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HomeMy WebLinkAbout0217 BISHOPS TERRACE � ► �1 �..ts 1�0�s 1-�.�-�-� ��� � qS �_ _ � t Application numbe ................ JJ1........ 0 .n Date Issued............4(IA( ° BARNSfA$LE ........................................ MPNESS 183 - Building Inspectors Initials..........0...................... Map/Parcel...Q?5..1.d5....:............................... TOWN OF BARNST LIM-q EXPEDITED PERMIT APPLICATION: ROOF/SID1NG/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY MORMATION Address of Project: 0 7 S S r NLTIvMF.R STREET VILLA Owner's Name:�� ,A- /� Phone Number � — Email Address: Cell Phone Number Project cost$ M - Check one Residential V1 Commercial OVVTNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: -5 e v 0t3 ,41-4 Date: TYPE OF W!!� 0 Siding xWindows(no header chang #1---LInsulation/Weatherization 0 Doors (no header change)# Coin rczal Doors require an inspector's review u Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S I FORMATION Contractor's name APtJ Fr, <ICV4 �-11'n d ouw s Home Improvement Contractors Registration(if applicable)# 17 3 2-Lt S (attach copy) Construction.Supervisor's License# bJ S 7 0y (attach copy) Email of Contractor C1Sea 9 q S �� C brn Phone number q01- Z 2 R -`�X OCR ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY 15 tiv A HISTORIC D/STRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *For Tents Only* Date Tent(s).will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X , X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s)of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMTTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICANT'S SIGNATURE Date Signature All permit applications are subject to a building official's approval prior to issuance. Repn�ewal Agreement Document and Payment -Terms bYAC1C�ei"Sehl.. dba:Renewal B Andersen of Southern'New, En and" Y gl : Jean Martin Legal Name:Southern New England Windows,LLC, 217Bishops Ten, O�iAll#36079, MA#173245,CT#0634555;Lead Firm#1237: Hyannis,Ma 02601 wINoow pE ucEMExr 10 Reservoir Rd I.Smithfield RI 02917 H:(781)395-79.42 " Phone:.866-563=2235 I Fax:401-633-6602 I sales®renewalsne.com' Buyer(s)Name: Jean.Martin Contract Date: 01 01/19 Buyer(s) Street Address: 217.Bishops Terr, Hyannis; MA 02601 Primary Telephone Number: (781)395-7942. Secondary Telephone Number Primary Email' lmbusiness65@yahoo.com Secondary' Email: Buyer(s)hereby jointly:and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor),in accordance with the terms and conditions described'in this Agreement . Document and Payinent.Terms,any documents listed in the Table of Contents,and any other document attached to.this Agreement Document,the terms.of which are all agreed to by the parties and incorporated herein by reference:(collecdvely, this "Agreement'). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all Work 'Under.this Agreement. Total job Amount: $9,695- By signing this Agreement,you acknowledge that the Balance Due,and.the Amount Financed must be:made by personal check;.bank check,credit card,or cash: Deposit Received: $31231 Balance Due: $6,464 Estimated$tart: , Estimated Completion: Amount Financed: $0 8 to 10 weeks - 8 to 10.weeks. Method of Payment: Cash/.Check We schedule installations based on the date;of the signed contract and secondarily on the date in which we complete the technical'measurements.The installation date that we are providing at this time is only an estimate.,We will communicate an official date. and time at a later date.Rain and extreme.weather are.the most common causes for delay. Notes: .. : � . Taxes paid in Barnstable,.Ma. Buyer(s)agrees and understands that this Agreement.constitutes the entire understandings between the parties and that there are no verbal. understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will:be . valid without the signed,written consent of both the Buyer(s) and Contractor.Buyers) hereby acknowledges that Buyer(s) 1)has read thus Agreement, understands the terms of this Agreement;and has received a completed,signed;and dated copy of this Agreement,including the;two attached Notices of Cancellation,.on the date first written above and.2)was orally informedof Buyer's right to cancel this Agreement. NOTICE TO BUYER; Do not sign this contract if blank.You are,entitled to a copy of the contract at:the time you sign. YOU THE BUYER MAY CAN E C L THI5 TRAN SACTI N O AT ANY TIME NOT.LATER THAN MIDNIGHT OF 01/04/2019 OR THE.THIRD BUSINESS.DAY AFTER THE DATE OF THIS TRANSACTION; WHICHEVER DATE IS LATER:SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows;LLC