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HomeMy WebLinkAbout0281 OCEAN STREET c-e C.r) �f - Anderson, Robin From: David Delaney <david.delaney@icloud.com> Sent: Tuesday, May 25, 2021 6:14 AM To: Anderson, Robin Cc: Mark Anderson; Suzanne Brennan;Alicia Cummings; Eileen L. Delaney Subject: 281 Old Craigville Road, Hyannis Robin, Following up on our discussion a few days ago about the house we are purchasing at 281 Old Craigville Road in Hyannis, we wanted to provide you with the following information: 1. Once purchased, we intend to use the house as a single-family residence 2. As requested,we will apply for a permit to change from a "family apartment" to a "single family" 3.The locks will be removed from doors between units A and B 4.A floorplan of the house layout is attached, showing the locks which will be removed. 5.The closing date is June 2nd, 2021 Please confirm that you have received this email, and let us know if you need any additional information. Regards, David and Eileen Delaney david.delanev@me.com CAUTION:This email originated from outside of the Town of Barnstable! Do not click links,open attachments or reply, unless you recognize the sender's email address and know the content is safe! 1 Town of BarnstableBuilding E=\�.. PPWo,h.s"'et{:e.;rx.ed aU:,nCi'bt'e�irtzl;F►fiincaaltel.>n=�'.,os<.2pf��',ek0`''sc.eteiounp aHnacsy=B��►'�se s,eRn�e q,M.u..r,a,►rde„�e'd'���.;s;�ua°c7h�$B�;u�►�1dm �s�,hal�43lr N�o t be O,gcr-c u ►er'S�d,3,u..�n t►I a na'2 l,�I ns"ec tion has_be n"ma�de���i ,. Permi t Permit No. B-18-1208 Applicant Name: sean sweeney Approvals Date Issued: 04/25/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 10/25/2018 Foundation: Location: 281 OCEAN STREET,HYANNIS Map/Lot: 325 022 Zoning District: RB Sheathing: Owner on Record: SWEENEY SEAN E& ConttactorName� Framing: 1 1 g: f�do �E C4,4 ontractor liicense 2 Address: 62 JASMINE LANE GLASTONBURY,CT 06033 N3 _ Este Protect Cost: $4,000.00 Chimney: Description: Current 6x8 flat roof is leaking. Permit Fete: $85.00 Plan to change flat roof of first floor bathroom from a flat roof to a Insulation: Fee Paid'` $85.00 Z6 pitched roof. Bathrroom is 6x8 ft. Will have to,6 pitch using 2x6 rafters and 5/8 plywood. Date 4/25/2018 Final: i N 3 Apply ice and water shield on entire roof and architectural shingles - -Certainteed. Plumbing/Gas Re-shingle side wall,apply trip and re-attach gutter S& Rough Plumbing: Building Official Project Review Req: PITCH AN EXISTING FLAT ROOF-NO CH ANGE IN FOOTPRINT a Final Plumbing: OR FLOOR AREA. g� Rough Gas: � 3 � 5 This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Final Gas: All work authorized by this permit shall conform to the approved applicat�enend the approved construction document No which�this permit has been granted. All construction,alterations and changes of use of any building and str"uctures shall be in comp ancce with the local zo��ning y laws and codes. Electrical This permit shall be displayed in a location clearly visible from access sireefor road and,shall be,"fri - d open for$public inspection for the entire duration of the work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Bwldmg and3F ri efFicials are provided n this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Final: 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Health 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: dw1-PE t t: oFIK r Town of Barnstable *Permit# �j Expires 6 months nt issue date Regulatory Services Pee + aMMSTABLE. + r TMt^SS. $ Thomas F. Geiler,Director lED�APt -PRESS PERMIT , Building Division Tom Perry,CBO, Building Commissioner APR 2 9 2010 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us TOWN OF BARNSTABLE Office: 508-862-4038 Fax: 508=790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X=Press hnprint Map/parcel Number Property Address fKResidential Value of Work Minimum fee of.$2S.00 for work under$6000.00 Owner's Name&Address S -- Contractor's Name Telephone Number ' (CC, Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Xworkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ® I have Worker's Compensation Insurance Insurance Company Name ��. ��f` 1 ' � Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over. existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value (maximum .44)#t of windowsT *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of t Ho e I rovement Contractors License & Construction Supervisors License is required SIGNATURE: Q:\WPFILESWORMS\building permitforms EXPRESS.d The Commonwalth of Massachusetts Department oflndustrialAccidents Office oflnvestigations I' cj 600 Washington Street Boston MA 02111 mvw;mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Address: CA.A. A City/State/Zip: e a \1 J r\A$S Phone Are you.nn employer? Check the appropriate box: Type of project(required): 1.1k I am a employer with o3 4. ❑ I am a general contractor and 1 6 '❑ New..construction employees (full and/or part-time),* have hired the sub-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 working for me in any capacity. employees and have workers' Building addition [No workers' comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its IO.