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HomeMy WebLinkAbout0165 SCUDDER AVENUE QV4� Town of Barnstable Building, :Post?his Gard So That�t is�V�s�ble�From�the�Street 'A' roved;Ptans�Must beRetairied:onJob,;and this�CardFMos"'t be=Ke' t � g, uceQ Wherea Certificate ofOccu ane =�sRe u�red 'such B,uil`dm shall Not-be Oecu ied unt�la Fm`atans ectiori hasbeen,matle. Permit Permit No. B-18-1550 Applicant Name: Approvals Date Issued: 06/07/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 12/07/2018 Foundation: Location: 165 SCUDDER AVENUE, HYANNIS Map/Lot 289 076 Zoning District: RB Sheathing: Owner on Record: CLARK, LOUIS J JR&PSOMOS,ANNEContractorName Framing: 1 Address: 165 SCUDDER AVE Contractor License, x 2 .. , ` .. Est Pro ect Cost: HYANNIS, MA 02601 �d J $4,800.00 Chimney: Description: weatherization Permit Fee: $85.00 k Insulation: Fee Paitl $85.00 Project Review Req: �° QDate 6/7/2018 Final: ---- �c^—Z-5 Plumbing/Gas Rough Plumbing: Building Official I Final Plumbing: s_ This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months afier issuance. Rough Gas: All work authorized by this permit shall conform to the approved application,%h the approved construction documen, for ich this permit has been granted. All construction,alterations and changes of use of any building and structures�shall be in compliance with the local zoning by,416Ws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street orAroad and shall be maintained open for public mspection for the entire duration of the work until the completion of the same. x x Electrical ' � � , The Certificate of Occupancy will not be issued until all applicable signatures byathe Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work s ' 1.Foundation or Footing Rough: 2.Sheathing Inspection F 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "P ,36ns tracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department cep - ��z� Building plans are to be available on site Final: C All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel B�ILD1 a: Application # �G Dip,. Health Division Date Issued Conservation Division MAY 17 2018 Application Fee O, l31�F� TOWN F d Planning Dept. i�iS;Ao��r Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address J� 3"� _e,2,4, ,9d Village i&YYi,/A1 S Owner ,l°el i S Address Telephone�,3 d 7 Z Permit Request /o u,y i� � � ✓�J / C� jf�. /�.s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed . Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family 0' Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes LI-No On Old King's Highway: ❑Yes .9-No Basement Type: ❑ Full ❑ 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 Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number T y'/ Address �r� , t��eZ ale License# Zz� 9 —/7�, Home Improvement Contractor# /�� �-72 Email xwe-4&5V ZW pj°C.��/c®SU,� 7i'a,�J Worker's Compensation # q.:-Jf, Y--�) ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 3s-�/ FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Y. The Commonwealth of Massachusetts Department of XndustrialAccidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www,mass,gov/dia Workers' Compensation Insurance AMdavlt;Bullders/Contractors/Electricians/Plumbers, TO BE FILED WITH THE PERMITTIM AUTHORITY. Applicant InformadonPie e Print Le b Name (Buslness/OrganizaHorAndivldual): Cape Cod Insulation ly Address; 18 Reardon Circle City/State/Zip; South Yarmouth,MA 02664 Phone#: 508-775-1214 Are you an employer?Cbeck the appropriate boxt Type of project(required): 1,©I am a employer with 48 employees(full and/or parwime),* 7. ❑New construction 2,❑1 am a sole proprietor or partnership and have no employees working for me In $, ❑ Remodeling any oapaclty,(No workers'comp,Insurance required,) 371 am a homeowner doing all work myself,(No workers'comp.Insurance required,)t 9. ❑ Demolition 4,❑I am a homeowner and will be hiring contractors to conduct all work on my property, I wi11 10 ❑ Building addition ensure that