Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0090 MITCHELL'S WAY
� _ Y ,� i 'I --ALTERNATIVE W EATHERIZATION a6 $ Date ' Town of Bamstable . 200 Main St Hyannis,MA 02601 Re: Permit it The insulation work-at has been completed In accordance with 780CM'R: z7 • co E Agency work performed for Cb ) .Rbgards- C::) Timothy Cabral; President CSL-1054S4 1 SS pICKIN50N STREET I FALL RIVER,MA 02721 I (508)567-4240 I AUBINq'OVEWEATHERiWONOGMAILCOM � I Town of Barnstable Building nAWMAHl.C, Post This Card So``�That it s Visible From;the Streets Approved Plans_Must be Retained on,Job and:;this.Card Must be Kept F M'M R Where a,Cert�ficate of Occupancy is Regwred,such Bulldmgshall Not be Occupied until a Final Inspection has�been made¢ Permit Permit NO. B-18-1402 Applicant Name: ALTERNATIVE WEATHERIZATION, INC. Approvals Date Issued: 05/29/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 11/29/2018 Foundation: Location: 90 MITCHELL'S WAY, HYANNIS Map/Lot 308-012 Zoning District: RB Sheathing: P. Owner on Record: DALUZ,JOSEPH &DELORES E Contractor Name x., ALTERNATIVE WEATHERIZATION, Framing: 1 Address: 90 MITCHELL'S.WAY ° fv; ', C 2 M. HYANNIS, MA 02601 • > •Contractor Ucense 175683 Chimney: E st Description: Weatherization Pro ect Cost: $447.00 , � J u Insulation: �� PermitFe'e: $85.00 Project Review Req: Fee Paid $85.00 Final 5 IN; 5/29/2018 Plumbing/Gas Rough Plu mbing: brig: i Final Plumbing: Building Official Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sixtmionths after issuance. Fi ndnal Gas: All work authorized by this permit shall conform to the approved application theapproved construction documents.for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall bye in compliance with the local zornng bylaws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintain open for pu ic�mIpection for the entire duration of the Electrical work until the completion of the same. Service: r> The Certificate of Occupancy will not be issued until all applicable signatures by the Building 8611 Fire Officials are,providecl on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. . Fire Department "Persons 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 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application I pp anon Number...... I � t3ARN3TABI.E, �f, MAS& Permit:Fee...,,.:.e.l/..........................Other Fee...,............:....,.. abgq.. TotalFee Paid... . ..............................:................ . TOWN OF BARNST��L Ay0 ? PermitApprovalby..,� ........On..:�.. ./.� BUILDING PERMIT C� 19A � APPLICATION SectionI -' Owner's Information "d Project Location:. Project Address 26C 'pillage _,�. Owners Name ;Owners Legal Address f® . ;City State Zip E 1Owners Cell# 77V' V(Y7''l fl E-mail r Section 2 --Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single I 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 1 Rebuild ❑ Deck Apartment ❑ Sprinkler System Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation ther— Specif '2 Section 4 - Work Description ` A,�- 3 Last updated:3/15/2018 Application Number..................................................... Section 5—Detail Cost of Proposed Construction yyU v Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method R MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics [� Wiring ❑ Oil Tank Storage ❑ Smoke Detectors [� Plumbing ❑ Gas n Fire Suppression ❑ Heating System ❑ 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 amusing a crane E Yes ❑ No Section 7--Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section S--Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated:3/15/2018 r. Application Number.,............,... ....................... Section 9— Construction Supervisor Name , is Telephone Number Address A L.0 C c t City fiZ7g A&ev— State,,�JA Zip_N'7„?