HomeMy WebLinkAbout0480 OLD CRAIGVILLE ROAD u Nil
� �s 4
d
co
son
WON A.0
L , k
in
#Yn
iS.•N ,,m 1 y
MOO
..
.,a, h.,.;_ its.,
-
Am a:` '`�' m rw •ci ,.� ,5 y�. ,cr..
. .f .0 {.
.ti. n ,,:Y .:' 7's:: .N, r .,•k r - sr.`
kSAV1 WON—. - ,y
r.
•-`o A.. .^a' y'. '•.:' •,"
: 5 s
•..: .. k+,..a ..."oozy,III WAY I Q
WNW OW
ANY'+ - �.. .•', '� .,. ,..:. .,,&,,. a .,, ' .:- ,:' ;a�. . .... '�,.a. 6 *,s i,.-. - a ak-. •
r'
ro a
i�' "ALP
., x" ry'. Sri ..T �•.. 'A. -.• `�
-
'' G � S N
a.�. 9 r �.d S ::r5 .•d.^t ,k a.
,
Va/
fi
t .
TOO 7
.a
4 Y, u Y 4 R t
'+. 3 G
.s ':x .0
• y
•S }. � 4 Y Nr �. -
QATAR
7*41 Solo oil 1
' F .x r ... . _�.,.. Car ..�,,.r:,,:r :. �'.' e<:'. •. '
—Novi
r .as`
,
Y
u ¢
..�. ,.. .
3p J '4
is `� a ,� r ;:;M • a '"
J yf
u� - C1 ::�•' u^^-� .:.s � "t �'.:• .i. �.':: .t � ,i F *}SY' '}�. £.y.- R fi` iN'
"Own
,
a
yr,
-,.. �.. .. a -vr �.:�. 3 .• G, u, ...:lY, \ �.,:�a. 1 ,t� �1 v'+ I- ,q" 'rd�.'
YoRa
.4 .•:,� h. 4r,.. SK• ..`1^'�'
d�
N
Y "4
50 tea.
a
y '',r 'k +s.. } y ".: -:: ii.`.r Ve d• ,t v-,s �4 -^ .U,t 4q ,y, :.yti - F:.. Y�.
OIL
_._...p !,a>. .. �" .,•,'E 'y w ��'� .#:' "fit.."E' f-
.. •< ,'.F. : .:n: ;_.._ T :<i, ,r C' 'RYS`
` s,^,« # '.:&,. �;:- .. ➢,.�,•,� -, a �=� �, *^ �^�:';-, ,� '�.'; -:�'� -°. r. . .5 trr+ 5.�> ro.. v 4
,; .. _ -
',£M
, k
> u
.:
„� t'.-
.
e _ �- ..
'.. - .. -' 'Dl
d _ - I -
v
s : _ 3 - '�E
u
c •
... .. Y v '.e: -
PG h
c. : '- .- -
3•: F
1 <
_ I. k .� t
'1' V , �, z. :C...
11
i.
C
c
4
P
a
'
:
r.
1.
}. f
v c £ I+ 8 _ y t d _ t -
• F.
.,�. i _ - _
b
.' a+ ...,ti: a :,�v:' ,t^r{:. c ,�,' ,-'s1. „r L -t j
s. > '' .. 11
a '^r c a c
a:. .+: .. :a: _4 Lp x '. - - - ”.
x
ra
.. :. :x ..
t:
�` C y L 1F r - f f�4 rY. 3.•i'. 41 "h
�_. ! .-
r,.
u: - >y :.'
- - r '. a _
a: 'W -a a -
+ ,6 • •d
- ..
,, a .=,�, . x.
»'
.
, ' .._
r a g' Y a
- fie ' '� - -
r.. .. :,
�„ -F., t _
�'
z -
1.
•
y yy
,. . i ..,
.
..31 -
w ti.
s
9 �. •- ,
.y �. - -
x ..'a -I - - - ,
Ss.
4
5
t 5:v - _
.air c -
' !t :. % - -
,S
- ,. :fla r
a
_. y
e ,.
