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Home My WebLink About0048 MURPHY ROAD y8 rn grpny eo�e AuTIVE pFTHE Tp� Town of Barnstable *Permit# a� - Expires 6 m the from sue date 'RE ,r_ regulatory Services Fee • w • BARNSTABLE, �$ MASS. IUL 1679. — 6 Z00q Thomas F. Geiler, Director �0 AIfD MP't A TOWN OF BARNSTAKFBuilding 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 0 Property Address _ mta.f h QO+A r\15 ff) (D)G u ( [[;ARt idential Value of Wort. -4 qd, Minimum fee of$25.00 for work under.$6000.00 Owner's Name&Address t 1 J r< 7—Cl �06Lk- Contractor'sName..of'adde. tth j)rt�JeM1?j Telephone Number I tome Improvement Contractor License# (if applicable) 163-75 Z Construction Supervisor's License# (if applicable) COIP -[3 orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner wave Worker's Compensation insurance ` I Insurance Company Name 5o�'� d l-"4A_L. 4 ri;e_S Workman's Comp. Policy#_ U -700 '1 30 1 QOU1 -Copy of Insurance Cowpliance Certificate.must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be to ❑ Re-roof(not stripping. Going over. existing layers of roof) Re-side eplacement Window door sliders. 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. SIGNATURE: ):'.'A 1'1-11.1:S'0:01tMS\building permit forms\EXPRES .doc Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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): Sofnd,e_ W1i2_ tMOCoV:e1'Y�.✓ Address: City/State/Zip: 4 v 6t:n n 6 fnA c) (,Sp t Phone#: .59�- '7^7 5 T1 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.El 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 mein 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 11.❑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 *Any 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. :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: DS50luiCJZ TV.At_,S�f i'S 0C Policy#or Self-ins.Lic. UX_ _703 S9 y 30(JLU) Expiration Date: Job Site Address: ())UV l)�V ROCA-A City/State/Zip: Otv\rX lS (� aX 0 t 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. . I do hereby ce er t a and penalties of perjury that the information provided above is true and correct. Signature: Date: . 2 1 Phone#• -7 "? 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#: J fIN40MEIMPROIVEMENT SINCE 1348 SPRINKLE HOME IMPROVEMENT,INC CelebratinLy 63 Years in Business! 199 Barnstable Road-Hyannis,MA 02601 508 775-1778.800 2444778-Fax 508 775-1350 Email—spank@comcast.net Website address: www.sarinklehome.com Property Owner.Must.Complete and Sian This Section I, as Owner of thesubject property^ hereby authorize Sprinkle Home Improvement to act on my behalf, in all matters relative to work being done on my property. (107 C// Address of Jo Ilk Signature of Owner Date Print Name ------------------ 12/31/2008 14:18 Bryden & Sullivan Insurance Donna Seviour-*Margo 1/2 ACORD CERTIFICATE OF LIABILITY INSURANCE OP — DATE1 12 / SPRIN /31/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 62601 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER Associated Industries of MA INSURER B: Spprinkle Home Improvement Inc. INSURER C: 199 Barnstable Rd INSURER D: Hyannis MA 02601 INSURER E: ' COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 SR POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE IMM/DD(YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PREMISES Ea bccurence $ CLAIMS MADE r7 OCCUR MED w(Anyone person) $ r ` PERSONAL a ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LINT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT S ANY AI)TO (Ea accident) ALL OWNED AUTOS • BODILY INJURY $ - SCHEDULEDAUTOS (Per person) HIRED AUTOS .