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I I V L,- 'iZ.� � ��iioL,,,i�',`.Ii,?�U 1 01 , I _""N_ ,njTjjTQ5%T y­ym"M­-.0""'fl� ,� ,,�`� ,�;,�;,,,,,',�'��,.� ��.� ,' i, ,L �:, J�,,�"i_,`��;, A c � I , I" �6ll60 � �`� Town of Barnstable *Permit.# Ft 1 � Expires 6 months from issue date Regulatory Services FeeBAJMSTAB v� 1639- � Thomas F.Geiler,Director41�'! j �?fD,MA't A � ,b`"'.,rite R IN!s,-�S,�L7 LE �' ON Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstab le.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 02DS (�02 Property Address 'J L_o.,,a .Residential Value of Work oZs Do0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1V f}'NC_V Sp C k Z. � K/DOn� �c� �cf! L.'a1.��.� rh�1-• D1��-3 Contractor's Name S'E`zVf.N T• C3:51tiooCL�C Telephone Number 5D`6•-,?X 16.7 Home Improvement Contractor License#(if applicable) �060 Construction Supervisor's License#(if applicable) [13Workman's Compensation Insurance Check one: ❑ I am a sole proprietor Vam the Homeowne have Worker's Compensation Insurance Insurance Company Name /V &M -.L Workman's Comp:Policy# Copy of Insurance Compliance Certificate must accompany each permit. 'Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over' existing layers of roof) Re-side / -0 0 k1�4 4 #of doors Replacement Windows/doors/sliders.U-Value ANdfJls (maximum .35)#of windows L40 *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 Supervisors.License is .required: e. SIGNATURE: c�-- C:\Users\decollik\Apppata\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook DV87 AEXPRESS.doc Revised 07211Q ! Jlaaachusctts - Depiwtmcnt of Public Safet% Board*nf Building Re-ulations and Standards Construction Supervisor License f License: CS 76571 Restricted to: 00 r tea,i WILLIAM L'SCHMITZ s " 66 CARAVEL DR HATCH VILLES, MA 02536 Expiration: 9/9/2011 f'mnni<si,n•r. Tr#: 4448 . c y2'� ✓17� U/0117iI)1NIGCl�CCLGCit 6`J_.G�IX<k1CGf.JtC«[c6 • .... .. Y .. ., ' i E Office of Consumer Affairs&Business Regulation License or registration valid for individul use only i HOME IMPROVEMENT CONTRACTOR ' before the expiration date. If found return to: !� Registration 106141 Office of Consumer Affairs and Business Regulation Expiration 7/�2/2012 Type. 10 Park Plaza-Suite 5170 z3 Supplement C and Boston,MA 02116 } STEVEN J. BISHOPeeRIG ING WILLIAM SCHMITZ j 1112 MAIN ST UNIT 1'8 x g OSTERVILLE,MA 02655 � r _ Undersecretary- Not valid without lure t • r t , _ a The Commonwealth of Massachusetts Department of Industrial Accidents a Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance-Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Dame(Business/Organization/Individual): -�i EV�.N T• 131S7I�Q f`IC, LiU(_ Address: I I 12 Yr —, C,L:L T" V lu 1 T' City/State/Zip: DStt:-P,-ui i,t✓G,. m,� D (�c� ' Phone#: 50 •� q-Z0 _ Are you an employer?Check the appropriate box: Type of project(required)_: I. I am an employer with_Z& 4. L I am a general contractor and 1 6. C New construction employees(full and/or part time).* have hired the sub-contractors 7. ti Remodeling 2. L. I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 1 8. 1 Demolition working for me in any capacity. employees and have workers' 9. D Building addition [No workers'comp. insurance comp. insurance. required] 5.1_ We are a corporation and its 10. 1 Electrical repairs or additions 3. :-. 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL 1. 1.1 Plumbing repairs or additions insurance required] t c. 152, § 1(4),and we have no 12. D Roof repairs employees. [no workers' 4 T comp. insurance required.] 