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HomeMy WebLinkAbout0341 MEGAN ROAD L4 j Me at. n ` Rd* i� i _ 6. 6 Town of Barnstable *Permit# O 91 L �7 Expires 6 months from issue date Regulatory Services Fee tacoz, 9 b Thomas F.Geiler,Director p Building Division F-^ Tom Perry,CBO, Building Commissioner a 200 .Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 7 1?00 ®� Not Valid without Red X-Press Imprint ` 6 Map/parcel Number t �� Property Address 3`k vvA, (�Residential Value of Work 9000. O Minimum fee o 25.00 for work under$6000.00 Owner's Name&Address L o L)ISL FPl V 3Lf I /1/lcr 4N �1� y /t/i C 11BA Contractor's Name y���S Telephone Number Home Improvement Contractor License#(if applicable) /q (4 /7 Y Construction Supervisor's License#(if applicable) r ❑Workman's Compensation Insurance Check one: i VI 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 Request(check box) Re=roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side VReplacement Windows/doors/sliders. U-Value - 3 I (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner m st sign Property Owner Letter of Permission. opy of e Improvement Contractors License is required. SIGNATURE: ` Q:Fonns:expmtrg Revise061306 RAY EDWARDS HOME IMPROVEMENT Roofing • Siding • Doors •Windows f For All Your Home Improvement Needs Ray Edwards 80 Constance Ave. Fully Insured W.Yarmouth, MA 02673 MA Reg.#144174 508-685-4176 THE COMMONWEALTH OF MASSACHUSE'l"1'S Registration: 144174 Board of Building Regulations and Standards Home Improvement Contractor Registration Program Expiration: 9/14/2006 One Ashburton Place,Room 1301 Received: Boston,MA 02108-1618 d Application for Renewal of Registration 7 �,•�� Home Improvement Contractor or Subcontractor MGL Chapter 142A,780 CMR R6 (PLEASE READ INSTRUCTIONS CAREFULLY) -- --------- ----—-- Business name can not change on renewal form? 1. RAY EDWARDS HOME IMPROVEMENT RAYMOND J EDWARDS 2. 80 CONSTANCE AVE 3. W. YARMOUTH, MA 02673 Please note changes to mailing address. 4. Street Addresss(if different): t 80 CONSTANCE AVE yy tl Please note changes to street address. 5. Applicant type:I DBA —� 6. Federal ID No See Instructions to change Application type. 7. No.of Employees: No.Employees 9. Individual responsible for Home Improvement Contracts: RAYMOND J EDWARDS First Mid Last 10. Title of Individual responsible for Home Improvement Contracts: OWNER Please note changes to title. Phone No: (508)685-4176 11. Does the applicant or responsible person hold any other construction related,state,city,town licenses or registrations? Yes No Construction Supervisor License: Expires: _ Motor Vehicle Repair Shop: F Expires: 12. List all partners,trustees,officers,directors and major owners(10%or greater of ownership)of an applicant partnership or corporation below. Use additional paper if necessary. Check here if you wish to receive an application for additional ID cards for key persoe:s. Last First Mid. Title in Applicant Business °ib Owner Address 13. Is the applicant claiming exemption from the registration fee?(See the instructions) -J Yes No 14. Registration fee enclosed:$ Guaranty Fund fee enclosed:$ l0 d If necessary,include two separate certified.checks or money orders-one marked"Registration Fee";one marked"Guaranty Fund". See instructions for amount of fees.Make all certified checks or money.orders payable to"Commonwealth of Massachusetts". NO PERSONAL OR BUSINESS CHECKS WILL BE ACCEPTED UNLESS THEY ARE CERTIFIED. Pursuant to Massachusetts General Laws Chapter 62C§49A,I certify under the penalties of perjury that 1, to my best knowledge d belief have filed all state tax returns and paid all state taxes required under law. Siinatu—reA applicant or applicant's representative Title held with applicant Date A false answer to any question in this application constitutes grounds for suspension or revocation of the applicant's registration. Results t�,r,�. •�" P,..°t � ��'a x ash + �k� `.€� r �i't�+�F.,�,= � .._�.. ry t r, � Look eIr .pnt o tractor spy z ` Hom Enter Search terms separated by spaces. Search to s:can be Town/City,Name, or License number r1 f e 4 +5[ 1 't �' . �S�arch� Select Search typeAND r. OR `�7 � t t Search Results C — ,�..-�.. -.�. _.._M,.�.. _ .:Title jeg."ado. kpwlicant street {City Stag Zvi lmt � . RAY E]DWARDS 80 } W. EDWA S, =° 4 HOME 14417 CONSTANCE MA 02673 Viz. OWNER 9/14/YAZMOUTH RAYiM IMPREMENT AVE OV ! 