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HomeMy WebLinkAbout0129 BACON ROAD Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 1/5/15 Thomas Perry CBO Town of Barnstable .� Building Division - 200 Main St. _ Hyannis,MA 02601 rn RE: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for 129 Bacon Road,Hyannis (201408374) has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey } TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 'SO 9 Parcel ®3 6 Application # Health Division Date Issued f Z-3 4-1 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address a q �P-c0� eg,d Village n Owner c,m �c,,5Mb1 Address Z>OL41e. Telephone _ I (,a b 1 o l Permit Request I RM JMX occkejGo l0 e -�o +N Wk1k� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Lu NONumbAgof ohs: Full existing new Half: existing new .d Numbt9of Eidrooms: existing _new Total Fwm Count (no including baths): existing new First Floor Room Count Heat lope am d Fuel: gas ❑ Oil ❑ Electric ❑Other C � Centrir: =]Yes o Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0,No Detached garage- ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes JXNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name c. IW41�INwI,SS Telephone Number Address n 4y6 License # a S� KLPASIA,+bf 6D� "I Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ( � �� FOR OFFICIAL USE ONLY APPLICATION# DATE.ISSUED i MAP/PARCEL NO. y 1 i"Tir f T V t, .T ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Building Permit Authorization , I, James Desmond as owner hereby give my permission to P Cape Save, Inc. 7-D Huntington'Avenue South Yarmouth, MA 02664 Office:508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at - 129 Bacon Rd Hyannis, MA 02601 Signed 1 , Date f The COM.Monwealth of Massachusetts �• �', Department of Indrtstrial Accidents . Office of Investigations t h 1 Congress Street, suite 1 oo Bostnn,.MA 0,2114-2017 r,. www:mass;govA a' Workers'Compensation Insurance Affid.avit: Builders/Contracto is/Electricians/Plumbers Applicant Information Please,Print LeRiblv. 111n1e (Business/Organization/Individual)'t Cape Save lnc. Address.: 7D Huntingtori Ave City/State/Zip;. South Yarmouth, MA 02664 Phone#: 508-398-0398' Are you an employer?"Check the.appropriate box: Type of project(required):. 1,.�✓ ;1 am a employer with 4. [] 1.am a general contractor and l p = 6. Q.INew construe"tion;. employees(full atidlbr part-tone). have hired the sub-contractors" - 2..0 1 am,a sole proprietor or partner- listed on the attached:sheet. £ I ❑Remodeling These sub-contractors have Demolition ship Gild have no employees g•.[� working for me in .any capacit employees and have workers' I 9 . [] Buildir a addition [No workers'comp.insurance. comp.;insurance b required j 5- [ we are a corporation_;and its; 10.�:Electrical repairs or additions 3.1 1 am,a laoineowner doing all.work; officers have exercised then ILF-I Tiumbing repairs or additions myself.[N6workers'comp;. right of exemption per MGL 72,�Roof repairs insurance required:]'t c. 152, §1(4),and we have no F employees. [No workers' 13.�✓ :Other Insulation comp,insurance.required] ` *Ally applicant Utat checis box#.1;must also fill outkhe section below slioaingtheir workers'con.pensation policy information.. t Htiineownct t�ho suk mit this•:af'lidavit indicating they site.ilci ng at, H!c rk and then hire outside contractors must subm i a new afftlavit indicating such;: 'Contractors that check.this box must attached an additional sheet show ng the name of itte.sub-con'trwors and,state whether i not those entities have: employees.If the sub-contractors have eriiptoyees,they must,pmvide their workers'comp::policy number: I air:an eitpJoyer that is providing workers'Corupensati0n insirdiceforo .employees. Belatu is.thepaJiiy rnd job srte infurtnatioir. t Insurance.Company Name; WeSCO Insurance Compaay, y Policy#or 9elf4n§ Ltc #.. WWC3085633 _.._ Expiration°Date: .04/09/2015 _. Cn 1st. - nnqq Job:Site Addie . `oL l a.Go 6 R-oA y ate/Zip:;_ ann I S. Attach a copy of:the workers'compensation policy declaration page(showing the policy nutti _F snd expiration date).; `Failure to secure cod erage<asxequired under Section 25A of,MGL c. 152 can lead to the;imposit on'of criminal penalties of a trine up to$1,500.00 and/or one-year imprisonment,as well.as cival penalties in the.form,of a STOP WORK ORDER:arid a fine. ofup to$250.00':day against tlic yi.olator. Be advised:that a copy of this statement maybe forwarded to'the C?ftice of Investigations of the D1A for insurance coverage verification: 1 do hereb ce:k cinder-the gaitis.and j7enaldes of er`` that the in orrnatiorx provided above is true and correct: i¢nat re Date .. . -6 .