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HomeMy WebLinkAbout0006 BACON ROAD Town of Barnstable j"E' ti Regulatory Services Richard V. Scali,Director * BMWSCABLE. MASS' Building Division. 039. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us , Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE: $35.00 SHED REGISTRATION etjkol/I/ RESIDENTIAL ONLY 200.square feet or less TOWN F 2.20�6 ��6BaconqNc Location of shed(address) Villa Pr perty owner's name Telephone number (►/ M� 3 og f Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic.District? , Old King's Highway Historic District Commission jurisdiction? You must file with Old King's Highway Conservation Commission(signature is required) Sign,off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE ,IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT-PLAN Q-forms-shedreg REV:040914 +'NEW ENGLAND LAND SURVEY MORTGAGE INSPECTION PLAN Professional Land Surveyors NAME PETER H KENDALL 25 SUTTON AVENUE N /IKOxford, MA 01540 LOCATION 6 BACON ROAD �0 PHONE: (508) 987-0025 HYANNIS, MA FAX: (508) 234-7723 REGISTRY BARNSTABLE SCALE 1 "=50' DATE 4/28/2014 BASED UPON DOCUMENTATION PROVIDED, REQUIRED MEASUREMENTS WERE CERTIFY TO:BANK OF CAPE COD MADE OF THE FRONTAGE AND BUILDING(S) SHOWN ON THIS MORTGAGE N OF INSPECTION PLAN. IN OUR JUDGEMENT ALL VISIBLE EASEMENTS ARE DEED REFERENCE: CERT: 1 CZSO$ SHOWN AND THERE ARE NO VIOLATIONS OF ZONING REQUIREMENTS REGARDING STRUCTURES TO PROPERTY LINE OFFSETS (UNLESS OTHERWISE JA NOTED IN DRAWING BELOW). NOTE: NOT DEFINED ARE ABOVEGROUND PA CK PLAN REFERENCE: LC PLAN: 18327-E POOLS, DRIVEWAYS, OR SHEDS WITH NO FOUNDATIONS. THIS IS A m MORTGAGE INSPECTION PLAN; NOT AN INSTRUMENT SURVEY. DO NOT USE NO. 51 WE CERTIFY THAT THE BUILDING($)ARE NOT WITHIN THE SPECIAL TO ERECT FENCES, OTHER BOUNDARY STRUCTURES, OR TO PLANT $ FLOOD HAZARD AREA SEE FIRM; SHRUBS. LOCATION OF THE STRUCTURE(S) SHOWN HEREON IS EITHER IN 'QE(,� E��O COMPLIANCE WITH LOCAL ZONING FOR PROPERTY LINE OFFSET ST 2S0001 OOOSC OTD; 08�19�198cJ REQUIREMENTS, OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION �'q( LAND UNDER MASS. G.L. TITLE VII. CHAP. 40A, SEC. 7, UNLESS OTHERWISE FLOOD HAZARD ZONE HAS BEEN DETERMINED BY SCALE AND IS NOTED. THIS CERTIFICATION IS NON-TRANSFERABLE. THE ABOVE NOT NECESSARILY ACCURATE. UNTIL DEFINITIVE PLANS ARE ISSUED CERTIFICATIONS ARE MADE WITH THE PROVISION THAT THE INFORMATION BY HUD AND/OR A VERTICAL CONTROL SURVEY IS PERFORMED, PROVIDED IS ACCURATE AND THAT THE MEASUREMENTS USED ARE PRECISE ELEVATIONS CANNOT BE DETERMINED. ACCURATELY LOCATED IN RELATION TO THE PROPERTY LINES. I o'104.09' � SNrD �O �o 1V . Z o LOT 108 04 BFq�sFs ��� lyq y 0' 25, 50' 75' 100' 150' REQUESTED BY: STAN NOWAK DRAWN BY: JPT CHECKED BY; ALB FILE: 14MIP2946 SCALE: 1'=50' Cape Save Inc.', TQT441 OF BV STAOL 7-D Huntington Avenue ^44 CC I I AV, 1 : 06 South Yarmouth, MA 0266 Tel: 508-398-0398 Fag: 508-398-0399 9/29/14 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, Thisaffidavit i a s to certify that all work completed for 6 Bacon Rd,Hyannis has been,inspected by a certified Building Performance Institute (BPI) Inspector. _ u Ceiling: R-52 cellulose; R-21 cellulose under decking, Walls: R-14 densepack cellulose Basement: R-19 fiberglass blanket on box sill All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map,.' C Parcel M Application # o� d`J fj Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 0 Village Owner a-"'t Ke i l o e y Address 6 Telephone f / " Qa — (a / 1)6 .:Permit Request �`� sew/ a ///`c IQ-fP w /Y4 K c� Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation4/00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ul-/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No N 0 Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area: .ft) Number of Baths: Full: existing new Half: existing few k Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor F Dom Count %A M Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other "' Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ' ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name W, ��`ZAP (� e Saptoe Telephone Number.