- w ..., - .. :.sue .* + f: .x,x.::.'..' P i3.:: 3a.. ,' ».c..... _ C e rs .. k"
, F :.T , t' i ay
S'
Ia. t. n y `d4
• ,'. `,'c ,9v ,;.% 'k s' „.. - k d.• x ,I f,:., F.9 _
.. p , tl.
b 4
.t v2.._ - •�w v ...4
•
.f a - - rj
x.
Ft•' > R 2 ,t 9�
r.
' - 9 -.
k�, ^ k i.
ti_
.,
.;, ? - ..'g.: C V.n' - '9 1.-
.. r
•1. 33 - - -
., .
..
'0 - E , .
a:' s -
• ,.- .. .
,.. P -
r - ' '. ,. -
-
,>. ,- J' .
%, u' , G - ,
i. ... .
. s -.. v
-
7
b � : A ... _
.. ._ - -
w
I., , - - .-
4,_ - s ,
- x
. + .,.. ,.
.. .. -
. r ... -n
L - .�.% -
Town of Barnstable *Permit#�
FA*es 6 months from issue date
Regulatory Services Fee a
�® ®� Thomas F.Geller,Director
Building Division _U C7 ;• :
90ot Tom Perry,CBO, Building Commissioner
200 Mam Street,Hyannis,-MA 02601 �-
WW�':��. www.townbarnstabie.ma.us
308-862-4038 Fax:508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 0 3 �-
Property Address tit- $ 6 6 A �c.��'1 U
{Residential Value of Work 4, 0 0 D Mmimum fee of$25.00 for work under$6000.00
Owner's Name&Address J,4 M e S C7 O d cy
/,$ y-- ins e sT sT W ey
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supergisor's License#(if
[ 6rkman's Compensationlnsurance
Check one:
-E]:I am a sole-proprietor-
13 I am-the-Homeowner
❑ I-have Worker's-Compensation-Insurance
Insurance CompanyName
Workman's Comp.Policy
Copy of Insurance Compliance Certificate must-be on file.
Permit-Request(check box)-
Cl:Re-roof(stripping_old_shingles).All:construction debris will_be.taken1b
t Re•roof(not stripping. Gong:over existing:layers of roof)
Re-sine
Replacement Windows.- U=Value (maximttin.4t1)
*Vfi mquimd:.Issuanceofthis.p=k.does_not-exempt.compliance-wiiti_odiertowndepartment-mguL-akns,!.-C.Hiatorio,_(o=wztkm,_ete.
***Note- Property Owner must sign Property Owner Letter of Permission:
Home ImprovementContractors License is required:
SIGNATURE:
(2�t�ms:ezp�tx@
�es�eo7io{3S
The Commonwealth of Massachusetts
Department of Industrial Accidents -
= Office of Investigations
v.- 600 Washington Street
- .. Boston,MA 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): 3dM eS _d-O tn/
Address: Z,4 L,%)e sT S-T
City/State/Zip: (n/�y ,��/f {�'JfJ 0 / Phone#: 33 9-�3 5- 0) 72
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet$ ❑Remodeling
ship and have no 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 are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.;,1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.] t employees. [No workers' .�13 Other
comp.insurance required.] /Pe- S'��
*Any applicant that checks box#1 must also fill out the section below showing their worker;'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their worker;'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
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(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 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification .,
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: 4 —9 - 0 6
Phone# 1�13 3 9- cA,?.S- O/ 7 3
Official use only..Do not write in this area,to be completed by city or town of`uzaL
City or Town: - t Permit/License#
Issuing Authority(circle one):
1.Board of Health'2.Building Department 3.City/Town Clerk 4.'Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Pe n: Phone#: ;
.. � � _ �•�C'r.4 4'"� �rlr r f:���� "�T�'ut... titL��
!,i`s�..�i.
..IN
wool
Will
•w '� i `..,y !' ` ���' tyn"IRi a cc-r_ '°.tea.y"a. .+:
a = 1211 WOMMlip
.4�r•-[a '• - .� � -:A.IIDS�JI +� "ti .tom_ �Z f
MaC
IN
Mao
RM
x � i
vv
/ -
i � •
r -
.ssi� .a � �l'` '��� ` :.f��...•�.r :I. +'1rf"'.'�I'..F.-'r\�. �"'� _--' -n..a• ,� .>..,.es:s4-a,e..s....s, y
} r-
r