` .0ociol rise only' Do. tot writ in tlr s areq,-fo be co�>tpleted:by city or towrr.;official: City or Town: Permit/License e# Issuing Authority(circle one); 1.Board of Health 2;`Building Department I City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other. Contact Persona Phone:#: ACrJ►RL I CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed: If SUBROGATION IS WAIVED,subject to the terms:and conditions of the policy,certain policies may requlre.an endorsement. A statement on this certificate does not confer rights to the certificate holder In ilea.of such.endorserhen s. PRODUCER. NAME:c`r Colleen Crowley Risk Strategies Company PHONE (781)986-4400 ac No:(lei>9sa-aa2o 15 Pacella Park4Drive _ Ccrowley®risk-stra,tegies.com Suite 240 INSURE S AFFORDING COVERAGE NAICt. Randolph Ate, _02368 IINSURERA:Seleci ive Ins. of America IkSUREO I LIRERs-Allmdrica. Financial Alliance 10212 Cape Save;, Inc INsuRERc Dfesco. 2asuraace Company ` 7 D Hunt-ingtoiv,Ave INSURERO: INSURERf South Yarmouth. MA ,;02'664. INSURERF: COVERAGES' CERTIFICATE NUM BER:CL141110.85532 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INADDL POLICY EFF'I .POLIC 'EXP LT TYPE OF INSURANCE POLICY NUMBER M /DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 120MFOCA ML GENERAL LIABILITY PREMISES(Ea o ! $ 100,OOO A CMS-MADE Ei]OCCUR 1994480 0/16/2014' 0/16/2015 'MED EXIT(Any one person) $ 10',0Do PERSONAL&ADV INJURY''. $ 1,0001000 GENERAL AGGREGATE $ '2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS--COMP/OP AGG $ 2,000,000 POLICY ri M X' LOC- $ COMBINED AUTOMOBILELIABILnY Esaccldert 1 000 000' BIx ANY AUTO' BODILY INJURY,;(Per person) $ ALL OWNED X SCHEDULED 6796600 1/6/261'4 1/6/2015 BODIIY INJURY{Peraccident) $ HIRED AUTOS X NOWOVMED OPE TY D AG $ AUTOS PsrecId x UMBRELLA LIAR X I OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED' <: RETENTION ®il 1994480 0/16/2014 0/16/2015 $ X C WORKERS.COMPENSATION fficers Included for OR ST M OTH- AND EMPLOYERS'LIABILITY YIN rS12YJ R _ ANY PROPRIETOR/PARTNERIE)(ECUTIVE overage. E.L.IEACHACCIDENT _ $ 500 000 OFFICER/MEMBER EYCLUDED7 N!A (Mandatory in NH) 73085633 /9/2014 /9/2015 E.L.,DISEASE-.EA EMPLOYEE $ 500 000 ees describe under MS�RIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,AddWonel Romarks'Schedule;it more space Is required) Issued as evidence of insurance Issued as evidence of insurance. Thielsch Engineering, Inc. is,l.isted as additional insured as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION msonq@capelightcoMact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape bight Compact ACCORDANCE WITH THE POLICY PROVISIONS., Attn: Margaret song PO Box 427/SC.H° AunawzEOREPRESE�JIATIVE 3195'Main•Street Barnstable, MA 02630 'Chael Christian/CLC ACORD 2.5(20.10/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).09 The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 -= Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. ' WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 - — - - — - .Y Update Address and return card.Mark reason for change. Or ,Address Renewal Employment Lost Card SCA 1 0 20M-05111 - r?f�e (C[al'I/N/4COv,CI.i'.��[ff�'!(�kid(I[�ICJ�' .- • �• Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 41 1380 Type: Office of Consumer Affairs and Business Regulation ' 10 Park Plaza-Suite 5170 go; xpiration 31:120a6 Corporation Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE ; SOUTH YARMOUTH,MA 02664 Undersecretary? Not vali rthout signature , Re Massachusetts -Department of Public Safety Board of Building Regulations and Standards : Construction Supe-n-isorSpecialt} License: 6SSL-102776 WILLIAM J MC C3 USIE 37 NAUSET ROAD West Yarmouth NIA Expiration Commissioner 06/28/2015 t _ - t y Efficient Buildings, LLC October 31, 2011 Town of Barnstable Attn: Thomas Perry, CBO 200 Main Street Hyannis, MA 02601 re: 129 Bacon Road, Hyannis, MA 02601 , Dear Mr. Perry: This affidavit is to certify that all work completed at 129 Bacon Road, Hyannis, MA 02601, has been inspected by a certified Building Performance Institute (BPI) inspector. Work included air sealing, door insulation, and installation of 1414 sq. ft. R-30 cellulose in attic, 96 sq. ft. R-30 unfaced FB in attic as dams, 74 sq. ft. of Polyiso in attic stairwell, and 165 ft. R-19 FB blockers to sills. All work performed meets or exceeds Federal and State requirements. Sincerely, Steve C. White Owner/Managing Member Efficient Buildings, LLC CD 8 Jan Sebastian Drive, Unit 10, Sandwich, MA 02563 Tel: 508-888-1110 Fax: 908-888-1109 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 30 Parcel UIG Application # . ` 6. (� Health Division Date Issued �: I Conservation Division Application Fee Planning.Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address AjaACC)1j liz.0 A-0 Villagey L� NN1 S Owner M A 4 1 u ry Address Telephone - 7.)IS-—QI ® `i ��c,) Nibk" MPr d ��C> Permit Request ':4:T,3SysLPV-010 I , IL --)g59'rF g jy �� Sl"gigs 6_�- 1 y SQ�rT 9.-3cv cawwsts -To 1i 1 . G� ��c;� r (2 3a �p6 '71 'b,1.. 'D.A►-A s IDS n4F i fZ- ) q 'f& '1�LOCe-C le s'.-- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0G___� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Craws ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn:0 existing C7 ne8 size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other:s c :u J Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ q Commercial ❑Yes ❑ No If yes, site plan review# `" ` I Current-Use - -= Proposed Use co APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name N C Telephone Number Address FL 5 AoJ� i T (a�J 1 1cJYC License # N>>wW F-C 0 Home Improvement Contractor# W 3 S j Worker's Compensation # w y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO PhQ Or SIGNATURE �✓ DATE i r j J E FOR OFFICIAL USE ONLY Y 'APPLICATION# DATE ISSUED . :I MAP/PARCEL NO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: Aa FOUNDATION. : - FRAME ,z INSULATION:: FIREPLACE s ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL t t } AS: ;"< ROUGH f-�O-? i�."•' FINAL ii _ _ .,FINAL B.UILDIN.G 1 1�'I�� : ;fir;. r i DATE CLOSED OUT A ASSOCIATION PLAN NO. 'lRg; The Commonwealth of Massachusetts a� Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 lz www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly \ o ` ti NJ111C (Business/organization/Individual); Lc Address:__ al•� �� s-��cZv\ wive, C'it_y/State/Zip:�qt c�J►�r 1 MA 025!�3Phone#: _510g F6E El1 _ are a an employer:' Check th appropriate box: � Type of project (required): II an, a employer with_ ❑ 1 am a general contractor and I cmployccs (full and/or part-tune).` have hired the sub-contractors 6. New construction ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ha ve ave ship and have no employees These sub-contractorsR. ❑ Demolition working for me in an capacity. employees and have workers' Y P' y 9. ❑ Building addition j [No workers' comp. insurance comp. insurance.* required.] t 5. ❑ We arc a corporation and its 10.0 Electrical repairs or additions officers have exercised their ❑ 1 am a homeowner doing all work 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Mof repairs ,,urancc required.] ' c. 152, §1(4), and we have no employees. [No workers` 13. Other �YLSJ1Q�kOt.1 comp. insurance required.] :pea icant that checks box#1 must also till out the section below showing their wprkers'compensation policy information. who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. mn that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have i r the sub-conL*actors have employees,they must provide their workers'comp.policy number. am an employer that iv providing workers'compensation insurance for my employees. Below is the policy and job site n , Company Name: -- lf �"� _ Expiration Date: 2 1!;,. or Self-ins. Lic. #:__._ P T J —2 — 2c k h Site Address:--------- City/State/Zip: .attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ti'urz 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 Lic to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invcsti,aions of the DIA for insurance coverage verification. I do herebt certif er the pains and penalties(f perjury that the information provided above is true and correct Mein:tore: < Date: on,.!. Do nor ft-rirein, ;his area,to be completed by city or town official. Permit/License# _.:r -xmtbaano tcircle one): _ 4> He-aIth '. BuiIdinr Department 1City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector _., Person:__ i Phone#: t ACORN;e =INZEION , CERTIFICATE OF LIABILITY INSURANCE2011S08.945.0393 FAX SOE.94S.4048 THIS CERTIFICATE M ISSUED AS A MATTER OF Eldredge & Luapkin Ins. Agency ONLY AND CONFERS NO RWITS UPON THE CERTIFICATE 697 Main Street �TTHIS CERTIFICATE DOES NOT COVERAGE��BY THE AMEND,EXTEND ORW. Chatham, MA 62633 Alan Long INSURERS AFFORDING COVERAGE _ NAIC IS uLSlxLeo Caliber Bui ng and Renlode�ing LLC. Steven VAI IHSIMRA National Grange Mutual Ins Co- ----�14788 --------- DBA: INSURER01 Commerce Group --- CI0001 8 Jan Sebastian Drive #10 INSURERc: Ace American Ins. Co. - ARMK . 