dba:Renews B Andersen dSouthern New England Buyer(sj. Signature of Sales Person Signature Signature g. g. Gino Montesi Jean Martin Print Name of Sales Person Print Name . Print Name UPDATED:.01/01/19 Page 2 / 12 X -a Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home improvement Contractor Registration Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS,LLC Registration: 173245 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD, RI 02917 Update Address and Return Card. SCA 1 G 20M-05/17 I Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SuoDlement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 17324.6 09/18/2020 1000 Washington Street-Suite 710 V SOUTHERN NEW ENGLAND WINDOWS.LLC Boston,MA 0211 BRIAN DENNISON 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary rove dal Without signature y Commonwealth of Massachusett, Division of Professional Licensure Board of Building Regulations and Standards COi�s�r � Sup wiser CS-095707 EXp i res : 09/08/2020 BRIAN ® DENNISON 8 BLACKWELLr_®RIVE : E saT Y CHARLTON A.=01507 — s i Commissioner CIL ate.\ TheCommonwealdt ofMassachusetts Department of Industrial Accidents I Congress Streets Suite 100 to Boston,MA 02114-2017 www mass gov/dta lj orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER-MIITUNG AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): !A. hern, Address: j o t P Vol r Ci /State)2i : M t n e /�- ! DZ 1 tY p S �'l'l � � � 7 Phone#: Are you an employer'Check the appropriate box: Type of project(required): 1. I am a employer with �'f'employees(full and/or part-time).* 7. ❑New construction I 9am a sole proprietor or partnership and have no employees working for me in 8: Remodeling any capacity.(No workers'comp.insurance required.] 3.�I am a homeowner doing all work myself.(No workers'comp.insurance required.] 9. ❑Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 D Build ilia addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions S.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: p 6. We are a corporation and its officers have exercised their right 14.�btYier l ❑ ght of exemption per MGL a i 152,§1(4),and we have no employees.(No workers'comp.insurance required.] 'Arty applicant that checks box#l must also fill out the section below showing their workers'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. tontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:_(PSI ea'LS t rs(,( a n►(,— t,0 . pj W h., / >.(i . Policy#or Self-ins.Lic.#: !A/C�} �� j S'Tr 7 2 91 Expiration Date: Job Site Address: 6 c5 City/Stateaip: l Attach a copy of the workers'compensallon policy declaration page(showing the policy nu-- er and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerdA under the p ' Amdpenafties of perjury that the information provided a ove is a and correct Signature: Date: Phone#: Official use only. Do not write in dds area,to be completed by city or town official City or Town: 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 Person: . Phone#: r CERTIFICATE OF LIABILITY INSURANCE DATE 8,2"I' o°8"0 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 require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONrACT CoBiz Insurance, Inc.-CO NAME` 1401 Lawrence St., Ste. 1200 PHDNE Fxtk 303-988-0446 c No:303-988-0804 Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER'B:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC'dba Renewal by Andersen of Southern New England INSURER c;Homeland Insurance Company of Newyork 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:787175890 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF CY EXP ILTR TYPE OF INSURANCE DDL SUB POLICY NUMBER MM/DD/YYYY MM1DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 11112020 EACH OCCURRENCE $1,000,000 CLAIMS MADE a OCCUR DAMAGE TO RENTED--— PREMISES occurrence $300,000 MED EXP(Any oneperson) $1 o'wo PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000,000 X POLICY JJEECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE LIMIT $ a accident 1 000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X ALIT NON-OWNED PPROP`EcRT DAMAGE $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/112019 1/1/2020 EACH OCCURRENCE' _ $15,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $15,0MAM DED I X I RETENTION$ $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X ST TIJTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEj$1,13W,00o If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000.000 C PoOution Liability 7930073340000 1/1/2019 1/112020 Each Occurrence Gaims-Made PoT $2,000,000 Retroactive Data20/T013 Aggregate $2,000,000 D�ucffide $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable Building I?Ost:ThlSCard So.That it`is:Ursible�From the Street `A roved;:Plans:Must,be.Reta�ned on Job:and this CardMust benKe t :, ABLE, � ,<^•' �x ,�',^ .