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Home My WebLink About0037 CROSBY CIRCLE 3�CRosay Cizc�� " V Town of Barnstable *�a� P mit Expires 6 rn nthr from issue date Regulatory Services Fee Thomas F.Geiler,Director Building.]Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barmtable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIN r NTLA-L ONLY Not Valid>vitho:it ked X-Press Imprint Map/parcel Number4 d� Property Address Cr0 CI(c. W1-1'C-' I I (-e., [fResidential Value of Work a Minimum fee of S25.00 for work under$6000.00 Owner's Name&Address to -0 h (t , Contractors Name �.:�r� Telephone'Number —7q o ~ 4r)n Home Improvement Contractor License#(if applicable) Constriction Supervisor's License#(if applicable) q 1 13 , ❑Worlanan's Compensation Insurance Che" one: A P R 9.6 2 01 i I am a sole proprietor ❑ I am the Homeowner TOWN OF BARNSTABLE ❑ I have Worker's Compensation Insurance Insurance Company Name Worlonan's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request.(check box) (� Pp dRe-roof(stripping old shingles) All construction debris will be taken to �� .�1S�C�S�,� �(rn .�•,� ❑Re-roof(not stripping, Going over existing layers of ro of) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance- ith other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. :. copy of 'Iorr I prov ent Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 t - The COMITtonwealth ofMassachusetts Departnterct of)ndustrial Adcidenis `*t' Office oflnvestigatlons - 600 Washfnffton Street Boson,MA 021111 www;rn ass.gov/dra Workers` Compensation lnsurance Affidavit Builders/Contractors/El ectricians/Plurabers Applicant Information Please Print Le 'bi Name (Business/Organiztition/Individual) �O.IriQS, Address: City/State/Zip: (�1'1n�S, � cq�OOI Phone.#: Are you an employer? Check the appropriate box: 1.❑ I am a employer with 4. [] I am a general contractor and I 'Type of project(required):- �loyees (full and/or part_time). have hired the sub-contractors 6• E New construction . 2. T am a'sole proprietor or partner- listed on the'attached sheet, Remodeling ; ship and have no,employees These sub--contractors havo working for me in any capacity. employees and have workers' 8' Dem°h on [No workers'comp.insurance comp.insurance.$ `9• Ej Building addition required_] 5. [� We are a corporation and its 10-El Electrical repairs or additions -3.❑ I am a homeowner doing all work officers Kaye exercised their .[homeowner 11.❑ bing repairs or additions y [No workers comp, right of exemption per MGL insurance required,] t g. 152, §1(4),and we have no 12. Roof repairs employees. [No workers' .13.❑ Other comp. insurance required] *Any applicant that checks box#1 must also fill out the section below sbowing tbeir workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and lbcn hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additionalshect abowing tho niunc of the sub-eonlractors and state whether ornot those entities have employees. If the sub-contractors have omployces,they must provide their wor]eei co s number. ' rnp.policy Iam an employer that is providing workers'compensation insurance for my employees Below is�he policy and job site information. Insurance Company Name: Policy#f or Self-ins.Lic:#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the,workers' compensation policy"declaration page(showing the policy nuumber and expiration`dare),;Failure to secure coyorage as required under Section 25A ofMGL c. 152 can lead to the osition of c fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form i f a STOP WORD ORDER and of a of up to$250.00 a day against the violator. Do advised that a copy of this statement may be forwarded to the Office of Investi ations ofthe b o unance coVera e verification., I do her�eT)Jf,,;rn er fhe p in nd penalties ofperjury that the information provided hove 's true and correct Sienature; } Date- Phone #: Official use only. Do not Write in this area,'fo be completed by city ax town official City or Towne Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. O tht:r P Contact Person: Phone 1h oF1HErow� Town of Barnstable Regulatory Services i 1AANSTASLE, • - .. - . Thomas F. Geller,Director ..,Fo► ,��, Building Dl.'V1S10Il Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 wwW.town.barnstable.ma.us Office: 508-862-403 8 Fax: 50B-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder r, �e n'o c 0 Y l'I in as Owner of the subject property berebyauthorize J G` T Q-S to act on znY behalf in all matters relative to work autborized by this building permit application for: Cird c ss off 0b) as i Signature/f Ownez Date Pent Name QToRMs:OWE"EluMlssrorr •an a�z oG < Bh5o1 Ong 1eguliiEions a�r7 �a`o ar s License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 124310 Board of Building Regulations and Standards Expiration: 6/1/2011 Tr# '284683 One Ashburton Place Rm 1301 Type: Individual Boston,Ma.02103 . James Curley James Curley 287 Fuller Rd: Centerville,MA 02632 Administrator of without valid without signature . lid t - f �- fIasstchusetts- Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License License: CS SL 99138 < Restricted.to: .RF,WS JAMES CURLEY - 287 FULLER ROAD. I CENTERVILLE, MA 02632 Expiration: 1/28/2012 Commissioner Tr;,: 99138 Boa d of Bwlc mA R gulations.a.nd...St�` - _ - 7 icelis'e dr isiration valid,for nr di' 1dul use onl MHO EIMPROVEM NTCONTRACTOR . Y before the a iration da a found return to: Registration 124 70 —w-•-Board-of Bui ding Regal�tiv s'�and-S an.dards Ex iration 6/.,-04. " Tr#�1 0873 One Ashburton Place Rm 13 Boston Ma.0 108 Indiv :Gal 1 James rley - James Burley =_ ' 287 Full r.Rd " -- --C e, A 02632 Administrators t yali without ure No = , Town of Barnstable CF THE Tp� do Regulatory Services Thomas F.Oeiler,Director * BAMSraBl.B. • MAM Building Division 039. ♦0 ArEo NIA' °i Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508462-4038 Fax: 508-790-6230 2s1et/ PERMIT# q'7505 FEE: $ SHED REGISTRATION 120 square feet or less "27 &I'd y elw C�iyT,�jz I,//L C A!E- Location of shed(address) Village ��Ca/s✓/-i�/ �o vGff�/�/ s J� 77/ Z3 Z Property owner's name Telephone number LL9 x Size of Shed Map/Parcel# /g o Signature V Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? ,* Conservation Commission(signature is required) 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 7 Q-forms-shedreg REV:121901 LO T O N O F P RO P E'RTY ES MAY NOT B AC ATE STANDARD LEGEND NOTE:not all symbols will appear on a map `- GOLF COURSE FAIRWAY - MAP 18 � _.. ��% �•�'•" EDGE OF DECIDUOy�:TREES ❑ ' " � EDGE OF BRUSH MAP 188 113 ORCHARD OR NURSERY '• EDGE OF CONIFEROUS TREES 66 # 22 MARSH AREA 1-379 --- , ^ - --- EDGE OF WATER DIRT ROAD O DRIVEWAY PARKING LOT � PAVED ROAD - - - DRAINAGE DITCH ----- PATH/TRAIL MAP1 }{}{ PARCEL LINE** 8 8 MAP 326 '< —MAP# O 021--PARCEL NUMBER #367 E HOUSE NUMBER 2 FOOT CONTOUR LINE io 10 FOOT CONTOUR LINE Elevation based on NGVD29 �i 4.9 SPOT ELEVATION STONE WALL -X—X- FENCE - RETAINING WALL - - RAIL ROAD TRACK STONE JETTY Poo SWIMMING POOL PORCH/DECK 1 0 BUILDING/STRUCTURE 06 DOCK/PIER ... e� I 7 � HYDRANT VALVE O MANHOLE o POST Ov" FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H 7 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T .Q SIGN ® STORM DRNN N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetiics(man-made features)were interpreted from 1995 aerial photographs by The James ❑ TOWER w e 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD o UTILITY POLE 0 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Plonimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards LIGHT POLE O EIECfRIC BOX s 1 INCH=40 FEET* enlarged scale. on the map. at a sale of 1"=10D'. Parcel lines were digitized from FY2004 Town of Barnstable Assessors tax maps.