HomeMy WebLinkAbout64-66 WOODBURY AVENUE (0�• 66 �lfoodbu� fyE
Town of Barnstable *Permit#
'b Tres 6 months from issue date
fe Regulatory Services e
* sA Wr5T.ems,
MASS. Richard V.Scali,Director
�039- PERMIT
t Building Division ,
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601 SEP 01 2016
www.town.barnstable:ma.us
�I TARIA-
Office:
508-862-4038 TOWN OF PPAR o8�-7
EXPRESS PERMIT APPLICATION - RESIDENTIAL. ONLY
Not valid without Red X-Press Imprint
Map/parcel Number f ` �A//� B
Property Address �� �(/V),J j?,a
❑Residential Value of Work$ LIVE ( Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address f yal 44 yi d,z' j
Contractor's Name j 01 Telephone Number
Home Improvement Contractor License#(if applicable) Email:
g� 4
Construction Supervisor's License#(if applicable)_ ��
❑Workman's Compensation Insurance .
C eck one: ,
I am a sole proprietor m
I am the Homeowner
El have Worker's Compensation Insurance
Insurance Company Name
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
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
Re-side
Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors: Ai
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*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 thelHome Improvement Contractors License&Construction Supervisors License is
required.
SIGNATURE: 4
QAWPFILESTORM uilding permit forms\EXPRESS.doc
06/20/16
ti
The Commompealtit gfMauadt
Department qfIudush id Accid6i&
Q �e afbillesfigaiiom.
600 Washing m Shwet
Bastin,MA 02112 '
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Wor lcerss Campensatian TIISIIrauce,Afffdayit BmldeFs/C�mtmctGrsMe -LTCL3II�lIImbers
APPUMMt IHfQrMatiGII Please Pxin
xT pler. • ( F' - .
1'1Effie�Bnein�S r� 1 ►" 5 On
Address: C ,
t712110 i) .
c�istax vJ� ��6 �ne
Are you an employer?:Checkthe appropriate bom . Type of project(re
quired):
1.❑ I am a employes with 4. ❑I am ageueral contractor and I
6. ❑New rinnstnXtic
employees(fall andfor part-time.* have lsiredtltee sub-coatrackws
2.64 I am a sole propHeto€orpartner Tisted cathe attadmd sheet, I- ❑Remodeling.
slap and have no employees i Mese sub-contractors have 8 ❑Demolition
wv -Ing for me iu any rapacity: employecas and Im a woAmrs' 9. .El Snip aci3ifiaa
LNQ 'romp-insurance comp_insuran e 1
reguired_j 5_ ❑ We are a-corporation and its 1O-❑Electrical repairs or adds
3_❑ I am a homeowner daMg all work officers have exercised their 1L❑Plumbsngrepaus or additions _
Myself[No
a workers' - rioL L.El Roof of exempfim per MGL repairs
,r, te e��,d-j T c.152, §I(4h and We have no
_ employees_[NOwodoess' 13-❑other
comp-insaraaz regmrei]
•gory WUcm=dnt cbecksbax 91 mmst also Molt a secflonb9awkIwmn&e rvin&es' msff=-
Ekmmmners
mdw submit thisafi"idavd deyaxeduingallvra&saaiBaer him amtsidecontm..�±mam smcb-
ICaatracmadial checYthisbox mast attached sm sdditiaaal sheer shoumg tl+enazne of the sub��sad state whether oraatf6ase entities bwe
emp3oyees.Ifthesnb-co-at have empIoye,-s,dieyxmxstpmuide&eir wadxeWa=p.palicyamaher:
I am au euiplaysr Heat ispratddun;urarkers'romperesatiatc htsrirarrcefor my,errrpFQyem 8etaev is ripe pa£icy arcd jQb stye.
