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Home My WebLink About0024 CHASE STREET i C �s , s � _ _ �r � __ __ � �, - - --- ___ _ ___-J e 1 'i r 4 r /�. c^� "`—� l J ' � 1 � : -� � Q 316 R Assessor's Office 1st floor) Map v Lot 2 t Permit# Conservation Office Oth floor) i'��?lr►'l i Date Issued 11 719Y Board of Health Ord floor - i Engineering Dept. Ord floor) House# °4 � Planning Dept. (1st floor/School Admin:Bldg.): 's R MNIKA NUM Definitive Plan Approved by Planning Board 19 '639. �O AA/S (Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.) TOWN OF BARNSTABLE Building Permit Application Proiect Street Address oZ`t CY*sE .5e Village R`fp tNN b S Fire District HY6,ulji5 Owner GUIC U`,-I�ivl 12- 6 ,yiCCEAt1 Address c;LS- ChfA5E' Si. 14 PePWV/S Telcphonc '771-96 8'0 Permit Request: (52Q4 Zoning District /! C Flood Plain Water Protection Lot Size hC,gF— Grandfathered Zoning Board of Appeals Authorization Recorded Current Use � S i l>EaUWAIL Proposed Use S?gmg Construction Type Woo h� R'- /ME Existing Information Dwelling Type: Single Family Two family Multi-family Age of structure 7 U fi X25 . Basement type 1---�buge-b caycxtrE Historic House Alp Finished Old King's Highway- !�Z4 Unfinished YES Number of Baths o1 No.of Bedrooms .3 Total Room Count(not including baths) & First Floor Heat Type and Fuel Oi(, F1'KE'D B LE/Z Central Air Fireplaces —" Garage: Detached V65 Other Detached Structures: Pool Attached Barn None _ Sheds L'cs Other Builder Information Name Telephone number Address License# Home Improvement Contractor# Worker's Com usation # 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 go Project Cost Cad .00 Fee ,�/�, — SIGNATURE - DATE Il'l7�/ BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T FOR OFFICE USE ONLY # 37246 ADDRESS 24 .Cfiase Street VH LAGE Hyannis OWNER WILLIAM R. QUILLEN DATE OF INSPECTION: `- FOUNDATION - Q Ian V `�� -�1' 1� /� I • FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING: DATE CLOSED OUT: ASSOCIATE PLAN NO.- 11;02.9a 17:02 'Z36177277122 DEPT IND ACCID e001 t{�' _:� �."ccc;:.i��un<<-r,•ai i�l c;�'/ i i"/cz�jczC/•t/rs�(�Ll,� — �J�a�tnten�o��ndu�tru��cccde�i 600 t/Vu�&...�tnRst James J.Campbell [?osfon c�1ac 5= l: lta 02f 11 Commissioner Workers' Compensation insurance Affidavit (aoecseeiQamir�eel with a principal place of business at: - I� do hereby certify under the pains and penalties of perjury, that: Q 1 am an employer providing workers' compensation coverage for nnr employees working on this job. Insurance Company Policy Number 0 1 am a sole proprietor and have no one worl4ng for me in any capacity. 0 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number- (v� [ am a homeowner performing all the work myself. s-,enlent x-ill be ter+:aced tc tf:e Office cf lnvesjgadons of&-e DIA for coVerzge verification and that tilu.e to severe cc.erage a<rEc;!d•-EC,Urger SCC::On 25A of MGL 152 c--c le2c to tM inp6tion of cn iminaf perat;es cor,;s n¢of a fine of up to 51,500.00 an&cr cr.= )'E�:S I(T7pfI5C'.^En; µell 2S Cr✓ii pEnaitle:in the fcr..cf a STO P WORK ORD Eft and a fine of 5100.00 a day against mc. Sign -d this I 94- day of 19 I nseelPermitt Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TOWN OF. BARNSTABLE BUILDING PERMIT 1# s � � eJtR y �1 '•.