-BODILY INJURY $ NON-OWNEDAUTOS (Per accident) - PROPERTYOAM.AGE $ - (Per accident) GARAGE LIABILITY AUTO ONLY.EA ACCIDENT $ ANY AUTO . OTHER THAN EA ACC $AUTO ONLY. AGO $ EXCESSNMBRELLA LIABILITY r EACH OCCURRENCE $ t OCCUR El CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WC STATLL OTH- WORKERS COMPENSATION AND ITORYLIMITS ER EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTNE AWC7004943012009 01/01/09 01/01/10 E.L.EACH ACCIDENT $500000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500000 a yes,describe under SPECIAL PROVISIONS below - - E.L.DISEASE-POLICY UMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SpRNMO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEN Sprinkle Home Improvement, Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL Fax Mack IMPOSE NO OBLIGATIONOR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Margoo Mack 199 "Barnstable Rd. REPRESENTATIVES. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE lKelley A.Sullivan ACORD 25(2001/08) O ACORD CORPORATION 1988 . �i •.crltf.u�{4!!e(ram c�t fl. � c. ,•iZa . li`aild of'a3ilildingl2egulati[uis and Sirl;iidarrls Construcaron S.upervrsor<Lrcense" Ui'cense.CS g643 Expa'atron: 1078/2009 TiF' �927 Rest"r"coon 00, BRAJ:K SPRINKLE 190 LOTHRO:PS LANE i W BARNSTARLE,MA 02668 C 411*1 nnsioRel, t 0.0 .3$;:Q:0;0.cf.en'closed space' 4A 1VIaSonry ony kG- 1 _2 FamilyrHomes l ( Farluire to possess•a curreait edrzia:►of'fh`e 1Nassachysettsj. State Building Code r is ca:uselor revoeatron•ofahis heens:e: F 1 4 Y: Jrfft. ti !I/ .:+n! 7lr„3, 1� 1�Y9 l:r fl redEtilG Boai d=oC Bulldrng[iegulations Atli=Standards a i gar i k HOME IMPROVEMENT CONTRACTOR Registration: 103757 ExpiraGo.n .7/9/2010 Tr# 271;033 Ty00 Private.Corporati0n SPIRINK,L='E HOME IMPROVEMENT, IN'C. Brad. Sprinkle 199'Barnstabl''e Rd. Hya'r his MA'. A 02601 Administrator: License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,.Ma.02108 Not valid wit out sig ture 'i Town of Barnstable *Permit# 6z ' 0.* Expires 6 months from issue date BARNMBM : Regulatory Services Fees-� 9 1 6 Thomas F.Geiler,Director Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w X-PRESS S PERMIT Office: 508-862-4038 Fax: 508-790-6230 VL.L;; 1 1 2001 -00 EXPRESS PERNUT APPLICATION Not valid without Red X Pressrtnprint TOWN OF BARNSTABLE Map/parcel Number !2 Z `] Property Address 0- 24esidential OR ❑Commercial Value of Work Owner's Name&Address_&n 0 a/S Contractor's Name �jZ- T Telephone Number Home Improvement Contractor License#(if applicable)_Op 7 1-1O Construction Supervisor's License#(if applicable) C.So 7c? 7 l 7 \ orr 's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner fg-flive Worker's Compensation Insurance Insurance Company Name ? ��(' �'j�1/�P df('0 A Workman's Comp.Policy#-L' ,)c,3/ -c2 7- � Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof] ❑ Re-side [ eplacement Windows. U-Value (maximum.44) Other(specify) Ct'. ./' — /r' �S//, 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature expmtrg I � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel l Permit# � Health Division Date Issued Conservation Division Feed - Q Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project StreetZAess UIC A O Village Owner Red �/� �(� Address Telephone 97f Permit Request /MS1 I'GL 1//"11 rfDl% /�!I/1� ¢�/L� T 1�Aw Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full 0 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 vtal Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: O Gas ❑Oil ❑Electric 0 Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: O Yes ❑No Detached garage:Cl existing ❑new size Pool:0 existing ❑new size Barn:0 existing ❑new size Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial Cl Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name ��` Telephone Number '_W-141fS VZ` Address M ee4 mcx License# /1/1k"A& AW• Home Improvement Contractor# Worker's Compensation# )�,� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE G6`'� DATE � �� rti I` FOR OFFICIAL USE ONLY . PERMIT NO. Ik DATE ISSUED " MAP/PARCEL NO. , It ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION r' FRAME fi ` INSULATION r/ FIREPLACE c - ELECTRICAL: ROUGH FINAL , " PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING j DATE CLOSED OUT ASSOCIATION PLAN NO. 4 The Commonwealth of Massachusetts a — Department of Industrial Accidents =- — men ol/firesuffatieos - 600 Washington Street - - Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit r lime. location: city phone# ❑ I am a homeowner performing all work mysei£ ❑ I am a sole rietor and have no one worlds rn amity ❑ I am an employer ding workers'compensation for my employees working on this 0"1 job. :::.:::::::::::::.::....::.::::::.:...::............................:...........::.:::::::..........................................:...:..........................:........:..................:::..:::.::::.:::. t�ID178>tY:::>:>:>::«<>::;:::2;:;::i::::::::>::;:::»<::::t:>"<z: :::::»:: .................................................. tnnnraaee .:..... }:::.::,<.... . .... ::.:. :::. ❑ I am a sole contractor, homeowner(circle one)and have hired the contractors-listed below who have the full worla on lives: x,.v. ..............................:..,:•:::,:.:..::::.:::..:::::::::::.:.::::::.:::.,•::::::::::..:.::.:::::::::::::::::::. r::.:::.::.:::::..:.xr.::•:.N..N . ......°� .............,.:.:.:::...:.... ..............................................:.::.::}:....................................:.........::........,..............................................:...:............................::r}:4:. 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I mmdaatand that a eopy of thb stater�tmq be forwarded to the Once of Investiptlons otthe DIA for coverate veriflcatloa I do hereby eerli pains of e;ryry that the injorneadon provided above is&w.and correct Date CO - Print name Phone# o®dal me only do notw he in thh area to be eomphded by city or town ofndal City or town: permiNieenae# QBuffding DePartraeat QIdmsinY Board ❑dmddf iamediate response is regdred ❑Selectmen's Office OHealth Department contad person; phone#; ❑Other_ _ Onmd MS PW 1 - . �1 q Tor, :•l• •11 :.• 1 1 =. I :1.11• • . / • . - • .111•.11 •1• •11 • :IItoo . . �. • •III 1/ .it . 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VM .�:IIR 11 . . • 1 1 .11 1 1 • .II ..rl • 11 a •) • �. 111 _• 1• • t V.111 'it/..�• i i1111/.•.1 LW.11 ill 1 • l Am 1 1 • .1 111 till .1 II null •••1 1_4 1 • ' VON 1 1 1 I..Iyy :t . ` 1 V•Il llt _'1 .11 / 1 /1111_1 .n'. 1 1 1 1 •11 :111 1 1 • • �/ . .1 1/ 1 . / •I11 /t • 1 1•I • • t t1I • 11 11 /1 till 11 1 11 V' •) 1 �+. r •".11 •11 1 1• V•ill V. M •• 1 w•Y. •11/ • 11 r 1 V'=111 1 1 11 /• .11 I1 •�/rllll wl 111111 / ••• ' 11 1 / 1 _• a a _11 111111 1.1 1 // • 1•, 11 t - /11.1�• I 1 11 1 / 111 till • • 11 it 111 �/. • 11 -• .1/ .11 ' .•11 ..111, 1 • ��/ 11 V. l 1 � ■/ V' • I _+ • •Y.11 •11 '• I 1 !• II .11 •• I II • • .11 V' • • 1 •• t_1 .1• •II 1 • I • • • 1 •11 • I � • • I jj�ME// 1 1 •.1 11/.+11 •re 1 •II1 11 • Y•' 111111 /�/ " 1 •11 1 1 I I . 1 1 •,' INJ i 111 H 1 1 1 � � • 1 1 1 1 1 1 1 1 I l . 1 �TMe r� The Town of Barnstable ' a�srvsresrE, • '& Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT 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. r Estimated Cost - v Type of Work:_�l/ ��l%r�Ql�/J Address of Work: Owner's Name: A Date of Application: % a 7 _ I hereby certify that: Registration is not required for the following reason(s): Work 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 FOND UNDER MGL c. 142A. SIGNED UNDER P ALTIES OF PERJURY I hereby apply for apermit as the agent o e o r. Date Con or Name Registration No. OR Date Owner's Name q:forms:Affidav , g� & &z a HOME IMPROVEMENT CONTRACTOR'S REGISTRATION Board of Building Regulations and Standards One Ashburton Place -- Room 1301 ._ _ - -• - . Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR _ >...:- R'egistrat:ion: .,120.456 Expiration 01 /01 /01 PR iV.ATE.;CGRPORATION! . . BIL"OpiY ALUM'. SIDING- CORP ._. . ..