trcfarmalrats
Insurance Company blame: -
Po-ficy,41-cr Self-ins.Lic-4: ' ExpimtionDate-
Job safe AA&e= CitVIStMWzip_
Attach a-copp of the w•orl:ere compensationpolicy declaration pap(shaving the policy number and expiration date). '
Failure to secure coverage as regtured under Section 25A of MCL c~1572 can lead to the imposition Qf criminal penalises of a
fine up to$L54aOD an:dfor o6i-yesrimpriso3mezA.as well as-civil,penalties is ihe form of a STOP WORK€7RDE.Rand a EM
of up-to$25t1_00 a dap ab�aiast the violator_ Be adidsed oaf a copy ofthis statement maybef.rwarded to tie,Office of
It<v f fire DIAL for insurance cavetage verification-
I afa iferzby t
undar and psr�s of pediu7 that face inf or mi mrprmigni a i s tare and correct
;7
4iasaatrer - Dates
_ PhDne A - 3L -c4,. 73
tgki d use aa£y: Do not write in dds area,to be cvmpTeted by city ar6wn of j'raf mI
CRy or Town: -Permitffkense f
Issuing Autlmrfty(circle one):
L Sid of 13ea1 y D 3.e partmeat j Ioira C1er� :Electrical IuspeetQr .P bing Inspector
&Other
Coact Person: 'Phow#-
- 6
laformation and lastractions r ' v
Massach=e'tE4 CTM!IIe� Laws Gbq)trd 152 rmgmi=all=ploy=to FUV1de WdtiM�conlpeosaflon for ffieI r eo P'C`Ye
Pursue ibis sty,an MMPIayW iS defined as-`°_every person in ffie service of anoiber under any contort ofbire,
express or implied,oral ar wift mf
An employe-is defined as"aa mdrvi ina1,parfnM ,assocAona corpor-�ion or other legal entity,or any two or mCTM
of the foregoing=gaged is a3omt ,and inchidmg the legal seIrmen atives of a deceased emplayer,or ibe
receiver or t ustee of an iad�partnership,assocfifim or otheriegal entity,employing employees_ However the
owner of a.dwelling house having not more than three agartam is and who resuics thnem,or the;occ¢Qant of the -
dwelling house of another who employs pcmcns to do mai�ce,consUucti-on or repay wDi.on such dwelling house
or on the grounds or bm7dmg appmt= . thereto shag not b===of such employment be deemed to bean employPa_"
MGL chapter 152,§25C(6)also states that-every state or local licensing agency shall WMhoId fhe issuance or
renewal of a license or permit to operate a business or to construct burZdsngs in the commonwealth for any
applicantw•ho has notproduced acceptable evidence of cnmplrancewitIr the insurance.coveJrageregnired"
Additionally,Mtsl.rester 152,§25CM states Neither fhe r, *****+mwcahh nor jay ofits poIifical subdivisions shall
entry info any contract for the performance ofpublic Wmkuntcl acceptable evideam of complian.mwhfi the fiL=m2ce-.
M ets of fhis d apter have been presented to fiie co—*d ,¢aofhozity
Applies ,
please f of Dirt the workers'compensation affrdavrt completely,by g ibe boxes!hat apply to your situation and,if
necessary,supply sub-conttactor(s)name(s), addresses)and phanennmberr(s) along Wifhtheir catcacafe(s) of
m=mce_ L=itDd LiabrIty Conrpam.es(LLC)or United LiabRity Partnerships(LIP)wr&no employees oilier than the
members or pmtae xs,are not mined to catty wonke&compensation iDsmmom- If an LLC or LLP does have
employees,a.policyisrequfiTZ Be advised that this affidavitmaybesabmitfe:dtotheDepmtnentof Industrial
Accideats for confirmation of msnrp cove'aage,. Also be sure to siLm and data the 215davit The affidavit should
be retomed to the city or town that the application for the peonit or license is being requested,not the Department of ;
Teri r�efrial As e ts_ Should you have any gncstions regarding the law or ifyou are requited to obtain a wormers'
compensation poky,please call the Department at tha unmber listed below. Self-insured companies should entcr their
self-insarmce Iieeuse number on.the apprapriafe line_
City or Town O fdri2IS
t
please be sore tb at the afhdaPit is complete and printed legibly- The Depm nenthas provided a space at the botb=
of the affidayst for you to fill out is the event the Office oflnvestigations has to con by t you regazdmg the applicant:
Please be sure to fill in the prn�iVlicrose min er which w7l be used as a ref xr-ace nnmber. In-addition,an applicant
that must submit mirbiple p license applibatians in any given year,need only submit one affidavit indicating cure at
policy inf)n:uation(if necessary)and under`lob Sits Address"the applicant should wntr--"all 1Dc afions in (cfiY or
A copy of tht-affidavit that has been,officially stamped or maimed by ire city or town may be provided to the
applicant as proo-fthat a valid affidavit is on file for frdme putts or licenses_ A new affidavitmust be fined olt each
year.Whew a home owner or citizen is Dbtammg a license or permit not related to any business Dr commercial vete
(i e_ a dog license or permit to bum leaves etr.)said person is MOT rcT&,d to complete this affidavit
The:Office of Inyesfigadans would Irke to thank you in advance for your cooper djaIL and should you.have any questions,
please do not hesitate to give us a call
The DeparfinenfS address,telephone and fax number:
-ffiE of M&ssar u '
Dent c&ILa l AODUCnta
ice of luvestkati= ,
Basko.YA Oil11
Tf,-L:1617' -4 Md4€1f 4r 14 MAS �
Fax#617 727 7749
Rnvised 4-24-)7 p Vt V-MaS5-&-GV/di&
8/25/16
To whom it may concern. Y ` -2, �L—
I have hired Jason Childs of 28 Chapman Rd.,Sandwich, MA to repair some wood rot on my property at
64 and 66 Woodbury Ave, Hyannis, MA
Please allow Jason to pull a permit so that he may begin the work.The town of Barnstable/Hyannis has
my permission to issue Jason a permit to effect the work.
