HomeMy WebLinkAbout0055 SECURITY STREET Town of Barnstable Permit
Expires 6 mon r is at
Regulatory Services Fee
annxsr LJL
6 . Richard V:Scali,Interim Director
_ Building Division =
Tom Perry,CBO,Building Commissioner _
r 200`Main Street,Hyannis,MA 02601
wwwtown.barnstable.ma.us ,
Office: 508-862-4038 t, Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ;
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address
Residential Value of Work S Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address ( -AIN
''
Contractor's Name Q LlC /tti. Telephone Number U v�A
Home Improvement+Contractor License#(if applicable) j, 3� Email:
Construction Supervisor's License#(if applicable) C U� �Y v
❑Workman s Compensation Insurance « c' p
Check one: 1 ''
❑ I am a sole proprietor Ali a 1 LU t�
❑,Yam the Homeowner _
I have Worker's Compensation Insurance
Insurance Company Name TV4N OF BARRBLE
Workman's Comp.Policy#_
Copy of Insurance Compliance Certificate must accompany each permit. `
Permit Request(check box) -
❑ Re-roof.(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Ike-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
Re-side y, >
❑ Replacement Windows/doors/sliders:U-Value '' _ (maximum.35)#-of windows
#of doors
❑ Smoke/Garb Monox' a detectors4 floor plans marked with red S and inspections required. -
Separate E ctrical ire Permits required.
"Where required: suance of permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc:
***Note: f Prope Owner must sign Property Owner Letter of Permission.
A op of he Home Improvement Contractors License&Construction Supervisors License is
r 111 ui d. t'
SIGNATURE: r,
TAKEVIN ges\EXVESS PERivIIT�EXPRESS.doc `
Revised 061313
'Z+ BARNSTABIdw
NAM
Town of Barnstable T
'Regulatory Services
- n,
Richard V.Scali,Interim Director
Building Division
Thomas Perry,CBO
"Building Commissioner f'
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
as Owner of the subject property. ,
,.
C? ta "onmyhereby authorize! behalf,
in all matters relative to work authorized by this building permit application for:
47)
r C � Duo I
{ (Address of ob)-
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side. Q
TAKEVIN Muilding Changes\EXPRESS PERMIT )E PRESS.doc
Revised 061313 -
27te Commonmeakh o,f Massachusetts .
D►epaphnewt of lmiustyial Acc desra
Office of Iirvestigazions
600 Washirrgton Street
Boston,MA 02111
rvww rnas&gov/dia
Workers' Compensation Insurance Affidavit:Builders/C ntractorsfBb�tricians(Plambers
Appficant Information (. VV / ease Print Lexibly
Name(Businemiogpizaftmalndividnal}:
Address: 1
City/Sta&Zip:�' ��/1-v� ( � pb&
Are you an employer?Check t appropriate box:,-, - - 4. I am a contractor and I Type of project(required):
L E 1 am s employee-with ❑ �a� b. ❑NewconsftuCtii=
employees(full and/or paet4ime)_* have hied the sub-eontaactoss
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
worming for me in any capacity- employees and have wooers' 9. ❑Building addition
workers'comp-insurance comp.rnsuranmi
required] .5- ❑ We.are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work• officers have exercised their 1 l-❑Plumbing repairs or additions
myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]1 c.152,§1(4),and we have no / -
employees.[No workers'
comp-insurance required.]
•tiny applixaut that checks box##1 m=also fM an the section below showing theb wmkers'compensation policy infonnatim
Homeowners who smbmit this affid"uAmsdmg they are doing all wof and then lake outside cmtaactors nhnst sub=a new affidavit indicating suclL
Contractors that char$dais ban mast attached=additional sheet showing the name of the sub-comisctors sad state whetter or not those entiti>,have
ezplopees. If the suhaontractoas have empltayses,they mast pmvide their workers'comp.paltry number-
lain are employer that is proving nvrkem'congwnsalion insurance for my enq%layem. Below is the poncy d"Id j'ob.site
information.
Insmance Company Name- ( (j j)4d Q/1
Policy#or Sel=ins.Lie-##: oe co1 L, 0 Ly lxpiiation'Date. I q
Job Site Address: v C City/StatelZip ,D�r1 n 1/1 PLO— d
Attach a copy of the orkers'co ensation policy declaration page(showing the'policy number and expiration date).