22667 Sandwich, NA 02653 RPAWR0: - - - --- - INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAKED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE.POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFEC'nVE ------ - LTII TYPE OF INSURANCE POLICY NBYIER OyL --.--- ITg ..--------- ----- i GE„�L,�„ MP027360 09/15/2010 09/15/2011 EACHOCCURRENCE f — 1,000, I CX I COMMERCIAL GENERAL LYIBILRY ppq ,p� 3 Soo ~-I ;CLAIMS MADE a OCCUR MED EXP(ANM arm person) f 10 1000 A PERSONAL t ADV IWURY i 1 000, - --- - --'- GENERAL AGGREGATE f 2 000, -- GEN-L AGGREGATE LIMIT APPLIES FEW. � PRODUCTS-COMPIOP AGG f i 2,000, 1 POLICY TEC LOC L 0110wLEUMpUTY BBNVCS 02/16/2011 02/16/2012COMBINED 88MGlE LIAR ANY AUTO 1,000.ALL OWNED AUTOS BODILY BLAJRYSCHEDULEDAUTOS (PW I i _ B HIRED AUTOS BODILY SWURY i f WON-OWNED AUTOS (Pr soo 0srt) PROPERTY DMAAGE GARAGEUABIUTY AUTO ONLY-EA ACCIDENT f - ANY AUTO OTHER THAN EA ACC I f AUTO ONLY: AGG f ERCEAS,UM.RELL.AUAanftY ,� CLI027360 10/01/2010 09/1S/2011 EACH OCCURRENCE - OCCUR �7!CLAIMS WADE I AGGREGATE f 1,000� A s -_— DEDUCTIBLE -- f X - RETENTIOII f 10, ---— f VfORXERSCOMPESATION 4494P844 03/02/2011 103/02/2012 AM EVPLD1VWW UAaEIrY YIN Ri ER- AMY PROPRETORRMTNEWEXECUTNn E.L.EACH ACCIDENT f S00, Oc'F/CERAIB.6EREXCLUDED'7 EL.ONWASE-EAEMPLOYEF f 5OO I�tlyAeisbl+o�Y d,NN) ' SP£ undw 6%AL Pf4OVISIONS ONow / E.L.DISEASE•POLICY LIMIT f SWIM t or"ER I i 3E3=PT10N OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED SY ENDORSEMENT I SPECIAL PROVISION{ . Carpentry i CERTIFICATE HOLDER CANCELLATION SHOULD ANT OF THE ABOVE DESC�►OLIgEA BE CANCELED BEFORE THE EXPIRATION DATE THEREOF.THE ISBWIO BSUR6I WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTnCATE MOLDER HAYED TO THE LEFT,BUT FAILURE TO DO 80 SHALL Town of Barnstable WPM NO OBLIGATION OR LIABI/TY OF ANY WHO UPON TINE M>SURFR ITS AGEN M OR . Building Departmwt 200 Main Street AO1A1OIMD Hy nis, MA 02601 ACORD 26( 1) N. AB 6"nuemed. The ACORD name and lop are m9isbnd=Am of Massachusetts - Dcpartmcnt of PuhliC SafctN Board.•o1' Building- Regulations and Standards i Construction Supervisor License License: CS 95038 E Restricted to: 00 STEVEN WHITE r 147 RIDGEWOOD AVENUE HYANNIS, MA 02601 --o-��C� Expiration: 2t28/2012 ( nmii.•i,ncr Tr#: 19311 Office of Consumer Affairs&B siicess Regolation h MOME IMPROVEMENT CONTRACTOR 4 io Registratlon 754359 Type: Expiration: 2rA 2013 Ltd Liability Corpo� CA ER BUILDING A"ikt(ELING,LLC. ' STEVEN WHITE,.:` 8 JAN SEBASTIAM,Ehf1lfi'1'0 SANDWICH,MA 02563 Undersecretary i License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affitirs and Busiiress:Regulation { ati 10 Park Piam-Suite 5176 Boston,MA 02116 E I I Qu;yte/ Not valid without signature � e r I, Mk 4 t210 pl l .,ANY L O IL , as owner(s) of the subject property at: I,Q 'KP►c�� � � . �y� �s , w+ A oho I hereby authorize Steve White of Caliber Building And Remodeling, LLC (contractor) to act on my behalf in all matters relative to the building permit application. signature of o l r date signature of owner date z Assessor's offioe (1st floor): Assessor's map,and lot number .. ........O3(,,. oFTNeto . ... °i a If STEM MUST BE Board of Health (3rd floor): _ d Smwage Permit number ..... �/.a`^.^..$?.................. f• COMPLIANCE • NM 7 H q�+��p � � Z B9Hl9TADLE, • Engineering Department (3rd floor• 41 }1. �o "sea �Irl1639. ouse number ....................... .. �......:. <...... .... � ^. '°�o V a. APPLICATIONS PROCESSED 8:30-9:30 AM, and 1:00-2:00•'P.M. only In'. F.�ti� REGUL+T90I yp TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............(c/.t!.!. (. ....... ,��. .- ..p.,r�.,... A,.........�sty�r�rl� ....... ...... TYPE OF CONSTRUCTION ..............G'll.o.o..ol............... ...................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r Location .... yi!t.wj4.o....5......I....... ... ........................................................... ProposedUse .........17..It ✓`. .—C....................................................................... ................................................................... Zoning District ........ ..... /.?. ........................................Fire District ......./.I/..?..4t.h.1....5............................................ Name of Owner .. H.......T -/40.*/.'....................Address ......IA.?.......(�1.!!!.C,.D..til......... ......................... Name of Builder .... ,free. / .A.v..q.............Address it iJ 11 r, Name of Architect .. ..t�M..�.. .:++�.�.......*.....0.y..t...............Address .............'.'`..................... .......................... Number of Rooms ........./.. ..(�ed.�!'Mr��... .........................Foundation ..... . .:A..F/ Exterior ......... .bj...........................................................Roofing .......�1.�t.4.w. ............................................................ Floors ...... .......ZaN..AW,1! �.........................Interior ... �.a�c f'....../r�.o.�L........................................... Heating ...........f/ .®...............................................................Plumbing ............•: D.. ...................................................... Fireplace ............4.Q...............................................................Approximate Cost .........o2, rJ� Definitive Plan Approved by Planning Board ________________________________19________ . Area ..........L,1 6.:o..... Diagram of Lot and Building with Dimensions Fee f .. . .r.`.............................. SUBJECT TO APPROVAL F BOARD OF HE & � ire Ir 10,11) 5 a^ Ca ....................... OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name/�) �/s`'� �,. .. ....�".4 ? ..... Construction Supervisor's License .................................... TAYLOR, MAROON No Permit for ...PA41/Garage., G a 2r .......... Single Fami1v Dwell.ing....... Dingle ................. ..... Location .....129 Bacon Road ............................................................ .............. ............................................ nrio M Owner ......... a ................... ...................... Type of Construction ....Frame...................................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ...... 87 C Date of Inspection ..........................I.........19 Date Completed ..............................T........19 41 L �y Assessor's offioe (1st floor): Assessor's map and lot number" 1�—. f ..... 0. Board of Health (3rd floor):.' �nrr$� Sewage*.Permit number .....:.... ..... ..................................... 2 BASII9TSDLL, S Engineering Department (3rd floor):7 +moo M63}9 ♦� "House number ........ .......: .... . ...,:..,...........f�, ..........c... '°��aMA-4 f y1 APPEICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only r , TOWN OF BARNSTABLE �— 6 s.•__ BUILDING INSPECTOR ...:1.. ...... ���. ` � APPLICATION FOR PERMIT TO .......... ........ �...- - d s jTYPE OF CONSTRUCTION .............. ................................ ................................................................... ........�1.. ../.. .........................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby pplies for a permit according to the following information: .a Location''!-.,%4 .r....5............... <. .... .................................... ProiDosed Use ' ? ......... ..a................................... Zoning D"i:strict' ,.. ... ..... f.1Lf<. ..........y..........*...................Fire District ....... .. ,/. .h.l9.�.. 5... '� * :. .... .1� 1 '`t"" h ft' � .✓1`J "' i•! tla�• x'^ ,.. .„<• gyp .e Name of Owner ..M49. ..c�+!1.......,��!'# f.. & .r.�....................Address ...... ar�.J�......./s'! ea..!!......... r � o r 5.... l! .........................................ame N Af- f h i i, Name of Architect ..110?.ex+, ....../?'..,T........ .R..A.0..V�.............Address ................................................ ................................... 1 � Number`of Rooms /...... �.r.�!.5+. -..�.........................Foundation (....c.w,. K. ...... 1C?.�. Exterior .........i1�.Cx.e+..e�............................................................Roofing .......�a9�r �. ............................................................ Floors ...... ......! .ee+.N.R+ ...... ...................Interior ..... ` .......La..a...ff�...................... .................... Heating g ................................. Fireplace ............17.O..........................