••:-.+-rya—>r't+ l I r jG'co* pty a tw t.),9 NtAOtRS. 1 l.�- 1'1'L�Iil •1� 7 t,•vr.�y eO G w nQCII .ir (.. � G pExlTt•14 is,rL. �•I .-•...,__ ....._ _' __ �.. N•�rH IxV 1"3. cot+y lot dxly"I.1G . P(A RIy -. 1 � - • i a >. O P.FT]CIDOM I� I I _ I t7-V- 4j ML _ f 1 O I O O ,)r3ro a 7l r '-l/9 v /cv ry•3fq L"_. `s 6:L Y�9% )V'Ar.v d3'�c .tea,— _ -Jv'ddD FLOOR ADLITIOAJ-Fb4 7DA4 Mn1EoS —" nF stt r�De� •PPAoveD ev: L/ —7, F'—R PLAJ_- ey. SngaeJ/N Al en1F- =eNJsoJ 77d•4'47Y ._ _— - w•tvw Nu.ecc BUILDING SPECIFICATIONS ADDITION - 100 CHANNEL POINT ROAD, HYANNIS, MASSACHUSETTS LUMBER All construction Grade "A" kiln dried spruce; Maibec clear white cedar shingles on sides and back. All framing to meet or exceed Massachusetts State Building Code. ROOF Maibec "extra" white cedar shingle roof WINDOWS High performance, thermopane, vinyl clad windows by "Andersen" with screens attached. Two (2) "Velux" skylight windows installed as per plan. ELECTRICAL All electrical work per code with 100 AMP service. Smoke detectors are included as required. Two (2) recessed lights and exhaust fan installed in bathroom. Telephone and television jacks to be installed in bedroom. PLUMBING One full bathroom as per plan with Fiberglass tub unit. "Mansfield" or equivalent faucets installed. HEATING Gas forced hot water heat to be installed and added to upstairs zone. INSULATION Three (311) inches of fiberglass batts installed in exterior walls and underneath floor. Six (611) inches of fiberglass batts installed over ceiling. Roof vents and louvers included for ventilation as needed. BATHROOM Bathroom includes hardwood vanity, minimum thirty (3011) inch. Thirty (3011) inch mirror will be installed over vanity. Five (51 ) foot linen closet to be installed in bathroom as per plan. Page 1 \100CP.spc October 27, 1994 BATH AND BEDROOM FLOORING Bath floor to be white, four (411) inch "Potters Touch" tile, $6.00 per square foot installed. Wall-to wall carpet installed in hall and bedroom floor, selection from Cape Cod Carpet, $20. 00 per square yard installed. INTERIOR DOORS Six panel Provincial solid wood door with colonial casing. INTERIOR DECOR All windows trimmed out with two and one half (2 1/211) inch colonial casing with pine sills. 1" x 5" baseboard with base cap throughout. Woodwork and door are primed and painted with antique white semi-gloss. Walls are painted on off-white flat. The ceiling has a white finish. EXTERIOR PAINTING All trim sealed, primed and painted white. All white cedar shingles to remain natural. EXTRAS AND CHANGES Any and all modifications to above specifications must be authorized by a written change order signed by both Seller and Buyer. Price will be determined by Seller on a "per plan" basis. Seller is not responsible for changes unless a work order has been signed. Page 2 \100CP.spc October 27, 1994 TFl[T The TwN 307 Main Strc,:t,1i)-2miis MA 02601 Ofoe: SM-790-6227 fi Fa�c 508 775 3344 Bui7dingCpmmissione, For office useoniy Permit no- Date AFFIDAVIT HOME IMPROTCCOPTIRACPORLAW SUPPLEMENTTO PO IITAPPUCAZI N MGL c I42A require s that the"reoorrstrvction,aitaatioras,rem, tion,ttepaii�modaaQatioa, .'