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Home My WebLink About0047 LONGFELLOW DRIVE ,��. - �". . . „F s..... ? n .:i•»r ., n -` �.P. ��{� iN Tr?`. �3✓n Pu - rr ^',f,�{.t... y ,s K4•-.. • t �..•. .,a.. -tTk. .�.. ,: --,:: .. ea":aria .? ,t.....'. +. +,: f. !. q'E:l, �'' 4 --.ear. ''� T•'! #, lr n •,a. "w' .•Y. P.�3'^'� ,r o ;�# .+-�• .. . :, W „_� +:,-py.:, ,,. . ., .�° _R".''�n � <tr.t., e ,,,a.' r�.�a' �,�„- �a.: ��S�r,.. a. •N�`iM,YF :�i r,�+n. �'6t_ _ 'FY;: ... „�,�•- �i: - S/" s^., s .-,�'.!��•(j.�A5.i-s, �4 wL'i1 P,n{A � Y N.,. "� 1"r.S �{S ti c afS�y,'e .S t �.� }fit^11i 'u; uk> A :;.5.xs •.r ` r - •;t'. oq Iuµ 5�Oslo A Oil le not not vAl got VAN A A, t Y 4 t y f r t " S E • Oy- Y, .n...� +f 5 ,-: Y.Sol c- r , Town of Barnstable *Permit# 16-/0 — �a Regulatory Services fee 6 months from isle date �_ -o • nnsrtsrABM MAss Richard V.Scali,Director Building Division X31PRESS PERMD Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 AUG 10 2016 www.town.barnstable.ma.us Office: 508-862-4038 TOWN OF BA YA&T-30 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �S Not Valid without Red X-Press Imprint Map/parcel Number 073 rr Property Address t4 7 1nikgfe-L,/ D r P a �Vl��t/tic �Je M-Residential Value of Work$ / 000 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address b p,,r`� A . -T w n P-��2AN 23 !� 3 ez c� �`f l c ref lrb 0 V►1A a z IZ Contractor's Name Telephone Number `� ' 7 7, 'L0 Elf �O Home Improvement Contractor License#(if applicable) t �� f Email' Construction Supervisor's License#(if applicable) - C S S L cl q ❑Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 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 Replacement Windows/doors/sliders.U-Value (maximum.32)#of_windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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. SIGNATURE: Q:\WPFILES\FORMS\building permi rms\EXPRESS.doc 06/20/16 41ii 17ie Commomvealth n,f Massadrusetft Department a,f rndurfrid Acddmtg fIlfwe-of lmwfigadom. 600 WashfiVIOrt SYMet Boston,MA 02111 - ' ivis numas&gorldIa . War.lors' Cmapensafaan Iusurance $uitdet-dCantractarsMectricians(PhEmbers AppHcan#Tnfk=tean JAe King Please Print Iv .Na= - 36 Checkerber Line. AA,,,,-- e AW 508-t.Yarmouth, MA 02673 A i ens: PhO-MAW 76 6448 City/Statm(Zig Phow Are you an employer?Qaeck the appropriate box: T of project r 4_ I am a general contractor and I Y� P�'i t etlmred}: I.❑ I am a employer v>tith ❑ 6. New oonstDction employees(fanandfor part-time).* have]sired the sub-cmi ractcws ❑ 2.[ LJ am a sole.propdetor orpartner- Tisted on the attached sheep. 7. ❑Remodeling ship and have no employees. Mese=b-c=tractars have 9. ❑Demolition working forme in any sty. employees andhave wod=' 9. .❑Building addition. ¢ 'ootnp_: a nce comp- required.] 5_❑ We are a corporation and its 10-❑Electrical repairs or addiflorts 3.❑ I am a homeowner doing all work officers have exercised their 11-❑Plturibsng repairs or additions myself[No workers'comp. fight of exemption per M(M' �❑ , � �&]a c.152,§1(4�andwehavena L_ Roofr employees-[NO woz�b=' 1J_�tither lZ,L� 5 !c�t vtc camp.insarance nquire&I *Aay IWffsavt&Xt cbeftbos#1 mast also Moulthe swflc ab9o-sbnving theQwadcers'=pmsst; UPnyegirff3MnXdM.. Y t Hbmeoeraers who mb.