Robert Keyworth—Owner,64 and 66 Woodbury,Ave. Hyannis, MA
Please contact me if you have any questions:
617-449-2905 (W) -
617-851-4617 (C) p
Robertrth
F
k
(L�parromaxwecz�l�c�- ee
ulafion
• � Office of Consumer Affairs&Busm CROR
HOME IMPROVEMENT CONTRA. Type..
Registratio.07 p'4.62939 Individual
Expiratiot = (]8
JASON CHILDS _'
JASON CHILDS
28 CHIPMAN RU.
r SANDWIbH,MA 02563 ' Undersecretary
License or registration valid for individual use only ,
before the expiration date. If found return to: ro which
Office of Consumer Unrestricted-Build of
at? '
10 Park Plaza_ Affairs and Business Regulation Contain less than 35,0-- cubic feet(991m') .
Boston Suite 5170 _
MA 02116
enclosed space. .
Not valid without signature
Failure to possess a current edition of the.Massachusetts
State Building Code is cause for revocation of this license.
..-
- For DPS Licensin;information visit: www.Mass.Gov DPS
1 Massachusetts -Department of Oublic Safety
Board of Building Regulations and Standards
' C,n�trurtiun Surcn i+ur �
License: CS-099040
r;7c—
JASON E CHMDS
�- ..,. PO BOX 1363 ti, .
- --� ""' ?` iV1ARSTONS NULLS MA 02648
�hprrvr2p rcurea- e ulafion =
e gairs&Business R g
ofconsumerp CONTRACTOR J54-�' � xpiraticn• .
pffice OVEMENT Type: 05/22/2017
HpMEIMPR V Can,n,ssioner
Registration.` F62939 Individual _
.�;F25k�18
Expiratiotx r
�1
JASON CHILDS ia
CHILDS
JASON
28 CHIPMA.N tary
RC Undersecre .
SANDWIt-H,MA 02563
i
THE rqt� Town of Barnstable *Permit# 7 ? y!S
�* Expires 6 months from issue date
RUMUE
STAB . RegulatorMASS. y Services Fee �?5 QQ
9 &63 �e� Thomas F.Geiler,Director
Building Division � � �
Tom Perry, Building Commissioner IT
200 Main Street, Hyannis,MA 02601 0 C�. ZAA3 tA►Office: 508-862-4038 ¢
Fax: 508-790-6230 :TOWN OF BARNSTABLE
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number lRel 7 0�
Property Address 4t U)e
❑Residential Value of Work'07ZF®®
Owner's Name&Address �z V",
Contractor's Name gC
/�!/J,P� jy�� Telephone.Number
Home Improvement Contractor License#(if applicable)_ 3 �j��
Construction Supervisor's License#(if applicable) 0 �41-7
❑Workman's Compensation Insurance
Check one:
ET 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)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. v
r ,
***Note: Property Owner must sign Property Owner Letter of Permission.
Home ro�ent Contractors License is required.
Signature
2:Forms:expmtrg x
tevise053003
FROM r w I N I TE_SoU!r 10NS_FZEg0DC-L I NG Fak h10. !70&-?E0-Sa34
19�u. 1 20t1 11:�s7t1 F1
�of Town of Darnsta ble
e
Regulatory Services
naasa Themes F.Gegtr,Director
Building Division
TOM Fems Btwftg Comtaamiouer
200 Maim Strftt, HY=is.MA 02601
Office- 508-862-4038 P'Lx 508-790-6230
Property Owner Must Complete and Sign This Section If'Usiuig A
Builder .
/as Owner of the subjectro
P P rcq
C'IGIC� iP/�y' �t3A !ti1r/yii�.S44 r''�r;
hereby zuthorize to act an�.) beli:ttf,
in all mstreis relative to-cork authorized by this building p=Jit.job) application fox(ad3ress of
Avcic c 43 r4tvc
Signature of -
Date -
Print Name
Y
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