+:.....................................Approximate Cost ......... P. .......... .................... .................. Definitive. Plan Approved by Planning Board -__---19---_---- . Area O -------------------------- Diagram of Lot and Building with,Dimensions Fee ... ...........{:............ SUBJECT TO APPROVAL F BOARDAOF HEAILTH / l OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Construction Supervisor's License .................................... ��r TAY10R, MARION A=309-036 No 31198 Permit for ....04ild Garage Sing Y le Famil Dwellin. g........ ' ............... ..................... .......... .......... . t . 129 Bacon Road = `� Location ................................................................ H annis Owner ..Marion Tax.for.............................. ............. 4 Type of Construction ...'....Frame - ............................................................................... Plot ............................ Lot ................................ . f. Permit Granted ......Sept. 15, 87 r" .................................19 Date of Inspection ....................................19 r a Date Completed ' . .......19 J J�D� Ov, ow o) r' Er neering Dept.(3rd floor) Map -0 , Parcel U `2 ro Permit# ` House# - Date Issued — Board of Health(3rd floor)(8:15 -9:30/•1:00-4 39) Fee 2� • C�l� . Conservation Office(4th floor)(8:30-9:30/1:00 2:00) Planning De st floor/School Admin. Bldg.) ` THE ' Defi ' ve Plan proved by Planning Board 19 2 BARNSTABLE, EO". TOWN OF BARNSTABLE Building Permit Application Project Street Address 1 a`j _!�wtb p " Village, v4n a l s f Owner M(Z S TA yu jZ Address A* - �:b_ H vn atiw ,.-Telephone 771-01 OL/ ' -Permit Request STR!1� is Ike F2cx�k= - �► a=x�s+�,:.� } F SL u, ,2 . ice, 1 4-C e 4r)CO 2�,�' SIB��,l..t,' o�� � ,r '�s 1=r' " • .First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ �C�j Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: . Full: Existing New Half: Existing New No.of Bedrooms: Existing i New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces:Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) - ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review.# Current Use Proposed Use Builder Information Nameyj//,q u i C Us4,ia;ct/v t,_ Telephone Number 77B-dSI?a YA8-(?69 9 Address ?AuL. 644:22,,L*- 11 JR,eA V,114-P / License# 61S7793Y V 76 W 4{CT'F_ ,'i is 5 S 7e. r4 Ad2,mo Home Improvement Contractor# t A y?a A Worker's Compensation# GJC-3S'ySG?oZ� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION RIS R TING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE BUILDIIERMTDENIE Fit OWING REASONS 41 ���d FOR OFFICIAL USE ONLY 3 33 PERMIT NO. - DATE ISSUED MAP/PARCEL NO. ADDRESS L VILLAGE' '^ OWNER DATE OF INSPECTION: t FOUNDATION FRAME INSULATION FIREPLACE 1 h - f #� } _ � r .� i � t 1 r .. •_ __€ � ; + t ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH 'FINAL GAS:' ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. • The Town of Barnstable MWM �$ Department of Health Safety and Environmental Services •T� Building Division 367 Main Stress,Kyaaais MA 02601 ` ` Crossas Office: 308.790-62Z7 g��g COMMissicn-- Fax: 508-790-6730 For oflIce use only / Permit no._ Date AFFIDAVIT ` HOME IMPROVEMENT'CONTRACTORZAW SUPPLEMENT TO PERMIT APPLICATION MGL a 14ZA requ ires that the "teeonstructfon, alterations, renovation. repair, modernizatioit. conversion. improvement, removal, demolition, or construction of am addition to any pre-existing owner occupied building containing at least one but not more than fbur dweiling units or to structures which are adfucent to such residence or building be done by registered contractors, with certain exceptions.along with other requirements Type of Work: ' • Est.Cost C/V - ` Address of Worst. Owner's Name p Date of Permit AppiIcstion: 1 / hereby c=-:iry that: Registration is not required for the following reason(s): Work ezcfuded by taw _Job under SI,000. Building not owner-occupied —owner pufUmg own permit Notice is hereby gig that: OWN PERMIT OR DEALING WITH UNREGISTERED OWNERS .pULI,ING THEIIZ ROME _ CONTRACTORS FOR 77O LE AC THE ARB PROGRAM OR GUARANTY FUND WUNDER,MGLORK 00 O 142A � CFSS TO SIGVED TIES OF PERIURY i apply for a as the age of the owner. - C q/`6/�9� ' 1 Date Registration Contractor Name Registration No. OR Owners Name Daze v The Commonwealth of Massachusetts .? _j' =6 Department of Industrial Accidents _: .. •,� == , ; ����i� Olf/ct allnyestl�atioas ' 600 Washington Street 3?r Boston,Mass. 02111 Workers' Compensation Insurance davit a�i i�... %%%%%��%��%//G'%�//% %%�i ""'�e'£Rii' E"%'��!