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HomeMy WebLinkAbout0165 IRVING AVENUE 1 ,< zHE r Town of Barnstable *Paa 6-, Ot" ( f g QY° °�'1� Expires 6 months ronr issue date Regulatory Services Fee T + BARNSTABLE, ' MASS. $s639. Thomas F. Geiler, Director / AlF0 MAC 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 jC�(O Property.Address S ;1 TYI /� U� Etesidential Value of Work ���� Minimum fee of$25.00 for work udder$6000:00. Owner's Name & Address -- Qe- � _ Contractor's Name _f t7-01 " 7 //JC Telephone Number I lome Improvement Contractor License#(if applicable)_ _____ 1_--A tf& _ Construction Supervisor's I.,icense#(if applicable) _ ❑workman's.C:ompensation Insurance Check one: � i �,u � ❑ I am a sole proprietor WI❑ I •m the Homeowner OCT. 3 �O��i ave Worker's Compensation Insurancce Insurance Company Name � TOWN OF BARNS TAKE ABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Pcrmit Request (check box) ff"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/doors/sliders. U-Value (maximum .44) - �, rv; *Where required: Issuance of't_his pen-nit does not exempt compliance with other town department regulations i.e.Historic,Conservn,etc . ***Note: Property Owner must sign Property Owner Letter of Permission. Ca y of the Home Improvement Contractors License is required. O -- — ro (l:'4\'PFILES'•.('ORMS;building pennit forms\EXPRESS, e "" Revised 100,608 Island Sidj -a Roo i a division of RL7Construction,Inc. Proposal To: October 2,2008 Mr. Wood Re: Jelly house street side, remodeled wing roofs. 165 Irving Ave. Hyannisport, Ma. We are pleased to submit the following specifications and estimates for re-roof Remove existing shingles and flashings. Install aluminum drip edge and pipe flashings. Install 3 ft. ice shield to eaves. , Install 15 lb. paper to remaining roof. Install 30 yr. Certainteed Woodscape architectural shingles matching existing one Clean up and haul away debris. We hereby propose to furnish material and labor- complete in accordance with the above specification, for the sum of: For Jelly house street side only. $350.00 For remodeled wing roof. -1-,:;oojeo @Aeb-sidwar$3,200.00 for entire roof. PAYMENT TO BE MADE AS FOLLOWS: Payment in full due upon completion. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents,or delays beyond our control. Owners to carry fire,wind damage and other necessary insurance. RLT Construction,Inc. carries Oeneral Liability and Workman's Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the as specified. Payment will be made as outlined above. Date of Acceptance: `O 09, Signature 1 c Signature j Start Date: g I, 31 Manni Circle Centerville, Massachusetts 02632 Telephone 508.420.5243 and 508.833.5249 Fax 508.420.1776 Emai(caperoofer@caperoofer.com The Commonwealth of Massachusetts, Department of Industrial Accidents Office of Investigations a ` 600 Washington Street Boston,AL4 02111 www.mass.gov/dia Workersr Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl NaII1e(Business/Organization/Individual): . ((/7L G7 0J •Address: 3 < 1. (� i G✓'� City/State/Zip: (2 1l6 INA Phone'.#: S`7) 7 7 6 l Are.You an employer? Check the appropriate box: :Type of project(required):, 1,L_] 1 am a employer with_� .4• ❑ I am a general contractor and I employees(full and/or p art-time). * have hired the sub-contractors 6 El New construction 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 workin for me in an capacity. employees and have workers' g Y P tY• 9. ❑Building addition [No workers'comp,insurance comp.insurance,$ . 5. [] We are a corporation and its 10.[]•Electrical repairs or additions required.] ' 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑Plummbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.n Roof repairs insurance,required]t C. 152,§1(4), and we have no 13•0 Other employees. [No workers' 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, 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. Insurance Com any Name: P . Policy#or Self-ins.Lic•#: Expiration Date: Job Site Address: � City/State/Zip /State/ZiP9 Attach a copy of the workers' compensation policy declaration page"(showing the policy num er and expiration date). Failure•to secure coverage as iequired 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 WOR ,;ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement maybe forwarded to the Office of Investigations of the MA for insurance coverage verification. I do hereby certify u e e pains-a enalties of perjury that the information provided above is true and correct. Si ature: Date: Phone 77& 61 f l 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 Phone#: Contact Person: ` Massachusetts General Laws chapter 152 requires all ernployers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hiie, express or implied, oral or written." An employer is defined as "an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or tnistee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage_required." Additionally,MGL chapter-.152, §25C(7)states"Neither the.commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidenceof compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that.apply to your situation and,if necessary,supply sub-contractors)name(s),addresses) and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies*(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members'or partners, are not required to carry workers' compensation insurance, If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-hne, City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number, In addition,an applicant that must submit multiple permit/license applications in.any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in.advance for your cooperation and should you have any questions, please'do not hesitate to give us a call. The Department's address,telephone-and fax number:. ` b' Gom one wffi of Ma,ssachusctts Dvartmemt of lndv�al Aceidents. Off oc of lauvest gataous 600 WaAingtoii Street Bos o,_MA 0.2111 TO. ## 6,17-72TO—Q0 ext 406 err 1-377-MASSAFE Fax#6.17-727-774 Revised 11-22-06 www.mass.gov/dia W 03113-AM I T-,�nxTFORD . 2420 LAKEMONT AVE STE 100 ORLANDO FL 32814 CP 01 6640 G664OPOS 08278 03113 01 TOWN OF BARNSTABLE ATTN: BUILDING DEPARTMENT 200 MAIN STREET HYANNIS MA 02601 REINSTATEMENT NOTICE Please take notice that the Policy designated below has been reinstated as of the effective date of the reinstatement stated below,notice of cancellation heretofore issued being hereby withdrawn as null and void. cexs POLICY NUMBER:(GSGOUB-1051 C04-5-07) ISSUE DATE: 10-03-08 S-2 - NAM_ E AND ADDRESS OF INSURED PRODUCER OR AGENT u ` R-L T CONSTRUCTION INC. EDWARD A GRAZUL INS Y 3;8Y2K 31 MANNI CIRCLE ISSUING OFFICE 1p CENTERVILLE MA 02G32 ORLANDO DA HTFD 05G _ EFFECTIVE DATE OF THIS NOTICE VEHICLE IDENTIFICATION 10-20-08 (Com Bete for Auto Policies or eoverages Only) LOCATION (Com Bete)br Fire Policies or Fire Coverages ONLY) WRITTEN NOTICE IS HEREBY GIVEN TO YOU AS: ❑X THE PERSON TO WHOM AN INSURANCE CERTIFICATE WAS ORIGINALLY ISSUED.OR A BANK OR FINANCE COMPANY; ❑ AN ADDITIONAL INSURED UNDER THE TERMS OF THE POLICY;' ❑ A MORTGAGES THIS NOTICE IS GIVEN ONLY BY THE ` COMPANY OR COMPANIES WHICH ISSUED THE POLICY DESIGNATED ABOVE.. Page l of l CN 00 3C 03 94 RightFax C1-2 4/23/2008 8 : 58 : 36 AM PAGE 3/003 Fax Server ACORD. CERTIFICATE OF INSURANCE DATE(MM\DD\YY) 04-23-08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EDWARD A GRAZUL INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO BOX 337 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE MARSTONS MILLS,MA 02648 COMPANY 28Y2K A 14ARTFORD GROUP INSURED COMPANY B R L T CONSTRUCTION INC COMPANY 31 MANNI CIRCLE C CENTERVILLE,MA 02632 COMPANY D COVERAGE 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. _ .. CO POLICYEFF POLICY.EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM\DD\YY) DATE(MM\DD\YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. - PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Anyone person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per.Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE. $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH!ACCIDENTJ AGREGATE EXCESS LIABILITY j UMBRELLA FORM EACH OCCURRENCE OTHER THAN UMBRELLA FORM AGGREGATE $, WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-1051CO45-07 12-24-07 12L24-08 STATUTORYI.'IMITS ``-' X THE PROPRIETOR/ EACH ACCIDENT 4 $ 100,000 PARTNERS/EXECUTIVE X INCL DISEASE-POLICY 1 11 T $ 500,000 OFFICERS ARE: EXCL DISEASE-EACH EMP OYEE $ :..100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS r— - THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE THEREOF,THE ISSUING COMPANY W ILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT ATTN:BUILDING DEPARTMENT - FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY 200 MAIN STREET KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE ACORD 25-5(3/93) Ramani AyeI ,... tlIassachusetts= Department of Public S<rfcty . .. ✓1tB: 00/7/l72pp7,�up QL i .