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right ofexerpption 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 fll 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 isproviding workers'compensation insurance for my employees. Below is thepolicyandjob site information. , Insurance Company Name: NVAQ A Policy or Self-ins. Lic:# Expiration Date:' --6i 9\� Job Site Address: '��\ ���S� City/State/Zip: A�lrll Attach a copy of the workers' compensation policy declaration page(showing the policy numb 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 D1A for insurance.coverage verification. I rlo here rh under i and nalties ofperjury that the information prov' d above is true and correct. Si nature: Date: \ Phone 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 d. Electrical Inspector 5. Plumbing Inspector 6. Other. Information and Instructions MassachuSe:ts General Laws chapter 152 requires all employers 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 hire, . express or implied, oral or written." f 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'empIoyer, 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, constriction 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 conunonwealth 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 out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (UP.)with no employees other than the members or partners, are not required to carry workers compensation ins urance. If an LLC or LLP doe s 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 line. City or Town Officials ` Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom Office of Investigations has to contact You regarding the applicant. ' the event the Off g of the affidavit for you to fill out m 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 subinit 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 filture 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 burn 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: The Commonwealth'of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASS.AFE Fax # 617-727-7749 Revised 4-24-07 www.tnass.gov/dia �JHEr Town of ]Barnstable Regulatory Services ' BARNST^gLE• Thomas F. Geiler,Director y rcnss. � 019. ., Building Division Tom Perry,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 Usiny A Builder I, S as Owner of the subject property Y behalf,m on act hereby authorize �', � to in all matters relative to work authorized by this b ding permit application for \� Fu (Address of Job) Signature of Owner Ate �E'R . Pae Print Name If Property, Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable f'SNF Tp� T Regulatory Services Thomas F. Geiler,Director i HAHNSTABLE, "6"9 9� 1659• Building Division ��� - PrED '�a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": work hone tl name home phone 4 p CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of,six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to dQ such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2,15) This lack of awareness often results in serious problems,particularly when.the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently. used by several towns. You may care t amend and adopt such a form/certification for use in your community. (),\WPFII.ESTORMS\homeexempt.DOC x s r .4 ice' wt K glp fi 5r al, '.. a5 S I � t • W}I�VC fl!t #f�,fit' \x � > '�4 � t7''Y'`''m� 3 _ tt�l9 k x E�F '�'i pp -�j.•t 5xz�+�e�-;�ri'��"'•F a�t5 ��*a��'tj. "lby,�. • iw� i�b s `�'�1�`E�,F..' R�k.:E �Kx k r �,yv'ifr� �ro i • �• � • � � ap.R�-�,4n� �,�+'.� ^t Y+,Sva.�st y��.v. Fe } p.a'Y� .s. • r �,jrr3�+zl�ay'p ir, e .. 3 i Lw>§ '�•"''�' 9 l�4 . • , f ���St,1�4{"���'��'�.Jy� r4 S� � l���p �"'��'. i� •`vi ircE z! f il. 1�L�I-- � • • �- 1 - 1 1 �t�k�4 Rf� "R�k��p-,R�c.""UP '+wi� �'Sr� �. �--1�� :/ / 1 1 1 1 / / +�h,�a iq"c i 1��'F E yr + M,g 'p! �]•ya ..�' °' • 1 � 1 �i l��T�Sn trot ti a ' i/ 1• 1 1: �'�ti.:iy�','c+t""Ft+qR:''�'T xc'Ik��l'+�� �:�d �, M From:Kathy Geddis FaxID:Northwood Insurance Page 3 of 3 Date:9J23/2009 11:37 AM Page:3 of 9/4/2C09 11:00:02 AM PST (GMT-8) FROM: insurancevisions.com-TO: 15083932955 Page: 3 of 3 ACC CERTIFICATE OF LIABILITY INSURANCE r ATE(MfN/DDIYYYY) 91412009 PRODUCER NORTHWOOD ESHBAUGH INS AGCY INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 540 MAIN STREET SUITE 9 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HYANNIS, MA 02609 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (508)540-1223 INSURERS AFFORDING COVERAGE NAIC# INSURED DEAN STANLEY BUILDING CONTRACTOR INC INSURERA, LIBERTY MUTUAL 359 CAPT LIJAHS ROAD INSURERS: CENTERVILLE MA 02632 INsuReRc: INSURER D: 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. