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Home My WebLink About0051 CAMP OPECHEE ROAD �/ �m�. ,�. ,; :. ., .._: .,; > � , .. `.: , . ,� u w ,� s r �' T � o. �. .r i .., � - .. � .. q �� 1 � .�. f - ^... - � - ,. .. �. � � ,.. � � .. ... j. �- � � � _� 5 � .� � � .. ,� �, >9 } ,. o i i _. i� i e i :, � zl { � a o. �. 4 � — ,� i o 'l a Town of Barnstable 'T"E' j,� Regulatory Services Thomas F.Geiler,Director * S" MASS. ' Building Division'K"ss. �, ow SIuI�i p �I& Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# � �a�a3 FEE: $ 'OD SHED REGISTRATION 200 square feet or less Sf 661"P Cph ee 1QJ �lt-14er✓ He e Location of shed(address) Village 5—®? V40- Property owner's name Telephone number Size of a Map/Parcel# CD I6 Signature Date `"" ` ' r� Hyannis Main Street Waterfront Historic District? NU Old King's Highway Historic District Commission jurisdiction? AJ 0 Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN 0�" l rQ' Q-forms-shedreg REV:042911 Town of Barnstable Geographic Information System May 6, 2011 — 10150� 3 / a 'loon oe - ; 210103012 73 �«b 190104 i #340 210151 j 65 / INNER i130105 y ,,ID15 21000IN 01MI cy fit... l r 322 ,. • c�/ 4a /a�aiiiii/L///.�i// /i/9�/m,// '�, /v/ rmm�Ga�/, Y��/uai/ari/i.9/la � J - - 1'39136001 189037 q r#319 I , l 20909, .. #ssVON . 2090a9 UNION #3_ t 'P,', 33 Feet _09012 - DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:210 Parcel:001. Adjacent(Please choose abutter list type)• ' Selected Parcel 3 ; U boundary determination or regulatory interpretation. Enlargements beyond a scale of - . Abutter List T 1"=100'may not meet established map accuracy standards. The parcel lines on this map Type-Default buffer of parcels adjacent to the selected parcel are only graphic representations of Assessor's tax parcels. They are not true property 'ti Abutters d '`B b*.undaries and do not represent accurate relationships to physical features on the map - - - such as building locations. ' Buffer �-+ - Of YHe ram, 'Town of Barnstable *Permit# � �G�2 { Expire i,,ulrs from issue.date 0 Regulatory Services Fe r BARNSTABLE, .� MASS. $ Thomas F. Geiler, Director - 1, MIT Building Division fig JUN 3 p 2U09 Tom Perry, CBO, 13u►Idmg Co mmissioner -D 200 Main Street, Hyannis, MA 02601 TOWN OF BARNSTABLE www.town.barnstable.ma.us O 'rice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Maplparcel Number r/ Property Address _ 5 D cif PD ' Residential Value of Work 00016 0 Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address 111A k 4.0a - 1 CAM p 0P gGltfC- IUD, (StAT.- Contractor's Name Telephone Number I lome Improvement Contractor License# (if applicable) Construction Supervisor's License # (if applicable) ❑Workman's Compensation Insurance Check one: UO'Tam a sole proprietor ❑ 1 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy #_ , Copy of Insurance Compliance Certificate must be on tile. Permit Request (check box) Re-roof(stripping old shingles) All construction debris will be taken to 01WOW77f e—/Tbfl a— ❑ 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: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. 51GNATURE: I'V Q. U Pl-II.I.S"�' ORMSNIdding permit forms\EXPRESS.doc Revised 100608 �fze "Vo?r✓rnaruueaLt+li o�,i�sa�,.�ae.Cta Board of 11uildinl;Regalatic nsand Standards License or registr tion valid for iudividul use only HOI diE IMPROVE11ENT CO,4TRACTOR before the expiration.d4tc. If found rekurn to: Rgaistraton:} 119766 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration p/28/2009 Tr# 132550 y4 Boston,Ma.02108- iType =DBA WEBB CRAFT DESIGN DAVID WEBB } µ 17 ACADEMY LN t _ FAt.MOUTH,MA 02540' '' Not valid without signature Adminktrator - •- Nlassachusetts - Department of Public S:ifetN Board ot', uj,I�llin Reulations and Standards N ,,,r,Gonstructio4 Supervisor License ..ut' +dense::CS .46t89 :Re&tricte6to: 00 e DAVID H WEBB 17 ACADEMY LN FALMOUTH, MA 02540 3 o-- J"� ;! Expiration: 1 012 9/2 0 1 0 F ('umniisiuncr Tr#: 5826 - i ,per The Commonwealth of Massachusetts \ Department of Industrial Accidents kiOffice of Investigations- 600 Washington Street . Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Please Print Ledbly Applicant Information Name (Business/Organization/Individual): D { / S Address: City/State/Zip: Are you an employer? Check the appropriate b Type of project(required): 1.❑ I am a employer with 4. 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.: 1 am a'soleprpprietor or partber-' 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 have workers' 9 ❑Building addition °O�' insur [No workers'-comp.•insurance ance'# -10. airs or additions required.] 5. [] We are a corporation and its ❑Electrical rep 3.❑ I am a homeowner doing all work officers have exercised their I I E1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required_]t G. 152, §1(4),and we have no 13.❑Other —/COS employees.[No workers comp.insurance required] •Any applicant that checks box#1 must also fill out the section below showing their workers'comparsation policy information. Homeowners who submit this affidavit 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 sub-contractors and state whether or not those entities:have employees. If the sub-contractors have employes,they must provide their workers'comp•policy number. Iam an employer that isproviding workers'compensation insurance for my employees Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address:` S , P OPE uff f P,b, City/State/Zip:�3 foft Vki f Al y2 � 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 finC tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a•STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification_ I do hereby ce under the pains and Penalti of perjury that the information provided above is true and correct. Signature: Date: -= - Phone# SOO --Its G 33�2& Official use only. Don write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6.Other a. � ro�ti Town of Barnstable ' Regulatory Services BAMNST"M$; Thomas F. Geiler,Director Building 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 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this bAding permit application for. cI-t Cf- , •(A.ddress of Job) Signature of r ate - Print Nirne If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. _ i