(X.06LLC6 \ _ _ Board o�$uilaing'Regulations and Standards ' B0;)rd Qt B'w1dtn!� Re�ulata0ns and St ind';irds _ — HOME.IMPROVEMENTC:ONTR4CTOR Construction Supervisor Specialty License License: CS SL 99910 Registration: 134286 E - Restricted RE T0/22/20 to: .RF,WS09Tr# 133426 7TYI?e DBA ... . T ," 'r t Ci RONNIE TAYLOR - RLT CONST. INC pBA:ISLAND SIDING&ROOFIN 31 MANNI CIRCLE ;i ram. ,�.:_. s ;'- RONNIE TAYLORY-' CENTERVILLE, MA 02632 1"" 31 MANNI CIRCLET>` .j CENTERVILLE, MA 02362� " Administrator.' Gib--�' ExpiYaton: 10126/ i 11 .._, ._......: _.. .__..-. < . � ' {'uinmissiunci• 20 Tom; 99910 --- _ I . License of'registration valid for individul use only before the expiration date.Jf found return to: Board'of Building Regulations and Standards One Ashburton Place Rm 1301 , . Boston,Ma.02108, 3 ' ot;vand w..ithout signature:. 5 � Town of B ctg astable *Permit pFTME rQ{t,� Upires 6,months from issue dafe ulator Sery e 3:ces F , yomas:F -Geiler,Director 9��f ��,---• .._. _._�. ......riding Division -. - _ — -TomPerry, Building Commissioner m , zf • •-•200 Main-Street,•Hyannis,MA 02601-••-.-- L e A Office: 50g-862-4038 = m ... Fax, 508-790-6230' „ r S:S_; � 1VII'T:...'�I'�IC "Y'T�N ItESID � � d�f T;16LE Not Valid without Red X-Press Imprint vIa /parcelNumber P Property Address • y'e ti.q [Residential Value of Work `'Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address /.� %✓ Af Contractor'sName_ 6.04 noo o U t.�Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) orkman's Compensation Insurance Check one: y n I am a sole proprietor 0 I am the Homeowner ' [] I have Worker's Compensation Insuranncce Insurance Company Name • Co Policy# /O U �6 0!J l S" O ya d Workman s comp. cY Copy of Insurance Compliance Certificate'must be on file. Permit Request(check box) _ to �A4(g Re-roof(stripping old shingles) All constructson debris will be taken �"�'f [�Re-roof(not stripping. Going over existing layers of roof) [� Re-side C Replacement Windows. U-Value_________-__(ina� •44) " *Where required: Issuance of this pecrmt does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ; ***Note: Property Owner must sign Property Owner Letter of Permission. ome Iznprov eat Contractors License is required. Signature Q:FozMzexpmtrg Revise063004 Isfand siding and Roofing a division of ELT Constriction, Inc. 8Ian Se6astian(Drive #14 Sanduich, 9Kassachusetts 02563 Telephone 508.420.5243 and S08.833.5249 Facsimile 508.833.0098 Email caperooferG caperoofer com 9Kass YaC#134286 Proposal To: October 19, 2004 Kathleen Wood Re: 165 Irving Avenue Hyannisport, MA We are pleased to submit the following specifications and estimates for reroofing main house asphalt roofs only, plus flat roof near roof deck: Strip existing asphalt shingles and flashings Install new aluminum drip edge and pipe flashings Install 3 ft. Ice&Water Shield to eaves, interwoven w/step flashing on cheeks& skylights Install Typar 30 roof underlayment to remaining roof Install 30 yr. algae resistant architectural grade shingles Install continuous ridge vent.to all ridges Install white rubber roof on flat roof to match roof deck Clean up and haul away all debris to landfill We hereby propose to furnish material and labor- complete in accordance with the above specification, for the sum of: SIXTEEN THOUSAND FIVE HUNDRED DOLLARS ($16,500.00) PAYMENT TO BE MADE AS FOLLOWS: $16,500.00 Upon Completion All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents,or delays beyond our control. Owners to carry fire,wind damage and other necessary insurance, RLT Construction,Inc. carries General Liability and Workman's Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Z+ Zt, Signatur Start Date: itit,Q — Signature - LQ4 .e V The Commonwealth of Massachusetts Department of Industrial Accidents - Office otlnvesagatfens 600 Washington Street, 7`h Floor Boston,Mass. 02111 Workers'Compensation Insurance Affidavit:Building/Plumbing/Electrical Contractors o x. name: (f/9 T At address �( � �i citv_� 9�` �!