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION .Lm TYPE OF INSURANCE POLICY NUMBER LIMITS - GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTEIT COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS MADE OCCUR MED EXP(An one person $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PR0- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Es accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS ' BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC1-31S-374314-019 8/31/2009 8/3112010 1/ wCSLjATILMrr OER AND EMPLOYERS'LIABILITY Y f N ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? F (Mandatory in NH) E.L,DISEASE-EA EMPLOYE $ 100000 Ifyes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY,LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The workers'compensation policy provides coverage only for the state of MA as noted in section 3A of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF YARMOUTH DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 7 DAYS WRITTEN 507 BUCK ISLAND RD N0710E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL WEST YARMOUTH MA 02673 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _ n op THE roy, Town of Barnstable *Permit# ? 3. Expires 6 months from issue date BMW STAB , : Regulatory Services Fee v MAW. $ i63q. Thomas F.Geiler,Director A ♦0 'ED1A"`A Building Division Tom Perry, Building Commissioner X.PRESS PERMIT 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 MAR 1 0 2003 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESII; AQ.F( STABLE �y /Not Valid without Red X-Press Imprint Map/parcel Number o� 11 b L 7 _ Property Address04 nin , (m Q4esidential Value of Work ' Owner's Name&Address -jg1 41 tits W4-- dritractor's Name j ( '1 �qey Telephone Number 5rp —� t 5a8 -- Hbme Improvement Contractor License#(if applicable) Construction 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 Insurance Insurance Company Name Workman's Comp.Policy# 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) ❑ Re-side ❑ Replacement Windows. U--Value (maximum.44) Other(specify) Palms fi1/1da j ���►�� *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. Signature &gJ-4, Q:Forms:expmtrg Revised121901 16 .01 antuvsrnst�.i Regulatory Services Fee v, ��.e Thomas F.Geller ecto Dirr pTfO�''i'v Building Division X-PRESS PERMIT Peter F.Diliatteo, Building Commissioner 367 Main Strt:et, Hya=is.,MA 02601w.' APR 16 2002 Office: 508-$62--�038 . T Fax: 508-790-621-0 OWN OF BARNSTABLE EXPRESS PERINTIT APPLICATION - RESIDENTTAL ONLY ' Not Valid w;thostrF"X-PrmINPrutt ��%ap�pafaei'Vumocr �0�� sideatial Value of Work Owner's Name&Address Contractor's Name �— 'telephone Number_� Home improvement Contractor license (if applicable) Construction Supervisor's License_(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a soleproprietor - I wn the Hon=,%I er ❑ 1 have Worker's Compensation Insurance Insurance Company Varese Workman's Comp.Policy_ - Permit Request(check box) 'Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers ofroof) Q Re-rider . ❑ Replacement ri indoors. U-Value (�-44) ❑ Other(specify) •Where required: Issuance of this permit does not exempt compliance with other town deparm=t regulations.i.e.Historic._Consemation.:tc. Sisnature � . O:Forms:expmug:re�'atT0601 cr Fee Regulatory Servicesgy ��e"� Thomas F.Geilet,Dlceetor '°Tfo!A0't'v Building Division <3aZ S- d-AL Peter F.DiMatteo, Building Conmdssioner 36 i plain Street, Hyannis,MA 02601W (,����� Office: 508-862�38 Ily Fax: 508 ,90-6__0 ENT RESS PERIIITT :�PPLICaTION - RESID T AL ItY 1002 Not Valid)vithorrt Rtd X-Press'1fflM Or BAR ViaP:P arcel Number ®22 �S,' Pro P .erty Address a GP�N value ofWork esidential Owner's Name&Address 01 Jqrx Telephone Nu mb Contractor's Name - Home improvement Contractor license 4{if applicable) Construction Supervisor's License_(if applicable) t ❑Worktoan's Compensation Insurance Check one: Q atn a sole proprietor .am the Homeonmer Q I have Worker's Compensation Insurance Insurance Company Name /L�//�/fTh Ale Worianan's Comp.POECY Permit Request(check box) ❑ Re-roof(stripping old shingles) Q Re-roof(not stripping. Going over existing iaYets ofroof) Re-side �a/fT�� 44 eplacement Windows. U Value _ { ) ❑ Other(specifti) . •Where required; Ltsu>.-tcr of this permit does not exempt compiiance with other too" d nt �aons.i.e.Historic.Consem 4tion.::c. Signature Q:Fartns:c.%vrm c:rev-41;0601