13. :I Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contactors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. l am an employer that is providing workers'compensation insurance for my employees.Below is thepolicy and job site information. _ _ Insurance Company Name: N,4'll C AJ (�R1 �'(�u 1111 U 1 V+L L/V,SY�M�i r Policy#or Self-ins. Lic.#: W 0 I `� ;�`J n / Expiration Date: //17 C]I Job Site Address: l 3 Lt.^e,. 11?> �.t, C.ity/State/Zip: _�Cg4e— tr 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 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Si nalztre: �G�=Gem Date: Print;Name: r.116¢.+� �Ati 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): l.Board of Heath 2. Building Department 3.City/Town Clerk _4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: ' I - 01/27/2011 02:41 1-508-428-4841 STEVEN J. BISHOPRIC PAGE 01/01 0�iJ61201c) TNt ';\' ill DO LI G PYh II, IDS '``i,�r.'EiiJP�. . f 1 A.W- COMFICATE OF LIABILITY INSURANCE T1118 C�31X1F)CA7>"4�a{5 D AS A!4!k uAAt1GN ramafcnFa glJf Dowlina&0,461ti Insurance QABY AMD COUFFRA kd RsOPtP9 UPON �ER�3FiCA11S Agency 1 OM TMcrknfwArE SIB W)T A>iiM' W90 QR 1 ft0iALA TH8 6O1f�ItAOB r!FQ�tRkD 6YTl( P8 rfFLCt1k: $7"3 lysafm+v+gov Bd.f PO Box:880 �-•^— �..r—,• -� Hyannts,QA 02601 iVkWflZM AifOIZD7prG COVERAGE - Steven J-8lahalarlc,IfTG.aChostnu!Bay •W '`A Adka Inefaenee ! _ cawner co'.Inc. ncs a Nalforetod C?rfine lt�tua!beslmane _., — ' 1112 Mlaln Street,lln:t 1d s�9,1'w3 OF aJiihh its"GD BELQvf f?',=BFt N 4350JEO TC TW.I�WREO kUA5b ABC.'@ FCA TW- VEX Cr^cARY+.nYt4U rd%TMTH$ A--ANNC 9 ANY RGSl36Atrw:W:I W,A};Y?CO°;Y;)ACT N OikIER OCcuy�Nt 4vni W ',Y p�$iTASf•I-TrsE it�aJF.4nIGa AF'Ff3w`C+c.^.By r. '.?';2cMa FSF�4CIRAAEL. R.eM 8 SUBJECT TV Ah Tr2GTZp.',g. AN*C�Y7Prtgf9a Qp 91.:_r< ' FOLICIF5.A3%;M-'0AT@UWEStsYN:Y WA`r:VclS MIN t (>Vc DFNPAMC�A!M& I ...,..,,:,..���..,.�i21NCG..,.-..,,.�,...........,._�"P:�C'rKw� sera I. �.-er..--•....,..�. OdA[r9 __.__{ ^AlAQ049i7tZt -._...._ Q �naw��<fAel e�y �� 0�}13110 0Z`"Sr1t mac-f:xaex� 01,000, G Jf li„S[ntsF:�,V•t GnNa4A,l�.::i•.: - ' r�......�(._ ,,.,._•._. i ::f4t M%7W r - p�r:1�.CCavA"�.',:rx^nWf lcg.•c•,",i y i fi=TOhWt1�G 1,eA.W[61T, .r I !V '""'i '.Ea a%xS L,�-1 p 4 � �rwo:o?.eves i ---.�..,_........-, •_..� ,,..,,:...n pw is i 1tir n; I ! I EX;.FaSA.Wt1Rk`.k.I�.4+�".STa 1 r Elwol�r ytt cCaepENBArt,a,UO WCT4 06K OThAf10 �..�• _ ,........�.......,,.`A` l E?6p.0Y8.itY UADI�lS" i b 11'�f11 '� ..�._f..:5ni3� +..`•.ice—..-..-,..._,...,,� ...,.; i 000 f w• . 7r�es �L- 1 �8CRW71G206'npLxATP6F8..�L'-a`KMJruSl�Cr,.tygrl'X_s vSiClkt AZf%20 Br Poemarme>rLwTrO�i�Gf>,vOr.wS - - . ODmevtionm Ao►fcrrz*+oa 2�Y t!v®»a>rad[ns aro0 edD}oet to paWey ngndfLiana 1 ii and eXcYuslonry, i 1 _ �a7':.:LCtiTf !f:7�T?C� __ Ci4 6Y.1A41QN. .�tf..l� t_ C Pirx'6-Psavmr�'= - i4ND4tb!WYCf'lh�MtY��3tJB.t�rWa%�a^.�".crdoGEi�$D'WQ45T![C.QPfRAT1Gr: . .. SDAT�'lt'KgUESK'!I[E ffisa�:miuiSK WvIM f;pAYF?'�f)A c:�.lUk'. .,�J;,.. CaY&w'GR`Aw - I"QlftQ TO Ttd CW-&LCAT>Z NOLMA AA&KQ FA4.1,7$TD OU%O&4A,.. . 44oCuSF 00 GO SOA71=02-"QTY ps'b.�►K77a flp0[�1l�.ifd$�SNiq f7'><A6CK5'�P _i - ACORD 25{256:!0.8)1 of 2 s1157:005jM7280+E per( 0 AC�[I<D.COR�31Al10to 1008 oFT► �ati = Tow n' of Barnstable ,;, Regulatory Ser-vices BARNSTABLE 9 etnss ��' Thomas F. Geiler,Director1639. ` ►may Building Division } Tom Perry, Building Commissioner 200 Main S Y eec Hva.=-s, NI-A.132601 Ofuce: 508-862--038 Fax', 508-790-6230 i F i i Property Owner Must Complete and Sign This Section If Usin A Builder i as Omer of the subject pro e hereby authorize W� f � 6��_ �. Z to act on my behalf,, iii all matters relative to cork authorized by this bu-2ding pe: il;t application for (add. ss of job) c 123 UW Si�at� re o ner Date Pr"t \a.