HomeMy WebLinkAbout0039 YORK TERRACE � t'� ��r�c�.
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Town of Barnstable *Permit#
097
Expires 6 months from issue date
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x Regulatory Services Fee •�1
MA g Thomas F.Geiler,Director
16.79-
�fo �a Building Division
Tom 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_„? W�6 zy QMCc OW69VI Lim y�
[TResidential Value of Work /-1xiy00 Minimum fee of$25.00 for work under$6000.00
Owner's Dame&Address .ftnAll"- t�te
Contractor's Name IrYy l b mtTztl Telephone Number `•�2-0 5�
Home Improvement Contractor License#(if applicable) fYJ /y k
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance r� 5 PERMIT
Check one: i�
P�ram a sole proprietor APR 17 2007
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
TOWN OF SARNSTABLF,
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
B Re-roof(stripping old shingles) All construction debris will be taken to �lrl�/YST�1�l,C �u1/I►�
❑Re-roof(not stripping. Going over existing layers of roof)
cr ❑ Re-side
❑ Replacement Windows. U-Value (maximum .44)
'Where required: Issuance of this permit does not exempt compliance with other town department regulations;i:e:-Historic;Conservation,etc.
***Note: AH
0 ust sign Property Owner Letter of Permission.
ry ent Contractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise071405
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The Commonwealth of Massachusetts
c d Department of Industrial Accidents
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Office o Investigations
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600 Washington Street
` 4 Boston, MA02111
y �b� www.mass.gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluinbers
Applicant Information \\^^ Please Print Legibly
Name(Business/Organization/Individual): 1�✓�� � �
Address: PO 60X (03Y
City/State/Zip: W. -64"81"A&E, Phone #:
Are you an employer? Check the appropriate box: 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.R i am a sole proprietor or partner- listed on the attached sheet. $ �• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work - right of exemption per MGL I L❑Plumbing repairs or additions
myself [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.] t 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.
$Contractors 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:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day aga the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the D fo insurance v rage verification.
I do hereby certify er he p s and enalties of perjury that the information provided above is true and correct;
Sianature: Date: ' /7— 01
Phone
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
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Town of Barnstable
Regulatory Services
gEDe Thomas F. Geiler,Director
Building Division
Tom Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and.Sign This Section
If Using A Builder
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 job)
Signature of Owner Date
Print Name
i
Q:Fomis:expmtrg
Revise071405
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Rmwdo ft&F'tttri k CaMernly
PO Box 638
West Bwmtabk MA 02668
March 29,2007
Mrs.Susan Carey
12707 Iverary Circle
Fort Myers, FL 33912
Re: Proposal for Home Remodeling—78 York Terrace,Osterville, MA 02655
New Asphalt Roof,Chimney Repair,SWewall
1.) Roof
Remove and replace existing asphalt shingle roof with 30 year architecMW asphalt shingles in color
selected by owner.
Prior to installation of new roofing shingles the roof sheathing will be covered with 18"of ice and water
shield and asphalt paper.
Shingles will be nailed with the appropriate nailing as recommended by the manufacturer.
Appropriate vent pipe flashing and drip edge wilt be installed.
Vented ride will be installed
Total Roof$10,330.00
2.) Sidewall Repair
Remove and replace white cedar siding on 5 side-wall"cheeks".
Total Sidewall$2,865.00
3.) Chimney Flashing
Remove worn lead apron flashing around the existing chimney.Replace with new flashing.
Total Chimney Repair$675.00
The above to be completed for the amount of$LWO.00 for all materials,labor and job site debris removal.
Upon acceptance of this proposal payment is to be made as follows:
501.due to start the job(6,935.00), and the balance (6,935.00)due upon completion
Please note:any rotted sheathing,trim etc.found by the carpenter will be brought to the attention of the
homeowner. Repairs to such will be billed over and above the contracted rate on a time and materials basis at
S55.00 per hoes plus matyri�ls upon approval of homeowner. Contractor is licensed and insured.
Submined:by: Accepted by--
David L44sres Sum Carey
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