3 Total of Records matched O - �t{� �fBac�c toy ©��ne•Page �'� �" � k�,� v a � �' Statement s { . . 3Y ,- The Commonwealth of Massachusetts Department of Industrial Accidents t Office of Inyestigations 600 Washington Street L \i Boston,MA 02111 `.f { www-inass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organizatior✓lndividual): Address: C0Xj57- kKfC- � City/State/Zip: W. 2 YVw-J Phone#:. �11� C��S o`/7� Are you an employer? Check the appropriate bog: Type of proj ect(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.t 7. ❑Remodeling ship and have no employees ' These sub-contractors have 8. ❑Demolition working for me in any capacity, workers' comp:insurance, g, ❑Building addition [No workers' comp,insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions zequired,] officers have exercised their 3,❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' pomp. c. 152, §1(4), and we have no 12.[]Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required,] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. •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 workers'comp,policy information. ram an employer that is providing workers'compensation insurance foamy employees. Below is the policy and job site.. 'nformation. assurance Company Name: 'olicy#or Self-ins.Lie.#: Expiration Date: ob Site Address: City/State/Zip: attach a copy of the workers' compensation.policy declaration page (showing the•policy number and expiration date). . ailure to,secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a . ine 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. •do hereby certify u r the poi d aloes of perjury that the information provided above is true and correct. i ature: 'hone#: l� Official use only, Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.BuiIding Department 3. City/Town Clerk 4,Electrical Inspector 5.PIumbing Inspector 6. Other Contact Person: Phone#: -Information and. Instruction - Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees, Pursuant to this statute, an employee is defined as"...every person in the.service of another under any contract of hire, express or implied,oral or v,itten." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more engaged in a joint enterprise,and including the legal representatives of a deceased em to er,or the ) rP F F Y of the foregoing receiver or trustee of an individual;partnership,association or other legal entity,employing employees.'However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shallnot because of such employment be deemed to bean employer." . .MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate.a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance.with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance re4uirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by chep1dug the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s),of insurance. Limited Liability Companies(LLC)or.Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance, If an LLC or LLP does have employees,a policy,is required. Be advised that this affidavit maybe submitted to.the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have-any questions regarding the law or if you-are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant e e e t' diva ' current rmi 'cease applications in an given ar,need only submit one affidavit m tin 't multiplee t/li p y g y y g that must submit p F policy.information(if necessary)and under"lob Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e,a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: y' The Common-malth of Massachusetts Department of Industrial Accidents Mee of InTesagationa 6QQ'�a�ington Street . Bostoa,MA,0211I Tt 1, #-617-727-49QQ ext 4Q6 or i-977-MASSA'B Fax.#i 617-727-7'-49 Revised 5-26-OS wwwinaagovidia ° z►,E, ti Town'of Barnstable P °+ Regulatory Services • sAxxsrAB Thomas F. Geiler,Director 9 MASS' 019. per. g Buildin Division Ev r� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-79076230 Property Owner Must Complete and Sign This Section If Using A Builder I 0o( S L��� ,as Owner of the subject property hereby authorize I VTR -1-;>L,_7 to act on my behalf, in all matters relative to work authorized by this building permit application for: 341 Val F 6-PA. PT,-� r (Address of Job) .