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HomeMy WebLinkAbout0121 GREENWOOD AVENUE ACTIVE TOWN,OF BARNSTABLE BUILDING PERMIT APPLICATION Map oZg ^Parcel Permit# I Health in), sio6(& �(' Date Issued _ 2. 10,( Conservation Division -off Fee ✓ Tax Collector ,� 10 L, f 0 Treasurer v Coro ! S`'7}Ti,' SYSTEM MUST BE Planning Dept. �� !i i; b¢I 4 a4 � LLED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved b Planning Board ° pp Y f 9 NCI, ONMENTAL CODE AND Historic-OKH Preservation/Hyannis . 1'OVUN F EGULAT11%iiS , Project Street Address d � �CecA) wooer s9cif t '-Village Owner, AV 3,4iGE-A, Address J PMJC Telephone fiy (9�� `7-7S Permit Request C oNS (2-JC T- /b X Z z &- gJCA r� 0 > Square,feet:.1 st floor: existing proposed 2nd floor: existing proposed Total new t(C.l Estimated Project Cost 1? o go no Zoning District Flood Plain Groundwater Overlay r . Construction Type d s y `a 36qi►'L Lot Size .l'Z, �-o o s;) F" !7 Graridfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Z - Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes . 9No On Old King's Highway: ❑Yes allo Basement Type: .❑Full Cl Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths:. Full: existing new Half:existing - new Numberof Bedrooms: existing —new' , Total Room Count .(not including baths):existing new �= First Floor Room Count �I Il`Flcrtri� � � ' - Heat Type and Fuel: - Central Air: : isting New Existing wood/coal stove: ❑Yes ❑No Y Detached garage:❑existing knew size Aa h LL 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 ❑No If yes,site plan review#, Current Use Proposed.Use, BUILDER INFORMATION r Name TAMC_ s Inc G-4,9-no Telephone Number. So B ' 1-/3 0 -.2 S® 0 -Address 2.5 g ou E6 nV 4IV" License# it-7 3 R b� 9*AWt 0_4 n��5 0 Zco 4 6 Home Improvement Contractor# 1,,�a 4 3 b Worker's Compensation# &Cg4 UQ - -767 x/Sb 4,n7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO q�glt a/wctf 1-42✓4 FILE SIGNATURE DATE W/ZV/l FOR OFFICIAL USE ONLY = - - PERMIT;NO.—' _ - .. •. 2* y _. ,v -- `., - � '_ , DATE ISSUED; } MAP/PARCEL NO. ADDRESS VILLAGE OWNER'._ :4`•Y ° t 1. t. 4 DATE OF INSPECTION: t t _ a r •FOUNDATION ol FRAME . • r,1 l r INSULATION FIREPLACE` { ELECTRICAL: ROUGH ' FINAL PLUMBING: ROUGH - FINAL GAS: .ROUGH FINAL •� ! , �. ;r r FINAL BUILDING w p i?( DATE CLOSED OUT ASSOCIATION PLAN NO. f•_ J . .T� Zfo .rr \ \ II z Lai~ '*3 Zoo A x z,T,� I certify that this property is located in Flood Hazard Zone C (out- side the 500 year flood) as identified by the Department of Housing and Urban Development (HUD) . Date AloV Zoo, CERTI FI ED- PLOT PLAN LOCATION BA�!�7.9d1. EDWA l k SCALE DATE !Y4V;.i4 2oai LL Reg., �D n�.,�,u,rvey`or PLAN REFERENCE . .. . . . �'�.rs�'�EC►stEaEg��� /� ,�,�,r,�.v.+.� v!�t �':f�� 38 I certify to Cape Cod Bank B+Tr. and its title ins.co. that there are . no visible encroachments I CERTIFY THAT THE E>�/J]; CQ•�/C, Sl or 'easements except as shown and that this SHOWN ON THIS PLAN IS LOCATED ON-THE GROUND plan was prepared under my immediate AS SHOWN HEREON . supervision, DATE .. REGISTERED LAND SURVEypt t Town of Barnstable pEVE l Regulatory Services P�• ti0 Thomas F.Geiler,Director • r $" ASS.MASS' ' Building Division y M $' 039• ♦0 AtEp Mai a Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINQUIRY REPORT Date• 6 ' 3c-) C Rec'd by: � Complaint Name• /'� ��—,o a Map/Parcel Location Address: ee,,? wod Originator Name: Street: zf je,ecJoo Village: A State: Zip: Telephone: � �� 7 7/ Complaint Description: CA FOR OFFIGt USE ONLY Inspector's Action/Comments