all contractors either have workers'compensation Insurance or are sole 11,❑Electrical repairs or additions proprietors with no employees, ❑ 5,❑1 am a general contractor and I have hired the sub•oontractora listed on the attached shoot, 12, Plumbing repairs or additions These sub•contraotors have employees and have workers'comp,Insurance,t 13,❑Roof repairs <1 We are a corporation and Its officers have exercised tholt right of exemption per MaL o, 14.0 Other Weatherization 152,11(4),and we have no employees,(No workers'comp.Insurnnoe required.) °Any applicant that oheeks box#1 must also All out the section below showing their workers'compensetionpolicy information. t Homeowners who submit UsTVIdavit Indloating they are doing all work and then hire outside contractors must submit a new affidavit Indicating suoh, ;Contractors that check this box must attached an additional sheet showing the name bf the sub•oontractois and state whether or not those entitles have employees. If the sukontrsctors 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 ;' Ir�ormaKon. Insurance Company Name: Atlantic Charter Policy#or Self-Ins,Llo,#; WCE00431902 Expiration Date- 06/30/2018 Job Site Address:,Yds" f� ��/�' w/ LCity/State/Zlp: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), Failure to secure coverage as required under MOL o, 152, §25A is a criminal violation punishable by a fine up to$1,500,00 and/or one-year Imprisonment, as well as civil penalties in the form of a STOP WORK ORDLR and a tine of up to$250,00 a day against the violator,A copy of this statement may be forwarded to the Offioe of Investigations of the DIA for insurance coverage vorifioatlon, I do lie""ce cep ns and penalties of perjury that the lrf'ormatlon provided above is true and correct. +�SlanatureA n lut ro ww Phone# , , 5 -775-12 4 Official use only, Do not write In this area, to be completed by city or town offlclal. City or Town Permlt/License# Issuing Authority(circle one); 1. Board of Health 2. Building Department 3, City/Town Clerk 4, Electrical Inspector-.51 Plumbing inspector 6,Other Contact Person; Phone Ni S i � 6 ,' Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Ma tusetts 02116 Home Im rovema ,. a ractor Registration Type, Corporation Reg( fratbly Ca a Cod Insulation Inc z 153s87 p �, Expiration; 12/14/2018 18 Reardon Circle - oil So, Yarmouth, MA 02664 �� I �W SCAT 0 20M•05f11 Update Address and return card, Mark reason for change,_ ------...._---CJ A�lrizmssa_. .Ltaruw:�l_��t�,�loyrtas�nt_ 1. nat.rar�L.. �aantuealt�a� aaaac�ccoetld• Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TT� el Corporation before the expiration date, If foun urn to; ,� egis.t:ration Ex iration Office of Consumer Affair;and of so Regulation lop n 1., •.;•.•.. 77,, 12/14/2018 10 Park Plaza• e 5170 �'>> �:' lb Boston,MA pfil Cape Cod Insu Henry Cassidy , `Vf 18 Reardon Ciro. R•c� —. So,Yarmouth,MA��� f,��?' Undersecretary t a Vhut si at - Commonwealth of Massachusetts 1 DIVlsion of Professlon`al Llcensure -Board of Building R,egulatlons and Standards Constry0tbNbPyrvisor 1'sty!' 4�O ires, 11/1,1/201.9 HENRY E CA$OIDY WE8 SHED ROW� 4 ST YARMOIJ, ir Commissioner • 1 • o CAPECOD-27 KDOYLE CERTIFICATE OF LIABILITY INSURANCE DATE 04/03/2018Y) 04/03/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER C ACT Ro ers Rte&3 Gray Insurance Agency,Inc. PHONE FAX A/C,No Ext: A/C,No: 877 816-2156 South Dennis,MA 02660 jt&hss.mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Peerless Insurance Company 24198 INSURED INSURER B:SafelyIndemnity Insurance Company 33618 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE I OCCUR BKW63328281 04/01I2018 04/01/2019 DAMAGE TO RENTED occurrence) $ 100,000 MED EXP(Any one erson 51000 PERSONAL&ADVINJURY 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY El jPCOT El LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: B AUTOMOBILE LIABILITY a COMBINED SINGLE LIMIT 1,000 000 (Ea accident) $ ANY AUTO 6232707 04/01/2018 04/01/2019 BODILY