-r.e i . i r F. } j f114E r Town of Barnstable *Permit# 00 b 5/0q Expires 6 months from issue date - Regulatory Services Fee 4 III 1 . BA"SPABLB, ,• 9 M"� 04Thomas F:Geiler,Director C � ®� 1639• �0 plfo►r►A�°V Building Division .. v Tom Perry, Building Commissioner /�- RESS PERMIT 200 Main Street, Hyannis,MA 02601 office: 508-862-4038 SEP 11 2006 Fax: 508-790-6230 TQWN OF gARNSTABLE EXPRESS PEMT APPLICATION - RESIDENTIAL ONLY" Not Valid without Red&Press Imprint Map/parcel Number c2= QGL � Property Address Residential Value of Work � � ❑ i Owner's Name&Address GcJ o 1/s 4 Contractor's Name �/ S�o � e1 �/d,l2 S . Telephone Number Home Improvement Contractor License#(if applicable) j4 8730 I CojSstrsction Supervisor's License#(if applicable) d V-91 ' ❑Workman s Compensation Insurance ' Check one: ❑ I am a sole proprietor ❑ I am the Homeowner XErI have Worker's Compensation Insurance Insurance Company Name a r i C workman's Comp.Policy# - Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to 1� ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *where required: Issuance of this permit.does not exempt compliance with other town depa tment regulations,i.e.Historic,Conservation,etc. ***Note: Prope O er must Property Owner Letter of Permission. Signature Q:Forms:expmtrg Revised121901 `''� °� ✓�e "lJo»tanoyrcuep�`i a�i/,�pq��utde�.6 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR ` Number: CS O47928 ' Birthdate: 09/29/1948 Expires: 09/29/2007_ Tr. no: 4358.0 Restricted: 00, STEVEN J BISHOPRIC i i BOX 656 MA � MARSTONS MILLS, MA 02648 Commissioner 1 k -- fie too�nircanureaLCf• Q��Z�crasac�uaseltal Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR l Re * ration: 106141 lug Expiration: 7/22/2006 ! Type: Private Cor. oration `STEVEN J.BIS OPRIC INC. : ` Steven Bishopric 1112 MAIN ST UNIT 18 , . i,i��*✓ OSTERVILLE,MA 02655 Administrator ' x o i� w Y °'IKE r Town of Barnstable Regulatory Services + BARNSTABLE, = Thomas F.Geiler,Director 9�'Arf�01 Building Division Tom Perry, Building Commissioner - 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A. Builder C ' 5c�/Z:V , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for(address of Job) 22 . SigiLature .cLOwner Date Na 1 Print Name • y Department of Industrial Accidents Office.of Investigations ' a 600 Washington Street Boston,MA 02111'. www.mass.gov/dia Workers' Compens.ation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kpplicant Information Please Print Legibly Vame. (Business/orpnization/a&viduo): Address: l I.;)L E:ity/State/Zip: - S 4-qL y A'( 1M Phone .re you an employer? Check the-approprito Type of project(required):' El am a employer with 4. am a general contractor and I 6. ❑ New construction employees(full-and/or part-time).* have hired the sub-contractors❑ I am a sole proprietor or partner 7• Remodelinglisted on the attached sheet 1 ❑ ship and have m employees These sub-contractors have 8. ❑ Demolition - working for me in any capacity. workers' comp.insurance. ' 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We'area corporation and its required.-]--- ----- fcers-have-exercis 10.❑ Electrical repairs or.additions ❑ I am a homeowner doing all work right of exemption per MGL 11-M Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.E�7Roof repairs insurance required.] t employees. [No workers'' 13.❑ Other c6mp.insurance required.] ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: [omeowners who submitthis affidavit indicating they are doing all work and then hire outside contractors must submit a new e$davit indicating such. mtracton;that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'camp,policy information. . im an employer that isproviding workers'compensation insurance for my employees'Below is thepolicy and job site Formation. ,urance Company Name: licy#or Self-ins.Lic.#:__500 J// 0/ems Expiration Date: CD b Site Address: City/State/Zip: tach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ilure to,secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ,e up to$1,500,.00 and/or one-year imprisonment, as well as.civil penalties iu the form of a STOP WORK ORDER and a fine up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of iestigations of the DIA for insurance cover ge verification. 'o hereby rti u r h pains and pen !ties of perjury that the information provided above true and correct afore:. 'Date: ..�� one 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): I.Board of Health L.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#• Information and. Instru' d ons fassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. ursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, Kpress or implied,oral or written." m empIoyer is defined as`:au individual,:Parmerslup,:association,corporation or other legal entity,or any two or more f the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the eceiver or trustee of an individual,Partnership, association or other legal entity,employing employees. Howev..er:the ,wner of a dwelling house having not more than three apartments and who resides therein, or.the occupant of the welling house of another who employs persons to do maintenance, construction or repair woiK'on such dwelling house iron the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." vIGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or enewal of a license or.permit to operate a business or to construct buildings in the commonwealth for any ►pplicaut who has not produced acceptable evidence-of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall ;rater into any contract for the perfoanance of public work until acceptable evidence.of compliance with the insurance -equirements of this chapter have been presented to the contracting authority." Applicants Please-fil-out—the-work er '"on�pEnsation-affida ;t�rognpletely,by checking the boxes that apply to your situation and,if.aecessary,supply sub-contractors)name(s),address(es) and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members orparosers) are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Departinent of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their... self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fiu out is the event the Office of Investigations has to contact you regarding the applicant: Please be sure'to fill in the permit/license number which will be used as a reference number. In addition, an applicant in an en ear,need only submit one affidavit indicating current Permit/license applications y given y y . that must submit multiple perms app . d under"Job Site Address"'the applicant should write all locations in (city or policy information(if necessary)an PP town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provide d to the applicant as proof that'a valid affidavit is-on file for,future permits•or-libenses..A new affidavitmust be filled out-each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office.of Investigations would like tti thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts . Department of IndnstrialAccidmts ..Office Qf Investigations . 