Date: -7 " _ ®6 Inspector: 7 — `7" o & A -.a Additional Info.Attached Q:forms:complaint um. Board of Bu=kr 'R uiafions ,. Aar% 1301 One Ashbu Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Sh hdale: 03MM970 Number. CS 073855- Expitew 03/14&= Restricted To: 1G JAM U- R MCGRAIII -in WINTERGREEN LANE BREWSTER- MA 0631 Tr.no: 73M ------ .. �sop fanaeeipi and tdonge of adWess notification. ////.m U. a wwj e ts rr Board of Building Re8tt1 one and Standards tz V., One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 132935 Type: Private Cz�orawn Expiration: :0/31/2002 McGRATH POST & BEAM CO JAMES McGRATH 259 QUEEN ANNE RD. -- - —� HARWICH. MA 02645 - -- -- Update Address and return card.ytsrk reason for chanage -_ Address "' Renewal Employment ._' Last Car ,* .//..: i:.,wuuc�furs►%// r f.ltas:.r�.iu1G � Board orBnildit Aqiihtioaf sad.%mdanis L.icsnse or registration valid for indirldul use oolr NOW WROVEUENT CONTRA=R beforr the impiratioa date. IT found recant to: Board of Building Regulations and Standards Reeishation: 13Z935 One Ashburton Ptaee An 1301 Expiration: 10/SV2tlOZ Boston..Ms.82106 Type: WGRATH POST&BEAM CO.JAMES WGRATH 259 QUEEN ANNE RD. � ,..� j___ __/1- 4k— Z7— - HARMCH.MA 02645 fldmiootratar ` Not valid withoutstgaature Suggested.Affidavit for Home Improvement Contractor Permit Applicatlou For oma Use 0* NAME OF CriY/TOWN Pasmlt No. 1>.te AFFIDAVIT Home Improvement Contractor Imo► Supplement w Permit Application MGLG142AMRuittttbudw teeonsttaaimmkerat'm t om°1O �t t. �l.demdition. or eottstrttetion d as stdditiorh to ast►ehtr�seate oNaerooeoaied bn7dtar aot m iotst age bat not mar than fourdwdhmt umts_or to structures Which am sdaoett to suds t+edeethe A or bnldint'be dose by N*Wen d aomoaoes.IrA h ors M CWgXWM Sioag-;b 01ha . tagUKCMCW.L / Type of wort: ConsiyvG-hon C� P05i T 6e�� Est. Cost, Address of Wok/v Owner Name Date of Permit Application: I hereby certify that: Registration is not required for the following rcason(s): g _Work excluded by law _Job undcr S1.000 Building not owner-ouvpicd _Owner pulling own permit Other (specify) Noticc is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED . CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 1 s2A. Signed undcr penalties of perjury: I herebv apply for a permit asWMild- �,t r. OQ 7�1 Date PIAL&#to tractor a e Registration No. 77 r . OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property. Datc Owner Namc The Ca nwoon vats of m imba.,as".s .s.• t t ' itdeaf t na'atC �ttrsnian• 0 1 am a homeowner p:rfamb g all wot mysrJf p 1 am a sok propriaor and balm so otle vacidog M mly capachy i am an"Upliwa irowim$workers' ittgl!bt®!n► ON this M cz L05L &-a rely I,I,IG! n iS ra7,Q 7 7/ t-= ' issorawrr cw. , 4 — _6jX KJV !am a sok proprietor.oettersl eontcactor,or tsotseoartaer(stack ttetq)sett!ISM hind the CoManors fisted bekw who have the following workers'compensation polices: roinnaor namr: :Arirrcc• - - -nsur_anrr co. nnlirr>g •-+ - :•r- r.. .ems+..�A Tea- yr-e�srr_+-sir�,-�e_}��s- _ f • �.... .. ..-...M-.. -1• _ _ � ._.+�.._. L.�.��•fit_ �__� i.i�"` f���l- -�l� ; .. .y.:���� . .. �mjl inv"-I n1r: arldra•ar • Mane 1r- met, - .r.ra. ::warhaddi{1gWlshedilnttisufepr_�_•:. :1'r._.__.Z.:�_.r.�y�e�.r`ty�FFIr �a •��:•�;! wv.a,"- +.+T....