� License Number 11D5VSy License Type fib Expiration Date — Contractors Email �P�`/u,`�iy�1�JeA 2 ai ctx,@ Cell # I understand my responsibiliti sc� under the rues 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 require 80 CM t e To f Barnstable..Attach a copy of your license. Signature Date Section 10--Home Improvement Contractor NameA1f& 1, ve. jA j l-Za- "�- Telephone Number J '�7_Sid SOU Address -- l Q,rk Sf' City J ?Q AV e— State,J A.. Zip_ Dol7,/ Registration Number !76Z 63 Expiration Date VV,1''2 1 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 b CMR e ow o.Barnstable.Attach a copy of your H.I.C.- Signature I/ DateT �S Section I I —Home Owners License Exemption Home Owners 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 APPLICANT SIGNATURE Signature Date _ S Print Name i Telephone Number �D 7 50r0 E-mail permit to:Q-`YWfitieWea�the�� Last updated:3/15/2018 ` Section 12 •-Department Sign-Offs Health Department Zoning Board (if required) El Historic District Site Plan Review(if required) i Fire Department Conservation 0 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 i to act on my behalf, in all matters rel�t ive to wdJauthorized by this building permit application for: yU � ( dress of job) Signature of Owner date Print Name Last updated:3/15/2018 o� rt � ray Town of Barnstable Regulatory Services AARYSTABi E, :* Richard V. Scali,Director M% ASS. A 00 1639' Building Division ATE1 M A Paul Roma Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, JOSEPH DALUZ , as Owner of the subject property hereby authorize A k -f�ve. W eAihcr zw m, 9�nG to act on my behalf, in all matters relative to work authorized by this building permit application for: 90 Mitchells Way Hyannis, MA 02601 (Address of Job) y- 7 j_y_ Signature of Owner 0 Date t47, Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form. C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information .Please Print Legibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC. t Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type Of project(required): 1.Q[am a employer with 16 employees(full and/or part-time).* 7. ❑New construction In I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]} 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building 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 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp:insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other INSULATION 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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:STAR INSURANCE COMPANY Policy#or Self-ins.Lic.#:0849257 00 Expiration Date:4/4/19 Job Site Address: !26a,& City/State/Zip: r S M4 Attach a copy of the workers' compensation policy decliKafion page(showing the policy n er and ex iration 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 S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. I do hereby certify under t e pains and pen es of jury that the information provided above is true and correct. Si nature: Date: R's X'? Phone#:508-567-42 0 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#: ALTEWEA-01 SNERONHA AZJT�` DATE(NM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 0312312018 � 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 balder Is an ADDITIONAL INSURED,the poiicy(ies)must have ADDITIONAL INSURED provisions or 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(;). 