INJURY Perperson) OWNED AAUTOS ONLY X AUTOS BODILY 11000,000 E� 0 OyyN D BODILY INJURY Per accident X AUTOS ONLY X AUTOS ONLY PPe�accRd nt AMAGE C UMBRELLA LIAB X OCCUR EACH OCCURRENCE x2,000,000 X EXCESS LIAB CLAIMS-MADE R/O EXC10006635002 04/01/2018 04/01/2019 AGGREGATE DED RETENTION$ Aggregate 2,000,000 D WORKERS COMPENSATION STEATUTr OTH- AND EMPLOYERS'LIABILITY Xf ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCE00431903 06/30/2017 06/30/2018 E.L.EACH ACCIDENT 1,000,000 W.FICER/MEMBEREXCLUDED? �N NIA 1,000'000 andatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD of IHE rp Town of Barnstable co .; � °;6 Regulatory Services RaRNftna[.E, ' Richard V.Scali, Director MASS. o, 9opA 1639. Building Division rF� M Ar a Paul Roma Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, LOUIS J CLARK , as Owner of the subject property .hereby authorize �fiff 00)) 114s0 cN-r(bW to act on my behalf, in all matters relative to work authorized by this building permit application for: 165 Scudder Avenue Hyannis, MA 02601 (Address of Job) JU Signature of OWer Date I /-Y)fl e'`r�s_.6►�1'l:oS:'�'L` �' C Q r Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form. C:\Users\decollik\AppData\Local\Microsotl\Windows\INetCache\Content.Outlook\L7U69Lf 2\EXPRESS(2).doc 01/25/17 L FRIEDLINE&CARTER ADJUSTMENT, INC. 436 Main Street, P. O. Box 338 Hyannis, Massachusetts 02601 Tel. (508) 771-3232 FAX (508) 790-2344 TO: (:4Building Commissioner or.Inspector of Buildings { ) Board of Health or Board of Selectmen ( ) Fire Department TOWN OF BARNSTABLE TOWN HALL HYANNIS, MA RE: Insured: PSOMOS, Anne&CLARK, Louis J. Jr. . °4. Property Address: 165 Scudder Ave. 0 Hyannis, MA 02601 t t Policy Number: HOM00337780 Type of Loss: Fire -- Date of Loss: 11/27/2014 File#: 121160 Claim has been made involving loss, damage or destruction of the above captioned , property,which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy,number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the < addresses indicated above by First Class Mail. D. A. BENTLEY Adjuster 12/1/2014 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this font) at 200 Main St., Hyannis. Take the completed firm to the Town Clerk's Office, Is[ FI., 367 Mein St., Hyannis, ;MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: `� ' y 1 3 Fill in please: -IGANT'g= YOUR NAME/S: /mil 6L BUSINESS YOUR HOME ADDRESS: S 0 ed 7 3(o g o 3 q l=(v aw.v1 i H 5 ivl 1-1 • Home Telephone Number SO �— —2 S— l g 3'-( NAME OF CORPORATION: NAME OF NEW BUSINESS/,/rn r✓`y, 4- TYPE OF BUSINESS 5 r,'✓1-1- f 51.9rt IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS I Co G7 Scuds v/ - MAP/PARCEL NUMBER� '-G (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMM SSIO ER'S OFF E This individual had n infor. e o %er it require ents th t pertain to this type of business. IV J MUST COMPLY WITH HOME OCCUPATION Auth riz Si ature* RULES AND REGULATIONS. FAILURE TO COMM "SO, i^ l 2. BOARD OF HEALTH This individual ha sl bee r o�t�l' �{the permit requirements that pertain to this type of business. MUST�XMPLYWITH ALL li 1' V l►' I .p-gnnr;��c+�,nL.Tt_•r.!gl �r,+.-.•, , nT�„-. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSI ` AUTHORITY) This individual has b11n inf tv t! licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Town of Barnstable Regulatory Services Richard V. Scali,Interim Director IIAJMMABM ; Building Division 1g6 `0� Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 08-790-6230 Approved: II�� Fee: _ `� 3. Permit#: HOME OCCUPATION REGISTRATION Date: i Z.U 3 Name:_ P�Lt,/ C `G���G-- Phone#: .�U 3 6 — 0 3 CJ Address: !