/i P state: 6"��i zip: ddlo?J- phone# work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction[]Remodel ❑ I am a sole procrietor and have no one Working in an cmacity. Building Addition am an employer providing workers'compensation for my employees working on this job. �•.�S Y •G� �� ��1' fin" � � { ..y r r eF,. v. c+X"'e-'"' $'S��F—9ir '�4�-�'�T 5 �y 1 3-:y#t ✓�'^'^^^'r^�� ` _ arJdS•eS� �u, � x,,�i�` �r � i�- i r �,r a 7i -7/ �a, 'd.r1 ,ph•S'PLk£.'k.�a? rP�,,� toF .s 4 t, w". "t u b.°,. �' y��K•�� ��� r�"�k„,+,'�,s' u+b.��hY�.���.s�.�J�ts��F�.:d(rw� +t ` *u�rff� e a ' y-� 3 i lnS�1T$7ICe'C� ;'*e,r. � �.}^`w,?',ht ;t;� S+;.,t..^.,�`:.;�.�_�r�� h�{r....„...v;�....�.v�.: �11C•.., .:::, •<�:, _ _ ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation polices cart3aanv>aame �•...^ i I)710ne Z. ....... ... _..._ f.-..r•. ._.. T binaanvtti<me f _ - .;ry ufione# _ rab Vt6 e Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify un he pains and aloes of perjury that the information provided above is true and correct. Signature / Date Print name h/ / : Phone# official use only do not write in this area to be completed by city or town official city or town: permittlicense# ❑Building Department' ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office []Health Department contact person: phone#; ❑Other (revised Sept 2003) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or implied,oral or written. An employer is defined as an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. M, NINE City or Towns The Department has provided a space at the bottom of the affidavit is complete and Tinted legibly. p Please be sure that p p g Y p P you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please the affidavit for g Y be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. . The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7`"Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 Boardof B' HOjyE MpROV Regulatio and Standards u*Qelta ` Re Eftkr CONT OR q stratior RACT xp�rat 134286 Pn: hp122/2005 j RLT CONST. YAe DBE �.' RONNIE TA Y OR DBE ISL,gND SIDING&ROOFIN JA TIA NSESAS SANDWICHN D4 :Mq p2653 s 4 ° Administrator J ' t i r Boardof$uih -.. g:Regai tionsan w; HOME IM pn Standar Registrattot, E COIVTds RgCTOR xP+rat 134286 10/2�2/2005 RL 96q / TCONST. _, INC. ,.D BONNIE TAYLORr 'JA t E3�fSLgIVp SIDING&ROOFI NSEBASTIA N SAND ,�-_ WICI•j, i r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2 g Parcel 6 Permit# Health Division (a Od Date Issued /?Wkyd f�.."i,L=. :. Conservation Division 1e �. Application Fee Tax Collector /,?;/9/o 9, ash./� Permit Fee VA Treasurer Planning Dept. EXSVNG SEM Date Definitive Plan Approvedtv PII 2va'afin/Hyan Board UMRED TOOF BEDROOMS Historic OKH PresnisT04I ryd`"` "d 0 �'�� V 1 2. ra✓ u w.. Project Street Address 6V6 _ U 1 (OA r Village Owner Address _ Telephone -71 1.3 2-2 Permit Request R nctwF__ 1q' RF_P"cc_ FLL4malJC.r f i xTuQES - 2top �LR 13d4ri4, Y mono 1Q=rZ1nri m ew S I I,) F4 tol LA4 "Room e'lo uk, )OPW a0W) Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District /I Flood Plain Groundwater Overlay Project Valuation `I�� 0� Construction Type Mg— Lot Size 121� Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family )i( Two Family ❑ Multi-Family(#units) Age of Existing Structure X P_ Historic House: ❑Yes 54 No On Old King's Highway: ❑Yes ❑No Basement Type: O Full 2(Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new - 0 _ Total Room Count(not including baths): existing { a new First Floor Room Count 17 Heat Type and Fuel: Cl Gas A Oil ❑Electric ❑Other Central Air: ❑Yes 0 No Fireplaces:Existing New Existing wood/coal stove: ❑Yes �fNo Detached garage:-61 existing 0 new size Pool: 0 existing ❑new size Barn:0 existing ❑new size Attached garage:0 existing ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ . Commercial 0 Yes X No If yes,site plan review# Current Use 1?es 10fk2T1A2_ Proposed Use BUILDER INFORMATION CP.f� 5V 3 g Name I 1 L L _ tJ 14 L -tlC_ Telephone Number -509 '7 Address 4;�;7 CRSaC r e p 1?r License# zttz, 0,56 3 zlo Xn 1 L L,5, Home Improvement Contractor# Worker's Compensation# ( - Aft. - Z2. