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HomeMy WebLinkAbout0245 LINCOLN ROAD o� y� t i r, c0) to - Town of Barnstable *Perini Expires 6 months a Hate t ' Regulatory Services Fee ti Richard V. Scali,Director 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 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY � ®� Not Valid without Red X-Press Imprint Map/parcel Number 2 Property Address 245 Li n 0C3(n i3ak IWA ❑Residential Value of Work 00 — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Br uct 4" t_1°-SI 1-e, l r'[CrG�iL' r ✓� `POQ©x 133-7 026IT4 Contractor's Name MQ►^KK 1 v l r.t re u Telephone Number 77q'Z3S- 36 41 Home Improvement Contractor License#(if applicable) Email: yam r-\eur e r I P.O d✓I Construction Supervisor's License#(if applicable) 01-5_©Q 21N. ❑Worktan's Compensation Insurance Check one: I am a sole proprietPRESS - or. . . 11040�`` ❑ I am the Homeowner I have Worker's Compensation Insurance T AUGAUtl n^/�g� t p�� ®C 12015 Insurance Company Name /V A !' pi/! Workman's Comp.Policy# ' —a11'�Sr48LE 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) ruf 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: C:\Users\Decollik\AppData\Local\Nficrosoft\WindWs emporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS:doe' Revised 040215' i 7J'%° Town of Barnstable :Regulatory Services Richard V. Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 509-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I I L " 4' as Owner of.the subject property hereby authorize ► '4^ Mr l Come— to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) i Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 Ile Cortintanyveiritit of Massachusetts Deptn4wou e,fludustrid Accid-ei s ce�+,f hmestigati€ns• tin Boston,MA 02111 Waricers'CGmpensaf a n Insurance A ffada iit: Bn ersiContr;tctur-siEIectrici ns.IPlu nbers Uplicaut Information ]/ Please Prism I:e_ilih �'+a>t�2e�usitaes,••�>�?r�a3rizz3m>:kndii-irhtalj_ �Y`fl �L�tt°c.Jr Address: :�O -acxx (O s-z city."'Statt'-Z* Cis)- F-r'lmau+� /lA ph.,a- 77 Ll- 2-3 a-936'] Are you an employes-1 Check the appropriate box: Type of project(required): 1.❑ I am a enTloifer siith 4• ❑ F atu a general contractor and I e}nple}ees t,fisl and'irr part tiruel. bin slued .snub-nib � ❑News cfls��uericru ?. l MU sole gnoprieiiar or partner- li_ted on:the attached aheet.. I�esnodeliirg ship and have so etnplo}ves These sub-contractor Imm R. De=itiou -%v-mking for me in 8uI achy 23flp1Ce ees and have;t orkers' p to p . El Building addition zQ. ,erlcerg comp-ir3suraLc a cot3�g•iu.t3.anre.� 5. i'e are a cokP . eration.and its l Ct.❑Esecical repairs Dr r�ddititsrls req�sired-� �:, 3.Elas.I am a home3imer doing alia offxcefs haee.exercised their 11-❑Plumbing repasrs or additiom. tm>;elf.[No woikeix'ran p. hgbt of exensption per''•IGL l.•3.❑Roof rep aia insurance t-equired-] ti 152,j 1(4.),and we shave na employee&- o workers l3.❑Othe3: cep.ias3srauce mquired-J 'day app c:aut t:m cbecki box#1 twist 21se fish om tae secft=below sbmike Meir orbirs''c3mpeLso3aa polies mfoax .m EF�meo c ues=.wkd3 subaut suis affidavit iTaii::atctz th—ey are dolag all ww,mt then h;1e,owskae c ttt7o sass nttst sti :ti:a nex aff:daz t satticai g such. ti;caear6ei�55L ckaec'st Otis sxe mztst attarl:e<i s�xddi�tiras i�E>'T s:tonsy�tte fl2m,2 ai dte i33-rtrcir2tinrs arvd state it'kSEt3T-�sot Q}.058¢GYtiSdi k[2SE empltry%--. L tte scab-:onuacro r.ire a emp ioyses,ilwy tt>�t3r pmiide their n o ke s amp.pchcy m=ber. �QftY fltt trri�7�6}bY t�,[it>•S�tYlJ1'It�Ilt�fi�t7l'�>8}'3''a:'eAi�7d5fE3'6dtSQ!!-lilS'FLYN1tCP•�fk.Y ffit}'S1rd�.3d09��=xr5. BeL1ATf'7S�J.rpii�llt•'itFffl�'6�iS3le 33�6f7dTt13tVli. _ .. ILiurance Compaz Markle: Police,r of Se t=ius.Lit::.#: Expifation Dale: Job Si:a Address: 2q.5 L.t l co hh WCMh•s 44 Attach a:copy of the workers'compen-sation.policy de.daration page(showing the policy number and expiration date). Failure to:cure coverage as required under Sectim 2 A of MGL c. l S1 can lead to the iaTpositicn.?f cria�al penalsi,es of a fine W to:51;5W.0a aud"or one-Vear Wipli.saftmerA,as well as civil penalties in the:fox cif a.STOP S ORKORDEP:and a fif3e of up pa to$_50.00 a da' agaimt the violator. Be adv.ued that a ccVr of this statement may be forw3rded,to the Office-of Investigatiom of the DLk for in malice ccrveaage 1,61ifcation- Islall�^re�#igrettif�>ttrader ins tza�iii•ponalfirs'afyodlt.YS'•thatl<lB77f�Of1dTl1l3f7t3tUMi2a7i���>Q�DO?1mis rue and correct Date.- d 3� s— Pli-tie : Z —2 6 f7rf1`acgnI u s:e anal.}. Igo rant}trite it?ifrts nines),to Sue roftiptete-d kv city or r'rrirril atria} cit%�or`Ton•:i: Per3giii{Li>e3ase l sting ikut#w.rit (circle one): 1.11oard of Health Z.Building Department I C:itT;rm-u.clerk 4.Electrical laspector 5.Plumbing lnspeeto3~ 6.Other contact Per�rtn: Phone#tz 6 Massachusetts -Department of Public Safety 1�f Board of Building Regulations and Standards Construction supervisor License: CS-092961 MARK E MLWUP` . PO BOX 682 = limb i EAST FALM0111M A. Expiration ` Z4 ► Commissioner 17 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only O0 ME IMPROVEMENT CONTRACTOR r before the expiration date. If found return to: Registration: 160192 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 expiration 7/2l2016 DBA Boston,MA 02116 MARK MEJEUR CON8TRiCT1ON.' MARK MEJEUR 20 PARKER RD. �+ EAST FALMOUTH, MA 02536 `' Undersecretary Not vali thout signature