(a S s C, U 2 /q v e ` Village: Y, t ` S Name of Business:"Al o—y Y o L j Type of Business:W e- 6 pr 1 n-r D f 5 l !il\ Map/Lot: Z 5 CJ ' o—7 (o INTEN'r: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carved on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • -There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read an ee with the above restrictions for my home occupation I am registering. Date: Homeoc.doc Rev.103113 J1\40F NEW BEDFORD A WEATHERIZATION CO. www.JMofnb.com T: 508.992.5770 info@jmofnb.com 423 Coggeshall Street F: 508.992.5773 New Bedford,MA 02746 f- March 21,2013 Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 RE: Insulation permits Dear Mr. Perry: This affidavit is to certify that all work completed for insulation work at 165 Scudder Ave., Hyannis has been inspected by a certified Building Performance(BPI) Inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Matthew Perry JM.of New Bedford . �.q 0 7.77 w . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- Parcel. 4 Application 9>ZU 9V Health Division " Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board po Historic - OKH _ Preservation/ Hyannis Project Street Address Village rk Owner �,.`����� �� Address_Its SQAAA--Q A�� P Telephone PeA.rmit Request &-Q— 1 �� , �1 MQu& \n Gl s?._➢ ��\&X&420 bccu�cc_�\ r�\ A�_ 0a, 10_� 6-n q rWY Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuati ®thc> 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 ❑ Crawl ❑Walkout ❑ Other Basement Finished Areas ft. Basement Unfinished Area-,(s ft ��_., Numberlof Baths: Full: existing new Half: existing nevu` Number of Bedrooms: _. existing new Total Room Count (not including baths): existing new First FlooQRoom Coount Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other s ?' Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) I � 6 Name � P � Telephone NumberS.&gW S' Address License # ) 49_ Home Improvement Contractor# ) b3 )c< Worker's Compensation # .-� p �� ALL CONSTRUCTION DEBRIS RESULTING FRO THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE A FOR OFFICIAL USE ONLY z APPLICATION# S DATE ISSUED c + t .MAP/PARCEL NO. E, ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION . FRAME f , ` INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL b PLUMBING: ROUGH FINAL i ROUGH FINAL ;FINAL BUILDING E r - f . DATE CLOSED OUT ASSOCIATION PLAN NO. 1 A . 4 I J� The Coi:niP2onweallh. of Massachusetts :-- Department of11ndustrialAccidents in) 7Z Qf ffce �f bivestrgations d 6�� Wash, ,S-Yreet Boston, MA 02111 i",mmass.novIdia Wo3-kers' C0• ..3p€ns2tlon Inst3k'puce Affidavit: 36?�7isc'd����3F?i 3C�QPlS L�'�� 3�kiFYis/ p64si7�7i b'Ii"� : IIisa.AEn '€zriztio3: ^—_ Please 1? antLe Name (13,isin.css,Orgarxizatioii'Individua.l): JM of New Bedford Co. , Inc. Address: 423 Coggeshall Street City/State%Zip: New Bedford, MA 02746 Phone#: 508-992-5770 Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer vrith 4 4. ❑ I am a genera] contractor and I 6. ❑ New construction - employees(full and/or part-tune).- have hired the sub-contractors 7 ❑ Remodeling ! 2.U 1 am a sole proprietor or partner- listed ou the arncLcd sheet t I ship and have no employees These sub-contractors have 8. ❑ Demolition I) working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition t to workers' comp. insurance 5. ❑ We are a corporation and its �' J.O.❑ Electrical repairs or additions required,I officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I LE] Plumbing repairs or additions myself [No workers' comp. c. 152, S 1(4),and we have no 12.❑ Roof repairs insurance required.] i employees. NO workers' 13)M Other Insulation [ comp.insurzt.-e required.] _ - -Ar)y applicant that chcc?,s box r I must also fill out Ore section below showing their workers'corrtpensation policy information: 1 Homeowners whc subrnit f.-ds affidt!vit 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 subcontractors and their workers'comp.policy infon-nation. I arn an employer that is providing workers'$T CG/1it1L'Pd$(dF1UlL USS1LrarLCf for my employees. ,below is tlzepol:y and job site in1`ormatiom Insurance CompanyNarlie: _Savers Property & Casualty Policy#or Self ins. Lic. #: wC 0 0 0 0 6 5 5 Expiration Date: 1 0/21 /1 2 Je'o Site Address:-Ns C��A.J� City/State/Zip: (`A�'1� IS, M-, 1A mot` n w. s Bi r 7 n r I c r4,4- ` I attach a copy oL'-;,r,, orkcrs compensation o,�c� declaration page(sho« ng the pc.i.:y sr�1..:tn and expiratF�an d,ate). P 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 S 1,500.00 and/or one-year ii npt isonznent, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against tee violator. Be advised that a copy of this statement maybe forwarded to the Office of Investiga ti.Ons of tLe DIA for insurance cove,.