__.._ JOHN O 'NEIL 40 ELMONT RD ELMONT NY 11003 . I . I �y A4CORD. CERTIFICATE OF LIABILITY INSURANCE °ATE°�"�°°9 08/Osi9� PfrooucaR Tf•IIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIC COUNTRY' INN• INS-URANCE AGENCY, ONLY AND C!71U.FERS;NO. RJGHTS .UPON T'HE CERnFiCAT- HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND 0 217 MERRSCiC ROAD ALTER THE CtIVERAGE AFFORDED BY THE POUCIES g�Oyr SUITE 212 AMITYVILLE NY 117 C' _ NSURERS AFFORDING COVERAGE 3IL-RAY ALUMINUM SIDING CORD IHSURERA.-U'HE 1.1TSIIRANCE CORPORATION OF NY 13 4-10 ATLANTIC AVENUE INsuaE;B--CIGNA- 'INSURANCE COMPANY R2CMIOND $ILL, NEW YORK 11419 cREALM INSURANCE COMPANY INSLJR3r'S DUARD.IAN . INSURANCE COMPANY COVERAGES THE POLICIES OF RVSURANCE'USTED BELOW HAVE BEEN'ISSUED TO THE'INSURPO NAMPO ABOYE :ORTHEPOUCYPEMOO INDICATED:Nbrv1,.rH.TANOWI ANY REG.Ll RENfEA4T,-TEAM`OR CONDMON OF AM CONTRACT OR OTHER DOCUMENT`WUH E!—PECT TO WHICH THIS'CERTIFICATE MAY BE ;SSUED a MP.Y'PE, AlN.'THE BVSURANCE AFFORDED BY THE,POUCIES DESCRIBED HEREIN IS SUB lECT TO ALL THE TEMv*-6(CL'JSJ0ff3 N0 CONOMIONS OF SUC. POLICIES.AGGFZ-GATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAims- ,NSA I.:. TYr--W u,"mm Axce POLICY NUMQ9t POLICY I�Ty" I PO z Y DCT9tATtON � .. LfMrl'i GENERAL LtALZV.= EAG1 occuRRENCE :1 0 0 0 0 0 x COfv13iERC:AL GBIE AC UAB1LrrY r o RRE DAMAGE IAm am rmW S 50,100 CJ1MS MADE a OCCUR MED ma Wry one c�sonl 0 5 00 05/14/9;9 0-5/T4/0.0 A IGLOO. 8 6 _' RSOPLAL L'AOV,WJURYg1 ,000 , 00 GENERAL AaGAECATE. *2 0 0 0 0 0 GEN'L AGGREGAT't L SA11T'AYPCtE9'P3t. PRODUCTS-COMPfOP ACC s 1 O 0 0 00, Poucr I 1 tea- Loc - iuT omca71E LLAAMrTY COMBINED-SINGLE LIMIT-_.,. ALL OWN M ALTOS t _ ... .. _ 900LLY INJURY = - SCHEDU'I 'AUTOS_' v 'BODILY INJURY '*, •': : o- ;.;..• W` NON OWMED AUTOS :'_ .. - - PROPERTY DAMAGE i tALtAGE LIA82StTY AUTO ONLY-SA ACCD9NT a ANY AU-r O ,--.. - . ...:.._.... �;:. _ OTHE9 THAN EA ACC t AUTO ONLY: A06 • txctas L Anarrr EACH OCCURRENCE I s 3 0 0 0 0 0 i OCCUR CLALLMS MADE AGGREGATE z3 , 000 ,00( B BINDER n.., O5/14/99 � 105/14/00 : DEDucnsLE CI I514 9 7 t RIcrENr,oe, s � a WOf%ff=C07HT�=AT)GH ABC WC STATIJ OTH- g I�o�Y�r�I�L C Emp-Layalcir uAJSLurY BINDER "0 5/'1 4/9.9 0 5/1 4/0 0 LIr SACH AC=DEAT s 5 0 0 000 CI 1514 9 8 E.L.DISEASE-CA EMM-OYM 8500 , 000 E.L DISEASe-POLICY UMrr 85 0 0 0 0 0 oTHe� D DISABILITY BINDER x 06101198IUyrIL C1151499 I CP_'�CELED :OMCMrMN CW ADDED aY sYaos�saa:xtrsr ALZRav�aMs , - F tERTIFICATE HOLDER i==NAL imano: tNsusot LETTSt: CANCELLATION SHbInM AMY OF THE DESC=0 POL=E:M CANC=M M=09E TFM 0ZP1RA 01 CAT.- TMr-=F.THE I=UNC IN7.w=WILL ENDEAVOR ra WIL 3 0 DAY- WF]T�Z NOT?c=T}IE CSM:1CATE HOLDSI NAMM rO THE LFrrr.Sur l uLL m TO 00 sa s14�1 PAPO.SE NO 03UCATInIt OR IJAVUrY or AM iaAD UPON THE[K%XtEP-ri3 ACLNr6 01 A�TOSSF?ITA 'i1 r. AtJT7iO4ca=Pt='Axr- Town of Barnstable *Permit#�93B' Expires 6 months from issue date BszAB Regulatory Services Fee `�� g o MASS. v� 059. `0$ Thomas F.Geiler,Director Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w X-PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 l'�.� 1 1 2001 -u1p EXPRESS PERMIT APPLICATION TOWN OF BARNSTABLE h !2 Not Valid without Red X-Press Imprint Map/parcel Number Z _7Gar v�T / I Property Address -AT Mur-DAki 2' esidential OR ❑Commercial Value of Work RJ ,3. 4 Owner's Name&Address /')o-n d onNi S Contractor's Name 1� Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) CS07o? 7 1 y orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner D-rfiave Worker's Compensation Insurance Insurance Company Name AneYl CO, Workman's Comp.Policy#__L )c j I —a2 7 �15 6 — Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side [replacement Windows. U-Value (maximum.44) Other(specify) —'Y Irl eL 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. expmtrg