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HomeMy WebLinkAbout0021 BAYBERRY LANE ;�—, — ,p 1..� i ,��� ' .. �. �,. t �. < .. .. i � „ — 6.. _ k „, a h�3 + �. �q. P p ,^ �, ii !li n �; p ail '� I� ,. j 4 e ii Town of Barnstable eL/ -7, Expires 6 months from issue e Regulatory Services Fee M"M 0 Thomas F.Geiler,Director z63q. p,� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address r3 I C U r J(\A 07_(c'3 2— Residential Value of Work`` 2 C cf,, Ca 4 Minimum,fee of$25.00 for work under$6000.00 Owner's Name&Address (yl<� , ccv` ro4tievy,«e ,J(A P7 4`S? Contractor's Name VA-5 c'n ) 1 Telephone Number S�IJS -3 S A 1 S'1 C Home Improvement Contractor License#(if applicable) ct3 Construction Supervisor's License# if applicable) X-PRES 11 P (� aPP ) (`�-���t+�C� ❑Workman's Compensation Insurance OCT 13 2009 Check one: ,®'I am a sole proprietor TOWN OF BARNSTABLE. ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Werle� t'�EerPolicy# MT, ®5 11_4 T_ z_ 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 1 Replacement Windows/doors/sliders.U-Value © , Q (maximum.44)#of windows *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 the Home Improvement Contractors License&Construction Supervisor_s License is required. SIGNATURE: C:\Users\decollikUppData\L.ocal\Microsoft\Windows\Temp ary Internet Files\Content.Outlook\4STGUSQO\EXPRESS.doc Revised 090809 The Coniniomvealth of Massachusetts - Departntent of Industrial Acci dents Office of Imestigations 600 Washington Street Boston,CIA 02111 ivwrv.mass go►l dia Workers'Compensation Insnrance Affidavit:Builders/Contractors/]Electricians/Plumbers Applicant Information Please Print Leiibly Name(Iiussiness/organ zationitndividuaq. �CO N U N EZ - Mayfair d. Address: 'fH DENNIS, MA 02660 City/State/Zip: Phone#_ 5 Are you an employer?Check the appropriate boa: T of project r 4. I am a general contractor and I 3� p ] ( egniretl): 1.❑ I am a employer with ❑ g 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 hat a workers' 9. [:]Building addition [No workers'comp.insurance comp.insurance required 5. ❑ We are a corporation and its 10.❑Electrical iepairs or additions officers have exercised their 11. Plumbing repairs airs or additions 3.❑ I am a homeowner doing all.work ❑ g eP myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]F c. 152, §1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] ;Any applicam that checks box#1 t also fill cut the.section below showing their waakera'compensation policy information. Homeowners who submit this affidavit indicating they are doing all worts and then hue aumile contractors am submit a new of &mit indicating such lContractars that check this box must attm bW an additional sheet showing the name of the sub-ccuawoors rind state whether at not those entities have employees. ffthe sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that rsprovidisg wortkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Dame: U&-M e-LV%—% Policy# Self-ins Lie.4: O S 1%-4 7 Expiration Date: 1 Z. zo 1 O Job Site Address: 21'tCevl',,k�P�4 LA City/State/Zip: (.eyt-VI't�(K ` 4 t92t.3-2- Attach a copy of the workers'compensation policy declaration page(showing the policy number 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 ci-61 penalties in the.forum 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 DIA for insurance coverage verification. I do hereby ce under the ins and penalties of pedury that the information provided above is into and correct Si lure: Date: 6 [2 Phone Official use only. Do not write in this area,to be cornpteted by city or town official. City or Town: Permit/Ijicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk $.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • BARNSCABI�. • L,� Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder o as Owner of the ero subject (� (� 1 p P m' hereby authorize �I ���, \\�tIQZ to act on my behalf, in all matters relative to work authorized by this building permit application for: v'CCQv 02&3Z- Address of Job) Signature of Owner Date Ut6 cr) SL&AXZ Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. I C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 i, , ,• F PROPOSAL �L VASCO;NUNEZ CARPENTRY 79 Mayfair Rd.: SOUTH;:DENNIS MA<;02660 MA Ltc. #069680 ` H_a C #124793 ; (866) 398 1511 • Tolt free (508) 398 1511. • Denms, MA PHONE;; DATE " TO pis Barn :W 508 .367 4138 ':'f3C'09 : 2.1 Bayberry: JOB NAME/LOCATION Andersen Frenchwood. G -n �QQ Centervil .e.. rn -,?632. JOB NUMBER JOB PHONE 33 4138. 947.. Xr ,We hereb submits y pecrflcations and estimates for b. ai �_ �-ra "3��-F:i• c-1� +N-1-t- 1--OFl��' �7_:j __ ""r � cry; gliasng door in,:t s m location New door will have a white vinyl;.clad' kYhtte 'pref nishe n erycr ; white "Tr'ibeca" har.dware:; full gliding 'screen, auXi: iary `qo To^k,' and ,grilles De�"7e n ahe glass with .a: 15 lite per panel % New door will ?avE Low 3.i n.gas "filled. "�,eartsdn" iris.itlated glass wh :.ch qualifies fo.r the 2010.;U _:. .go �r credit program 4 aupply nter.ic ;P_�-c or trim where needed :: 3 a ake cold :door: r,e 'town landfill' 4: Supply own c. Ba :.t,a a31e,buildiri g permit at cost'; payable "at completion . ' Remove::anc-reiover:::siidin.g door This proposal doe s not, include any:paint atairiirg, `or other repairs x Al 1Andersen pr _ _ s described ,above w lI de prepaid.by -he: home: owner y I f his: ro .c,; .._ saisfactor lease si n the. YELLOW co U ti p P. Y.,.p g pY and rett pay n,� schedule *� Please make a _ec r._a,,able to :-Vas'co Nunez Carpentry in the: amount c $� ,?, 9 64 z r lro>_ neca. Andersen door ue s c be d above, and please include this check with r spored apr Tsai Allow-.:3 4..weeks..fc de. every, this :is a factory. order. 41 . ( . We:Propose hereby to fumish material and labor—complete in accordance with the above specifications,for the sum of: Two Thousand Six �u ndred Nineteen and 64/100 Dollars dollars($ 2, 6``' ). Payment to be made as follows: Labor.: Pay.ment in upon completion at time of completion. . . . . . . . . . . . .$ "oj .' All material is guaranteed to be as specified.All work to be completed in a professional , manner according to standard practices.Any alteration or deviation from above spedficatlons Authorized involving extra costs will be executed only upon written orders:and will become an extra Signature charge over and above the estimate.AN agreements oontingert upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our Note:This proposal may be V 0 workers are fully covered by Worker's Compensation insurance. withdrawn b us if not accepted within %f' days. Acceptance of Proposal—The above prices,specifications and con- ditions are satisfactory and are hereby accepted.You are authorized to do the work as 3 O specified.Payment will be made as outlined above. Slgnatu 3�05 mature Date of A PRODUCT 13:28G. E WITH 771C ENVELOPE NEBS To Reorder:1-800-225-M or www.nebs.com PRINTED IN USA massitchusett:s-Depart"left t of Public Sare 'A Board of Building Re ulations and Standards Restricted to: 1G Construction. Supervisor License " 00- Unrestricted License Cs 69680 x ti 1G 1 2 Family Homes Restricted to: I.G. k VASCO E.A6NEZ III `s 79 MAYFAIR RD Failure to possess a current edition of the S DENNIS,`MA 02660 Massachusetts State Building Code _ M is cause for revocation,of this license. Expiration: 10/3/2010 Refer to: WWW.Mass.Gov/DPS ('ununisiunrr Tr#:- 4248 ..... � �lze �omi.�zancaealdc o��,/�avaa�u�aeEtd ' Office of Consumer Affairs&Busmess'Regulation License or registration valid;for individul use only j i' HOME IMPROVEMENT CONTRACTOR before the expiration:date. if found return to: . Re istration Office of Consumer Affairs and Business Regulation 9 �;:124793 Expiration 13/25/2011 Tr# 286910 10 Park'Plaza-.Suite 3170 Type, Indluidu- 1 Boston,MA 02116 w _ Vasco E. Nunez III Vasco Nunez Iil i 79 Mayfair Rd. r S.Dennis,MA 026E;0 Undersecretary l qs Not valid wAh6j ig ...m 1,.