_ imprOvernent, rern( al. demolition,or omstruction of an addition to any ping ow= building containing st least one but not more than four datlling units or to stYtreOMM which ane acUaccnt to such residence or building be done by re&cn:d contractors,azth certain Cx0eptions,along with other rcq ts- Type of Work:-bu I dQ -add.2^�C 4y n 4 Est.cost Address of Work;:__,,J� �'IQ.,/ r)d Owner Name: 1 f 1 nmaj)__ Date of Permit Application_ I hereby certify that: Rcgistration is not required for the folloWInf rr2son(s): Work<xcludcd br taw Job undo SI,000 Building not ou-ncr-occ upicd --L,/_O�,ncr pulling ovzi permit Voticc is hcrcbv gi,%cn tk t: PULLING THIEIR 10-WN PL-P,-jT OR DEALP G XVTTII U,\-REGISTERED CO,-TRACTORS FOR APPLICABLE HOB T`✓.PRO�i`•�1\i �:'O�is DO T;OT HAN ACCESS TO Tj—jE A.RBTTR.<,TION PROGRA1,;OR GU/&kNTY MND 1;GL c. 1<2A SIG'�ED UDDER PENALTIES OF PERRIZY 1 hcrc--\-2pp1t'for 2 l? J?Tiii 2s ilic 2Zcni cf L.c Dzic Contrcor n2rrc Rcsisuacion No. OR 1241 D2tc OAncr's n2m4C o ,VV�; 7� ii ` \ ! \. 0 PREPARED FOR 1 � CFR T/FI E D PLOT PLAN N1.1 L5 1`� LOCATION, SCALE, �"- 2� DATE: -1' " p RE`f ER£NC£ L07: l P. B. 331 L .C.P. �, - h1a�' r1;►Ji t 1�1►.� ��c+sj` lAr�.f.' FL 00D ZONF' At i C F: .F�.r+� I. i'.,Co� II•.l G_' 7.c% .J, ' , I H£RE8Y' CERTIFY THAT THE BUILDING oA�M�s,�., SHOWN ON THIS PL AN IS L 0CA TED ON THE GROUND AS SHOWN HEREON, AND THAT I T �a S � � CONFORM TO THE ZONING IN W. . BY- LAWS OF rH£ RUMBA TOWN OF ��1 C�� I WHEN GONSTRUCT£D, t-�orGJC7 NO, 35V9-1 WELL ER d ASSOCIATES 714 MAIN S Th£E T YARMOUTH, MASS. DAT '� TOWN OF BARNSTABLE BUILDING DEPARTIMIENT HOMEOINT'ER LICENS Please print. l , DATE zI J 4 JOB. LOCATION I DO . ISO yt�' ► a--� rl S Number Street address Section of`-town- "HOMEOWNER" Name Home hone ; P Work phone-= 77 - PRESENT MAILING ADDRESS .77 K, City town Stat Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less -and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a on a form accept two-year period shall not be consideredd -a homeowner. Such "homeowner" shall submit to the Building Official o e Building Official, that he/she shall be res able t th onsible for all such work erformed under the buildingpermit. p (Section 109.1.1) . The undersigned "homeowner" assumes responsibility for compliance with the Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she wil4cOm y with i ocedures and requirements. HOMEOWNER'S SIGNAT APPROVAL OF BUILDING OFFICIAL 000 Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. HOME The code state teat : i.o.aL 0,;::r_ : c«orming work for which a building permit is required shall be exempt frcm the provisions of this section (Section 109. 1 . 1 - Licensing of Construction Supervisors) ; provided that,.if Home Owner engages a persons) for hire to do such work, that .such Home Owner shall act as supervisor. " . . Many Home Owners who use this exemption are unaware that they aiew=zssuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for .licensing Construction Supervisors, Section 2.15) . This lack,,Of ..awarenes often results in serious problems, particularly when the Home Owner. hires unlicensed persons. In this case our Board cannot proceed against'.the inlicensed person as it would with licensed Supervisor. The. Home owner 'actin as supervisor is ultimately responsible. 