�te or rat�asz entities twee employe= If tie .crave emtpday�,bey n=pduvide Beare�°comp.poticyau�er lam an employer th9isprnvidhsg workeW eov4mz ss&m it zae for my evqA9yem Adlow is tyre poficy aadjdb site WomzmawL Insurance Comfy Name: AMGUARD-INSURANCE COMPANY Policy#or Self-ins-lac.k R2V C q--2.i 1 f 2-- won Ilse: I M&2019 .lob Site Address: OW-4- 1 -4 3 � ,'J o w err /�j�� � ° Citylstate74: Aftch a copy of the workers,comps on gohey declaration gage(showing,4he pohe y number and espiradon date). Farfure m st cgre Coverage as required corder Seddon 25A of MGI_c. 152 can lead to the imposition of dental penaMes ofa. fine up to S 1,5W.00 andlor ore-year hnpfisonment,as well as c ivil-germWes in Ste farm of a STOP WORK ORDER and a fire of up to SM-00 a day apiast the violator. Be advised that a cagy of this s�ate=wt may be,forwarded to the Office of Investigations of fire DIA for irmramme,coverage verification. d do h&aby cerdjyj order&epwns mdpmu dMw efpedM B`the insfenwdan pm v&W.abvw is date Band o nva S Date: e�v Phone 50&648-02-69 Offuid use only. Do not in this are'2,to he comphud by euy or twm offal City or Town: PeraitiIacense# Issuing Atriho:rity(chile ono; L Bo?ud of Dearth 2.BUBOD9 DqWft=t 3.(ttyffown Qwk 4y lReeftled Impemr 5 Phmabft for b.Offer CilttaetPerson: Phone tr: Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, MARY MCDONOUGH, OWN THE PROPERTY LOCATED AT 39 TOWER HILL ROAD UNIT IA IN OSTERVILLE, MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT 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 MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: T 4 OWNER'S ADDRESS: 39 Tower Hill Road Unit 1A, Osterville MA 02655 OWNER'S TELEPHONE: 507-7S7 -y9a3 LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: f On Tuesday, September 24, 2019, Mary Ann Hungerford <hungerford.maryann2@gmail.com>wrote: Mary, The Board has approved your request to soundproof the ceiling in your unit, 1 A. Please proceed with the work as planned. A minor detail:our attorney advised asking for a certificate of insurance from Capizzi Home Improvement. We do not expect you to delay scheduling your work, however, until we receive the insurance certificate.We understand that the process may take a few days, and we trust that an insurance certificate can be provided; Capizzi is a local and reputable contractor. Would you ask your contractor to mail the certificate to the Association's post office box, please? Village Square Souther -az- P.O. Box 598 Osterville, MA 02655 We appreciate your consideration in scheduling the construction project for a time when most neighbors are away for the season. Any questions, please contact me. Thank you. Mary Ann Hungerford President,VSSCA 09-20-19 McDonough Request-pi f t 890K 1 r ' I On Tuesday, September 24, 2019, Mary Ann Hungerford <hungerford.maryann2@gmail.com>wrote: Mary, The Board has approved your request to soundproof the ceiling in your unit, IA. Please proceed with the work as planned. A minor detail: our attorney advised asking for a certificate of insurance from Capizzi Home Improvement. We do not expect you to delay scheduling your work, however, until we receive the insurance certificate.We understand that the process may take a few days, and we trust that an insurance certificate can be provided; Capizzi is a local and reputable contractor. . Would you ask your contractor to mail the certificate to the Association's post office box, please? Village Square* ou h P.O. Box 598 - Osterville, MA 02655 We appreciate your consideration in scheduling the construction project for a time when most neighbors are away for the season. Any questions, please contact me. Thank you. Mary Ann Hungerford C President,VSSCA 09-20-19 McDonough Request.pdf E 890K i t r - J i i Sara Schiffmann <sara.schiffmann@capizzihome.com> Fwd: FW: Community Request Form 1 message Sara Schiffmann <sara.schiffmann@capizzihome.com> Wed, Oct 2, 2019 at 2:08 PM To: Matt Collard <Matt@capizzihome.com>, Jack Strumski <jack.strumski@capizzi home.com> From: mbmbridges@aol.com <mbmbridges@aol.com> Sent: Friday, September 27, 2019 4:19 PM To: chi@capecod.net Subject: Fwd: Community Request Form Hi, Here is the Board approval for the project for Mary McDonough at 39 Towerhill Rd, Unit 1 A, Osterville. In the email from the Board, it is requested that Capizzi send a certificate of insurance to the indicated address. The attachment includes the request for Board permission, including the request for a letter from the Board indicating permission for the project; and the project