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE /ZZ FOR OFFICIAL USE ONLY PERMIT NO. ' } DATE'ISSUED - MAP/PARCEL NO. ADDRESS VILLAGE':- OWNER DATE OF INSPECTION: FOUNDATION FRAME r INSULATION ' h/ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL , GAS: ROUGH FINAL 03 FINAL BUILDING _ rr ! T.r DATE CLOSED OUT ,. ASSOCIATION PLAN NO. �` °FAT Town of Barnstable I. 4 Regulatory Services BnarternscE, Thomas F.Geiler,Director F- • 94, '�� •� Building Division TomPerry, Building Commissioner 200 Main Street,I�yaunis,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 AB " der • as Owner of the subject property :hereby authorize - ,�, o to act on mYbehalf, in all riiatters relative to work authorized by this building permit application for;, Addre of job) Date Signs of Own. Print P�ame . . RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE , New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE ZU-5 square feet x$64/sq.foot= � *C)<) x.0041= 2 •6 plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft. ACCESSORY$TRUCTuRE>120.sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch �_x$30,00= (number) Deck x$30.00= . . (number) - Fireplace/Chimney x$25.00= • (number) . Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee 2 Projcost Rev:063004 1 1 The Commonwealth of Massachusetts Department of Industrial Accidents _ Iffes ifMWnwM 600 Washington Street ° Boston,Mass. 02111 . Workers' Co m ensation Insurance Affidavit-�General Businesses h v�°��_ wo •:°=jam• •v L L 1`�u .14-^ dress:ci address: 1 �l work site location fi3 a (]Retail[]RestaurantBar sting Establishment (] I am a sole proprietor and hate no one Business Type.. 0 Ofgce[]Sales(including Real Estate,Autos etc,) working in any capacity. I an ea 10 er with/ ei31 loyees(full Mart ❑Other / / W1171, �j/ y///�/�// GXY/e�//y/ r%///.l'%%//�////1%0il1 % orlong on this job. ' compensation for•my emp oy am an employer providing-workers ", ,• , O L COIa `8II IIeme: 4ri,f. .t., 'y'. ,.,. •r..• '••e•,.,��.�`�+'� .• 4U,1"•1✓ •.''�f'• '•{,',••+'t r• ' . .... tea:.+•., ,r1 t. h.?. �.w.t'.•6•a•. .. r.,' 'r. .' ••{jl!/- 73 t 1 o'I • �, ,: ,,`r, •;4 ,�; r� �. ,,., bone#••' '�'�.i'r' � .,.... etor and had a hired the independent contractors listed below who have the following workers' I an a sole propri ' en.sation polices: �;rti.;.'' .�,::`: :'t;;�++;' :�i;:�;; :;• -. ",,'' 'E: ••`in, .4; •J.'•' y ' •,, " , ••, ,'•`.•.. r,i: i4,,.,t '"r. "y t,.,t 1,, bald an n'aw ; t �t,}i'�; �:r -� r.::•, r: Ott' address: " . .,,;.4; •' ,;'� ••;•, •; �( ti• �' ••� hone :' �� •• • r..'• .;•tin. i :l��,a•t:•' `,:.y:r,,,. C1tV:. �^,•.y �:� .{�'1.4 t1''"' 'r"�. y•a; •�'•''`' ` a:.i•,.i; 't• '�' r' �y,�i• ���//�1 .. ,;�•t: r :i• '�'i'a''''t+;••..%; •t''.r •'OIiCV+# •:,,.; ;r.' i'•'•�•' l.,�I/1///��////.I//// ' rance co. _` t r ;,a// / insu �, /� .1;. :',f'1,:• ,rat•+ •r• r, ..a Y •Sti' t4.ti t .� r,t •n; r.. r:{•^„V�: or S'' :, n� .•i•.i�{' •i,• ,r •p•i•:'�;r• Y.. .i.: :,,, 1..• '�~"t FIRM r•.: '': .• ,�. �1r�4•"'•t, ''�' .f' ;r::r' '+ .i r, �' ' �'�'•'se'• com'an ' 'i '. .r�t4 •• 110nE�' ..' I C1GY'.'• _ .( k,.t.,• .1,i• .(•• .ti ' �•T':?4''r, t;;{• .e�`�.: ';1tk..' :1' •�' `'r.r}• Fill al olffion Ofpenaltt�a f to$1,500.DO andlor. Failure to secure coverage u required nner See in the.formMf a STOP'F'ORIfi OGL 152 am-lead to tRDERhe pand a fine of�S100.00 a day against au I understand.that g one years'imprisonment%s well as civil penalties o the 0ma of InvesUsations of the DIAror coverage verification. copy of this statementmay be fareyarded t I do hereby certify under the ains and n ties of perjury that the information provided above is trued cor O Date Signature �d V 71 g�d t name lC.l.!!Q J� Gk1 Ll P L 2 E Phone#_ ? ' Print .