-. •` r ,�',c�.` s PISe :C� � t ` t t s° yam a ,✓, .p 'Y;p�� x Posted Unt�1 Final Inspection Has Seen Made* �, x U �� '� S c •_ WFere,a,Certificateof Occupancy is Required,such Building shall Not beOceupied.until a Fnal'Inspect�n has been made e�n11� ....::.k:N.a,...,,..:.::m..e_ +rir. .>Y,,.,,,......� :,.,.. .»...aTs.....t :...... ....... .a,... ,,,,.>.a.... ,.. _ai.�n._ .�. « �,.t...a....o ..:;_.Ms, . i.. :.,. :.u .. ..`�Fs`.w,...n .... ', a� .H......<. .s>.,. . Permit No. B-19-212 Applicant Name: MARTIN,JEANNE MARIE Approvals Date Issued: 01/29/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 07/29/2019 Foundation: Residential Map/Lot: 251-195 Zoning District: RC-1 Sheathing: Location: 217 BISHOPS TERRACE, HYANNIS � :: Contractor:Name' Framing: 1 Y Owner on Record: MARTIN,JEANNE MARIE M Con tractor,License 2 Address: 217 BISHOPS TERRACE ;Est �Proj ct Cost: $5,000.00 Chimney: HYANNIS, MA 02601 \Permit Fee: $85.00 Description* BRING 1 2 BASEMENT UP TO CODE TO BE USED AS OFFICESPACE Insulation: p / Fee P i 5 85.00 Project Review Req: Combo Smoke/CO detector required near base of stairs inDate �_ 1/29/2019 Final: basement. No sleeping in Basement. , ` �� .4 ,�. l Plumbing/Gas D, Rough Plumbing: Building Official r - Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed�by aft this permit is commenced within six months er£issuance. All work authorized by this permit shall conform to the approved applicatn�andthe approved construction documents for which this permit has been granted. . Rough Gas: All construction,alterations and changes of use of any building and str:'uctures-shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access str"t" road and shall be maintained open for public mspectiori for the entire duration of the Final Gas: work until the completion of the same. �� •, The Certificate of Occupancy will not be issued until all applicable signatures'by the�Buildmg a d Fire Officials a 1.re prowde�d on`th s'permit. Electrical Minimum of Five Call Inspections Required for All Construction Work:; Service: 1.Foundation or Footing 'J 2.Sheathing Inspection ,, Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed� 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Person ting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department —� ��\ All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: ...........Application2nlble'r.a,�17� IMMMAX Permit Fee JAI Y 2 Other Fe ................00is. ........ OFTotal Fee Paid....................!............................................ ...... TOWN OF BARNSTABLE Permit Approval by..X ' �e...............on..../I.... . .............. ............... BUILDING PERMIT ....................Panel. APPLICATION Section I — Owner's Information and Project Location Project Address a2l 7 A ISHO,,ev Ff_lm,�je Village 4 fxwls Owners Name tj II&ICTA Owners Legal Address f 7 .0/s 1Efeglkk City a 412-N 4f State zip (32(0 / Owners Cell# 791324= 75Vz E-mail S riO 5- tO 1006.C1711 Section 2 —Use of Structure Use Group E] -Comm ial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3—Type of Permit ❑ New Construction ❑ Move/Relocate [:] Accessory Structure ❑ Change of use El Demo/(entire structure) Finish Basement El Family/Amnesty ❑ Fire Alarm Rebuild El Deck Apartment ❑ Sprinkler System ❑ Addition EJ Retaining wall El Solar El Renovation ❑ Pool El Insulation Other—Specify, Section 4 - Work Description T Mr)ve/) HtF)etf- 0 Cr 17, a®19 WEA2 F -2 _i F/E Q&T &'041ff ANE 6jL- A) Glygly C=Q-r 4dusd - Ab UAL-2 AWE , I HXZ� A [-- knEZILWE ANQ 4166LI)icl Z 4& L&EQ 17-6201 oAa,1L),6 711rMC ,fPE* Z 007-LJ:1s k -S1,J1c1Vf J 1,A) 61 Last updated. 11/15/2018 1 e Application Number.................................................... Section 5—Detail c Y G ,ss, Cost of Pr ov o 0 osed Construction ,�01 Square Footage of Project LF " a l L3E Age of Structure_U129IJoIdJ Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design • 1 Section 6—Project Specifics Wiring ❑ Oil Tank Storage ® Smoke Detectors 1 ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom i Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7 ' Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No Section 8—Zoning Information 3 ZoningDistrict Proposed Use Lot Area S . Ft AL r q � 6 Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed ac'dYod�+ Rear Yard Required Proposed A^C H 5nuLc Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes No S Last updated. 