+�:: ailrrr to xrrwrc cnvt rare as trcgaired ttttder U-nim 2m aRIM M eao ho0 to dwiMPOWM t=ainhud poaatfM at a am up to Sr300.R0 aftwar ,.or.ran'itp soa ReD as en moskio ie 1!e loan o[a Si OT�1'01tDC tMtrER scat w flee of SIM.tltl a day tt«aiasa ae. t aaaerwad that a cop.of this>tatr rnt twac hwmwldcd to the bMw sf iw " boas lit DLL forcenrapt%r:W aahm . ::o ltrrfr ifr r�t !'r t t �eatr pevaided aiaar its uttrr�d av„srtt ' ��enature ` —' ��per•, _ _ Print �� *aunt:ti_ •E'otf cat mr unla da Out.trite in tbi%arcs aw he Catapleted by city or was*WsCW + �. eih 4r Inttp• Q ^ ngpbdt M�nincest [-i r4btl it iwtardtate teattaa�is required (]4eemrae heard a%rketotra'a()!lies 01lcahb IN"norrrwt t- euataet Itesysat pl+ow!P.- ,o-.= nlAibrr f C�2iS_RLO=I027 SDP'zL"T-SOR ?LS SL PRl.NT: / 1,: JG: LOC%ION r _ ' cn:is_aJc=zoN sUF:.zW-IsGR ==cr:isE D 13 P�o2 i,_C_2+'SED DESIGNES (IF ...___._-_ cc: o =Ce__ - =e-_--3-' �C.. -�. C •v- ..Svc�� �.�.�CC C _ Ec _. _ _._- r �._aC zt- Cn-C?---C^ c_ _c_c-_C:� =a�G-_ ► :e- - ^o`=i _._t re Tr ..gip eve=—_ Gam:. G.--�».. . L.. S V«e-: --_-_ - _- - - � �ilCCe=SGT ��Cemse on -pP- - nTG -`."' =_��-..�_ .. \..L^..:_C.L-.iC•..-:L�.. -Cr 1o_er'-•--V-- rn ac=::i-...� rE --e -Zv_= ,c Ccce. I =under: =mac ��___, Sec_-O. 1 109 . . _ 1: .. _ _ _ _"e__-_C c_ i PLOT PLAN! FOR LOT if Indicate location of s=ase or acce:cry buii -- Ad&d=with chaired How Se++esaSe &sr=al(cmpool) ED I(Los..................... fbutsc'r r::-c s j Lot. Rea:Yard ................... i I ; a Lr d-i: : I ............... cicr ............ image) I / (14--me of r-eet) . + L-dorr.=tioo , Supplied by �!a-i- Nae ri Foin: I , LaT �3 9 /2 zoo s¢± \ A 0 S I Fc�c� X 4!>T I certify that this property is located in Flood Hazard Zone C (out- side the 500 year flood) as identified by the Department of Housing and Urban ' Development (HUD) . ` Date f 2 ! 98 CERTI FI ED PLOT ' PLAN �P LOCATION BA2�s!�ST.9dGE C.�f�/�Arv��i s� aro�' EDVV �. SCALE /,r=3o.�.... DATE Y y.. PLAN REFERENCE . ^!GT Reg. n�o.ga��e `.�� . .. . . I certify to Cape Cod Bank Mr. and its title ins.Co. THE LOCATION OF THE ORIGINAL DWELLING that there are no visible encroachments SHOWN HEREON ,EITHER WAS IN COMPLIANCE THE LOCAL APPLICABLE ZONING or easements except as shown and that this INITEFFECT WHEN CONSTRUCTED (W THBYLAWS plan was prepared under my immediate RESPECT TO HORIZONTAL DIMENSIONAL . supervision, REQUIREMENTS ONLY),OR EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER M.G.L. TITLE VI1 ,CHAPTER 40A,-SECTION 7,UNLESS OTHERWISE NOTED OR SHOWN HEREON. r tr+Ea• The Town of Barnstable Department of Health, Safety and Environmental Services ` wqrafrAMMl Building Division 1 a�� 367 Main Shoot,Hyannis MA 02601 Office: 308-790.6227 Ralph MCmssen Fax: 508 790-6230 Building Commissioner Home Occupation Registration Data: zoNan=. Address: 4?/ilkv 411 rl Vdlagem e of Busit. i /l4 r "/(9/U �NJ�iU - �'P MaPI . 24TENT. It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 44A of the 7 do ordinance,provided that the aztivity shall not be discernable frout outside the dwelling: there shall be no increase in noose or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above nmmnl residential volumes;and no increase in air or groaandwater poSurtion. After registration with the Building Inspector,a customary home aecaipation shall be permitted as of right subject to the following conditions+ • The activity is carried on by the permanent resi,;~of a single family residential dwelling unit,located within that dweilingtm t. • Such use occupies no more than 400 sgquee feet of space. • There are no external,alteration to the dweftwhic h are not customary in residential buildings,and there is no outside evidence of such use. • No traffic wall be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive mnterials,in excess of normal household gtaaatimes. • Any need for panting generated by such use shall.be met on the same lot containing the Customary Home Occupation,and not within the regarired fimt yaard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pukarp truck not to exceed one ton capadty,and am wAler not to exceed 20 feet in length and not to exceed 4 tires,parked an the same lot containing the Cwtomary Home 0caipation. • No sign shall be displayed indicating the Cua Haut ry Home Occupation • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included: • No person shalt be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1,the undersigned,have read and agree with the above restrictions for my home oaupation I am registering. Appdcam- `�Gam- Hate: ®D(J Homcoe.doc TO ALL NEW BUSINESS OWNERS Fill in please: APPLICANT'S ® ® I Ilk YOUR NAME: A411" BUSINESS YOU HOME ADDRES �a G,e �e �J w,,�y )c/wve TELEPHONE .; Telephone Number (Home)�z�i� NAME OF NEW BUSINESS % �1L ZEY4 1(-,gejYPE OF BUSINESS z ,9cP IS THIS A HOME OCCUPATION? V< ADDRESS OF BUSINESS %�2 I 17 feN nled� Lie'. /iS 0 4UZ-e/ MAP/PARCEL NUMBER --�a2 ,& Z When starting a new business there are several things you must do in. order to be in compliance.with the rules and regulations of the Town of Barnstable. This form is'intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall). 'S 1. GO TO BUILDING INSPECTOR'S OFFICE (4TH FLOOR TOWN HALL) This individual ha en 'nformed of any permit requirements that pertain to this type of business. Authoriz S' ature COMM NTS: Q v o 2. GO TO BOARD OF HEALTH (31113 FLOOR TOWN HALL) This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature y COMMENTS: 3. GO TO CONSUMER AFFAIRS (LICENSING AUTHORITY) - (3RD FLOOR SCHOOL ADMI ISTRATION BUILDING) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature 66MMENTS: After obtaining the required signatures you must return to the Town Clerk's Office to obtain your business certificate (cost $20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - It does not give you narmiccinn to nneratP - vnie miigt net that thrminh mrnnietion of the nrnrecceq frnm the uarinem danartments involved. R �4ssessor's Office'(I st floor) Maa r7l,)-Ijp ,q Lot 10 G`'�-� Permit# c3 6, - �q3 • - -- ) U .Y Date Issued ✓� XBoard of Health(3id floor tw �, En in rip ee Dept. Ord floor House# 'IiWo � P n D-ag, r flei� mi .•�td' '� � : �rvaree[a, _ NAM c p e Plan-A y dv a ninoard 19 (Applications 8:30-9:30 a.m.& 1:00-2:00 .m. �iv ;a°. TOWN OF BARNSTABL A Building Permit Application Project Street Address za z Village Fire District t Owner 44g, I �"L Address n Pnl/�/� ✓ i S Telephone 7 7 02 O Permit Rc uest: E Zoning District Flood Plain Water Protection Lot Size Grandfathered Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Existing Information Dwelling T__e:_ Sin le Family Two family Multi-family Age of structure Basement type Historic House Finished Old Kin 's Highway Unfinished Number of Baths No.of Bedrooms Total Room Count(not including baths) `� First Floor Heat Tyne and Fuel /t�'P/X` i �l Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds / Other Builder Information Name Telephone number Address License# Home Improvement Contractor# Worker's Compensation # 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 Proiect Cost !r Fee ©. U o / SIGNATUREI./' DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T �r; 9 3 FOR OFFICE USE ONLY f 4/13/95 3q•6#-1' 289. 