-6 C/6 03 F Address J �, ' � Ole License # . d Pit Oc)_aa Home Improvement Contractor# f - f 3 90 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Y(V11404t47 SIGNATURE DATE s f FOR OFFICIAL USE ONLY . �? x APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: - t .FOUNDATION FRAME INSULATION. FIREPLACE ELECTRICAL: ROUGH FINAL '. PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r. FINAL BUILDING DATE CLOSED OUT E ► - ASSOCIATION PLAN NO. Y Building Permit Authorization I, Mike Kenney as owner hereby give my permission to ,. Cape Save, Inc. 7-D Huntington Avenue, South Yarmouth, MA 02664 Office:508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at ; 6 Bacon Rd Hyannis, MA 02601 Signed Date .! The Commonwealth of Massachusetts PnntForrrr ' Departmeht of Industrial Accidents Office of Investigations - = I Congress Street, Suite 100 p. Boston,MA 02114-2017 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contiactors/Electricians/Plumbers Applicant Information Please Print Legibh Cape Save,Inc. Name (Business/Organization/Individual): ` Address: 7D Huntington Avenue City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-398-0398 " Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 17 4. ❑ h am a general contractor and I employees(full"and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.ElI am a sole proprietor or partner- listed on the attached sheet. T ElRemodeling These sub-contractors have ship and have no employees'` 8. ❑ Demolition M working for me in any capacity. ' employees and have workers' - [No workers' comp.insurance comp. insurance.t 9. Building addition 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_ I I-El 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. " ' I3.❑✓ Other Insulation` `employees. [No workers' - comp.insurance required.] *My 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.. tContractors 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. W r `' Technol Insurance Company Insurance Company Name.: •.. o .9Y P Y ' Policy#or Self-ins.Lic.#. .`+`TWC 3353968 -' Expiration"Date: 04/09/2014 Job Site Address: OLN11 �•" 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 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. J do hereby cert6 under the pains and penalties of perjury tat the information provided above is true:and correct Siaffature. =— --- =-- = Date 03 Phone# 508-398- 98. ' 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 t Contact.Person: Phone.#: ' e �o CERTIFICATE F LIA ILI`fY 1 D DD,YYYY, � � ��� ��� 4/9/29/2013 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 Ca-Colleen Crowley Risk Strategies Company PHONE (781)986-4400 IX No):(781)963-9920 15 Pacella Park Drive E-MAIL Suite 240 INSURER(S)AFFORDING COVERAGE NAIC0 Randolph MA, 02368 INsuRERA:Selective Insurance INSURED INsuRERB:Safetv Insurance cc=anV 33618 Cape Save, Inc _ - INSURER C-Technol0 Insurance Company 7 D Huntington Ave ` INSURERD: INSURERE: South Yarmouth MIL 02644 1 INSURERF: COVERAGES CERTIFICATE NUMBER:CL134960509 - 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 11 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 POLICY LTR TYPE OF INSURANCE 0m lam I POLICY NUMBER MMIDO POILICY EFF MMIIDD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENT ff- Ea occurrence) $ 100,000 A CLAIMS-MADEa OCCUR199448001 0/16l2012 0/16/2013 PREMISES MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ - 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY M PRO- JECT M LOC $ AUTOMOBILE LIABILITY Ea BIKE rlfl tr`!GLE LIMIT(Ea1,000,000 B A14Y AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 208200 1/6/2012 1/6/2013 gODILYWJURY(PeraceideM) X HIREOAUTOS N AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS I Per acatlerr, X Underinsured motorist BI split $ 100,000 A X UMBRELLA