detail page that was submitted with the request. Please let me know if anything else is needed. Would you please confirm that this email has Peached Capizzi? Thanks. Mary Sent from AOL Mobile Mail Get the new AOL app:mail.mobile.aol.com On Tuesday, September 24, 2019, Mary Ann Hungerford <hungerford.maryann2@gmail.com>wrote: Mary, The Board has approved your request to soundproof the ceiling in your unit, 1 A. Please proceed with the work as planned. A minor detail: our attorney advised asking for a certificate of insurance from Capizzi Home Improvement. We do not expect you to delay scheduling your work, however, until we receive the insurance certificate. We understand that the process may take a few days, and we trust that an insurance certificate can be provided; Capizzi is a local and reputable contractor. Would you ask your contractor to mail the certificate to the Association's post office box, please? Village Square South P.O. Box 598 Osterville, MA 02655 We appreciate your consideration in scheduling the construction project for a time when most neighbors are away for the season. Any questions, please contact me. Thank you. Mary Ann Hungerford President, VSSCA Sincerely, Sara Schiffmann Office Administrator Capizzi Home Improvement sara@capizzihome.com www.capizzihome.com 508-428-9518 800-262-5060 508-428-1547 (Fax) 09-20-19 McDonough Request.pdf 890K N Village Square South Condominium Association P.O. aox 598 Osterville, Massachusetts 02655 Thank you for submitting your request and or observation (could be a compliment or complaint). If Mary Ann Hungerford (as president and board spokesperson)determines this to require immediate action, she will communicate with the board. Otherwise, all submissions will be reviewed at the next scheduled board meeting. You will receive a response within 48 hours of receipt acknowledging your submission and providing you with an approximate date for action or other determination. Date: September 17, 2019 Unit Owner: Mary McDonough Unit number: 1A Indicate one: Request Subject: Permission to soundproof unit 1 ceiling Description: This request is accompanied by a proposal by Capizzi Home Improvement to soundproof the ceiling in Unit 1A. A letter is needed from the.Board indicating permission for me to undertake the project so that Capizzi can acquire the permit from the town of Barnstable for the work. r. My intent is to soundproof the unit's ceiling when most of the Building 1 owners are away to avoid inconvenience during the project. This project is a reflection of my commitment to protect the value of my real estate investment and provide peace of mind as a unit owner in Village Square South. DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 12/14/2018 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 policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers and Gray Processing ROGERS &GRAY INSURANCE AGENCY INC PHON o E . (508 398-7980 tFAX No: E-MAIL ril ADDRESS: ma @ Ogersgray.COm 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER B: CAPIZZI HOME IMPROVEMENT INC INSURERC: INSURER D: 1645 NEWTOWN ROAD INSURERE: COTUIT MA 02635 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 348068 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEOFINSURANCE ADDLSUBR POLICYNUMBER MMIDDIYYYY IY MM POLICY EFF POLICY FXP LTR /DDYYY LIMITS � COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO R1TE1 CLAIMS-MADE OCCUR PREMISES Ea oNccurrence $ MED EXP Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 PRO LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per acc dent UMBRELLA LIAB OCCUR EACHOCCURRENCE $ EXCESS LIAR HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? NIA N/A NIA R2WC921272 12/25/2018 12/25/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwdtworkers-compensationAnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601-0000 Daniel M.Cr ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD `:I DING DEPT. OCT 0, 72019 Application Number...... 3,3a .................................. .............. TOWN OF BARNSTABLE MASS. Permit Fee.............&.7 ..............Other Fee:....................... Total Fee Paid............................................... TOWN OF BARNSTABLE Permit Approval by.. 10/9//9......... iy�,....................On... BUILDING PERMIT / 1 -7 1. 0,a A Map........................................parcel.........:. . .. ...... ......... APPLICATION Section 1 — Owner's Information and Project Location Project Address 3 q -lo W 5- P' 0 -4'Offlage C) 5re-PL L) t`I l V e- + I AJ, I A- Owners Name 4/Z A1 "Do A a tj 6 Owners Legal Address 3 cl `Fo u-),,ee f"I 1) VA ;4- A O City d S Te i2 ul rile- State .