'PRODUCER CT Christine Costa i 458 South Ave.n Insurance Agency,Inc, ( ,Ext):(781)447-6531 FAX No):(781)4474230 'Whitman,MA 02382 ! ccosta masoninsure,com t _ INSURE S AFFORDING COVERAGE NAIL# INSURER A:Evanston Insurance Co. 36378 INSURED INSURERS:Safety Indemnity i33618 Alternative Weatherization,Inc. INSURER c:Star Insurance Company 18023 2 Lark Street INSURER D: t Fall River,MA 02721 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 i 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. _ ILT R TYPE OF INSURANCE ADDL tSUISIR POLICY NUMBER I POLICY EFF POLICY E7CPi LIMITS I A ! X i COMMERCIAL GENERAL LIABILITY I 1,000,000EACH OCCURRENCE 15 1 CLAIMS-MADE EX iOCCUR i C42088 0610712017 06i071201$;OAMAGETORENTEo 100,000i X E ( S(Ea occurrence) 5 6,000 MED EXP(Arvy one rson I S + i NJURY 1,000,000: i E PERSONAL&ADV I I GEN'L AGGREGATE LIMIT APPLIES PER j I GENERAL AGGREGATE 5 2,fl00;000 X POLICY } .�LOC ( 1 PRODUCTS-COMP70PAGG 5 2,000,000 i I OTHER. I g B AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT 1,000,I000! _ r !S ANY AUTO X 6237702 ;04108/2018 j 04/08/2019 BODILY INJURY(Per Persar� 'S i O'ANED X i SCHEDULED AUTOS ONLY AUTOS i l BODILY INJURY(PeraccidwO S — X HI X 1 NpN y y 0 ? (tP OV 2TY DAMAGE AUTOS ONLY AUTO ONLY t�„PBr 9rsadenti 5 A _i UMBRELLA LIAB i X OCCUR I EACH OCCURRENCE 5 1,000,000 X i EXCESS CLA?MS•MAD'c� X ' X OBW7i26S17 0610712017 1 0610712018 '1,000,0001 t E AGGREGATE IS DED [RETENTION 5 I ! i $ ' C SCOMPENSATION 1 AND EMMPPLOYERT LIABILITY 1 i i X STATUTE 1 ERH ' 1 ANY PROPRIETOR;PARTNERiEXECUTIVE Y N ' WC0849257 04104/2018;04/04/2019 1 E.L.EACH ACCIDENT $ 500,00701, I%��.Fig%9Mg%EXCLUDED? [Ai I.NIA' , (kmndatorY 1n NH) i i El.DISEASE-EA EMPLOYEE S- 500.00fl 1 if yes,describe raider —� 500 Ofl0 DESCRIPTION OF OPERATIONS oeow E.L. ISEASE-POLICY LIMIT I S I i I E E I E E i i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Addittomi Ranmrks Schaduie,may be attached if more space is feciWred) ;Action Inc.and NGRID USA,its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary& i ;Noncontributory basis per the terms and conditions of form CG2001(04113),for Ongoing Operations per the terms and conditions of form CG2010(04/13),for i .Completed Operations per the terms and conditions of form CG2037(04113)and Waiver of Subrogation applies per the terms and conditions of form MEGL0241-01(04-11). ;Additional Insured for Automobile Liability applies per the terms and conditions of form SCAOOS(02116). ;Excess Liability is a following form. CERTIFICATE HOLDER CANCELLATION i 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1 NGRID USA j THE EXPIRATION DATE: THEREOF, NOTICE WILL BE DELIVERED IN i ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02461 y AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ai 11 � t ,AW, .. c y 41 �f oy, err"/M 4 W,0 V, e al 11ml t 21 r Office of Consumer}affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, t��chusetts 02116 Horns Improvelrle l ntractor Registration Type: Corporation ALTERNATIVE WEATHERIZATION,INC . Registration: 175683 Expiration: 05/28/2019 2 LARK ST FALL RIVER,MA 02721 r s r` Update Address and return card. Mark reason for change, _. ..__.___---_------_l.I..........,._.f. .. ...,. �lin,�r iiri!r:.i�tt:Fitf�it C�.:,•I:�r7�..t1f3'tt,�cl�;. ' 1 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Oration before the expiration date. If found return to: ionf2g&0an Office of Consumer Affairs and Business Regulation _ 1756w 05/28/2019° 10 Park Plaza-Suite S170 ALTERNATIVE WEA?#iERIZA`GION,INC. n,MA 02116 TIMOTHY CABRAL' 2 LARK ST FALL RIVER,MA 0272i Undersecretary Ot V f3Ut 3>< 8turf: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , Map, 3 0 Parcel P Application # o�J Health Division AUG 1 2016 Date Issued Conservation Division TOWS OF aARn1ST Application Fee Planning Dept. ABLE Permit Fee ��•00 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Q� m�,I ( S as-► 6 Project Street Address 9 O M i +c-kC{ vwx. Village N Yawl n I' s Owner M.M To e D^ V Z. Address C Telephone S0s -7 7(e k O 3 dr Permit Request c1inir1S���t'�io n eKIS?i, riSvlalro,n -Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District J Flood Plain Groundwater Overlay Project Valuati n NTS Construction Type :Lot Size Grandfathered: ❑Yes U