LIAR X OCCUR S.199448001 0/16/2012 O/16/2013 EACH OCCURRENCE' $ 1,000,000 ?DED XCESSLIAB CLAItdsvADE AGGREGATE - $ 1,000,000 I I RETENTION$ $ C WORKERS COMPENSATION � Officers Excluded from X AhC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TO Y LIMITS I I ER ANY PROPRETOR/aN2TNEIRIEXECUTIVE coverage EL-EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? a NIA 3353968 /9/2013 /9/2019 (Mandatory In NH) E.L-DISEASE-EA EMPLOYE $ 500 000 If yres,describe under DESCRIPTION]OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AM ch ACORD 101,AddiHen.I Remark.9eheduro,if more apeee is required) Issued as evidence of insurance. Issued as evidence or insurance. National Grid Corporate Services LLC National Grid, Action Inc., Colonial Gas Company and NStar Electric are listed as additional insureds as respects General Liability as required by written contract_ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE _ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 427/SCH 3195 Main Street AUTHORIZED REPRESENTATIVE Barnstable, MA 02630 Michael Christian/CLC '� ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).0i The ACORD name and logo are registered marks of ACORD ..�.- )t•PUhhl ...dtCt ' r TrlCilt i t ♦• 4 S I)11d T _I Board of Buildinu Re-ulations and.Standart11 construction Supervisor Specialty _icense License: CS SL 102776 Restricted to: IC . WIL-LIAM MC CLUSKY ;T 37 NAUSET ROAD WEST YARMOUTH, MA 02673 Expiration: 6/28/2013 f mmi>siwruc'r, Tr-°: 102776 -'��,'. V �/,� �.� 'f��'!'` � ••" .r 1J✓'C/=.li✓:��r/ i��� ' �4��tY✓'J°n✓r1Vi�..���!' + . Office of Consumer Affairs and Business I2eulation 10 Park Plaza Suite 5170 Boston,Massachusetts 02116 Nome Improvement Contractor ReglStratlon ` Registration. 171380 Type: `Corporation ' Expiration: 311412014 Trd 222184 CAPE SAVE INC_ WILLIAM McCLUSKEY 7-D HUNTINGTONAVENUE, SOUTH YARMOUTH, MA 02664 - Update Address and return card.TMark reason for change. Address - Renewal _ Employment Lost Card PS-CA, 0 50M-04104-G1i1121e D JlZ6`V¢-37L•71ZG71fU?(ILf}Z•Gll v"f•IQ�2Cf111d8.�.+' �. 'i - .. Office of Consumer Affairs&c Bifsiness Regulation License or rea stration valid for individul use only - before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR _ Registration: 171380 J. Type:, Office of Consumer Affairs and Business Regulation '10 Park Plaza-Suite 5170 A' Expiration ;3l14/2014 Corporation • - Boston,-LvL9 02116 CAPE,SAVE INC WILLIAM McCWSKEY . . � °. • F 7-D HUNTINGTON AVENUE - SOUTH YARMOUTH.MA 02654 Undersecretary : Not valid w 6 signs Town of Barnstable Permit# Expires 6 months from issue date Regulatory Services _ Fee Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner ®PRESS PERn 7 200 Main Street,Hyannis,MA 02601 AUG 2 4 2005 www.town.bamstable.ma.us Office: 508-862-4038 MWN 0� JfA EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint :ap/parcel Number 0 6q�ro •operty Address Q C_UYI Residential Value of Work-'Z 6 0 6 Mi mum fee of$25.00 for work under$6000.00 wner's Name&.Address ��Vt'1 �� L•1 h eLl /S a tM l2d J G?.-L 6 1 ontractor's Name&j�g 114�_w aZf Z i/1 C C-' Telephone Number ome Improvement Contractor License#(if applicable) onstruction Supervisor's License#(if applicable) �Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation IIn�surance tsurance Company Name Torkman's Comp.Policy# opy of Insurance Compliance Certificate must be on file. ermit 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 Replacement Windows. U-Value .3� (maximum.44) 110. �S�-r`v *Where requucd: Issuance ormit�ex compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. IGNATURE: _ __�A J= &0- :Forms:expmtrg evise071405 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111 www mas&gov/dia Workers' Compensation In Affidavit: Builders/Contractors/Electricians/Plumbers licant Information Please Print Le ibl ame (Business/organization/Individual): ddress: 3 T_ Tf(-eAA C,) zA s,7- ity/State/Zip: W d V C iA/ (A_ Phone#:- U 7!