-age verification. .l do here -tif!w7der t t ris artdpenaltles ofperiury that the informdtion provided above is true and correctSi�natur _ _ Date: $ _ Phone: 508-992-5770 Official use only. Aso r1Jt write in this area,to be completed.by city or tosvrx official. City or Town: PermitfLicease# Issuing authority (circle one): I1.Board of Health 2.Building Department 3. City/Town Cleric 4.Electrical Inspector 5.Plumbing luspector ` 6. Other Information and. Instructiorls Massachusetts General Laws chapter 152 requites 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, cxp-ress or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other Icgal entity, or any two or more of the foregoing engaged in a joint enteryrise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other Iegal entity, ernployi.ng employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or t]ie 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 ap plicant who has not produced acceptable evidence of compliance with the insurance coverage required." p P P o q 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 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-contractors)name(s), address(es) 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 pezTnit 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 bot;orh 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 petmit/li.cense applications in any given year,need only subrrit one affidavit indicating current policy information (ifnec(,ssary)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 maybe provided to the applicant as proof fat a valid affidav t 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. w 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-MASSAFE 1~'av E F,1'7. '71-7 '7'7A 0 I - THE Town of Barnstable } Regulatory Services - s�tNsrws�, •, MASS. Thomas F.Geiler,Director 1639. Bnilding Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 rY Prop er Owner Must Complete and Sign This Section If Using A Builder 3`�--� , as Owner of the subject property hereby authorize nsy � � to act on my behalf, in all matters relative to work authorized by this building permit. (Address of Job) "Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is-installed and pools are not to be , utilized until all final inspections are performed and accepted. C � Signature of Owner Signature of Applicant sC :: c I Print Name Print Name Q TORMS:O WNERPERMISSIONPOOLS zHE r Town of Barnstable o Regulatory Services s BAMST.,BLE, ; Thomas F.Geiler,Director y MASS. g q,A 1639• Building Division TED MA't a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: V 1 JOB LOCATION: S �/ number le street () Q vi age "•HOMEOWNER":Lby�5 0�� 5L ` l ' )U 34 name home phone# work phone# CURRENT MAILING ADDRESS: `�� ��`�=-�\ fAIAL ty/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 Person(s)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 do 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. Q:forms:homeexempt r �- JMOFN-1 OP ID: PC CERTIFICATE OF LIABILITY INSURANCE DATE(M17/1YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 508-997-3321 CONTACT Humphrey,Covill&Coleman PHONE FAX Insurance Agency,Inc. ac No Ext: A/C,No): 195 Kempton St. P.O.Box 1901 E-MAIL New Bedford,MA 02741 ADDRESS: Raymond A.Covill INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Savers Property 8r Casualty INSURED J.M.of New Bedford Co.,Inc. INSURER B:Atlantic Casualty Ins.CO 423 Coggeshall Street New Bedford,MA 02746 INSURER C:Torus Specialty INSURER D:Norfolk 8r Dedham J23965 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR EXP LTR I TYPE OF INSURANCE D " POLICY NUMBER