HomeMy WebLinkAbout0016 MAPLE ROADIG Nla�o% �� v
Town Qf I��IC]C'st 'ble *permit#
Expires 6montla'from issue date
' Z Regulatory Services
Thomas F.Geiler,Director
Build ng.Division.
r t « Tom Perry;CBO, Building Commissioner
.200 Main Street,Hyannis, MA 02601
www.town.barnstable-,,ma.us
Office: 508-862-4038 Fax: 508-790-6230
ESP SS PERMIT APPLICATION RIESIDENTL4,L ONLY
q Not Valid fvithout Red X-Press Imprint
Map/parcel Number I I o
Property Address
WResidential Value of Work J® Minimum fee of$25.00 for work'under.$6000.00
Owner's Name&Address 1 Vla- a-f Jo l/ 1' 1
Contractor's Name �' Telephone Number•���� •1:-/w V �I
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) I
❑Workman's Compensation Insurance
CheX one:
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 be on file.
Permit Reques (check box)
Re-roof(stripping old shingles) All construction debris will be taken to 'hr1 R Des� o N.1 L' l
❑Re-roof not stripping, Goias o. ver existing layers of roof
)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum.44)
*Where required: Issuance of this,pennit does not exempt compliance with other.town department regulations,i.e.Historic,Conservation,etc.
***Note; Prop e Owner t rope: Owner Letter of Permission.
A c py of the ome mprovement ontractors License is required.
SIGNATURE:
Q:Forms:expmtrg.
Revise061306
pfIHF� Town of Barnstable:
�� do
Regulatory Services
LiRlaS BLE.
y MA-1a $ Thomas F. Geiler,Director
fn )31'ilding Division
Tom Perry, Building Conunissioner-
200 Main Street, Hyannis,Na 02601
"W-town.barnstable.maxs
Office: 508-862-4038
Fax: 5.OE-790-6230
Property Owner Must
Complete and, Sign This Section
Tf Using .A Builder
I, (Lat T�h nSO-h as Owner of the
subject property
herebyauthorize Ta.M-Q- to act on my behalf
in all matters relative to work authorized by this building pent application for:
I LO Ma (-e, (,off
(Address ofj ob)
- 3
Signature f Own Date
Print e
Q:FORMS:OWNERPERMISSION
- The Gommomveaith ofMassachusetts
Departnt,int of dastriar,4&1'dents
Off of_1"nvestlgations
600 Washington Street
-Boston,.A 02Y11 �.
wwW.M ass..gov/die
Workers" Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information
p Please Print Le
Name(Business/Organization/Individual) I5 'bl.
Address: X I
City/State/Zip: MP
Fshi.p
you an employer? Check the appropriate box:
T a employer with 4. [] Lam a general contractor and I Type of project(required):,
lloyees (full and/or part-time).* have hired the sltb-contractors 6 New construction
Tamasole proprietor orpartner listed on the'attached sheet 7. []Remodeling
and have no employees Thew sub=contractors havb g, Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp,insurance.$ q• �]Building addition
required-] We are a corporation and its 10.0 Electrical repairs or additions
3.El am a homeowner doing all work : officers have exercised their
11.[�P,ktimbi ng repairs or additi ons amyse]L [No workers' comp.`. right bf exemptionper MGL l,�_'1/
insurance required] t c. 152, §1(4),and we have no 12 Roof repairs
employees. [No workers' . 13.❑ Other
comp. insurance required]
*Any applicant that checks box#1 most also fm out the section bclowshowing tbcirworkcrs'c".ms;tion policy informztion.
t Homeowners who submit this aiidavit indicating they are doing all wank and then him outside contractors must submit a new affidavit indicating such."
Contractors that ehecic this box must attached an additionalshect showing the niunc of the sub-contractors and state whether ornot those entities have
cmployces. If the sub-contractors have employees,they must pravidb their workers'co policy. mp.p y number.
X am an employer that is providing workers campensafion irisrurance for
information. my employees Below is the policy find job site
Insurance Company Name:
Policy or Self-ins.Lic.#:
Expiration Date:
Job Site Address:
City/State/Zip:
Attach a copy of the workers' compensation policy declaration page
e as required
(showing the policy number and expiration date),
Failure.to secure covera
g under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine lip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to�250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the IDIA r ins a e verification.
Xda her y ce :rude th ains.. alties ofperjury That the information provided Bove is true and correct
Sitrnature: CJ I I
� [� • Date::
Phone #: - `T�o _.
