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Home My WebLink About0057 THOREAU DRIVE x J-F F r � _ a _ c c a o rt PERMIT- Town of Barnstable *Permit# 0? Expires 6 mon from issu�e _ Regulatory Services Fee * BAM 2014 1639. Richard V.Scali,Interim Director fD"" p �yJLSI�Y TOWN OF BARNS�TABLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ExP"SS PER MT APPLICATION - RESIDENTIAL ONLY 0 km Not valid without Red X-Press Imprint Map/parcel Number JJ y� Property Address 7/!®/ Pl U b/r. C czt JQ r u N\1(f Residential Value of Work$ 31000,40 Minimum fee of$35.00 for work under$6000.00 /Owner's Name&Address y IC v 0 tqS Contractor's Name C �. Telephone Number ! 7_I= l),2—21 0 Home Improvement Contractor License#(if applicable) /y / p 12 Email: �C� �f ®C5V1C6%`0AJj_ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: 19 I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Ai /',, j ,A Insurance Company Name Alax �CCt Ly�k�. �C�r r �'f ��` 1 v�4 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) 0 Re-side t [� Replacement Windows/doors/sliders.U-Value 3 \e5S(maximum.35)#of windows 2 #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 require . SIGNATURE: _&AdP� TAKEWN Muilding Changes\EXPRESS PERM[TIEXPRESS.doc Revised 061313 _License-or registration-valid-for-individul use-only . before the expiration date. If found return to: . Office of Consumer.Affairs and Business Regulation E 10 Park Plaza-Suite 5170 Boston,MA 02116 �! Not valid without signature ty Massachusetts - Department of nd Stan as d5 I Building Regulations a .Board of B cry isor w ConstructioCSu091804 - 4; License: 1`:v r. SC( TT D BgAT ti; 635 DEPOT S'T 0264 -S �. flarwich MA Expiration 0410512015 �JCo mmjssionef . cs u� _ —� z a ulation Office_of ConsumerAffairs_&�us�ess Rem_ ME IMPROVEMENT CONTRACTOR zph Type egistration 14�7812 Individual xpiratwn 8I912015 SCOTT BRATCHER `t. I� ` IT 99r"C" i pTT BRATCHERSC 635 DEPOT ST. ~r HARWICH, MA;:02645 Undersecretary y - w. pe artment of public.Safety Massachusetts - P and Standards uilding Regulations '.Board of B isor Construction Supers' Yam° ` License: CS-09�804��., gCOTT D 635 DEPOTS 026a5 Harwich MA 04105015 �J Commissioner • **cc i 039. Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 t Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize- ��'�-f��f'� /� to act on my behalf, in all matters relative to work authorized.by this building permit application for: (Address of Job) t q-s1-60 Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License:Exemption Form on the reverse side. T:\KEVIN_D\Building:Changes\EXPRESS PERMITREXPRESS.doc Revised 061313 '.s The. Connirouiiealth of fassachusetts Department of In dustrial Accidfents t . Office of Investigations o 600 Wayhmgton Street Boston,M4 02111 �� at�+ahr.riiass:got/ilia Workers' Compensation Insurance Affidas-it: Builders!Contractor-slElectllciinslPlumbers Apphcant Informarion Pleas .Print Le 'bh- Nam(Business,Org=aaon:'Individual):S(p�� Address: ��;1 (;4 . -7 City;State:'Zip: . �� 02Gq S Phone 4: / 7Y /2-2—2 l �� Are you an employer?Check the.appropriate box- 4. of project(required): 1.El am a employer with 4. ❑ I am a general contractor and I ❑hteu,constniction mployees(full and'orport-time).* harre lured the sub-contractors ? am a sole proprietor or partner- listed on the attached&beet, 7- ❑Remodeling / ,ship and hare.no employees These sub-contractors have. g. Demolition t w-orkina for me in any capacity employees and bate workers' 9. ❑Building addition comp.insurance:• [No Corkers comp.insurance 5. ❑ e. required.] 't are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeots,ner doing all work officers ha-a exercised their 11. Plumbing repairs or additions myself.[No 1, orkers'comp. right of exemption per�IGL 12FJ Roof repairs insurance required.]s c. 15?; §1 i4),and we.ha,`e no 13.0 Other 5Lntt employees.