HomeMy WebLinkAbout0057 BAY LANE r{ �' .� �d„1�''� 1 �r 4
��a �ik � 9 r �3, �`xxt � +t� t g'y1 ' � #-�
,_.:. - i .: - < .;,;. ,... x: ,. ..�..... :.•. - :.,.. .. -:. .. j'.- 1... P{* ��y7�,,Ria�r: �'1h,' :Sph x..to�.1 �,,�`!l «.
�,� � ,-.,fir ... .� �;.: .6+ a .� �'.. � (!' ,
.� ..n- ... .� r' �,..-.. :.;,.. ,. ..,a:::,rv' >;j.:v- ..,i4y+ t .,tw ..// S�',' � °r'I. ✓ is �� .p.. > ><� f'..I
.. � .. .. � S,x i'. 1'��R/ '. y. ", �..'� ! - �. i .� yn� d.��+".t""'> .'lf, .4br. k F 2 ."rr� +� !i��
I.' .. , "� ,Y��I/,� _ .. : � �.e .. ,._.r �, �.::.� yxiRt.' l�t. �I/ t[• g R�e.� T' {t
,'r•'a r .. y, � e .. _ n '.0 <�., - - 'I� IM & .�(M 1 fi"� �r•�3 1�
�`{ n ,. �.
_ _ ..r _ u
� '�', � k a�� :
.. v iy2..�. E +i,v�-n �y�r� G`p wK 4r�n�`arr t, g� i Y.i, •i""'+..
r - • � � �, at e,��id_, � i��a a^s��a '� g� al ;a�.i tY� 1'..,ti'�� ` -� ° fi{ s .
, e
s
V
v � y
• y � .. yJ ,.rR•t�df /g�t'.S�$� �'>� x Sure �it dY
.. ,
- .. � - �
_ .,
n
., .
,'',
, .. .. �
c f c
.. ��. �.
� . � - .. ,.
�; .. -. r.
p - -7,
e .. _ ...
9 � -
.- � - .,
" i .. .. ,
.-: .- - ,
.� ...
o
..:..
� ♦ .:.
�•:
-. rt � • ',
._ t � -
• ., ..
., •
., e
�,1 -.:
" :. �. t
�.. , .: '.
r
.. .. _' , ,
.+ .. 4-, �,-.
t
,. .. - .-
,_
„. s .
µ �
O I
k * � -
I � -
1
- 's��.
_ - _ ..
` .
.. . ..
��
I
M � .
. .. _ ,
.. ,.
,.-.. � ,
: � � � .;.
.. ..
� .. �.
�' �
��° ,.
r, a
-..
N �' '..
.,
'. � ..
. l ..,. ..
,; � t; �... ,. ,.�• ,,; a �..a ,.. � �:� ,.,. -,.., .,
,. . n. .. 7
_. .. . .,
. � �. .s
_ .. g -
� � .:
„ ,.
� ..
� ..- .
: R
4` + ..
,
,. - , ,.
- Town of Barnstable *Permit# D &a�-
�/ ���� Expires 6 m ntlu from-i sue date
/ii
P���� Regulatory. Services Fee
Thomas T.Geller,Director /
JAN. -3 1012 Building Division
Tom Perry,CBO.,.Building Commissioner
TOWN ®F.B 200 Main Street;Hyannis,MA 02601-
ARNSTABLE www.town.barn'tab'le,ma.us �VV/
Office: 508-862-4038. Fax:508-790-6230
EXPRESS PERAHT.APPLICATION - R:ESIDENTUL ONLY
/Q�r Not Valid without Red X-Press Imprint
Map/parcel Number v� O
Property Address L�►�M Y ((�i'
Q Residential Value of Work �l �00' Vy`Minimum fee of$25.00 for work under$6.000.00
Owner's-Name&Address -fye-U cr I LK
fxx (A
Q(J
Contractor's Name ��r I Telephone Number
Home Improvement Contractor License#,(if applicable) I I O
Construction Supervisor's-License#(if applicable) I I
❑Workman's Compensationlnsurauce ti
Ch k 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)
Q/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/doors/sliders. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt"compliance with other town department regulations,'i:e.Historic,Conservation,etc.
:. ***Note: Prope�Ofi
O t sign Property Owner Letter of Permission.
copthe H Im rovement Contractors-License is required.
SIGNATURE:
Q:Fortns:expmtrg
Revise061306
oF�HF, o r .Town of Barnstable.
Regulat6z-y
STABLE, Services
i 1ARN • .
MAC $ Thomas F. Geller,Director
Building
p�OjEp �A Buil7
dingDIVISZOn
Tom Perry,..Building Commissioner
200 Main Street Hyannis,MA 02601
"'w.town.barnstable.ma.us
Office: 508-862-403 8
Fax: 50B-790-6230
Property Owner Must
Complete and Sign This Section y
If Using A Builder
AV ' r as Owner of the subject property
herebyauthorize J am e S ��r�'0 to act on my e bhalf.
,
in all matters relative to work autborized by this building permit application for: ,
E64M (I
(Address of Job)
signature of Owner ate
Print Name
Q:FOR-Mf S:O WNFMERM1S S 1oN
The Camrnonwealth.ofMassachrtsetts
Deparfnrent of d"ndustrialAe dents
0ff ce Of rnvestXgatlrons
600 Washington Street
Boslan, MA 02X.1-1
www.rrt ass.gov/diet
Workers"Compensation 7 .Ance.Affidavit: guilders/ContractorsX]ectricians/Plumb
A licant Information ers
Name (Business/organization/Individual Please Print Le '}�j
' •Address: X 3� .