No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ 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 APPLICANT INFORMATION- (BUILDER OR HOMEOWNER) Name �e -F' Telephone Number(J4 O 1 ) 7 t 4- b 39 9 Address Q 0 00-540, T 1( License # /02-5"3 Sr Shre,-,JS 6yry ,. MA 0 1 n 57 Home Improvement Contractor# 12 Email ASwee4 01 q,e_ C o w Worker's Compensation # KIC- Q 1St ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C- Awl"C_ n-f- SIGNATURE DATE }� I FOR OFFICIAL USE ONLY 1 APPLICATION# t DATE ISSUED: MAP'/PARCEL NO. ADDRESS VILLAGE OWNER o- - DATE OF INSPECTION: t FOUNDATION r _ FRAME ' INSULATION .T FIREPLACE. k ELECTRICAL: ROUGH FINAL r PWIVIBING: ROUGH FINAL GAS: ROUGH — FINAL FINAL BUILDING -DATE�CLOSED OUT AiSS {-' ON PLAN NO. a � HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: PLEASE READ THIS CONTRACT THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 908 Boston Turnpike Unit 1,Shrewsbury,MA 1545 Branch Name: Boston North Date:7/31/2016 Toll Free 8779033768;Fax 8009863610ME Lie#C 02439 RI Cont.Lic#16427 CT Lic#HIC.0565522 MA Home Improvement Branch No: 33 Contractor Reg.#126893 Federal ID# 75-2698460 Installation Address: 90 Mitchell Way HYANNIS MA 02601 City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: M/M Joe Daluz (508)776-8038 (508)775-5661 Home Address: 90 Mitchell Way HYANNIS MA 02601 (If different from Installation Address) City State Zip E-mail Address (to receive project communications and Home Depot updates):idandbd6(aDnetzero.com Marketing emails will not be sent from The Home Depot. Project Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy,and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installati on")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary(where applicable)attached hereto and any Change Orders(collectively,"Contract"): Job#:(Internal Reference) Products: Spec Sheet(s): Project Amount 9462771 Insulation 9462771 $1,995.38 Minimum 25% Deposit of Contract Amount Total Contract Amount $1,995.38 due upon execution of this contract Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# 9462771 ,included as part of this Contract,sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). 06117/14SA Page 1 of 7 f HOME_IMPROVEMENT CONTRACT PLEASE READ THIS CONTRACT NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time of sign.Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the.event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor, expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law.THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVER OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands.that this Contract is the entire agreement between Customer and The Home Depot with regard to the products and installation services and supersedes all prior discussions and agreements, either oral or written,relating to said products and installation.This Contract cannot be assigned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. You are entitled to a paper copy of this Agreement if you choose. If you consent to an emailed copy,your consent applies only to this Agreement.By contacting sales office(R77)o03-376g ,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement at no charge. By signing below,you confirm the following: • You consent to receive only an emailed copy of this Agreement • You have access to a computer that can receive and open emails and PDF(Adobe Reader Version 10.1.4 or later)formatted documents. • Your email address is correctly listed on the Home Improvement Contract Submitted by: Accepted by: l Sales Consultant Paul F Mclean Customer 6� License Name. Signature: MIM Joe Daluz (Jul 31,2016,1217 PM) (877)903-3768 Customer Telephone No. Signature: Sales Consultant License No. (as applicable) CANCELLATION:CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION Bl DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT.THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE 0 6/1 711 4-SA Page 7 of 7 Board of Bu"ldl g Regulations and "Standrri rds �. License: CSSL-102535 1 ONALD L BURNi TT 31 MARION ROAD MARBLEHEAID M.A 01945 r; ormnis$Ioner 12/06/2016 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 o Boston;MA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �q 51117 iL Address: 1 3 Marion fZ' a ' City/State/Zip: 1P. 