`Yt'Y�//%%/%%%%///////////%1111///////%//%1�/////� %�//////,! �//% name. location: - city phone# [] I am a homeowner performing all work myself. ❑ I am a sole p rietor and have no one working in anv ca acity ❑ I am an employer providing workers' compensation for my employees working on this job. compnnvname \1 i AU 1 1ti'F address �O city- tic/rt h 1 1 1'y1 A(- 7 2— nhone#: insurance rn nniicv# t,Albb ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: .... .. coin anv name! address: dtP phone#! . insurance cn. .G//.l!//Llkl///.u"L.�(.,�c"✓,11,�4i�iir/ls'/,l�//.(%////.c'(/////////%////,CGI'/////%//////////////%////////////////////////////////////////////////.l!///////////////////////////////.(//////.l%//%%/////////////////// //////i companv name, address: city Phone 0. >. ...: : ..,::.. golfcvs Ingurance CO. ... ////% .1/%%%%/%//// Faltute to swears covers on ISA of"'OL I- can lead to the Impwitton of criminal penaltln of a One up to Sr.500.00 and/or one yeah'lmprno ss well s dull penaltin the form of a STOP♦VORK ORDER and a One of SI00.00 a day against ma I tutderstand flat a copy o[thb s tnt may be forwarded to We u of Investleatlotn of DU for covtxaSe veriOeatlon. I do herby c fy under the p d pert of perjury that the i anon provided above is trues and coned Si�ature Data Print mate 'Ca4 V L ln't L✓.!— Phtme# .......... .. oincial use only do not write in fhb area to be completed by city or town oO1dal dtv or town• penmtNcense 0 Mudding Department ❑Licensiat Board ❑dtecicif lttunediste response is required ❑Selecanea's Office ❑Health D.1,_Vaeut contact person• phone#• ❑Other pevnea 9/43 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers• compensation for their loyee is defined as every person in the service of another under any scut-: employees. As quoted from the "law", an emp of hire, express or implied, oral or written. An employer is defined as an individual. partnership,association, corporation or other legal entity, or any two or more of die foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver, . 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 ,•rl.e►..q3 o"v%lnq,s persons to do maintenance , construction or repair work on such dwelling house or on the grounds o: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings'iri the-common rwealth fo any:applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. neither the neithe the commonwealth nor anv of its political subdivisions shall enter into any contract for the performance of public woik until ce requirements of this chapter have been,presented to the contracting dense of compliance with the insuran q acceptable evidence p , authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be 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. ////////// City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the the Office of Investigations has to contact you regarding the applicant. Please affidavit for you to fill out in the event will be used as a reference number. The affidavits maybe rearmed t" be sure to fill in the permit/licease number which the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please 4.9 not hesitate to give us a call. / The Dep;irtrment's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents 0Mce of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 7274900 eat. 406, 409 or 375 i F l 11 �siP Fa o : mr •� • • = o . r-+ a.c cam. '� ►1+ _- -+ n a . n9 --4 i0 A 0. op �.n a —=i • 3 V Apr N x 3 tw N rr Pr O J Z G O n - S N C m . W rG-� m N r Z �O rm ( a G to O, C N --4 �p •� W r+Ni C� O N Z \ Cs co n �• w � RE-ROOFING ❑ If located in OKH or Hyannis Historic District-Certificate of Appropriateness required unless same color/same materials specified on application i Map/parcel number Sign-offs from: `—� ❑ Tax Collector ``—� ❑ Treasurer (]#/of squares of shingles or square footage of roof to be shingled �pecify stripping old shingles or going over old roof. If going over ❑how many roof layers existing now ❑what size are rafters? What is span? ❑ Complete dwelling information for the Assessor's Dept. - if known Workman's Comp. form Home Improvement Contractor Affidavit RESIDENTIAL ONL Y) LY) Cy' Home Improvement Contractor's License OR ❑ Homeowner's License Exemption(RESIDENTIAL ONLY [� Check expiration date on license COMMERCIAL WORK-No License is required. Fee q-forms-PERMITS I Rev 61?J98 Assessor's Office(1st floor) Map. ® Lot 6126>6 rmit# Conservation Office(4th floor) Date Issued_ Board of Health(3rd floor)(8:30-�9:30/1:00- ee` 5 0 Engineering Dept.