102 ADDRESS 121�Greenwood Avenue VII.IAGE Hyannis a Marilyn Baker OWNER DATE OF INSPECTION: FOUNDATION FRAME 4* INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL + PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL FINAL BUILDING: _ 1 DATE CLOSED OUT: ASSOCIATE PLAN NO. + + t I I I I I 1 I I � • + I ! I ` 11%02'9� li:02 V6177277122 DEPT IND ACCID Zoo] CatiunoiZU/PaCt{L o/ �Wa.66aclut-letf ' aUaPartineitf o��nc�u�fria[�cciden� 600 INcr ton s'fm f James J.Campbell &ton, Mm.LdA 02 f f f Commissioner Workers' Compensation 'l tsurance Affidavit eaoe�pamirrce� with a principal place of business at: (may'(srapiziv) do hereby certify under the pains and penalties of perjury, that: O I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Humber () i am a sole proprietor and have no one working for me in any capacity. () I am a sole proprietor, general contractor o homeown (circle one) and have hired the contractors listed below who have the following coo ers' compensation olicies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number O I am a homeowner performing all the work myself. 1 t:nder<_tand that a copy of this statement will be fone.zrded to the Office of invesdrations of the DIA for coverage verification and that failure to secure ccve-age as recaired under Section 25A of MGL 152 can lead to the imposition of criminal penalties eonsistine of a fine of up to S 1,500.00 and/or cn years' impriscnr-ent as well as civil penalties in the for:of a STOP WORK ORDER and a fine of S 100.00 a day against me. - Signed this /� /�� day of l 19 JJ� Licensee! rmittee Building Department Licensing Board SeIectmens Office 3 76 �1/ Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION /a - Number Street address Sec ion of town "HOMEOWNER" R 77 „713r Name Home phone Work phone - PRESENT MAILING ADDRESS City town 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: Persons) 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 Off icia on a form accapt'able to the Building Official, that he/she shall be responsibl for all such work performed under the building ermit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the S_ ta 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 proce ure and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL 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 OWNER' S 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 Home Owner engages a person(s) 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 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 " wner� actin as supervisor is ultimately 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. K NO- The Town of Barnstable ' �eS Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT. HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,_ improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: �� C VC, Cost Address of Work: Oa-rier Name: 4,00vj Date of Permit Application: I herein,certifv that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner-oocupied Owner pulling own permit Notice is herebv given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS 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 hctcby apply for a'permit as the agent of the oumcr: Date _ Contractor name Registration No. . OR Date Owner's name 1 /1 V ' r r l+ �f t¢: r% b f 5 'b i0 .� w101S �ncW 1p� 1 AwAo - s _ d„4 Fr. FAIM d s� ,I% it of _ _. ITT CA Cr, Alf- r w6AD - 1a �C£S X f x6 Goo "T, Y WInod TO r l.' iAs o-ab-oi - s - 5 u B �ad�'1�►� w�1is - - . - . 1 Tm- I I" .-M p IT O• --- --- il''T.IAd Ag t ................... 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