'a a 01 q Phone#:- q 7�- Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).*_- have hired the sub-contractors 6. ❑New construction 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 workingfor me in an capacity. employees and have workers' y p �'• 9. ❑Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]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.❑Other comp.insurance required.] *Any applicant that checks box#1 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.. tContractors 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-contractors have employees,they must provide their workers'comp.policy number. Iam 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. Lic. M 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb certify un r the ' s and penalties of perjury that the information provided above is true and correct Si tore: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: The Commonwealth of-Massachusetts _ Department of Industrial Accidents � Office of Investigations I Congress Street, Suite 100 4: Boston, M4 02114-20.17 www.mass.gov/dia Workers' Compensation Insurance Affidavit., 1$uilders/Contractors/tlectricianslPlumbers Applicant Information Please Print Legibly Name (Business/organization/Lndividual): The Home Depot At-Home Services Address: 908 Boston Tpk City/State/Zip: Shrewsbury,MA 01545 Phone#: 508-962-6942 Are you an employer.' Check the appropriate bog: Type of project(required): 4. I am a general contractor and I l.0 I am a employer with 200+ 6. New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have g. �Demolition ship and have no employees working for me in any capacity. cop.employees and have workers' 9. .�Building addition [No workers' comp. insurance m insurance.# required.] 5. We are a corporation and its 10. Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l:[]Plumbing repairs or additions myself [No workers' comp. right of exemption per ti�IGL I2:0 Roof repairs 13 insurance required.] ' c. t52, §1(4),and we have no employees. [No workers' ;��Other /►Su�R"Ft t�✓1 �— comp. insurance required.] 'Anv applicant that checks box'#l must also till 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. .Contractors that check this box must attached an additional sheet showing the name of the sub contractors and state whether or not those entities have ediplovees"-It the'sub=contractors have einvio}ees they must provide'their-Nvurkers'-comp policynum er.-~---"-° - 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. New Hampshire Insurance Company Insurance Company Name: _ Policy#or Self-ins. Lic. 9: WC 015519215 Expiration Date:3/112017 Job Site Address: qU �i 4C Gl2 t y City/State/Zip: Lin fl i s T 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 ins ance coverage verification. 1 do hereby certify under t pa s and penalties of perjury that the informatio�nvid�edabove o is true and correct Si ature: Phone#: 401-714-6 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 Phone#: Contact Person: ; —- =- Office of Consumer Affairs and Business Regulation _= 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 'nt ontractor Registration Home Improvem - - -' Reqistration: 126893 Type: Supplement Card Expiration: 8/3/2018 THD AT HOME SERVICES, INC. ANDREW SWEET 2455 PACES FERRY ROAD, HSC 0 11 r ATLANTA, GA 30339 %r Update Address and return card.Mark reason for change. Address