MWDDPOLICY EFF MM DDY YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 AMAGE TO RENTED B ( X COMMERCIAL GENERAL LIABILITY f IL081000893 j 11/15/11 11/15/12 PREMISES Ea occurrence) $ 50,00 T CLAIMS-MADE EX OCCUR 1 ! MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY 1$ 1,000900 F� GENERAL AGGREGATE I$ 2,000900 GENT AGGREGATE LIMIT APPLIES PER: 1 j PRODUCTS-COMP/OPAGG $ 2,000,00 POLICY JECTPRO- I 1 LOC $ AUTOMOBILE LIABILITY I CEOMaBBIINEDtSINGLE LIMIT $ 1,000,00 D ANY AUTO ( 191253253A 01/05/12 I 01/05/13 BODILY INJURY(Per person) 'Is —�ALL OWNED SCHEDULED I AUTOS X AUTOS ( BODILY INJURY(Per accident) $ �I X it HIRED AUTOS X NO�SWNED PROPERTY DAMAGE 1$ Per accident X I DOC I I 1 I $ X f UMBRELLA LIAB XOCCUR EACH OCCURRENCE $ 1,000,00 (+ EXCESSLIAB I CLAIMS-MADE] I81775C110AL1 12/27/11 12/27/12 1 AGGREGATE _Is F_rDED I X RETENTION$ j $ WORKERS COMPENSATION I X WC STATU- I JOTH- AND EMPLOYERS LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N I i WC0000655 10/21/11 10/21/12 'E.L.EACH ACCIDENT $ 1,000,00 I OFFICEWMEMBER EXCLUDED? ❑ N/A i IfMy ndator r be uH) I I ! E.L.DISEASE-EA EMPLOYEE $ 1,000,00 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $' 1,000900 i I I i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insulation & Roofing Contractor CERTIFICATE HOLDER CANCELLATION MECHANI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN JM of New Bedford Co Inc ACCORDANCE WITH THE POLICY PROVISIONS. 423 Coggeshall Street New Bedford, MA 02746 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/06) The ACORD name and logo are registered marks of ACORD of �la�,artiu.�rit, - I)clt:ti tnirut nl' Public oafc(% Board ni' Buildin-, Ilct"ttlatimis :111t1 �tantl;tril� Construction Supervisor License License: CS 104088 Restricted to: 00 ELWELL PERRY 75 MYRICKS ST k a t BERKLEY, MA 02779 * ter; Expiration: 5/20/2013 , c „nmii.,i,•i,•r Tr.--: 104088 uu2(s Inoq)in,eV t(un ION S-1L a.�aas.�apun -- 9tiLZ0 bW 'abOda38 M3N lldHS3CC b OC£Z NN3d ll3Ml3 9IIZO VVw`uo)sog ' CNI '00(hiO038 M3N�Q W( OLIS apn n u uol =� S- Id (and OT )e�od�oO a(enud uolle(n2ag ssatnsnII PuR s.tluJJv.tawnsao33o aauJO J ZIOZ/9/L :uol)etldx3 :adll 966£OL :uo( :o)u.ui)aa punoJ 3I •a;up ttollR.tidxa at a.w a I I b �, � � • fluo asn Inpinlput a03 pgen uo►)u.gsI�at to asuaal� uoitntn�agOssau�isailNOO JN3W3/�O2idWl 3WOH �_ U J }}8-p sa(RJJV.iaurnsuoOJo aauJO �(!gyp -,72y��IYGGfJ2lGll/O �7 V OWNER AUTHORIZATIONFORM (Owner's Name) owner of the property located at /I — 0 b6 xv .. .0/ (Property Address) (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. ,, Owner's Signature Date V rF Office of Consumer Affairs and Buslness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 103195 Type: Private Corporation Expiration: 7/6/2014 Tr# 226529 JM OF NEW BEDFORD CO. INC. ELWELL PERRY -- 423 COGGESHALL ST.NEW BEDFORD, MA 02746 — — - Update Address and return card.Mark reason for change. SCA 1 20M-05/11 El Address ❑ Renewal Employment Lost Card t3 n��l' (GCJ7N771071COC!!!l�O/ni�LCIJ.i CIC�!!JC'✓lJ ' \. Office of Consumer Affairs&Busibess Regulation License or registration valid for individui use only A. (� SOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: tj egistration: 103195 Type: Office of Consumer Affairs and Business Regulation xpiration: 7/6/2014 Private Corporation 10 Park Plaza-Suite 5170 =' Boston,MA 02116 JM OF NEW BEDFORD CO.INC. ELWELL PERRY x 423 GOGGESHALL ST: NEW BEDFORD,MA 02746 — Undersecretary Not vali with ut signature Town of Barnstable �pF IME Tn Regulatory Services Thomas F. Geiler,Director PEI Building Division # EAMSMLE, * . vQ M� Tom Perry,Building Commissioner y0rtb 1, 200 Main Street, Hyannis,MA 02601- f a '- _ . www.town.barnstable.ma.us Office: 508-862-4038 r Fax 508-790-6230 DO Approved:` Fee: 3eD Permit#: aON O�D'-1 ?5D HOME OCCUPATION REGISTRATION Date. ­7 � Name: 1M ck j t- V2� '. Phone#: -� U `6 3 (o t'( - Cv3 q S Address: Name of Business: P'� CCJ 0__r c Type of Business:\/G U_f�-1 Map t: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to