�� do not wrtte in t oiiidal use only his area to be completed by city or town official I permitNcease# ❑Building Department,icensin Board ❑ g city or town: ; ❑Selectmen's Office ❑ check if immediate response is required ❑HealthDepartmeat , ❑0ther • phone�i contaetperson: (revaed aepc 1003) �, e Information and Instructions Massachusetts General Laws Chapter�1�52 section 25 requires an employe�Sto pt on in.tvhe service of ande workers' on under any ensation for theircont ct employees. As quote d from the.lent,an de employee is fined as every p or inzpl1ed, oral or of hire,express written. _.. artnershi association,corporation or other,legal entity, or any two or more of 1 An employer is defined as an individual,P _. p, . the foregoing engaged in a joint enterprise, and including the legal representatives of a"deceased employer,or the receiveroi. trustee of an individual, partnershiP,association or other legal entity,employing employees,. -However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. ter 152 section 25 also states-that every state or Iocal licensing agenc}r shall withhold the issuance or renewal MGL c P , of a license or perm9t to operate a business or to construct buildings in the ctirri�ionweaIth for zany applicant�who-has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the any`of its political subdivisions shall enter into any contract for the performance of public`work until commonwealth nor a acceptable evidence corripliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply,comp2ny name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Departruent of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the applicationfor requested, re ardint the `lave' or ifor license is you are requested,not the Department of Industrial Accidents. Should you have any q g. $ required to obtain a wo=kerb' compensation policy,please call the Department at the number listedb.elow. i ' 114 City or Towns ?lease be sure.that the affidavit is complete and printed legibly. The Depaztaient�ias provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please, be sure to fill in the pa-r1it/license number which will b'e used as a reference num ber. The affidavits maybe returned to the Depar6ientby mail or FAX unless other arrangements have been made. The Office of Investigationswould like to thank y'ou in.advance for you cooperation and should you have any questions, s please do,not hesitate to give us a calla The Departnenes address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Qf�cs od t�stlgation� . 600 Washington Street Boston,Ma. 02111 fan#. (617)727-7749 phone#: (617) 727-4900 ext:406 I 12/09/2004 16:35 5087795731 CAPE COD IHSULATION PAGE 02 Permit Number RE&-heck Compliance Certificate Checked ByMate Massachusetts Energy Code REScheckSodlware Vcrsim 3,5 Release is Data filename:C:�Frogram File~;;Chcuk-\RESehmk\f*2250 Sbulzc Consl. PROJECT TITLE:Custom Reuovation CITY.Hyannis STATE:Massachusetts 1-10U:6137 C0NSTRUCTION TYPE: i or 2 Family,Detached - HEATING SYSTEM TYPE..: (khcr(Non-Electric Resistaucc) DATE: '12107/04 DATE Or PLANS: 12-7.04 PROJEC1 DESCRIPTION; 105 Frving Avc. 1.1vannisport,Ma.02647 T.)E SiGNER/C ONTRAC TOR: Schulze Const. Box 288 Centc %i.11e,Ma.02632 PROJECT NOTES; Ms. Check By Cape Cod Insulati.ou . CC?I`vII'L1ANCE;Passes Maximum UA= l 15 , Your Home UA= 11.3 1,71i6 Better Than Code(UAi ' Gross Glazing Area err Gatrity Ctmt. or Door 'Perimeter .R-Value R-Value U-r-actor UA Ceiling 1:Flat Ceiling or Scissor Truss 271 30,0 0.0 9 Ceiling 2: Cathedral Ceiling(no attic) 153 30.0 H. 5 Wsll 1:Wood Framc, 16" o.c. 534 13.0 0.0 33 Window 1: Wood Ftarnc:Dc uble Pan,-.wth.Low-F 95 0.340 32 Boor I: Solid 21 0.340 7 Door 2: Glas~s 20 0.330 7 Floor 1:All-Wood Joist17ru-,w0vcr Uncaltditivtcd Space 422 19.0 D.0 20 Boiler 1: Other(Except Gays-Fined Steam),92 AFIX CGAIIIsLIANCF STATLNIENT: The proposed building design dcscribcd here is cratsistent with the building plans,sp©cir'ieations, and other caleulatk.ms aui tnittcd with the permit applicatiot, The prgx-Aed building,bas bcrn designed to meet the Nlacsacdtu:.a is Energy Code requiretis.emis in.RESGher, Vctsacm 3.5 Release le (formerly MPCcAtac4 and to earttply'with the artaetdatory requirements listed in the REScheek.Inspeetion Chex;iclist. 12/09/2004 16:36 5087785731 CAPE COD INSULATION PAGE 04 `l REScheck Inspection Checklist - Massachusetts Energy Code REScheekSoftwvre Version 3.5 Release le DATE 12/07/04 PR.OJFCT TITLE: Custom Renovation Bldg. I Dept. i Use I I Ceilings: I 1 I 1. Ceiling l:Flat Ceiling or Scicgor Tress,R-30.0 cavity insulatkm Comment$. 2. Cei.li.n.g L:Cathedral Ceding(no attic),R-30.0 cavity insulation. I Comments: Above-Grade Wall@: ( ) I 1. Wall. l:Wood Frame, I F"ox,,R-13.0 cavity insulation - j C e)I meats: Windows: ( ) 1 1. Window 1: W�,od FTanle:Dotible Pane tuith Low-.F,I.J-fav~tx; 0340 ! For windows without,labeled U-:factors,dc-scribe.f,eatures: I #Panes_,,,_Pratte Tvpe Thermal Elreak? 