F� Renewal Employment Ej Lost Card SCA 1 Co 20M-05/11 oCJCneaircutel,/:i- 5 nice of Consumer Affairs&Business Regulation License or registration valid for individual use only ry before the expiration date. If found return to: 1: OME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation � Z J% Registration•�126893 Type: 10 Park Plaza-Suite 5170 ' Expifat ft 8/312018'„ Supplement Card B72k A 02116 �tr t , t THD AT HOME SERVIG.ES INCH�`; THE HOME DEPOT,AT-NOME,SERVICES ANDREW SWEET ra / 2455 PACES FERRY ROAD I HSC ? •" ATLANTA,GA 30339 Undersecretary Ne DATE(WADD(YYYY) 0211812015 AC40RD CERTIFICATE OF LIABILITY INSURANCE THII TiF1CATE iS ISSUED AS A MATYEROR N INFOR EGAT VELYI AMEND EXTEND OR ALTERON ONLY AND CONFERS NO TIHE COVERAGE AFFORDED 13Y THE POLICIEGHTS UPON THE CERTIFICATE HOLDER- S IAUTHORIZED CERTIFICATE DOES NOT AFFIRMATtVEL BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( , REPRESENTATVE OR PRODUCER.AND THE CERTIFICATE HOLDER. 1es must be indorsed. if SUBROGATION iS WAVED,subject to IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy( 1 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 ersdwsement(s). CONTACT NAME FAX PRODUCERPHONE I(Arr Nor uARSH USA INC. PAO.ALLIANCE CENTER lL 3011VOK ROAD,SUITE 2400 ADDRESS: NAIC!t INSURE S)AFFORDING COVERAGE ATLANTA GA 30326 ,26387 Steadfast Insurance Company INSURER A: - t6535 t00492-HomeD-CAW-15-17 INSURER B:Zurich American!nsurance Co NSU� 231t41 New Hampshire Ins Co HD A T 4iCME iERVICES.!NC- INSURER C: 23817 OBA THE HOME DEPOT AT-HOME SERVICES INSURER D:Illinois National Insurance Company 2690 CUMBERLAND PARICAAY,SUITE 300 ATLANTA,GA M339 INSURER E INSURER F: CERTIFICATE NUMBER: ATL-DD37a66a614 REVISION NUMBER:8 COVERAGESCE LISTED THIS IS TO CERTIFYNOTWITHSTANDING ANY REQUIREME�75 INS NT, TERM OR CONDITION OOD FBANY COSNTRACO OREOTHER DOCV MENT WITH RESPECED ABOVE FOR E FL THEWHICH TOLICY IMS, INDICATED- NOT'M CERTIFICATE MAY BE IITSIO S OF SUCH POLICIES.LIMITS SHOWN MAY HAVE EB EN-RE UCED BY PAID CLAIMS. HEREIN IS SUBJECT TO ALL 7HE TERN _XCLUSIONS.AND CON sus POLICY EFF : POLICY EXP LIMIT TYPE OF INSURANCE POLICY NUMBER MM,D I MGV00I17 ! 9,000,000 INS � 0310112016�. °03/0112017 EACH OCCURRENCE 'a I i( 04087714-06 I$ A X r•ONIptEEtCWI GENERAL I:IABlL1Tl' 1.�0,000 --- (1PR ISEs(Eri• EXCLUDED I I y:a;UMS-MADE ��OCCUR ! ' s AD IL(MITS OF POLICY;(S i. I MED EXP(AM�� rson) I iOF SIR:VM PER OCC PERSONAL, V INJURY 8 9,o0D.00D 4�1 I I � i ! GENERAL AGGREGATE 3 9,000,000 I I I APPLIES PER: i ( I� II CIXDUCTS-COMPIOP AGG 9,�00. 0;000 GENLAGGREGATE LMIT _� I i P �O- L POLICY 0 _ NBINED SINGLE LIMIT 1,000,00OTHER: 031il2016 031012t7 BA 1 I_(Eaacadenil 3 'AUTDMOB(t�LIABILITY �.BODILY INJURY(Per Person) f 3 '' x ANY AUTO ! I BODILY INJURY(Per accident) S ALL OvuP�m —'.SCHEDULED I I SELF INSURED AUTO PHY DMG PROPERTY DAMAGE S . AUTOS 1I_ I AUTOS I :I - ' -.er.accid NON-OWNED.. ( i—j HIRED AUTOS I;---�AUTOS EACH-OCCURRENCE $ � UMBRELLiI,IAB P OCCUR AGGREGATE EXCESSLIAB CLAIMS-MADE I ! DEp RETENTIONS ! 03101120t6 I11310112017 ;X sTATDTE ER WORKS COMPENSATION WC0155t9215(AOS) — 1,000,000 C AND EMPLOYERS'LIABILJTY Y I.N 0310112016 0310112017 ?_.L.EACH ACCIDENT i IWC0155192t7(AK,KY,NH;NJ,V'1 —�--�" 1 p00,000 C ANY PROPRIErORIPARTNE4rEXECI.TIVE N N I A I 03101/2016 03f01120V i E.L DISEASE-EA EMPLOYE"V 1,00D,000 D OFFICER/MEm ),F7(CLUDED) �i �WC015519216(FL) Conitnued on Additional Page !E.L DISEASE-POLICY LIMIT $ {ides ' :I DESCRIPTION OF OPERATIONS below I I i I i s Schedule ,.may OF OPERATIONS(LOCATIONS/VEHICLES (ACORD 101,Addrdonal;Remartc ,.may he attached n more space Is requlied) EVIDENCE OF INSURANCE 1 ! CANCELLATION j CERTIFICATE HOLDER ` INC.S, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THD AT4IOAfE SERVICES, DBA THE HOME DEPOT HOME SERVICES THE EXPIRATION DATE THEREOF', NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 