City/State/Zip: QI�NI 5 MA `��A I 1'hone.#:
[-El
ou an employer? ,
Check the appropriate box:
am a employer with 4. El I am a general contractor and I -Type of project(required):•
9tizployees (fu11 and/orpart= e) have hired the sltb-contractors 6 ❑New construction
Tama'sole proprietor or partner_ listed on the•attached sheet.hip and have no employees. These sub-contractors have . Q Remodeling
working for me in auy capacity. employees andhave workers8' ❑DemolitipnNo workers'camp.in uranee comp,insurance.$• 9. []Building addition
equired] 5. [] yPearea corporation andits I0,0 Electrical re airs or a
am a homed P dditions
caner doing all work officers have exercisedtheir ; l. 1. Pl b'
1 se ul
li o o r a'Y [N w rkers. comp. nght of exemphonpMGLg eP its or additions
nsurance required.] t P. 152, §1(4),and we have no 12. oof repairs
employees. (No workers' 13,0 Other
comp. insurance required_]
*Any applicant that checks box#1 must also fill out the section below showing lhcirworkm,c
t Homeowners who submit this affidavit indicating they are doing aU wark and then hire outsides o tractors muMsation stinformation
of or ti w affidayit indicating
tContractm that check this box must attached an additionalshect sbowing the niune of the sub-contracthether ornot those entities have
employees. If the sub-contractors have employees,they must P 'rovidt their tyorkcrs co olic nurnbcr,ors and state w such.
comp.p y
X am an employer That is proNidtn ff tt�orkers'compensation insurance for my employees Below isyhe olic and 'o
information. - P y ,/.b site
Insurance Company Name:
Policy#or Self-ins.Lic.#:
Expiration Date:
Job Site Address:
Attach copy of City/State/Zip:
the workers' compensation policy declaratil' page(showing the policy number and e
Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal
u atlott date),
fine tip to$1,SOp.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDERa liter of a
• Of Vrs to Signs o a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
and a fine
Investi ations of the CIA for ins ce a vets e verification.
16 here :ender th pains• pen ties o err1 u i thae the information provided bov is true and co
PJ
Sienature:�, erect:
Phone #:
Offzciat use only. Do not Write in this area,'to be completed by ,i c
- tJ'oT to tNn 0/1-ciaz
City or Town:
Permit/License
Issuing Authority(circle one);
L Board of Health 2.Building Department 3, Cityao-wn Cleric 4•Electrical Inspector S.Plumbing
6.Other Inspector
Contact Person:
Phone#:
-. ..; .,.. .,. .. _... �..,.. .�..�.. x. ,. �. .. 3..Y'•-� 'A V•:-�': z ... : .3... ',...2...' �"�it.-.( :N:•F51' -,.2- :5 [
}� .71-::..,ret'. , ..,a_ Y ;r?.h _ 'Y' N.. G ., •t1 4.,Y 5- � ,,,.
� .t xth:. 1+ S:- .,- .... 1 ..as?. .a- „s. .s:.a#. ♦ -.....-<r+Y fir' -, i.- r> �< .... .. t .,. v '1.,. 3r, .�F•k h
±i' .
. a��...��< .:'� �,�.. � r _:�- mac•, � r a
w�, t_, ..-,�_a, :>..,4 r•�� ,�:�,er. t ,y �
.;( .:. � eAx
v., ..vr: @.w.,e .. •LyK ti,., .e.�k"•?�_:. .,.f _. . .,.F c a_ ..r w... rK : 4 xl..= r.,. .•,..cu.. tl : � r„..
t�' .5t. w r.
..•...,, _. `,. .-.. J.��.-a.lF.:.r.r :-r ,.,y.• ,.,._. -. Y ....,t:._.. ). r •n:.x V.
. Jt.a.. S.. .t,.....,.F,. ,�&E...l i.*^•E.' ,. :,....�'�c .:.v. .. a,,.... .::'> f.: .�.c r' __ `z.T s- .:.' '.ti.�.�' ',i�•,_�
�• }. -
S
�� irdz `N ;.pA.s� k gt,�� :++ '•r,.,.:.>:.: ? 1:;.. tr �': -t n,: ,:.1 ',fir �r� ..
.e
N
1 -
r a
�Y"� s 3-:. S:- ' - r a +. u�fr"r �..• 1 � -
n.
5,�
rac.80.
� ,- R.G ...;;, ? �r.2- �..:C. -••Y ^F -�' ? .>e- r :.:' -l. ...K.^ t
- - :.:+..} ..;- 'k. -cam-•.:ems., �..,�..�. -,�.� ��,. .r "' '�' a,� - �
ti
• !` '.1 / f 1 ! 1
�s E
:
.. st ,-
0 �•- Massachusetts -Department of Puhlic Safety
Board of Building-Rel�ulations and StandardsMW
Construction Supervisor Specialty License
License: CS SL 99138 .
i_ Restricted.to• RF,WS
JAMES CURLEY
. I
j 287 FULLER ROAD
CENTERV.ILLE, MA 02632
I
Expiration:. 1/28/2012 j
Commissioner- Tr#: 99138 d
•
Boa d of Builebpa R gpl4tipns_an.d.StBndards--.• .�F
"`"7 iceb"se"ar gRtration valic for indJ'rduI use only
HO E IMPROVEN NT CONTRACTOR before the a iration date. found return to:
Re straiioti a24 0 v -�-Board-of Bui diti Rqu"latio' sand S'-andards
E iration_Elf/2q•g y �Tr# •1 0873 OneAshburt PlaceRm 13
lndivid:al Boston,Ma. 0 108
- YP
James udey. - -_
James urley
287 Full r..Rd
---�-C e, A 02632
Administrator of yali w]thout re
i