11/15/2018 s The Commonwealth of Massachusetts , Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 wwEv.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �-Da— AMIf— 1E Hifg%IA) Address: a 1. 7 a U/foes i,E,�',&E City/State/Zip: Zip Phone#: ��5""7?P Are you an employer?Check the appropriate box: Type of project(required): 1.El 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 Buildingaddition [No workers'comp.insurance comp.insurance.: � required.] 51 We are a corporation and its 10.0 Electrical repairs or additions 3.® I am a homeowner doing all.work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.M Other 4i�jtl �` 0 0 t a F comp.insurance required.] hlreAJse I'- ,' L- -,rIw.f *Anyapplicant that checks box#1 must also fill out the section below shown their workers'co on oli mfoLation. aPP g P cY /j f t Homeowners who submit this affidavit indicating they are doing all work and then hire outside wnttactors must submit a new affidavit indicating such. tr-ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contactors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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. Signafore: Date: 7 A0 Phone#: 7 r-/ -3 y-f-"79 5�2 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.Building Department 3.City/Town Clerk 4.Electrical Inspector. 5.Plumbing Inspector" 6.Other Contact Person: Phone M Information and Instructions 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 written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the 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 shall not because of such employment be deemed to be an 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 requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)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 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. 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 that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job 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: The Commonwealth of Massachusetts Department of IndusirW Accidents Me of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4400 ext 406 or 1-877-MASSAM Fax#617-727-7749 Revised 4-24-07 w , ,gov1dia oaf y ,pt a ( \ (CGS /Ay Nei S beG,CIA/Coo h Skye �� U� i �t stle 91 .5 Sif'l 3le A ,N--6 us f LJ Doi € or") 6 c I"ehl �Ier 49 tr1C�efj\ /.optu f vj;N .GW BAN TOWN o"$� �� File itumber: 180917-0 ' UNREGISTERED LAND Attorney: CAPE COD TITLE&ESCROW i Deed Book Pave Leader: Plan Book Pais Lot s Owner. JEANNE MARTIN REGISTERED LAND Rem Book 25305-B Sheet 3 Lot(s): 52 Date: 10/18/2018 I C'erti tcate of Title 190025 Assessor's M(lp 251 Blk: Lot 195 I Census Tract MORTGAGE INSPECTION PLAN Scale: ��••=35' 217 BISHOPS TERRACE, HYANNIS, MA L`ot 5.3 Lot o Lot 51 . , 135.00' Lot Y 52 Shed 1.5,246. S.F, (u Lot 5 A ON 51� co o s , Lot 50 o T� 4S ° 2017 a 48.30' 86.91' BISHOPS TERRACE. ' JAN 18f2i . TOWN OF.��l1'ty�,; CERTIFICATION I CERTIFY TO TH.E ABOVE.ATTORNEY,BANK,AND THEIR TITLE INSURANCE COMPANY THAT TIIE i<'LAIN BUILllING,FOl\1► T OR DWELLING WAS 1N COMPLIANCE WITH THE LOCAL ZONING BYLAWS.IN EFFECT WHEN CONSTRUCTED(WITH RESPECT"I'O r STRUCTURAL SETBACK RE,QUIRE4IENTS ONLY)OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS.GENERAL LAW TITLE VII,CHAPTER 40A,SECTION 7. FLOOD DETE WINATION 3 BY SCALI=.9'HF DWf 1.LING SHOWN HFRF DOGS NOT FALL WITHIN A SPECIAL FI-OOD HA7.ARD 7ONF.AS DEI.INFA'fFD ON A MAP OF COMMLMI"1'Y 2500IC05621 As ZONE X DATED 7/16/14 BY THE NATIONAL FLOOD INSURANCF PROGRAM. Application Number............................................ Section 9- Construction Supervisor Name /I. /-1rftT11g J Telephone Number Address d-f 7 A l S llol f T& City %iY� 1_)S State of f T Zip O Z L O/ License Number License Type Expiration Date Contractors Email ,T1'_113 11A)9ss LIE QY4_17t4'1',C6d Cell # S69��"'/E j I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand.the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature �&/-JE oW,v6ir2 Date 7 1v 17 Section 10-Home Improvement Contractor Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number 7 f/-3 2 s= 72 y 2 Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date 02_019 APPLICANT SIGNATURE Signature Date 7-'26/9 Print Name ��-L /U 41. Ht1jR i i/✓ Telephone Number E-mail permit to: _J t j 4 US/A6j_-f /v S- yy9 f0 0, ©l4_f Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name i Last updated. 