'Ycs( )No ! Comments: I Doors: ( l ! 1. Dor 1: Solid,IJ-factiw-10,340 Comments: ( ] I 2. Door 2: Glass,1.3-factoT:0.430 Comments: _ I Floor@: ' I I. Ficxu i-,Ail-wood Joistt`ftuv;:Over LTncanditioned space,R-1.9.o cavity insulation I Comments; I M I Hcat7ing and Cooling Equipment: ( J I 1. Boiler l: Other(Except Gag-Fired Steam),92 AFUE or higher I Make and:Model Number I �M i Air Leakage: l I Joints,penetrations,and all other such openings.in the building envelope that are soutces of ai.r I leakage musl be sealed. l I Whcn installed in the building envelope,reoeQseu.lighting rixtul'es I shall meet vase of the following requirements; I 1. Type IC rated,manufactured with no Penetrations between the in?idc of the recesseed fixt!ire I and ceiling cavity and sealed.or gasketed to prevent air, leakage into the unconditioned space;. 1 2. Type.IC rated,in:accordance with Standard ASTM 1?283,with,no more than 2.0 ct6(0,944 - Us)air movement fromm the the conditioned,space to the cx;il.ing cavity. The lighting fixwre I snali have bmn tested.at 75 PA or 1,37 lbsift2 pressure dilTerence and shall be labeled. I Vapor Retarder: Required on the warm-in-winter side of all non-vented.framed ceilings,wills, and f oors.. I Materials Identifleatim: Meterials and equipmcnt m.iiat he idcntified so that compliance can be dct'crminc-d. 12/09/2004 16:35 5087795731 CAFE COD INSULATION PAGE 05 ( j I .M.onufacturer mattwsals for all installed heating and cooling cclttipiner►t anct service water.heeling 1 equipment.must be provided, ( j ; Insulation R•valuvs,glazing U-factors,and healing equipment cfiftciency rnuat he clearly marked on I the building plans or.9veificatiMs. I Duct Insulation: - (. 1 I Dlicts shall be insulated per Tablc X4.7.1. DMt Constructiont 1 l I All accessible joints, seams,and canrcctions of supply and return.ductwork lacsted outside j conditioned space,including stud hays oe joist cavitie spaces u to transport air,s)~alR he scaltx4 using mastic and fibrous backing tape.installed aocording to the manufacturer's installation I instructions, M- csb tape may be omitted where gaps are less than 1/8 inch. Duct tape is not prrtnitted. j I The HVAC system mul..provide a means for halancing Or and water system& I Tcmperature Controls: [ I Tncrmostats are required for•cach separate HVAC system. A manual or automatic means to partially restrict or shut Off the heating and/or cooling input to each zone or floor shall be pro%i(ied. Heating and Cooling Equipment Sizing: ( j I Rated output capacity of the heating/cooling system is ntot.greater halt 125'/�ofthe design load as I specified in Sections 710CMR.13.10 and.J4,4. I lCireidating Hot W atsr SvstOMs. ( I I Insulate circulating hot water pipes to the levels in Table 1. i Swimming Pedn j All heated swiraming pools must have an on/cif`heater switch and require a.cover unless over 2(P,6 i of the heating energy is from note-depletshle soxtrocs. .Pool Pumps require a.time cloc 1:.- I I Heating and Cooling:Piping Insulation: ( ] I HV.A.0 piping umveyin:g fluids above 120°F or chillod'fluids Wow 55 IF nnno tw insulated to :Jie levels in Table 2. i r - 12!09/2004 16:36 5087785731 GAPE COD INSULATION PAGE 06 Tohle 1: Mirsinmu InsohWiva Tbdekmess jor CircwGtting Mod'Water Pipes. insulation Thic mms in Inchcg bt I'iPc Sizes licated water Nonce culatia4 RuTrouts Circwlatiou Maims artd RR out, Tcmyeraturc(F) LIP to 1" Uv to 1..25 1.,5" to I,O" Over 2" 170-180 0.5 1,0 l,S 2.0 140-160 100-130 0.5 0.5 0.5 1.0 Table 2. Mirtimmn Inrubdion Thick»esa for.R A.0 Rp c- Fluid Temp. Ihs�alaticm Tlliclrne4s in.Iaack�c4 Pine Sizes Piping System Tym, Ran c P 2"RunouLs i" and Loss 1.IS"to 2" 2.5"to 4 Hesttin�$,A$C6199 Low Prcq-.;w 7cmperaturc 207.-Z50 1.0 1.5 1,5 2,0 Lore Tempomure 1.20-200 4.5 1.0 1.0 1.5 Stcam Condcnsete(for fcod vaster) Any 1.0 1.0 1.5 ID contras 9yirtemA Chilled Water,Refrigerant, 40-55 0.5! 