4 To ensure that the Home Owner is fully aware of his/her. responsibilities,'- man communities require, as part of the permit application, that thetome.-.Owrier certify that he/she understands .the responsibilities of a supervisor. - On the last page of this issue is a form currently used by several towns._ Yop ,may care to amend and adopt such a form/certification for use 'in yo ur communit y.it . • _ Y . t UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE I USE TO AVOID PAYMENT ' OF POSTAGE,$300 I Print your name, address and ZIP Code here j Town of Barnstable Building Inspection Division 367 Main Street ` Hyann sa,�MA 02601 HIM III sisli::il::::::If::li:l:f::li:::l:l,I::Ilil SENDER: y • Complete items 1 and/or 2 for additional services. I also wish to receive the N • Complete items 3,and 4a&b. following Services (for an extra v U) • Print your name and address on the reverse of this form so that we can fee): > 47 return this card to you. > • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address does not permit. � M • Write"Return Receipt Requested"on the mail piece below the article number. �• p q p 2. El Restricted Delivery y LThe Return Receipt will show to whom the article was delivered and the date v c ivered. Consult postmaster for fee. d 3. Article Addressed to: 4a. Article Number _d P 375 771 618 Mr. Thomas B. Powers 4b. Service Type � $ 100 Channel Point Road ❑ Registered El Insured N Hyannis, MA 02601 1 ertified ❑ COD H W 26 Exp ss Mail ❑ Return Receipt for z 0 Merchandiseo Q- 7. DleuoDeliver,r 0 5. Signature (Addressee) >= `-8:``Ad r-,espee's Address(Only if requested Y Z d fee is paid) Lui S' ature (Agent) 3 0 P9 Form 3811, Dece r 991 *U.S.GPO:1993—W2414 DOMESTIC RETURN RECEIPT U' CE - EL - 5 - IMPOR -TANT NOT ALl_JMIr,JUM ALLOY 8c TEMPER 6063 --T6 FRAME FINISH : ( DURACRON STANDARD) ❑ PPG WHITE ❑ PPG QUAKER BRONZE ❑ MILL El CUSTOM ! GLAZING: f -�— -- SLOPE; ❑ TEMP ./TEMP . CLEAR ❑ TEMP . /TEMP . BRONZE TINT ❑ TEMP ./TEMP . S . C. B . R . C7 TEMP ./LAMI . CLEAR ❑ TEMP./LAMI . BRONZE TINT ❑ TEMP ./LAMI . S . C . B. R . ❑ S P E C I A L ALL GLAZING TO CURVES ; ❑ TEMP ./TEMP . CLEAR BE 7/8" L. G . U . # ❑ TEMP ./TEMP . BRONZE TINT ALL INNER LITES ❑ TEMP ./TEMP . S . C . B. R . TO BE CLEAR ❑ SPECIAL __ VERTICAL; ❑ TEMP ./TEMP . CLEAR ❑ TEMP ./TEMP . BRONZE TINT ! ❑ TEMP ./TEMP . S . C . B. R. ❑ SPECIAL 4. ALL FASTENERS ARE #300 SERIES S.S. OR ZINC PLATED 5. ALL COUNTERFLASHINGS AND CURBS BY OTHERS 6. FLASHING IS SUPPLIED BY SKYTECH IN 10' -0" MAX. LENGTHS WITH FINISH TO MATCH FRAME. FIELD CUT TO SUIT. 7. ALL GASKETS ARE KEYED SCR (SILICONE WHERE . SPECIFIED) OR NEOPRENE SPONGE. 8. SITE AND BASEWALL DIMENSIONS MUST BE HELD TO d t 1 /8" TOLERANCE. 9. CLEAN ALL SURFACES PRIOR TO THE APPLICATION OF SILICONE SEALANT. CAREFULLY SEAL ALL AREAS CALLED OUT ON THE ATTACHED DRAWINGS AND ALSO IN THE INSTAL— LATION MANUAL. 