*d2is of &m i g sorb. IC.aatzac, -ffizt rRxi tbdz box mast attarhea an addiei�al sfieet sbouiag the awe of the anti state whethe< not these entities bay employees.Iftheavbcoat�aesHasee�gia s,tfce3'�nP '�P•P Fa�trez I am an eriePl sr ffiat is prauidurg tvarkers�coeetperesaffort tirsrsraetce for t'enrpFay�eea: $etoev is flee pu8cy and job sfte Fnformatiars • _ Insurance Company Nmtne: Poficl* or Self-ins Lio_ ExpifationDate:' Job Site Addze= CitylStafel7.sp: Attach a-copy of the wort-ere compensationpolicy declaration page•(showing the policy,number and expi ation(late). Failure to seance coverage as requued under Section 25A of MC L c.M can lead to the i mposit of criminal penalties of a fine up to$L54aOD andtor one:y&ir impriso=nent,as well as rive penalties is the fog of a STOP WORK ORDER and a fine of up#s 0-00 a clay against the violator_ Be advised that a copy of this statement raay,be f orwnded to the Office of ,. Ittv*estegatioas ofthe DIA.for ms=mce coverage verificahon- I do hereby card,fp wrdw the pains andpmah&n afpedkq fhatAa infarma#forrprini&il abmv is trars and correct Date ,, 6 a � Pie �� Z 7ss`_ 9e Offal use arreIJ: Do rust awke in this area€a be c vmp&tesd by tiff artaarn o fdTat City orTown: germitlr tense Issuing Auf1writy(cam one): L Board of Health r.Bwffirmg Department 3.Cii)Yrown C k-xk.d.Electrical Inspector 5.Pbunbing Inspector (.Other Contact Person: Phone#: — - 6 Laformation and 11nstruc-ious =s.-±EM far f== Mass�achmssd�s Geueaal Laws cb�fear Isz req=es all employes 7n provide wozlsras'� ��- PMTaMA-tD this Vie,an M phg�is dcfined ac."_.sverp peasdn m ffie Sery'=of another under any aa*tmc'ofhire, cgpress or implied oral or wry-" An errrpFayer is defined as"an kTvidzA p ,awoc;isfi,corporation or other legal entity,or any two or mare of$ie foregoing engaged im a joint=fZXprise,and inchtdfug the legal repre =h6ves of a deceased employer,or the rmeiv=or trastes of an mdividnal,parmtrship,association or ofherlegal entity,employing employees- However fhe owner of a.dwelling house havmgnot mare tban three apartments and resides herein,or the occapant of the - dwelling house of anofer who employs pms=to do mamma ce�raustuc;on or repair wow an such dwelling horse: or on.the grounds or baildmg apprrrinn ,tiieteto shallnotbecause of soch cmploymeatbe a,,,=aedt,3 be an employed MGM chapter 152,§25C(6)also states that-every ts�or local ficensimg agency shall wit3ihoId fae issuance or ii 5�. o�•fY�....r:.• , renewal of a license.or permit to operate a bvsmess ur m comtract bindings la the commonwealth for any applicant who has not produced accepfable evidence of eompl anci..W-n tip a sura.nce.coverage ragmired. Additionally,MCrL chapter 152,§25C(7)s dd s t Neil OF ffia cc=mwcahh nor Ely of Its polhical subdiei_skns shall e�t�r iutD any contract for theperfinmance ofpnblfc warlcuhI ar;eptable evidence of mmpli;mcewith the inset-ante. Mqmrcm =tSOft3-iS havelien emtedto file g aufhozdy." Applicants ' Please fi l oi± the worlaeas'compensation affidavit completely,by checkg$e boxes flat apply to Yom-sitnafion and,if nmetssmay,supply sab- r(s)name(s), addresses)and phonemtmber(s) along w&their=t1ficste(s) of 10snrance- Limited Liability Campauies(LLG�or Lm=tmdLiability-Pmtamsbips(I LP)wiffi =3ployees other thaw the members or partners,ate