11/152018 Town of BarnstableBuilding, h ;' ... ,.r ,: aY v \ " . y�. as PostTh�s.GardSo TMatit is Visible.IFtom the_Street A roved.;':Plans:Must be Reta�nedon Job and'ahis Card Must be=Ke ,t• wtav ttABLr pP , �� ' p ` Posted Unt�I F,mal Ins ection Has Been Made M :.Where a Certificate of O:ccu anc, gis.Re uiredsuch;Bulldm shall Notbe Occu �ed•until a Final Inspection has been made r Permit" Permit NO. B-19-192 Applicant Name: MARTIN,JEANNE MARIE Approvals Date Issued: 01/29/2019. Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 07/29/2019 Foundation: Location: 217 BISHOPS TERRACE, HYANNIS Map/Lot 251-195 Zoning District: RC-1 Sheathing: Framing: 1 Owner on Record: MARTIN,JEANNE MARIE Contractor N me Address: 217BISHOPSTERRACE Con tractr;Ucense 2 Est Pro ect Cost: $7,000.00 HYANNIS, MA 02601 J . Chimney: Permit Fee: $85.00 Description:- Permit for spa/hot'previously installed in 2002 KIondiker Legend z. MP'FEf serial#A02HX33532 Insulation: • Fee Paid $85.00 Date Project Review Req: Must have a cover that can be secured or fenced per code 1/29/2019 Final: Plumbing/Gas -_ Rough h Plumbing: . ". Building Official This ermrt shall be deemed abandoned and invalid unless the work authorized b ;this permit is commenced wrthm=six m Final Plumbing: p y p onths after issuance: All work authorized by this permit shall conform to the approved application,and the`approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. a This permit shall be displayed in location clearly visible from access streetor road and shall be maintained open for public'inspection for the entire duration of.the,, .Final GasLL: work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are3provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: r Service: 1.Foundation or Footing Ai v 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed » 4.Wiring&Plumbing Inspections to be completed.prior to Frame Inspection ;Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation' Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction: Health "Pers s contracting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A). Final: Building plans are to be available on site'' Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: lq � 1,,, 110 p Application Number............................................................. Pennrt Fee.— �...D..... BAN 1 s 2o�q ............Other Fee........................ ��,�•�` � .- T0 WN OF Bq Total Fee Paid...................................................................... NS �E TOWN OF BARNSTABLE , Permit Approval by......�1..���........On BUIL DING PERMIT Pare.. .�51.-. 1, ................ ....................................... APPLICATION Section 1 — Owner's Information and Project Location - Project Address 1:2 l 7 )S I S/61'S T i—,re4 C E Village- H i " Owners Name J Er9NN,E M" ILId d T//V ` Owners Legal Address 7 Z f olf-r rf,69✓1C C- City 14 YhAlN%t State Zip a C o d I I Owners Cell# E-mail jM9 UJ/A✓I5 j/fif�fun"C Qt Section 2 Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet FRI Single/Two Family Dwelling Section 3 -Type of Permit ❑ New Construction ❑ Move/Relocate Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty, ❑ Fire Alarm Rebuild ❑ Deck Apartment © Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation pmlSPA ❑ Insulation Other—Specify Section 4 - Work Description rJcyED ff�Z&,F- ac/T w� / 7,20/ . T we,, -see (aX�i�l f 01ervrlr � t( ��,ie rJCEYh `Y I Vem Y 40 g� rG:J YI C� 1�')oi9e �C,ere C< TAD% =W Gt lA v e � b �► h v r 41;21 �: led tIOP L .' kLOND1x eP\ LE•CEA)D MiO FEE Ser+al l ' 1A 1 , Last updated: 11/152018 Application Number................................................ Section 5—Detail bC, y � poa �eRr.10;' gx �r fir x yy " '✓` Cost of Proposed Construction e,kis.-s Square Footage of Project V Se Feci Age of Structure Appro 4e/v dc,o a Dig Safe Number. UAj knJA e sN # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ® Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System 0 Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. IS d.V6 S. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed a 6 Jpot��� Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes 0 No /J. "1 T6� '1 I:nbi J 4- Last updated: 11/15/2018 The Commonwealth of Massachusetts' Department of IndustrialAccidents Office of Investigations t 600 Washington Street Boston,MA 02111 wwEv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleddcians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganimWon/Individual) Z EAAME 41 I C- /tf4yz I M2 Address:_ k) 7 J3 is lions T-f]"l CC City/State/Zip: � ttPLI IS 110 01601 Phone#: 7P:3 3 7 ,2 Are you an employer?Check the appropriate bog: 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.