Failure to secure co ge as req ' under Section 25A of MGL c- 152 can lead to the imposition of criminal penalties of a
fine up to$1,500. and/or rmprisonmesit as well as civil penalties iu the form of a STOP WORK ORDER and a fine
of nP to$250.00 ay agaiais violator_ Be advised that a cnlry of this statement may be fosvearded to fire Office of
Investigations a DJA urance coverage verification.
I do hereby 'ni e Pr
s and penalties of pedwy7 that die information prorrded bove' trite and carrect
S `" Date:
Phone# �
t3,,lcaat use only. Do not twite in this,area,to be completed by cite or totm official
City or Town: Permit/License#
Inning Authority(circle one):
1.Board of Heaitlt 2.Budding Department 3.Cityfrowcn Clerk 4.Electrical Inspector sc.Plumbing Inspector
6.Other
Contact Person: Phone#•
Rightfax C3-2 1111 /2:o13 6:::55 S6,.AM PAGE 3/004 FAA Server
ACC>R CERTIFICATE OF LIABILITY INS N E `i
THIS CERTIFICATE IS ISSUED AS A:MATTEWOF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES;NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER 1THE 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 It the cedi icatc holder is an ADDITIONAL INSURED,the policy(ins)must he endorsed.'If SUBROGATION IS WAIVE
I subject to the terms and conditions of the Policy,certain policies may requirc.nn endorsement. A siaterriant on this ceridicntn:does,�
not confer rights to the coriiticMe holder Iri Ueu of such endorsement(s).
!PRODUCER, -CONr-Acr
OLDC CAFE(,7D It +A(iC �''`
F C" k! i6 ax
IT,:rI R7
I I ANN S,h4A 02601
I AM
41 R1-h _
MEAGHER MIUTAEL.58A
WAGHERDROTI1ERSI.ONSTRUCTIO?1
9 EMERALD S I'REEI /cr
M Q5TONS t IILLG;P.1n s)264S I
~.,.COVERAGES W„,r_ ___ GERTIhICAfHNFItJrt�FR;�_ �_, RFVISit?iVNUMBER.,_.�,"_ E
mis IS i`C f.ERTIF'Y TUAF THEIPOLICIeS.OF INSURANCE LISTED DE Ow HAVC FIG"EN ISSUED TO TH[;NSt1E EQ.N-AME
ABOVE FOR THE Pf�LIr Y PERI47D INn Ci�TECi. NOTINiTHsrANDJNG ANY REOUIREN4ENT, TEPM OR CONDITION OF ANY
!UPITFlC7 OP t7THER OOf Uf4E^I1 li+7H RESPECT TO NHIGH THIS-GERTIFIQATE MAY BE ISSUED OR NiAY PERTAIN,THE
It SNRANCE AFFORDED GY iHL PiQLjC1ES,DESCRI6rD HEREIN IS SUBJECT -0 ALI THE TERMS. EXCLUSIONS. AND r
! CONDITIONS OF SUCI'ROLICIES LIMITS S1,10,A1hi.MAY.HAVE DEEM,REDUCED fly PAID GLAIIAS
T� - ""ADO t SUOR POLICY EFF I.POI.7CYf;XP
0R TYPE Or INSURANCE ,INSR YdYni POLrCYnUMETER jAit&Da'Y}yY1I(iihl'DID-MY Un1rtS
WIERAL LIA1111-HY
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L,IMBREL A LiAB 1IC [Uk I ! i Lra 11 C,r.;sla sti it -
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i WORKER3COMPENSATI9N t' ` I _
1 ,AN OEfrLMtRS!_tAOUTY t�(, i e i O NV;AW
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DRr Rt TOR ra c SccV ,dNi SSOJ:LO�J 1FW,A
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C,t r'{S*r E E+.PCrG_ $FOt1;C{Qv
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DESCRIPTION OF OPERATIONS.LOCATIONS VEHICLES(A Inch ACORD lel.AaUMorul Rwalbs Sdtooulo It mores r is Pats ..1{Gutredi
MEAG)iERT MICIIAEL l-G()V.ERED fly;TUILVVORKE RS-:C Oki PENSA ION POLICY.'
C� RTIFiCATLHO(,Oj__._� =r—^ _CANCELLATION.