600'Washin on Street ' St 4 - Boston�n MA 02111.' : Tel. #617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-727-7749 . wised 5-26-05 www.mass.gov/d.i.a IZ Board of 7u ding Regulations an _ t IMp d standards HOM ROVEMENT CON ' TRACTOR' Registration 148730 .expiration 70/.19/2607 RICHARD E LEBOEUF,JR ' ' RICHARD LEBO � EUF;JR 10 B LOCUST ST '6 �r HYANNIS MA 02601 .:.` t i Administrator QyoFTHET TOWN OF B.t RNSTABLE • BAHHSTADLE, i "ou 6 9 BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... `..IE 11...................................................................................................... TYPE OF CONSTRUCTION ...... ....IP.r....... !......� .......�.....�.J!� . .................... .. . .192L TO THE INSPECTOR OF BUILDINGS: The undersigned h�(ereby applies for a [permit according to the following,information: i Location ........ -1.4.... > ........... �.� o.L�` ...................................................................... L Proposed Use ........ 1 V ... W�....... .................................... � �h � ..,..... . Zoning District ........ s.........r..............................................Fire District ....... 42 Name of Owner . . ...........................Address ...�x�i.. ..`.d "fir. ....�..JCJ�h-�WV46?- Name of Builder ,�c! .... �► Q. ..........Address uA:. �.1�`e.C �."� � ................11 u�...Address .................. Name of Architect ....... l<W .—...... ... � ........�1......................................................... Number of Rooms ........................................ Founda,641.(a.4.`:}aQ`.1. Exterior ..IaU.11 .�... V... ..................Roofing .. .. � ... �11ti ` .. . Floors ..... -!J �.�Q.,U ....`�� ....................................Interior .........10�!t'C-........................................................... Heating .....................I.A., 1tS..g-...........................................Plumbing ........�.................................................... Fireplace .......................1!..' -......................................Approximate Cost . ..... .d...�.�Tfl Difinitive Plan Approved by Planning Board ________________________________19________. S• Diagram of Lot and Building with Dimensions LA- 0 kCl �V N � ►s s WO 4PROPO- T OD F Pr OVI ING FOR SANITARY WATER �c� , �� � _ ,�;, ISPOSAL AND DRAINAGE I` CIE.°° 4,. ' _�;_:;.;, �' g v ED S/ "! TOWN OF BARNSTABLE, BOA D OF HEALTH Ift e, A LICENSED INSTALLER MUST OBTAIN SEWAGE I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....LMA ..... W. B '. B. DEC f��� | u�u.�� um � ,�vn ) ' � | 13662add breezeway ` No —...........— Permh for ------------ > | ` & garage to dwelling —.---.-----------'—.~~------.. | � Ig� �"�� Road . Location --.'�—. Beach�z���-----.'.......-----. - Centerville � - ----.---.---.^.......-.----------. \ Owner --.�[..B� 8ocitb _.. .. —.. — _---.... ..� —.-----.. / - ~ Type of Construction --.��?���-------.. ' -----^--------------------'' Plot --------- Lot ----------' ' \ Permit Granted .......Karob..g............ ..... g7I �� Date of Inspection --� .----.lQ *71 ---- Dote Completed ...................................... } ° ^ / PERMIT REFUSED .----_—.—...----------. lg ^ . - ' ' -------...------------------ --..--.--.-----.—.---.---------.. ^ ` ,.---.---------..----.---,—~. --------------.—~.-...—.—.---.... , �t r�' I Approve6 _..!—..--..^^.-��—.��---.. l� °�~ -------'-----==�� —^'x��»--------' ~ -------'------------...~....... ' \ ! � � �