❑ I am a sole proprietor or partner- listed m the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in anycapacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.: required.] 5. �.We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.� I am a homeowner doing all work 11.El Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no B employees. [No workers' 13.M Other V7&QV A t comp.insurance required.] r - i c ,$ uf17� *Any applicant that checks box#1 must also fill out the section below showing their worker;'compensation policy information.1.1 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 sbeet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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. Si Date: 0 Phone#: 7Fl1-3 l.5 -N y12 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.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions 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 written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the 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 shall not because of such employment be deemed to be an 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 requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited LiabilityCompanies L or Limited Liability Partnerships(LLP with no employees other than the P � � ty P ) 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 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. Self-insured companies should enter their self-insurance license number on the appro priate 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 that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job 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 burn 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: The Commonwealth of Massa husetts . Department of Indust rW Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MA.SSAM Fax#617-727-7749 Revised 4-24-07 www.mass.gvvfdia , Hot Tube s SLUE FALLS Manufacturing Address: 4549 52st Thorsby, Alberta Canada ,, TOC 2P0 w k 1-800-309-1744 R Model: Klondiker Legend MP FEF Due Date: Thursday, September 19, 2002 Serial #: A02HX33532 1 Color: Lunar Sand s Dealer: Arctic Spa New England, ,, Note: Forever Closest Retailer: R & R Pool & Spa 256 Great Road Suite • - . - `� Littleton, MA 01460 File number: 180917-0 UNREGISTERED LAND Atffirne : CAPE COD TITLE&ESCROW i Deed Book Pau Lender: Plan Book page Lot(s) Owner. JEANNE MARTIN REGISTERED LAND ' Re .{.Book 25306-B Sheet 3 Lot(s): 52 Date: 10/18/2018 Certificate of Title 190025 Assessor's Map 251 Blk: Lot 195 Census Tract a MORTGAGE INSPECTION PLAN Scale: "=35' 217 BISHOPS TERRACE, HYANNIS, MA Lot 51 Lot .53 Lot 55 135.00' Lot 52 15,246 S.F. shed oJ �� N Lot 54 co 0 Lot 50 21 ►::: • . 86.91' 48.3o' 111"Lonve ,- BISHPS TERRACE JAN18 TOWN 0F CERTIFICATION i CERTIFY TO THE ABOVE ATTORNEY,BANK,AND THEIR TITLE INSURANCE COMPANY THAT THE MAIN BUILDING,FOUNDATION OR DWELLING WAS IN COMPLIANCE WITH THE LOCAL ZONING BYLAWS,IN EFFECT WHEN CONSTRUCTED(WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS ONLY)OR IS EXEMPT FROM VIOLATION ENFORCI MENT ACTION UNDER MASS.GENERAL` LAW TITLE Vll,CHAPTER 40A,SECTION 7. ' FLOOD DETERMINATION BY SCALE-THE DWELLING SHOWN HERE DOES NOT FALL WITHIN A SPECIAL FLC10D HA"Z_AIZD ZONE.•.AS DFL.INFAT D ON A MAP OF COMML1Nfl'Y 9 25001CO562J AS ZONE X DATED 7116114 BY"t'HE NAI'IONAL FL(_)Ot)INSLIRANC'E PROGRAM. •. •, 1. 4. Application Number........................................... Section 9-Construction Supervisor Name Al T /N Telephone Numbed/ ��j 7 is MOIJ er PcC r Address �,�-ter- City j4;;/UA1 d State /j/1 Zip 0,2 a License Number AJt i A License Type Expiration Date Contractors Email Cell# avg I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with.780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. s Signature l ej E OO)UIFA Date G d aT Section 10 Home Improvement Contractor Name Telephone Number Address City State . Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulation's for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.LC... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: �TE�NA,'E abg i L% H,41MA/ Telephone Number 7 9l:3 91— 79 Y2 Cell or Work Number S&LI jE I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature DatelI L� ©i APPLICANT SIGNATURE c Signature Date Print Name j ESN jV,C_ hj+gjjZ t j&7 i/AJ Telephone Number.7 F/--? 9S=7 f Vd E-mail permit to: J/1 2 V.;/NEIS ` d-d C,0 . G0 d4 Last updated: 11/15/2018 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval, Section 13—Owner's Authorization I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name l 11/152018 Last updated {