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Home My WebLink About0009 BISHOPS TERRACE Alt Town of Barnstable *Permit# Expires 6 months ro issu �7 Regulatory Services Fee anaxsrnat.s. v 6 9. Richard V.Scali,Interim Director CFO MA'I A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PEWMT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Map/parcel Number �.S I � Property Address Gi �S�t� �.v�dY-P.P_ tL,OeMlVtS KA ®0 &(Residential Value of Work$ ` :2- i.$®O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ka Li yl Us a3-7 cAsl„r e_A -, WeSA� //gam� l��- MA- o os Contractor's Name 1k 4X j �. ,� Telephone NutSjT(P)"r(&- Home Improvement Contractor License#(if applicable) V .(&!g T Email: ��yl, Construction Supervisor's License#(if applicable) 0. VIC+ ❑Workman's Compensation Insurance 0� Chk one: [V I am a sole proprietor 2 r"'' �it l4 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance al Insurance Company Name TOWN OF ARIMSfAELE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Ze-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Ve-side Replacement Windows/doors/sliders.U-Value a O�Cj (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C &V AA� T:\KEVIN D\Building Changes\EXPRESS PERNIMEXPRESS.doc Revised 061313 r - 77ae Coninioanveaith of Massachusetts Department of Indristraal Accidents Office of Investigadons if 600 Washington Street Bostor3,M4 02111 soya,.rrrass.gov/dara Workers' Cmmpensation Insurance_Affidavit: Builders(Contractors/Ele—diicians/Phunbel s Applicant Information Please Print Lexibly Nanw(Baasinem/thgsuizationiftAvidual): MogA kISCAILe�L_ Address_An�g Sal�— + beanvi. S A C1tyl trl&Llp: Phnne tr: s a,,S3 Are you an employer?Check the appropriate boa: Type of project(required): 1.❑ lain a employer unth 4• ❑ I am a general contractor and I 6_ ❑3 ew const$uction loyees(full and'or part-time).* have.Hired the sub-cori�actoFs ,L�1/ %am a sole proprietor"partner- listed on the attached sheet ?_ Remodeling ship and have no.employees Thez e sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' y. ❑Building addition [No workers'comp_insurance comp_insurance.$ required.] 5. ❑ We.are a corporation and its 10-El Electrical repairs or additions 3.❑ I am a homemmer doing all work officers have exercised their I LE]Plumbing.repairs or additions myself No workers' right.of exemption per MGI mY � �F- 12..❑Roof repairs insurance required.] c.152,§1(4),and we have no employees_[No workers' 110 Other comp_insurance required_] *Any applicant that checks box 11 must also fill rous the secdon belon,showing sheer workers''compensation policy information_ 1 Homeowners who submit this affidavit indicating they are doing all virc&aid then here outside contracsors must submit a new affidavit indicating such_ Contractors€hat check this bmc must attached an additional sheet showing the:wmaof she sub-conuurtirs and state whoher or notthose entitiEshave employees. If the subdoatraaors have employees,they must protzde their warkers'comp.policy number. l am an employer that is providing worker S'compensatioo1!insurance for u y empW@es. Below is thepo Cy and Job site informa tom Insurance Company Name: Policy#or Self--ins_I ic-4: Expiration Date: Job Site.Address: Cityistate/zip: Attach a cops of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 2.5A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 cedify wider the pains nand penaaities of p rleeaw that ties inforattatioon provided above is ante and correct Sigoture: CA ddtU_k_ r1 1 Date: s/1�,_/ 14 Phone#: Officirai.iase on(v. Do not ttrite in this area,to be completed by city or town n ficiraL City or Toum: PermitUcense# Issuing Authority(cii-tile.one): 1.Boar of Health 2.Building Department 3.City/Toum Clerk 4.Electrical Inspector S.Plumbing Iaisgector 6.Other Contact Person: Phone#: _. 6 L 4 MASS.6 19. Town of Barnstable bg9 Regulatory Services Richard V.Scali,Interim Director Building Division Thomas 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 I, �h.Ne olo y-er kA k A-1 LS ,as Owner of the subject property hereby authorize ale f WS<-k 110-111- to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Zi Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN D\Building Changes\EXPRESS PERMTIEXPRESS.doc Revised 061313 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen--isor License: CS-07241. 67 is y NOEL D MISCHLJtR 29 BAYBERRY RD ' W DENNIS MA 02670 k J, � • >�`�"`� Expiration Commissioner 08/10/2015 ��e amiruam,�aea�/�a 1/C2//ccwcec/1ute%(i Office of Consumer Affairs&Business Regulation WxPME IMPROVEMENT CONTRACTOR gistration: 126874 Type: iration: .-8/31201&.— DBA MISCHLER REMODELING , NOEL MISCHLER , U 29 BAYBERRY ROAD WEST DENNIS,MA 02670 - Undersecretary 4 5 4 *Permit# � IS-3 � E r Town of Barnstable Expires 6 monks from issue date WANSfABLZ Regulatory Services Fee v� MASS' Thomas F.Geller,Director PERMIT ®p A�'�' 1e19. ,0 '�fo►�+' Building Division x-PRESS Gioivt Peter F.DiMatteo, Building Commissioner S E P 2 8 Z 0 0 1 367 Main Street, Hyannis,MA 02601w Office: 508-862-4038 TOWN OF BA RNSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Mapiparcel Number '5 1 2001 Property Address &I�esidential Value of Work `�` J Owner's Name& Address L. s • Contractor's Name Telephone Number_ � LI�.1 �t-t Jam— �'� `� ' Home Improvement Connector License#(if applicable) r A Construction Supervisor's License#(if applicable) ❑Workmen's Compensation Insurance v ' Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name ZJLIX— ( s Workmen's Comp.Policy# & 0 13` _06% 1 DO[ Permit Request(check box) Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over " existing layers of roof) 17 ❑ Re-side ❑ Replacement Windows. U-Value (maximum•44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town dePar�tce°t regulations.i.e.Historic.Conservation etc. Signature Q:Forms:expmmg:rev-07060 I of ,/ iaaac/iu i>JC� Board of Building Regulations and Standards. License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: IF Board of Building Regal.tioni and.Standards Registration 128957 One Ashburton Place Rm 1301 Expiration 06/14/2003 �' Boston,Ma.02108 ` • k Tyne Individual Oliver Kelly ` 5 % M Oliver Kelly l . E 50' Main St.Unit 8 i ti;MA 02673 Not valid withou Yarrhout t signature , Administrator �; �