[No workers' comp.insurance.required.] •Any applicant that checks box=1 mast also fill out the section batcm 5howingtheirarwkers7 compensation policy informadoo- i Hontemmers who submit this affidavit indicating they are dais=all worts and then hire outside contractors mrast submit a new affidavit indicating.such- :Contractor that check this box must attached an addiciooae sheet shooing the name of the sub-contractors and stare whether or not those eaddes have employees. I€the sub-coatraccors have employees,the,must provide their workers'comp.policy number. lam air emplo er that is proridhig to orkers'comapensation insurance for tits,employees. Beloit,h the polh s,and fob site information. c Insurance Company Narne: 4a w J A4v r 1�� S SCE CQ►'i c Q C 0 , / dm 6' �p l' VYz Policy K-or Self-ins.Lic.'1: t "l PO L 7 I Expiration Date: `� 7?oI—(faU 0f. Cit.�t5tater'Zi .� ktt��`c ,Y�l.G2 Z Job Site Address� � p - Attach a copy of the corkers'compensation policy declaration page(,shondng the policy number and expiration date). Failure to secure coverage.as required under Section 25.A.of MGL c. 1.52 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andior one-tyear imprisoument,as well as ci-61 penalties in the,form of a STOP 14 ORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be fbmarded to the Office of Inv,estigations of the DIA for insurance coverage verification. I da hereby certi ,under the ills d petutl e of perjury that the information provided abos,e is true and correct Si Lure: "A Date: Phone 4: 7 7q--7 f2-a . /C.l U Ofriaal rase on{s,. Do riot write in this area,to be completed by city or totvrr official City-or Town: PermitUcense# Issuing Authority(circle one 1.Board of Health ?.Building Department 3.CityrFown Clerk 4.Electrical Inipector 5.Plumbing Inspector 6.Other Contact Person: Phone M 6 1 Arnica Mutual Insurance Company SOUTHEASTERN MASSACHUSETTS OFFICE Arnica Life Insurance Company 596 Paramount Drive Arnica General Agency,Inc. Raynham,Massachusetts 02767-5172 Mail: PO Box 529,East Taunton,MA 02718-0529 0 AUTO HOME LIFE September 24, 2002 Town of Barnstable Attn: Building Inspector 367 Main Street Barnstable, MA 026012 File Number: F12200206416D Date of Loss : September 21 , 2002 Owner/Insured: Eleanor Goldman Milione Street: 57- Thoreau.,Drive Town: Centerville. Type of Loss: Water To Whom It May Concern: Please be advised that we insure the above named individual(s) . A claim has been made for Damage to Real Property and as the insurer, we are presently in the process of adjusting the loss. We are mandated to comply....w .th_Massachusetts General Laws, Chapter 139 and as such, if there .are any• present liens on the above property, please notify us within 10 days of receipt of this letter. If we do not hear from .you, we will be under no obligation to pay you any portion of this claim. Very truly yours, William N. Lamb Jr. Claims .Department Amica Mutual_ Insurance Company yAw lam b@amica com *AR wa h Toll Free:1-800-59-AMiCA(1-800-592-6422),Web Site:www.amica.com Claims Fax: (508)824 5927,Production Fax: (5o8)821-5525 oFt Tom, Town of Barnstable *Permit# `1`�- �.�, Ezpir s 6 months fro issue date BARNSrABLE, » Regulatory Services Fe 38 , 5 1639. Thomas F.Geiler,Director A�FD MAC A Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 1 367 Main Street, Hyannis,MA 02601w )C PRESS P ` Office: 508-862-4038 MAR 9 ZdQ2 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION . Not Valid without Red X-Press Imprint TOWN of �AR� —-� Map/parcel Number / 6 a Property Address ( Zesidential OR ❑Commercial Value of Work Owner's Name&Address /V 1 C 0&S 5 7 /f 1 )✓e J? o ..LakA V l Contractor's Name ('4/ �f�U�jTelephone Number `7010 S�d Home Improvement Contractor License#(if applicable)_ LO 7y0 Cchstruction Supervisor's License#(if applicable) aS:(5'7Q 3 [Korkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Ian the Homeowner R 04 have Worker's Compensation Insurance Insurance Company Name )/V Q!rw to A 64P_ Workman's Comp.Policy# Permit Request(checkbox) [ /Ile-roof(stripping old shingles) ❑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 department regulations,i.e.Historic,Conservation,etc. Signature elj expmtrg