TCVVR C I'
t-,t3ARh STA[3LE I3UILDIN;a DEBT r SHOULD ANY OF THE ABOVE DESCRIBED POLICIE'S BE 230SOUTN;STREET CANCELLED BEFORE..THE .EXPIRATION DATE THEREOF
H'vllphrtS,panU24iUf' NOTICE WILL BE DELIVERED 1N ACCORDANCE. WITH THE
POLICY.PROVISIONS, . .
AVnibRUO REPRESENTATIVE. "
I _
rI 1988-2010 ACORD CORPORATION All.rights resetvcd. +
ACORD 25(20101015) The e,ACORD name,and logo are regictercd markS.of ACORD
M1
//, `For„)I it..)P("a:,rll/.
i
-.Office of Consumer Affairs&Business Regulation
eOME IMPROVEMENT CONTRACTOR ;
egistration 162938 Type:
xpiraUon:j,A/27/"2015:I DBA
MEAGHER 13ROTHE R&CONSTRUCTION
MICHAEL MEAGHER JR
97 EMERALD LN
. �MARSTONSMILL,MA 02648 Undersecretary
' t Massachusetts -Department of.pubiir' Safety
r
Ja Board of Building Regulations and Standards'
Construction Suprrl'isor
License: CSA02260F1r
_ MIcHAEL S MEAGHER JR
97 EMERALD
• Marstons Mitts MA 02648,
`J F I51 ! �XC3i'idt9
111051201414
Commissioner
r
UnreSicte ; r
contain less haMild ngs of
an
enclosed Space:n 35,Opp cubic eet(9 ouf which `
m I of
/FD,
ure to possess e Buildln a curve s r
g Code is cans t edition;of the S Lice e f Massachusetts
nsing infor °r reVocation of ,
oration visit: this license
www•Mass.Gov/DPS
•
i a License or registration valid forindmdul use only e —
;.
before the expiration date. If found return to:
Office of Consumer j 10 Park Plaza_Suit170 Affairs and Business Regulation `
Boston,MA 0211 �.
'( r No slid Without signature
�FR eV. El hiff, 7,-TJ 0r7fz2-
` y�%THET��♦ TOWN OF BARNSTABLE
ii •
i BARNSTABLE, i
b 9 0 w BUILDING INSPECTOR
ar a
i
APPLICATION FOR PERMIT TO ... .... .. . ... ..:.. 1 *p'?`v.. .............................................
TYPE OF CONSTRUCTION t`' .,.
........................:.l.. .........197.�-
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ........... ....... .......................... . ......f.:.. ....... 4�
ProposedUse ............� a �............ .....................................................................................
Zoning District ....... �:....� ,... . I.
...........Fire District ........ ..... .................................
Nameof Owner 's...... .........................................Address .r?................................... .......................... �
Name of Builder ....Address .....::.............................................................................
........... ......... `'� -........................
Nameof Architect ..................................................................Address .......H/. ....... ......:......:..............................................
i� �P
Number of Rooms ................��.......... ...................................Foundation ....................... '�?^: ......,.................
Exterior ... .................................................Roofing ....................................................................................
Floors 'Y. ........................................................Interior
Heating ... .z-cam..............................Plumbing ............... .....................
........ ......................................
Fireplace ......Approximate Cost ��
.... ... . .. . ......
...
O 4M(2k
Definitive Plan Approved by Planning Board -------------------_-----------19--------. ® E /
Diagram of Lot and Building with Dimensions iR rEAR `� af9�,�j 1141,6*
SUBJECT TO APPROVAL OF BOARD OF HEALTH
7 N.
l ? 0 5 CR-rC KI EIV '15,4 7W Z3
jj
U) <N z s-rn o
>: >-
_ j
_ ; `n(
CAS
.� z /.
E<- p �0(1�-Lji-eirreby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
j I-✓construction.
S < z
LName ....... ... .......................... .. .
Perpall, E. A.
No .... 92 .. Permit for ..... enclose open ,
porch
........................................................ .. .. ...........
Location ......55::Security Street
West. Hyannisport
............... ...................................................
Owner ......... .•...A....Perpall.............................
1
Type of Construction frame -
Plot ......................... . Lot ................................
Permit Granted ...April 14 ........ 19 72
.. .......
Date of Inspectio� �*��7-
Date Completed .. ......19 1
^ T
PERMIT REFUSED
................................................................ 19
............................................................................... -
I
............ ...............................................................
...............................................................................
Approved
............................................................................... ¢
.................... .........................................................