0,5 0.75 1..0 and Brine Below 40 110 1 U 1.5 1.5 NOTES TO FIELD (Building Dcpartment Uwc Chly) y 12/09/2004 16:36 5087785731 CAPE COD INSULATION PAGE 03 Th.c heating load for this building,and the cooling load if aMcgwi•ate,has boom dWermmed rising the appl.icabte Standard Design Conditions foamd in the Cock. The HVA,C cquipm=t scleeted to heat os cool the building shall be no greater than 125VD of the dcaigr.load as specified in Scctiow 780C R 310 and J4.4. / Puildcr Designee Date c. �" BOARD OF BUILDING REGULATIONS License .CONSTRUCTION SUPERVISOR 4 Number GS 0,56340 Brrthdate Y10%29/1954 Expfres 10i2912006 Tr.no: 37250 Restncted��OOr WILLIAM L _SCHULZE CENTERV{LLE, MA"02632 ` Comiriissioner� _. ,;�,, ✓/zP, �amzmuncuere/C� o�✓i�i'cuw�u•/ucve�la u9s Board ofBuiiding Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration 112049 Expiration. 2/1.9/2005 Type: Individual SCHULZE BUILDING CO.,LLC WILLIAM SCHULZE PO BOX 288/65 CROCKER ST CENTERVILLE, MA 02632 Administrator F. pFISE,p� Town of Barnstable w Regulatory Services BAMSUBr s, Thomas F.Geiler,Director 9 KAN. `bA i639' Building Division QED MA'S Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME L%4PROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: /314T�11, /91�ilaNK�► Estimated Cost Address of Work: Owner's Name: Date of Application: /72' 17' b I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDERMGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: _ Z -g - D 561441�1 4 Z v 1 Date Contractor Name Registration No. OR Date Owner's Name Qlomwhomeaf6dav i - r 2ND FLOOR BATH 0" 2.8 2.4"Oc. fheb ES RE' / \ �!�I VANfNS�Nk�Yoi�Erc9�lOt.}ER ➢MpsR -R.,30 'R•30 FIEF TLEFLOOFZ VENT - - r�1 ?eMovE — Nr Ex" "', F IS(INfj FAMILY RPbPq 2x4 16"Oc, 1 CElll/y(j� RAISECS-�LIM�.EIhISrALL R_In� r'iNb�WS TzZsE 4FWSKIRD0146i 'DoOP- Ex%6T I N(, HPAD WwD FI.DoR .: - 30� ExKTING 19 2. 16"O-r-• LJo 45t- \ e — L� 51NK I— ANDERSEI�I �INoavJs` Y AKnLr OOM CRO56 SEerar► ExuTl�ly Z G 33 NEW pANrRy • Poch�T , -poop. ,1�FJCIST�A�Ct W ILGiL�oM I1�. - � �E�� REL�r1oDe.l t✓CISTINC-� �INOOIA�S REMOhEL AMILY Room, ZNb LAUNDRY FAMIL, P,60M Fiona BAtH) L-AUNDRk R—Nl ROOIV' r _ � - - S�plbw►1 I4,5 LpvINGa.AVE. NYAUNI.S.POR.r NF-W VJgLS� SrspV ANDpERSEnI 1•_. tww LU-N s.3'QSEPN .WOOD-OW NtRS. DoW4l 2-`�55 SLWALZE.bUlL.b1.NGa Co LLC GQr.L*i�C�ofl tuwTIN4 - 1luusE Ex15T INc,, LAUNDRY .- - '-I,- - --� - R�R R QNDERS�tJ ANDEGt51<N FWo 2R68A0. 4- rW 2-44(o +ZiPL KIRDOK ANDERStA 2- (a5'5 L�, y O YZ " xTr _ tj PAr�� o.o5£l NAu-- HALL _ • Li . P)N I N y { mM Qoo� -�- Y I,a„ 3 Qt�r Q���oorn �j�CD . L�L 0N�L o +� u �FLc)o� ��SGT �A►� rcws—* II «ser � .I ► HALL 00 goo 1 Is -RATS RAM �Ls)SV-T a *IHE Town of Barnstable *Permit# "o ,�, •...;;. . ., ,. ...:... Expires 6 months from issue date BAMSTABLE, Regulatory Services Fee 102 Y 0 163 ��� Thomas F.Geiler,Director AIED"A°`A Building Division Tom Perry,`Building Coir signer' '����� PERMIT 200 Main Street.Hyannis;MA 02601 NOV �. �004 Office: 508-862-4038 Fax: 508-790-6230. TABLE - TOWN OF [3ARNS EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 Property Address 5 / Residential Value of Work - 2�QW� Minimum fee of$25.00.for work under$60 A- lo 1 ��T� �EjC� WIZ 0 �c CD Owner's Name&Address -, ;:j AA r_. Contractor's Name Telephone Number d in Crl-11 Home Improvement Contractor License#(if applicable) ?_O 1 49 Construction Supervisor's License#(if applicable) O'S 6 3 L{O ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 1, 1*7r, Workman's Comp.Policy# Ul G - '75 Z / 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) P/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. HZvement Contractors License is required. Signature Q:Forms:expmtrg Revise063004 y oF,�+E ra _� Town.of B arnstable : -rO egulatory Services R K _ .�- 1 :. snaNsrnBi , • t lThomas F.Geller,Director Building Division Tom Perry, Building Commissioner'_ 200 Main Street, $yannis,MA 02601 P Y ww.town.barnstable.ma.us Office: 508-862-4038 - _ :=Fax:-508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, bbS�l'jk Wfl � ,as Owner of the subject property hereby authorize to act on my behalf, rued by this b permit a r; in all matters relative to work autho g p application for, (Address of Job) Signature of er Date Print Name r �teom�r�ianuweai �a B'.O�ARD OF Slut1116,IINIG REG.UIL ATaIONS License:,CONSTRUCTION$UPERUIS'OR a Ntimr,b S 056340 ,I. gt a 0 1a954— Tr.no: 3725.0 , � Q WIILLIAM L SCH = PO;�OX _'" CE�ITERVdLLE, MA Gortimlsslorier Board of Building Regulations and Standards HOME I IP VEMENT CONTRACTOR Re. iist-,ation 12049 xpira#for% 2/a-9/2005 _ Y -11l1ividual• SCHULZE BUIL LL j WiLLIAM SCHU �. PO BOX 288/65 CF2()C}�� CENTERVILLE,MA 02632 � . Administrator