10. PRIOR TO PREPARING THE SITE TO ACCEPT SUNROOM PLEASE REFER TO SKYTECH SYSTEMS SUNROOM INSTALLATION MANUAL FOR PROPER PROCEDURES FOR INSTALLING THIS UNIT. IT IS j IMPORTANT THAT YOU READ THIS MANUAL CAREFULLY;..... . PRIOR TO INSTALLATION . 11 . O /A UNIT DEPTH IS TAKEN FROM OUT OF SILL MEMBER TO I BACK OF RIDGE MEMBER. THIS DOES- NOT TAKE INTO AC— COUNT 2X RIDGE PLATE OR ANY DESIRED SETBACK OF SILL MEMBER. (INSTALLER TO MAKE ALLOWANCES) i 12. O/A UNIT HEIGHT IS TAKEN FROM BOTTOM OF SILL MEMBER j TO TOP OF RIDGE MEMBER. THIS DOES NOT TAKE INTO SEE DETAILS ON ACCOUNT BASEWALL OR 2X MUD SILL. (INSTALLER TO MAKE FOLLOWING SHEETS t ALLOWANCES) 13. O/A UNIT LENGTH IS TAKEN FROM OUT OF SILL MEMBER TO OUT OF SILL MEMBER. DOES NOT TAKE INTO ACCOUNT ANY DESIRED SETBACK OF SILL MEMBER ON WALL. (INSTALLER TO MAKE ALLOWANCES) 14. VERTICAL MUNTIN BAR LOCATIONS ARE TAKEN FROM 'TOP OF SOLARIUM SILL TO BOTTOM OF HORIZONTAL MUNTIN BAR. i 15. SLOPE MUNTIN BAR LOCATIONS (ARE AS FOLLOWS) l A = POINT OF RIDGE MEMBER TO TOP OF MUNTIN BAR , B = TOP OF MUNTIN BAR TO TOP OF MUNTIN BAR. 16 . IF YOU ARE UNSURE OF ANY AREA OF 'THE INSTAL— LATION DO NOT CONTINUE, CONSULT YOUR LOCAL SKYTECH REPRESENTATIVE TO ANSWER ' ANY QUEST ONS YOU MAY H,'\',:'E. 11/02/94 17:02 $6177277122 DEPT IND ACCID Q 001 �- (f0rramos2cuea1t4 0/ Ma,6Jac1zuJetb ' alJapartme►tt o��ndu�tria�,�'dcci�nf.� - 600 t/VaInryt..Street .lames J.Campbell U2oaEort, Mmiackajalb 02111 Commissioner Workers' Compensation Insurance Affidavit with a principal place of business at: C 6(65 E 5 . Alyn4uVyi S , of 6 • da 6 a 1 (Cky/seuc/zip) do hereby certify under the pains and penalties of perjury, that: () I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number () I am a sole proprietor and have no one working for me in any capacity. �x) I am a sole proprietor, general contractor or meown (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number () I am a homeowner performing all the work myself. I understand that a copy of this statement will be forwarded to the Office of Investigations of the DIA for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties consisting of a fine of up to$1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. Signed this - JG day of A ol/e44,13t,2 , 19 4q- -JA Lic se /Permittee Building Department Licensing Board Sefectmens Office 7 Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 FILE # x 5088 CENSUS TRACT # CLIENT: a3eo-r,imp DEED BOOK PAGE OWNER : WiHiam Oi7i77in PLAN BOOK PAGE LOT APPLICANT: ASSESSORS PLAN PLOT MORTGAGE INSPECTION PLAN of LAND I N B A R N S T A B L E SCALE : 1"= 40' MARCH 16, 1993 LOT Z17 LoT Z1 Cry 70,00' SHQ LOT Z2Z O.?9 AG.+ LET 107 GAR. LOT Z2-3 I D I I e K WI !I � QI .42.4 2 sue. w i �2 , I I I I I 67.5'deec) (f? Q A4PndA�i CHASE STREET I CERTIFY TO HAMEL, WAXLER, ALLEN, & COLLINS, P .C., FIRST FEDERAL SAVINGS BANK OF AMERICA, AND ITS TITLE INSURANCE COMPANY, THAT THERE ARE NO VISIBLE ENCROACHMENTS OR EASEMENTS EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED f UNDER MY IMMEDIATE SUPERVISION . THE LOCATION OF DWELLING AS SHOWN IS IN COMPLIANCE WITH THE LOCAL ZONING BY-LAWS WITH RESPECT TO HORIZONTAL DIMENSIONAL REQUIREMENTS. THE DWELLING SHOWN HERE DOES NOT FALL iHA �. WITHIN A SPECIAL FLOOD HAZARD ZONE__AS TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE I dl/• JOB LOCATION 0(4 e IMS6` ST_ Number Street address Section of town';:-,.