�7, ak S�-at&e of Owner V Date 14 . 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"S 3 _ y1pir. ^,.,�`o� '_' g _ - `_ _ ++ - �- �t - z r "`r s 1 - ' yi.# •*y rl� i.T� ".-f ��`-."'. j "`'.'MiL - _-3 '� $� '�;nik i:..a ��'2. '•s.�. ~ r ` : AeF f'-FtEAE8Y C..E. RTUFY" rtHAT THE aUi L D I N G REG_ LANt? Fi'G-WiN ON THtS: PLAN: IS LOCATED O' N Y „ GROU"N6=A°g SfOWN MERE6N AN' D `tA'T4etF 4 S' C"0NF0Rm TO THff eZ'&t4'.EdW_ BY. LAW 5 ff THE TOWN O P_ M-S x-7�'A��.� w H E-N C O N s r R U C.T-E D. ,pt A.r•�-t c t` �+'v t�FC t T A- �f �j- - C ,e ...•iorwi ,•.r "-A--,E L G. 5 - 14 G.:�i ,2_�l N,v� -_4.. 1 11 1�L 1 1 1`�._Cr`5 ,e-'� `�•Y"t� •!u r. t VA WWO U T�ti A�1""A �'� '� ,- . _ � �•SUS ; - . x .47 4 f A essor%' map and lot number .......................................... //-/3- ,73 Sewage Permit number A ................................................. oFTHETo�i,� TOWN OF BARNSTABLE i BAHBSTADLE, i ab 9 o or. BUILDING INSPECTOR uar . APPLICATIONFOR PERMIT TO ............................................................................................................................. �pp TYPEOF CONSTRUCTION .............. R�.1::^... .................................................................:..:................:... ....... ............1................19.g. TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies for a permit/according to the following) information: L..�1. -....... ( P � {���..................... ..... .. ................ .............:• Location .......... •t• .................................. ................................... ProposedUse ......j......................... .............................................................:........................................................................... J1 J, Zoning District ...............�-.5...............................................Fire District ........1..!./.. .N['/!.. ....................................... Name of Owner ... ^:°.?........��.......E..........1..................Address ........... �.................: Nameof Builder ....................................................................Address .........................................:.......................................... IV r % il . Nameof Architect ..................................................................Address .................................................................................... i Number of Rooms J`. ...............................................Foundation UL.U.... ................ ....... ............... ............. ..... ....................... CP Exierior ...............`....I............ ...`=.,Pr..'L.......S.( -5.......Roofing .............R..> r .`� ....>d.... �.N.� �1.v.�........... Floors `�- Interior 5 �J`'�'��\ (� ..............:'�:...................�.......................................... ......................I.............!1��,-"- .............................. pL r---- 1 �►� S � i.1...... ,...........................Plumbing Heating ............................. . ..... .................................................................................. ....................................................Approximate Cost �� C1ZJ"� Fireplace ........I.................... .......................�............................................ Definitive Plan Approved by Planning Board ________________________________19________. Area ......:��. ..,��................ Diagram of Lot and Building with Dimensions Fee y. .�.. .�................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. , Name . ?r........................................ . ....... l_ ) / , Sirdth, Jame s K. ' A' Permit for .........�!�e zory -----. »' . ------' \ Locoh .[-------.-------------. . . . Hyannis —~-------------~----------. � ~ James K. &djh Ovvne, ---------------------'' ' . �razo� ! ' Type of Construction -------------... --------------------------. � ^ ) Plot ............................ Lot ...............+6................ � . ^ November Permit Granted ......... ----__��___]g �� Dote of Inspection -- lg Date � Completed ~~ | ^ � PERMIT REFUSED A . --� ------.--------------.. lV ) � ' --~-----------------------. '_'_____,___________^,______. - . —.. ^ � --.—.--------.—...—~.—.—. —..'.. � --^----''»`—^-----''^----'-----'' ' ' > ~ . ` ^