opente a home occupation «zthirn single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,proNaded that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;-no Visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;, and no increase in air or ground«ater pollution. After registration with die Building Inspector,a customary home occupation shall.the permitted as of right subject to the folloiAing conditions: • The activity is carved on by tine permanent resident of a single family residential dwelling unit,located iazdhin that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is, no outside e`ddence of such use. , • No traffic will be generated irn excess of normal residential volumes. • 'Ne use does not involve'the production of offensive noise,Nabration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,hunnidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,uh excess,of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing die Customary Home Occupation,and not Aithin the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles relatedto'-the Customary Home Occupation,other than oiie fan or one - pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. ` • No sign sliall be displayed.iridicating the Customary Home Occupation.. r • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be,employed uh the Customary Home Occupation xvlho is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with-die above restrictions for my home occupation I am registering:; Applicant: Dater /2_0t�! Homeoc.doc Rev.01/3/08 t YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for,4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by,M.G.L:-it does not give you permission to operate.) You must first obtain they necessary signatures on this fond at. 200 Main St., Hyannis. Take the ccimpletc>d form to the Town Clerk's Ofiic:c:>, 1st. FI., 3G7 Main St., Hyannis, NIA 02601 (Town Hall) and get the Business Certificate that is required by law'. DATE: Z II Fill in please: s APPLICANT'S YOUR NAME/S�1 �C.(,J 1G� BUSINESS YOUR HOME ADDRESS: G - 5 G u 4,/G_-'l V-1 t` M 5a�-333- G35K c� 20c� 3 TELEPHONE # Home Telephone Number NAME OF CORPORATION: FLU a K 55 _ NAME OF NEW BUSINESS e (_CJ 1 14b r I C�- S TYPE OF BUSINESS VoL)-r'tn 12un i✓r G ad a.►-y�.� IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS 5. Sc V ci d-e� ✓e- f F 5 /Yl,�} MAP/PARCEL NUMBER D� (Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street] to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE S This individual has been informed ny permit requirements that pertain to this type s . M UUMPLY WITH HOME OCCUPATION Authorized Signature*,V RULES AND REGULATIONS. FAILURE TO. COMMENTS: JO 1. r r z{ T e. �r �. -� /1 a / COMPLY MAY R€21,11 T IN FINES. 2. BOARD OF HEALTH. This individual has l een form f the permit requirements that pertain to this type of business. �'R T Author ed i nature** COMMENTS Q 3. CONSUMER AFFAIRS(LICENSING AUTHORITY} This individual has b formed of the ensi requirements that pertain to this type of business. Uld Au Signatu n� COMMENTS: 6,J ev k� Town of Barnstable --r,/'/'9y*Permit# �s-S ,*SHE tpK� Expires 6 months from Issue date �p° or BARtiSIABLE *' Regulatory Services Fee— s �o , y MASS. 9: 29 Thomas F.Geller,Director -PR �pTEe i9. Building Division �;ornPerry, Building Commissioner T �,{��, Z�R�I 200 Main Street, Hyannis,MA 02601 o�N OFe �004 Office: 508-862-4038 ,q%STNI., Fax: 508-790-6230 EXPRESS PEMT APPLICATION - RESIDENTIAL ONLY q��F Not Valid without Red X-Press Imprint Map/parcel Number C71 V 1 �✓ Property Address Value of Work 91esidential Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Worl=an'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# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken' Re-roof(not stripping. Going over existing layers of roof) [] 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. ome Improvement Contractors License is required. �� �_ �, Signature Q:Forms:expmtrg Revise053003