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Home My WebLink About0094 HERRING RUN DRIVE :. � ., _ _ .. ., . _. y .. . . _ .� F .. r o , . _ . ; . . .. .: _ w , � .. ,`I .y � _ � .. ,. � .. , 1` .. .. p e . o � „ 1 �i t - ,... x v ' 4 o .. aFt Town of Barnstable *Permit 06D e�706 Expires 6 months jrorrl.issue date BLE, fhomas�� egulatory Services Fee snwasrA F..Geiler,Director MASS. C 2 7 v�Al 2p07 Building Division �Is� D V OF BgTAe Tom Perry,CBO, Building Commissioner RNs L,E200 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/ J Property Address Residential Value of Work U G'0 . Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address p Contractor's Name f Pt- !` U�`�S, �t.S Telephone Number R� l 2-G 7- 1737 Home Improvement Contractor License#(if applicable) IS- 2 3 _ N'W'orkman's Compensation Insurance_ Check one: ❑ I am a sole proprietor ❑ I am the Homeowner N;/1 have Worker's Compensation Insurance Q Q Insurance Company Name - %; e` Workman's Comp. Policy#_ W 2 k d,`7 °j / Copy of Insurance Compliance Certificate must be on file, Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44). *Where required: Issuance of this permit does not exempt compliance with other town department regulations;i.e Historic,Conservation,etc: ***Note: Property Owner must sign Property Owner Letter of Permission. A_copy of'the Home Improvement Contractors License is required: j SIGNATURE: Q:Forms:build ingperm its/express - Revisel12807 ' The Commonwealth of Massachusetts Department of IndustrialAccidents „ Office of Investigations 600 Washington Street Boston,MA 02111' www.mass gov/dig ' Workers"-Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers _Applicant Information V/ � A S n./Please Print Legibly Name(Business/Organizationbdividual):. C Address: V f City/State/Zip: ( r t OZ66Phbne.#: `7 Are you an employer?Check the appropriate bo :Type of project(required):, 1,❑ I am a employer with 4• ' I am a general contractor and I T6. pi construction . loyees(full and/or part-time).* • have hired the sub-contractors 2• a'sole proprietor or p fir_ listed on the'attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, Demolition *arkin for me in an capacity. employees and have workers' g y p tY• 9. ❑Building addition [NO workers' camp.insurance Camp, incnranCe$ required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions '3.❑ I am a homeowner 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 ��9 �e camp,insurance required.] *Any applicant that checks box#1 must also EU aut the section below showing their workers'compensation policy information. t Umneownemy ho submit this aTidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tCmthaetors that check this box mutt attached ea additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. Xthe sub-contractors have employees,they must provide their workers'comp.polio number. I ant an employer that is providing workers'compensation insurance for my employees. Below isthe policy'and job site' c=, rg utformation. Q Lr Insurance Company Name: 15/" ce� w � Soc�C r 1vo,� CI tA S LC c � Policy#or Self ins.Lic.#: VC 2 D rl I Expiration Date: d Ic ZI 3 2 s �� "�' ru Dr. (ems �- y� ly ' Job Site Address: !�1 City/State/Zip: t 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 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 maybe forwarded to the.Office of Investigations of the 1)IA for insurance coverage verification. I do hereby certify under the pains•and penalties of per that the information provided.above is true and correct. Si afore Date- Phone#• Official use only. Do not write in this area, to be completed by.city or town,official, City or Town: Permit/License# Issuing Authority(circle one): Electrical.Insp ector 5.Plumbing Inspector: e artment 3. Ci /Town Clerk 4.E g t uildm D P 1.Board of Heal h 2.B g p ty 6. Other Contact Person: Phone#; MMENME o = ice... looms mom M 0 ME@ Elm M looms No 0 ON loME MMOMMEMSEEM sm 0 M M om Emommomm so looms MEMO 0 momommom so ME ME So NOMENNNOMMENNNN on ii�i��'iiimCi�iiiMEN moommmmomm mom M MENNE Nii �� i Ell mmmom INN MMORM M 0 0 M M ro nomm" mmmums M M i■�iiii�i■ni�n■�i i �i =M mom MENNEN mom M momommi No so 0 No M MEN on �niii iOi�i■i ii � �i �� i r 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: Registrations 152372 Board of Building Regulations and Standards Expiration .g/23/2008 One Ashburton Place Rm 1301 tType DBA Boston,Ma.02108 BALTIC COMPANYe r LINAS REVINSKAS'�� "'` �✓:�� - 166 UPPER COUNTY RD 1 11 DENNISPORT,MA 02689� Deputy Administrator Not valid without signature L a Town of Barnstable *Permit# �-PRESS PERMIT �Pjres 6 monthsjrom issue date Regulatory Services Fee ° /03. JAN _ 9 2006 Thomas F.Geiler,Director Building Division TOWN OF BARNSTABLE 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 p/parcel Number <:)sO dS(7 perty Address _ 11 y 4 e-rr i y)rA R U r) -b r('U P Residential Value of Work D. Minimum fee of$25.00 for work under$6000.00 mer's Name&Address On nc a [+u L t l 7 L-a- t,c lnet 5 l,o s .4 I ct_ivl o� W �l �.� y ntractor's Name :�p p mac' ��d1 Telephone Number -7(o 0 ~G C © IPiprovement Contractor License#(if applicable) nstruction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Durance Company Name Drkman's Comp.Policy# W ipy of Insurance Compliance Certificate must be on file. rmit 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 Ard�s�in Replacement Windows. U-Value , 3 (maximum.44) i aj Vj i MO WL5� � Frees D46 r /*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. Home Improvement Contractors License is required. GNATURE: ?orms:expmtrg _ . vise071405 BOARD OF BUILDINIVREGUL:ATIONS 1 '"�,�•+ license: CONSTRUCTION SUPERVISOR + Number: CS O48044 i Expires-4,3+1612007 Tr.no: 3776.0 Restricted: 00 DALE R NrKULA N ST DENN SPORT, MA 02639 F Ae &ornwwM o�✓l�aaeaa�uasQ2 M rd of Biddle= ttbas aad Sbadards HOME MPROVEMENT CONTRACTOR 4.� Rep WVWA., 126781 EN d 4 ),1,912008 Ual DALE R.NIKULI� DALE NIKULA- 11 103 MAIN ST. �i 'u•i December 19, 2005 To Whom It May Concern: RE: 94 Herring Run Drive, Centerville (owner name), as OWNER of the subject property, hereby authorize Encore Construction Company, Inc. to act in my behalf in matters regarding the obtaining of building permits and construction work on the property. OWNER: Date: 17 .