—,zip :L cp !rr Owners Cell # S 0 13 rl qi 223 E-mail M g M P5Yi*61j ,9S e A01 - co" Section 2 — Use of Structure Use Group1 IV/ F-1 Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,060 cubic feet ER/ 0 Single/Two Family Dwelling C— 0 AAD 0 Section 3 —Type of Permit Fj New Construction F] Move/Relocate E] Accessory Structure E:] Change of use D Demo/(entire structure) E:1 Finish Basement El Family/Amnesty El Fire Alarm Rebuild El Deck Apartment ❑ Sprinkler System F] Addition ❑ Retaining wall Solar VRenovation Insula /Tjff�4/ Pool El Insulation . q 11 /,0 600) Other-Specify, C e' Section 4 - Work Description /°sV S ,/ A?- 2-/ e e l l jE:0,q1-1 141,1 L14-47j arj 7-,1 136' V 0 ZI 07,0 D &,,I A/�V5 C114-ee-'7A e 0 Q / a 00 7, fd(-,04 W4.11d,04,ell T 11/1 ICP)Al Q Application Number..................................................... Section 5— Detail Cost of Proposed Construction-16 000 Square Footage of Project l Z G tea. o Ge``�i Age of Structure 7 �' Dig Safe Number # Of Bedrooms Existing Total# Of Bedrooms (proposed) O 110 MPH Wind Zorie Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke;Detectors ❑ Plumbing ❑ Gas Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public Private Sewage Disposal El municipalZEI On Site Historic District ❑ Hyannis Historic Di Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ERINo _ n Section 7—Flood Zone Flood Zone Designation V 14 Within or adjacent to a wetland, coastal bank? Yes ElNo Section 8—Zoning Information Zoning District 3 Proposed Use Lot Area Sq. Ft. Total Frontage '� °f R Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard C a'Kequired Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last undated: 11/15/2018 t f Application Number........................................... r Section 9- Construction Supervisor - 'ke Name J40 I lllat lz Telephone Number •��� �° S S �2!! Address &Y r &P.l,!lhallf ?P City /6,y/f State R4 Zip License Number S License Type Expiration Date & l�&2 G Z o Contractors Email �� C!Y 2-?40,l e • 1'64 Cell # ��� 6 (ld I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Mass usetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation quired y�7O CMR and of Barnstable.Attach a copy of your license. ' Signature � Date Section 10—Home Improvement Contractor Name J 6hO vU m J t Telephone Number Address 14 VT 4ktP'7001 RI City State )V4 Zip d ZOO V f Registration Number 1()'67 Y 6 Expiration Date 6 /22 /-A I understand my resp ibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massach State Building Code. I understand the construction inspection procedures,specific inspections and documentation re ed by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... -�eSignature Date 10����jr Section 11 —Home Owners License Exemption Home Owners 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 SIGNATURE Signatur - Date j�la'1'/�� Print a -,� 4) ' �GLl Telephone Number �� 2 r_ A VE-mail permit to: ( °f C i Last undated: 11/15/2018 i Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ' Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ 1 Conservation, ❑ For commercial work,please take your plans directly to the fire department for'approvaL Section 13— Owner's Authorization A Q ii��l �u✓ Tit°�`�'<�as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of j ob) Signature of Owner date Print Name . i // Last updated: 11/15/2018 n of Barnstable *Permit# Tow °p ZME t°1� Expires 6 months from issue date • : Regulatory Services e,,t�,srxet.r. HAS& Thomas F.Geiler,Director v tbs .0� �''�E ►9. Building Division Elbert C.Ulshoeffer,Jr. Building CommissioneX-p R E S S P E R M I 367 Main Street. Hyannis.MA 02601w . K / Office: 508-862-4038 JUN 2 8 2001 Fax: 508-790-6230 EXPRESS PERMIT APPLICATIONFOWN OF BARNSTABLE Not Valid without Red X-Press Imprint Map/parcel Number c�36s Property Address aAJS LT f A � 0-D ❑ Residential OR commercial Value of Work Owner's Name&Address Sgbu�t �f 4S 8V bt__CS Telephone Number. Contractor's Name Home Improvement Contractor License#(if applicable) 1313��� Construction Supervisor's License#(if applicable) ss� ❑Workman's Compensation Insurance Check one: I am a sole proprietor 17 JAm the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) �t Re-side replacement Windows. U-Value A (maximum .44) Other(specify) liance with other town department regulations.i.e.Historic.Conservation.etc *Where required: Issuance of this permit does not exempt comp • Sisinature expmug