� Z 4 y y�— e you an employer?Check the-appropriate box:. Type of project(required): 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 ❑ 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 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 10-0 Electrical repairs or additions ❑ I am a homeowner doing all work right of exemption per MGL II-❑ 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' comp.insurance required.] 13•❑ Other y applicant that checks box#I must also fill out the section below showing their workers'compensation policy information: �r omeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tractors that check this box must attached an additional sheet showing the name of the sub contractors and their workers'comp,policy information. m an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site ormation. urance Company Name: S d 1- le4ill •cy#or Self-ins.Lic.#: t/ 2- Expiration Date:_ �(J 3 — Site Address: (eCe CUV1 City/State/ZiP: YI IJ j�2(� ach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ure to.secure coverage as required under Section 25A of MGL c. 152 cari lead to the imposition of criminal penalties of a 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 to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of . estigations of the DIA for insurance coverage verification. hereby certify under the pains and penalties of perjury that the information provided above is true and correct ature: Date: D_ . ne#: Icial use only. Do not write in this area,to be completed by city_or town official ity or Town: Permit/License# ssuing Authority(circle one): .Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical In 5.Plumbing Inspector .0 ontact Person: Phone#• 1NE Tq Town of Barnstable Regulatory Services ' SARNUABLr, ' Thomas F:Geller,Director v Mass. 03 p.�►`` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, `�� K-e )����� -,as Owner of the subjpct property hereby authorize ct,,VI L C��° � to act on my behalf, in all matters relative to work authorized bythis building permit application for. (Address of Job) - ' - 3J°r d;la ore f Owner Date Print Name QTORMS:OwNEUERMISSTON S 1 e O b $ i MM 111 M doR > rip ti s 1 • t ' .. Ta n: � .w of.Barnstable- Perm#- )2/�3�. Expires 6 months from4ssue date. Regulatory.Services Fee. y� MASS. 1639. `0� Thomas F.Geiler,Director ATEDN1°�A Building Division Tom Perry, Building Commissioner 41'PE 200 Main Street, Hyannis,MA 02601 �S Office: 508-862-4038 oc r Fax: 508-79076230 7'0 N 2003 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY OF egR�sT Not Valid without Red X-Press Imprint, �BL� Map/parcel Number �¢ Property Address 0-a to A 6.4 4 ❑Residential Value of Work �g`QO a� Owner's Name&.Address fZ 14-e Contractor's.Name_ o /QP �� L"'Wi P/l Telephone.Number Home Improvement Contractor License#(if applicable) 116 l0 Construction Supervisor's.License#(if applicable) J ❑Workman's.Compensation Insurance Check one: ❑ I am a sole proprietor VI am the Homeowner -. ;.. have Worker's Compensation Insurance. (nsurance Company Name r 14 s' Workman's.Comp.Policy# ?ermit Reque check box) Re-roof(stripping old shingles) All construction debris will be taken to a i� ❑Re-roof(not stripping. Going over existing layers of roof) ❑ 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: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. lignature !:Fomis:expmtrg evised121901 Town of Barnstable Regulatory Services RARNSUMA MAMW `�$ Thomas F.Geller,Director i639. �6�► Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Property e P �' Owner Must y Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize G �/ /� � ?m to act on my behalf,, in all matters relative to work authorized by this building permit application for: (Address of Job) tore of Owner Date Print Name Q;FORM&OWNMERIMSION r ' L09Z0 dW H111d 06V ao;ea;SluluiPbd,M N 3jr131 �12idW . �d� NOW30�lrldW •, lenp�nlp�?l ti00Z16L19 uol�aldx3 ' 09L9EL :uo►� ;sl5va dWl 31PIOH aOlOdalT403 W3 OPling{o p lvoS SPlepue3S Ppe$Q�1;eln�aS �f