24M PACES FERRY ROAD I ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc, _ Manashi Mukhetjee ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered mar ACORD 25(2014/01) ks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map-1208 Parcel TOWN OF BARNSTABLE Application # lqq Health Division , r� E Date Issued - Z� E Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 'TIS " Historic ' OKH _ Preservation / Hyannis Project Street Address MAINn Q A 1'� UV N Village 41 Owner - Address q0 W_ Telephone So R " � 1 S SUU I Permit Request V y�CA1 1.f)Z Q AiffJ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District A Flood Plain Groundwater Overlay Project Valuation d Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name NbW Telephone Number �� -�1j,-uZ��6 /� Address 2 License# l zt l- Tw� bar 'M f" 02 A Home Improvement Contractor# 7,S A EmailICu -n( "I VQ��[6 1YAj CrfM (Morker's Compensation # 00,72,5 7 " ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Frodo flew SIGNATU DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER . DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: , ROUGH FINAL FINAL BUILDING } DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable e l�Aory Serv.ic. es e Torm Perm,1wilding Comm sslauer 200 I&in Street Hyutnis k 02601` [ww.town.barnstable<Pia:u:s Offir e :508-862-40 8 Fax: SUB-:W§. 30 Props ' er Must. pee Sign This Section b I�crcby autboziz Loamdn,:y e a r in all t zc�t ve to ork=hwizcd b-y his buildLng pemoit application for.. "'Pool fear es an . r s c - c� EC t. PO& axe not-to be fie:rarut ;,ecfbefoie fki�e AwtLed and L fund', Mspections are performed and acc pte(L a o C'}�r S' :af< k2 t "a - ?P Z' ntt N :print Nam Date , Q:FOI22�15:0}�°;2F.kZE'�fL1�SlSS�ONPC?C�LS: The Commonwealth of Massachusetts Department of In4ustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pliimbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please.Print Legibly Name(Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC. Address:2 LARK ST City/State/Zip:FALL RIVER, MA 02721 Phone#:508-667-4240 Are you an employer?Check the appropriate box: Type of project(required): 1,❑✓ I am a employer with -6 employees(full and/or part-time).* 7. New construction 2.a I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] .9. ❑Demolition 3.0 1 am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Building addition 4.❑.I am a homeowner and will be hiring contractors to conduct ali work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.7 Electrical repairs,or additions. proprietors with no employees. 12.Q Plumbing repairs.or additions 5.n I am a general contractor and I have hired the sub-contractors listed on the attached sheet.; 13. Roof re airs These sub-contractors have employees and have workers'comp.insurance.: p 6.❑we are a corporation and its officers have exercised theif.right of exemption per MGL.c. 14.p Other INSULATION 152,§1(4),and we have no employees.[No workers'comp.insurance required.] , *Any applicant that checks box#1 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. :Contractors 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-contractors have employees,they must provide their workers'comp.policy number. I.am-an employer that is providing wor,.kers'compensation insurance for my employees..Below is the policy and job site information. Insurance Company Name:STAR INSURANCE COMPANY Policy#or Self-ins.Lic.#:0849257.00 Expiration Date:02/26/2017 44 Job Site Address: City/State/Zip1hirdfifu ' Attach a copy of the workers'compensation policy ecl ation page(showing the policy n m r and expiration date). Failure to secure coverage as required under MGL c. 15 ,§25A is a criminal.violation punishable y 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.