°.; ° "HOMEOWNER" cC1.I u iU,E`tl 71 1-96 cF0 Name ? Home phone Work phone-- PRESENT MAILING ADDRESS a C�14S�c- 57 Ci y town 0�601. State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the buildin permit. (Section 109.1.1) - The undersigned "homeowner" assumes responsibility for compliance with the Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC AL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME 017NE ' `•T R .. EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that-if 2 Home Owner engages a persons) for hire to do such work, that -such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware 'that they are ,assuming the responsibilities of a supervisor (see Appendix Q, Rules and 'Regulations for .licensing Supervisors, Section 2. 15) . This lack of awareries often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against....-the inlicensed person as it would with licensed Supervisor. . ,The. Home"64ner-actin as supervisor is ultimately P y responsible.` To ensure that the Home Owner is fully aware of his/her. responsibilities,`. man communities require, as part of the permit application, that the 'Home -Owner certify that he/she understands the responsibilities of a supervisor. : On the last page of this issue is a form currently used by several towns.. You may care to amend and adopt such a form/certification for use in 'your community. "•Jj' .fa ThC ` O WT1 Of 13 r-r1St ,1b1C l'(��- liilliuiil;! l�l\ 1�lUll 36%Main Street,Hyannis MA 02601 Office: 508 790-6227 Ralph Czti men Fax 508 775 3344 BruTdirtg Commissioner Foroffoe use only Permit no. Date AFFIDAVIT HOME EWPROV£MENf 00NTRACr0RL&W SUPPLEMENTTO PERMITAPPLICAZTON MGL c:I42A requires that the"remnstr action,alterations,remsfron,rq)arq modernization.oonyemion, Y improvement, remrnal, demolition, or construction of an addition to any pre pastutg owner occ*cd building containing at least one but not more than four dwelling units or to structures which are adjac=to such residence or building be done by registered contractors,with certain exceptions,along with other requirements- Type of Work: ?&.1<6b tAWDot77OA) Est.Cost ",SOU .UU Address of work: C.�fdFS E s - Owner Name: (P>I 6&M m v"u 000 Date of Permit Application: I hereby certify that Registration is not required for the foliouing rcmn(s): Work cxcludcd bV 12W L.7' Job under 51.000 Building not vwner-0ocupied �Oaner pulling own permit Notice is hereby gi,.•cn that: OWNTERS PULLTNG THEIR ONVN PER-`•4T OR DEALTNG t\7T'ri UNREGISTERED CONTRACTORS FOR APPLICABLE HOB rWPRO%T'•1z___I`t NVOR}: DO NOT HAVE ACCESS TO THE ARBITRATION PROGRALI OR GUARt),:-n'FLED L','DER 1.1GLc. 1<2A SIGNED UNDER PENALTIES OF PERJURY I hcrcb\•2pply for 2 permit 2s the 2Ecnt c`t`:c oN�-cr: Datc Contrctor name Registration No. OR . Date Owztcr's c u-�e - Ho + f C A � �o T V im i } 1 I rz L-?AA i W N l�J *7'-5 34 s mm E -----y- m z El i o f 0�0 N -TA "'