Offtciai use only. Do not Write in this area,'to be completed by city or town official
City or Town: Perm-it/License#
Issuing Authority(circle one):
Z.Board ofHe'alth 2.BuiIdingDepartment 3. Ci(y/To-vsra Clerk 4,Electrical Inspector S.Pluin6ingInspector
6, Other
Contact Person: Phone#:
'� �/ •Q%261P.Cll� O��✓!/C,lyJr( �yLLOy,�
C Bbaong egu a ions an J an(iar(fs License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 124310 Board of Building Regulations and Standards
Expiration: 6/1/2011 Tr# 284683 One Ashburton Place Rm 1301
Type: Individual Boston,Ma.02108
James Curley
James Curley
287 Fuller Rd.
Centerville,MA 02632 Administrator ot valid without signature
L- Massachusetts- Deportment of Public Safety
Board of Building Regrul;rtions and Standards
Construction Supervisor Specialty License
License: CS SL 99138
Restricted.to: ,RF,WS
JAMES CURLEY I
287 FULLER ROAD.-
CENTERVILLE, MA 02632
Expiration: 1/28/2012
Commissioner' Tr#: 99138
_ � �lze:�o�nmealCli a���Z�zaaacfiu4eC7a 7
Boa d of Buil4mg k2 gulatians:an.d..Stndards•- „ =r�... ,:,.
o I rce se or gisiration alit for ni di' Mui use only
HO E IMPROVEM NT CONTRACTORdate. e Y
b .ore the a iration found return to:
Re strati-n:;__1.243`10 �W uw ., --p Board-of$ui drib Reg>77atid rand andards
E' iration Tr#�1 0873 ace Rm 13
One Ashburta Pl
Type atidivid al Boston,Ma.0 108
James urley - - -
James Burley
287 Full r-Rd. .._.. . ""'
=-----�L e, A 02632
Administrator Not.yali without re
w w.,v
p�
Assessor's map and lot number ..�Q...C�—.. � ............
/vUoLvc� '
o - SG�!� O� ,�L/ity�►/ki
Sewage Permit number ................:......�.....�.......................
yofITIETp�i TOWN OF BAR.NSTABLE
Z BABBSTABLE. i
"6 9
n u .•� BUILDING INSPECTOR
ar a' _ '
APPLICATION FOR PERMIT TO ....... .... .. 1......... :............. ...// ............................... . . .................................
TYPE OF CONSTRUCTION U.�.. �. ..... . .�lI` ..�.L "Y.. . ............. ... .... .....
..1.3.................197:3..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a ermit according to the following information:
Location ..... v........ .......
� ..
��4 . .....C, .l.i-a.r. ^�i.1...............................................
Proposed Use .............
ZoningDistrict ................................................... ....................Fire District ........ .' .v... `. ...........................................
Name of Owner .. .. ........4..!...l.l.l...:.... Address ........ ........... 's°c.. ��
...................................
Name of Builder—W. ... ... .. Y.. .� ¢ Address .... ......... . .................. .............6T�:....§ 4...
c
Name of Architect ........Address
Numberof Rooms ..................................................................Foundation .......................... ...................................
Exterior ...........................................................:. ......................Roofing .....................................................................................
........Interior ...................
Floors ...................................................... .................................................................
Heating ................................. .. ......................................Plumbing ..................................................................................
Fireplace ........................................`.......................................Approximate Cost ......... ..���..................................
0 4 S
Definitive Plan Approved by Planning Board ________________________________19________. Area . ....!� ....... ............... .. .
C�C,
Diagram of Lot and Building with Dimensions Fee ........... ...............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
•
2b —�
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re arding the above
construction. IX.
Name ...... ...... ... ................................
Johnson, Ellis E. & M. T.
163o4 add deck to
No ................. Permit- for .................................... l
dingle family dwelling
...................... �{
}
Location 16 'Made Road
. . I
.. ...............
Centerville
>
...............................................................................
Ellis E, & M. T. Johnson
Owner ..................................................................
�r
Type of Construction .Brame
d r ;
................................................................................ t
Plot ............................ Lot ................................
� F
Permit Granted Juno 13 73 a
r
Date of Inspection ....................................19 #
Date Completed 1. .
PERMIT REFUSED
................................................................ 19 e
...............................................................................
............................................................................... 4
............................................................................... k
'A
e
Approved ................................................. 19
.........................................................................
..................... .........................................................
F