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Home My WebLink About0039 GREENWOOD AVENUE 39 Gz�„�o� f� Town of Barnstable *Permit# a60 70 �k Expires 6 months from issue date ®PRESS PERMIT Regulatory Services Fees.. SEP 1 9 2007 Thomas F.Geiler,Director. () r Building Division TOWN OF BARNSTABLE 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 :2 b 5 O�j 2-, Property Address v ❑Residential Value of Work Minimum fee of$25.00 for.work under$6000.00 Owner's Name&Address L u to 5 z- `� C e c r r a 5 9 Contractor's Name Telephone Number, a6 7(, 2 U"7 0 Home Improvement Contractor License#(if applicable) &)0,71 E Construction Supervisor's License#(if applicable) U _tom c)-7 l ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [jkl have Worker's Compensation Insurance Insurance Company Name — Workman's Comp.Policy# Z Z U 3 G Ll (-E rG! 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) t ❑ Re-side Replacement Windows/doors/sliders. U-Value ,3 (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 y of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 S Board of Building,k��'v�agaac/u`°eQa i - Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individ ul Registration _100718 before the expiration date. If found return to only JF Expiration F723/2008 Tr# 130119 Board of Building Regulations and Standards :+ One Ashburton place R J;U TYPe Private Corporation Boston 1301 Ma.02108 Francis Mogan,Jr 68 JOYCE-ANNE Centerville, MA 02632 Administrator � �, of valid thout signature t4 The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations a ' d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): T-h Address: ,,- ,� (.L� dzt`.3 ZPhone.#: ��U£� 7 7 `�t 0?0 City/State/Zip: Ce-,I 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/orpart.time).* have hired the stab-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 g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $. 9. �Building addition [No workers'comp.insurance comp.insurance. required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plum bmg repairs or additions '3.❑ I am a homeowner doing all work ❑ P 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 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. Insurance Company Name:Policy#or Self-ins.Lic.#: e, 2- Z LA 17, q Expiration Date: 512 k S Job Site Address: �� gfcc�wuct�L -HHT✓a.n;� City/State/Zip: MA o z(_oI 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 tip 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. I do hereby certify under the pains•and penalties ofperjury that the information provided above is true and correct. Signature: Date: 2[& D Phone#• 'o o, 7 7L 2y 70 Official use only. Do not write in this area,fib 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone M °FINE Town of Barnstable. )regulatory Services + BARNSfABLE, Mss. $ Thomas-F.Geller,Director sa3g. A,, Building Division AIFD MA`f Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ",w.town.b arnstable,ma.us Office: 508-862-403 S Fax: 50.8-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder L ��•0L4-.,!>C-- ccks.k ,as Owner of the subject property herebyauthorize t 1N`0!c, 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 } Q T O RM S:O W NERP ERM IS S ION f TO H OF BARNSTABLE Town of Barnstable Regulatory Services !$ P 1` Q Thomas F.Geiler,Director maxsrnsm 16309.MASS. �0� Building Di"-�i VI—S Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 PERMIT# (0 FEE: $ 00 SHED REGISTRATION 120 square feet or less 46,:AoJul Auc- Location of 9hed(address) Village ca Property.owner's Telephone number Size of Shed Map/Parcel# a%0- 9171, lure Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? t�Conservation Commission(signature required) 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:121901 AP2 NOTE:not all symbols will appear on a map ,'. "�--:•;� GOLF COURSE FAIRWAY j 4 EDGE OF DECIDUOUS TREES 3 �/ EDGE OF BRUSH # 25 ,-- ORCHARD OR NURSERY EDGE -- � GE OF CONIFEROUS TREES MARSH AREA MAP 9 i ---~~~---- EDGE OF WATER DIRT ROAD r - - � DRIVEWAY O __ PARKING LOT _......__� - ......__...._..._.._ I Q --------- ------- �—PAVED ROAD —- —- — DRAINAGE DITCH O ————— PATH/TRAIL PARCEL LINE** t r MnPtto F---MAP# JJ� 21 -c PARCEL NUMBER ` MAP 2 9 #rasa—HOUSE NUMBER tr � � 2 FOOT CONTOUR LINE —E$— 10 FOOT CONTOUR LINE Elevation based on NGVD29 # 39 l i 4.9 SPOT ELEVATION czx=;� STONE WALL t j � -X—X- FENCE A, RETAINING WALL 1 r F r RAIL ROAD TRACK STONE JETTY PUOI ' SWIMMING POOL PORCH/DECK (� ❑ BUILDING/STRUCTURE n..c..t._�- DOCK/PIER HYDRANT e VALVE O MANHOLE . . i.�n o POST O� FLAG POLE SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET fN, NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetdcs(man-made features)were interpreted from 1995 aerial photographs by The James n TOWER =100 scale map and may NOT meet of property boundaries.They are not hue locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD o UTILITY POLEw ` 0 20 40 tional Map Accuracy Standards at this do not represent actual relationships to ph ical ob'ects Cor orat on. Pianimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards fAdgn\conservation.dgn 07/08/02 12:48:51 PM