(3rd floor) House#1 $ {� SYSTEM INSTA C - Planning Dept.(1st floor/School Admin. Bldg.) �L��.� @ E W6T5'9 �!G -E ROISTABLE. .> Definitive proved by Planning Board 19 ASS, D TOWN OF BARNSTABLE O Building Permit A lication g p Project Stre Ad ess Village Owne L.1� Address 422 Telephone Permit Request R1YL -Total 1 Story Area(include 1 story garages&decks) square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ .2 Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family V11, Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name ��-�/ji� ��aj Telephone Number YZB 9SjS Address/,;!,;y,C'- UL p-yl,�,y 2b License# O:,/6/99 Home Improvement Contractor# f DO?of0 -Z- 7-7— Worker's Compensation# "&Long l 9 2V,9 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE i DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMITNO. #10470 ' DATE ISSUED Sept 20, 1995,, , e !` MAP/PARCEL NO. 309.036 129 Bacon Road Hyannis, MA 02601 ADDRESS VILLAGE Y • : , OWNER Marion A. Taylor t t i DATE OF INSPECTION: FOUNDATION .c FRAME INSULATION FIREPLACE !P . ELECTRICAL:, a ROUGH FINAL PLUMBING: 0 s "ROUGH .FINAL F GAS: k ROUGH .FINAL FINAL BUILDINGr } DATE CLOSED OUT, ASSOCIATION PLAN NO. f J The Commonwealth of Massachusetts — - ( Department of Industrial Accidents X — Olf/CBO!/ dgBdOtrs g 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit L G�� city C_ /� /!I"/� d Z(rj 3SJ phone# 0 I am a homeowner performing all work myself. I am a°sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. company name. address: . ... city: nhone insurance co: pbhcy#<;; am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comnanv name: ,, address: - city: p one insurance co. !:Jlolicv comnanv name! address: -:. city: phone#• insurance co. tac a [bd-n—J1H&—CULhcCc= Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /do hereby certify under t s an penalties rjury that the information provided above is true and correct Signature Date m Print nae Phone o: official use oniv do not write in this area to be completed by city or town official t r' f.? city or town: permit/license 9 nBuilding Department ❑Licensing Board �.: check if immediate response is required� P q Selectmen's Office i. �- OHealth Department contact person: phone M• nOtherw: I• Irmied 311M P1A1 � ✓/ie -Vo�intanca� o��,��ac�ivaeaa i . : HOME IMPROVEMENT CONTRACTORS REGISTRATION ° oard of Building Regulations and Standards One Ashburton Place - Room .1301 I Boston, Massachusetts :02108 I . HOME IMPROVEMENT CONTRACTOR r----------------------------------- �Registration 100740 Expiration 06/23/96 Type - PRIVATE--CORPORATION 110NE INPROYE1tENT CONTRACTOR, A"istrstiol 400140 Type -...PRIVATE CORPORATION•• ° capizzi Home Improvement , Inc . j -ENpilAtion -46/13/96 Thomas Capizzi , Sr . ° 1645 Newton Rd . ° Cepiili Nose IlproveNelt, INC • Cotuit MA 02635. j Thous Cepittt, Sr. 'g f±L4w Newton id. I ° AM MSTMM •Cotuit NA 01635 st �� �ommo••�laG gl..11�ue� . lestricted To: 10 DEPARTMENT 1F PUBLIC W111 CONSTRUCTION SUPERVISOR LIEENSE 10 - IOAt Inber: .. .Expires: lirtldite: I IA - !,sour oily ES 10181 '10/21111% IOR1/111S 16 - 1 1 1 Flailr poles leslricted To: 00 �1...L.. DAVID N IEBB 100 PLUM NOTION RO I E FALNOUIN, 0 02$36 i : The Town of Barnstable Department of Health Safety and Environmental Services 19. `° Building Division 367 Main Street,Hyannis MA 02601 Ralph Crosses Office: 508 790-6227 Building Commission: F= 508 775-3344 For office use only Permit no. Date AFFIDAVIT HOME ZWROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICAITON MGL c. 142A requires that the"recanstmction,alterations,'renovation,repair,modernization,conversion, improvement,remcnal, demolition, or construction of an addition to any pre-eadsring owner occupied building containing at least one but not mOm than four dwelling units or to S=cturas which are adjacent, to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. r/ Type of Work: �- Ek Cost 2a Address of Work: Owner.Name: e-5 Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 s Building not owner-occupied Owner pulling own permit Notice is hereby given that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING WITHDf7REG1STERED FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c- 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. A5 -ZV-fs �-- O d 7 4� Date on Registration No. OR ' Tlarr Owner's name