not rimed to crony warke&compeasatwu iasmance. If an LLC or IL P does have employces,apoIicyisrequheI Be advised tbat this affidaykmaybesnbmitted to,the Depa-imentof Industial Accidents for conformation of msm-�mce coverage Also be score to sign and date the affidavit The affidavit should be ret amed to!he city or town fl�d the application for file permit or Iice use is being requested,not the Department of BxIastifal.A-ca[ mo:±s. Should you have any questions regardmg the law or ifyou.air rued to obtain a wo3ers' compensation pofiey,please call the Departm m±at fiie number listed below. Self-iomnrd co=panies should enter their self;ns mute Hcanse number on the appmpzi2fe line City or Town OfEidals Plmse be sm-e fhat the affidavit is complete and prime legibly. The Depar(men:t has provided a space at the bottom cu the licant_ of the affidavit for you iD fill out in the event the Office of Investigati�has to cortct y g aFP Please be sure to fill in the permitlliccmt:munber which will be used as a reference nmbes Iu-addition,an applicant fat must submit mUltiple p�n;t lT; a appliiztions m a ay given year,need.only submit one affidavit indicafmg event p ohcv information(if necessary)and under`Job SIfn Address"the applicant should WI:6--"all locations in (ciLY or town) "A copy of the affidavit that has best officially stamped or maimed by the city or gown may be provided in the; " applicant as proo�fd at a valid affidavit is on file for firfnre permits or Iimmm A new affidav>tmust be filled out each year.Where a home owner or citizen is obtaining a license or peroak not related:b any business or commercial ems_ said is NOT to Iefe fhis affidavit Ct_e_a da licxnse or ' m Inun leaves ) person requiled � g Pam°¢ . i The Office of Investigations would IiCD to thank You m advance for your coopetafion and should you have any questions, please do not heshaiz to give us a call. - The DeRarlmenfs address,telephone and fax ru*mber: Depaxbn mt cif a1 Accidents • - �c�of X�tio� Bastma.MA Oil 1I Tf,-1<0 6 17— -4,000 e�ft 406 4r I-&77-MA SaAFR Fax#617`27 7M Revised¢24--07 - VAFM /...__ �. Joe King_ 36 Chec�erber Lane Yar �ane..... �� West , mouth, MA102673, 5;I 775 - Y� P, �P�t®nle P -fi448 i ._� .. 3 iP� f's ST_ ate- _ f t c `S C 'u ' Things I Need At... 157 Thornton Drive ONRTHASTTE100L 92 Rayber Road Hyannis, MA 02601 Phone: 508-778-4 Orleans, MA 02653 552 SUPPLY Phone: 508-240-0764 C��e�amr�rca�uuealC�o��cwaac�eC�r l Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ' Registration: `150889 Type:. Office of Consumer Affairs and Business Regulation Expiration 5/5/2018 Individual i 10 Park Plaza-Suite 5170 = Boston,MA 02116 JOSE�P E.KING JOSEPH KING 36 CHECKERBERRY WEST YARMOUTH,MA 02673 !'ram E '�All� Undersecretary ✓ Not/valid without signature Massachusetts Department of Public Safety . )nstruction Supervisor Specialty ` Board of Building Regulations and Sta �stricted to: License: ndards 3SL-RF-Roofing CSSL-099166 3SL-WS-Windows and Siding Construction Supervisor Specialty JOSEPH E KING 36 CHECKERBERRY LANE WEST YARMOUTH MA 02673 o allure to possess a current edition of the Massachusetts` Expiration::ate Building Code is cause for revocation of this license. Commissioner ti 'S Licensing information visit: WWW.MASS.GOV/DPS 01/24/2018