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i
a _ Town of Barnstable *Permit# r 06 0 �
F' PERMIT Expires 6 months from issue date
SEP 1 9 2007 Regulatory Services Fee V
Thomas F.Geiler,Director
BARNSTABLE Building Division
TOWN 0. >u--
Tom Perry,CBO, Building Commissioner qb
200 Main Street,Hyannis,MA 02601
q�Zllc�z
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
rr . Not Valid without Red X-Press Imprint
Map/parcel Number �Y1 — 1 5�
�
L /� / / `
Property Address `Z� �(1� 61 Gi : �! C eel C 11 C. %cliJ
❑Residential Value of Work 0�iQU�,�Q Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address A L f U
yV C t: � �ti ��( ��MZw L)d
Contractor's Name �d S�/�'\ e>-t/G/f Telephone Number s
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Ch one:
am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman is Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
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)
BRe-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: P operty Ownermust sign Property Owner Letter of Permission.
copy the Home provement Contractors License is required.
SIGNATURE: `
'Q:Forms:expmtrg
Revise061306
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
-N Board of Building Regulations and Standards
Registrati0n:_.,139619 One Ashburton Place Rm 1301
Expiraton 7/2g/2009 Tr# 131937 Boston,Ma.02108
Type: DBA
JOE POWERS HOME RENOVATIONS
JOSEPH POWERS,
130 FULLER RD «N `
CENTERVILLE,MA 02632 Administrator Not valid without signature
to
i
The Commonwealth ofMassaehusetts
Department of Industrial Accidents
Office of Investigations
d 600 Washington Street
Boston,M,4 02111 ,
www.mass.gov/dia
Workers'*Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeLribi
Name (Business/Organizetion/Individual):. ,JV 'D`"r'r6 �"joM t r I(,n o✓c+ �l �� S
•Address: Do,
V ( c f.►C
City/State/Zip: �, G►'17��t ' 'I '� y �6 3 'hone.#:
Are you an employer? Check the appropriate box: Type of project(required):,
1.❑ I am a employer with 4. ❑ I am a general contractor and I
ployees(full and/or part-time).* have hired the sttb-contractors
6. ❑New construction . �
2. I am a'sole proprietor or partner- listed on the'attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp.insurance.$-
required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions
'3.❑ I am ahomeowner doing ill work officers have exercised their 11.❑Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' . •13.❑Other
comp. insurance required.] .
•Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1C6ntractors 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-cont acton have employees,they must providb their workers'comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees Below islhe policy and job site
information.
Insurance Company Name:
Policy##or Self-ins,Lic.M Expiration Date:
Job Site Address: City/State/Zip:
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 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 and ,he pains•an enalties ofperjury that the information provided a ove is true and correct:
Sitrnature: Date:
Phone#:
Official use only. Do not write in this area,'tp 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
Contact Person: Phone#:
' �OF[HE�p�y
'I'ovvn of Barnstable,
Regulatory Services
BARNSTABLE. •
9 MASS. $ Thomas F.Geller,Director
�'AIfD ;�a1� )Building Division
_Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.b arnstable.ma.us
Office: 508-862-403 8
Fax: 508-790-6230
Property Owner Must
Complete and Sign TMs Section
If Using ABuilder
as Owner of the sub'ect roe
J P P riY
hereby authorize to act on my behalf,
in all matters relative to.work authorized by this biulding permit application for: ,
q>q �d� ve
(AdVs of Job)
ig tune o Owner D to
Print Name
Q:F0RMS:0Vn\T MERMISS10N
f -
'TOWN OF SB8N8ZgSLZ cN ZWOBT
g}1pOUT �� gBY/QOD�iT=l�IIB _
DZVZSZON
ult (rT, rnr. KE=ZW
M=XLS DNS-rmazz LRDY.l - SERM 15 E=- .
L ] [R226 157 . • ] •
LOC10884 CRAIGVILLE BEACH R CTY112 TDS] 300 CO KEY] 136702
----MAILING ADDRESS------- PCA] 1041 PCS] 00 YR] 00 PARENT] 0
HARB, ANN TR MAP] AREA146AD JV1290955 MTG12010
NORTH EASTON SVINGS BK SP1] SP21 SP31
P 0 BOX 299 UT11 UT21 . 13 SQ FT] 1350
NORTH EASTON MA 02356 AYB] 1950 EYB] 1975 OBS] CONST]
0000 LAND 53000 IMP 75000 OTHER
----LEGAL DESCRIPTION---- TRUE MKT 128000 REA CLASSIFIED
#LAND 1 53 , 000 ASD LND 53000 ASD IMP 75000 ASD OTH
#BLDG (S) -CARD-1 1 75, 000 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE
#PL 884 CRAIGVILLE BCH RD TAX EXEMPT
#DL LOT 1 RESIDENT'L 128000 128000 128000
#RR 0369 0092 1923 0059 OPEN SPACE
#SR SOUTH WIND CIRCLE COMMERCIAL
#UP FY98 SEE PR 226 157 INDUSTRIAL
EXEMPTIONS
SALE110/96 PRICE] 1 ORB110418094 AFD] I A
LAST ACTIVITY] 11/07/96 PCR] Y
'r
R226 157 . • P P R A I S A L D A T Jo KEY 136702
HARB, ANN TR
LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RC
53 , 000 75, 000 1 A-COST 128, 000
B-MKT 89, 700
BY 00/ BY /00 C-INCOME
PCA=1041 PCS=00 SIZE= 1350 JUST-VAL 128, 000
LEV=300 CONST-C 0
----COMPARISON TO CONTROL AREA 46AD -----------------------------
NEIGHBORHOOD 46AD CENTERVILLE
PARCEL CONTROL AREA TREND STANDARD
101 10 LAND-TYPE
530001 LAND-MEAN +Oo
1280001 91427 IMPROVED-MEAN -180 2006
] FRONT-FT
] 100 DEPTH/ACRES TABLE 02
10001 LOCATION-ADJ APPLY-VAL-STAT 1
LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES
COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC
FUNCTION- [ ] STRUCTURE-CARD NO- [000] DATA- [ ] XMT [?]