$250.00 a day against the violator.A copy'of this statement may be forwarded to the Office of Investigations of the DIA for.insurance coverage verification. I do hereby certify: the pain na sl perjury that the information provided above is true and correct Signature: Date: Phone#:508-56 r 2.:0 Official use only. Do not write in this area,.to be completed by city or town officiaL City or Town-Permit/License#. Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ALTEVItEA41 TRAMMZ A . . ou►rE r CERTIFICATE OF LIABILITY MURANCE 3/1712016. THIS CERTIFICATE IS.ISS1ED AS A MATTER WFOR -TION ONLY AND NO RIC,HTS l3i' I TI♦E CTEi�OLt.Tim Cl ffFlC�TE QOES NtiOT 1 ATiVEl.Y:OR NEGA Y:AMEND;..EXTE#D OR ALTER"THE CO�i0. EEt GE BYTt FOL4Gl S :OW TANS CEIFtCA'EE OF IN^ RAEIGE.DOES.N4 C�+ISTITUTE A CONTI?ACT.: TFfEk�t�tfs$ A tCER,ANfl':T.HE CERTIFICATE I Ai�T: #f :cep homer.is an ADDITION IL" Rl D,the Poi ► He endowed. If S T[E?Irk iii AIYED,sll"to the'.tee aad.;coFsd of ttte per►, :p1WICWS mar" act Odowe rt. A st enf.opCONTACT this cert eafe"�Oes aot:co�er cig�stio:N►e Cate tlaJde►fn Iu:of s> M a Wig)• PRODUCER MARL' PRONE Re :&kta.on.t +ce ageAcy.Inc. y 447�531 F7s1�:447 7230 ass S= AV& yr drA"oz38z. ADDRESS me s wsuRER A:•Sc WStIRED 2•LarlrSaet EMRS R B Aitepave Ae On+IAC. C: R ' D: FaR.RWw,MA.02721 WSURER E: . INSURER F COVERAGES CERTIFICATE NUMBER. Reva",MOM THIS':(S TO CERTIFY THAT tHE.POUCiES.:OF fldSi RA,NCE: BELOW:HAVE BEEN ISSUED TO THE[I�tSURED i*t6AB FQR_THE POLICY PERIOD INDICATED NOTWItHSTANDWG At tY REQUIREMENT, TEjW CONDMON.OF•ANY C013TRl�CT OR OTHER flOC;E iT VF,..' RESPECT T,1., H THtS CERTIFICATE MAY [SS13ED OR ItAAY.-PERTAIN, THE AFFORDED BY THE POL'IaM'DESCRMD—HPEIN:ISS.UBJECTTOALLTftETERNtS; E)CCCtiStONS AND CONDFTFONS OF SUCH POLICIES:LIMITS SHO .:MA1'HAVE BEEN REDIJCEE)BY PAID CIAH4F5: INsRj TYPEoE;9mRA im NUIIJ R LTR LOAMLOAMCO AL GENERAL LfABILITY EACH:OCp.iRRENCE $ CLAIMS-MADE OCCUR .g MED:E)CP{Anyoo>3pa<san) Is PERSONAL&ADY INAM 15 GEML AGGREGATE UMITAPPUES PER GENERAL,AGGREGATE. S POLICY JECaT LOC PRODUCTS-COMP/CPACaG :g S OTHER: SINGLEIIMIT $ AUT ILELl"ILITY -ffi fta BODILY tNJPJRY(Per person) .:g ANY AUTO SOMY INJURY OW is ALL OWNED SCHEDULED ALTOSNOMWED ;vPS Is HIRED AUTOS AUTOS g OCCUR EACH OCCURRENCE_ S UMBRBIA'Ui16 EXCESSUAB CLAIMS AAADE AGGREGATE g . . g DED.I RETENTION g WORIG�iS�N STATUTE ER. . AND'EMPillpYERSPLIABILM YIN WC 0849=00 02I26=116 0212WM.7 E.L.EACH ACCIDENT $ 58E1 A ANY:PROPRIEMRIPARTNE S(ECUTNE � N I A OFFICER7M R EXCLUDED?: EL DISEASE-EA EMPLOY SE $ (# cyMN� M, descabe unQer EL'DISEASE:-POLICY UMTT S D "OE OPERATIONS below DESCffiFnON.OFOPERAT1ONSI LOCArAW VEHICLES OCORD 1Q1, Regaft Sehedub,may bs W 14raerespaos is ) • 5 CERTIFICATE HOLDER CANCELLATION OVE DESCR�D•POLICWS:8E CA�iCELLED 1 FORE. SHOULD ANY OF THE AS THE EXPIRATION DATE NC3 Milt. BE 'END fN, Tom• National Grid ACCORDANCE VWH THE:POIJCY:PR • 401Riash�n St ' MA°01681 AUTHORIM ITATM 01.988.2044 ACORD:COW-MAP- All res®r ed. ACORD 2$.{20'Ia1) The ACORD na 0 and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation. - 10 Park Plaza --Suite 5 170 Boston, Massachusetts 02116 Home Improvement Co�ntrktor Registration Registration: 175683 Type: Corporation Expiration: 5/29/2017 Tr# 265489 ALTERNATIVE WEATHERIZt�TION;"If4G: ` TIMOTHY CABRAL • ��----___-- - _ 2 LARK ST —=� FALL RIVER, MA 02721 Update Address and return card.Mark reason for change. _ Address 71, Renewal Employment 7, Lost Card SCA 20M-055111 ��I"�:TIIdJtCJYCG['C!llll.!+�,r•(G[.11.�C/C7/CA:PII. , Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ;A,0 /SOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: `- �#tegistration: j83 Type: Office of Consumer Affairs and Business Regulation eta 10 Park Plaza-Suite 5170 ,;.Expiration:, :5f2933$37. Corporation Boston,MA 02116 ALTERNATIVE WEATHERIZATr TIMOTHY CABRAL 2 LARK ST __�i..�-�.•.:.--_-- __ - 11 t 1{\\ i I o valid wit u FALL RIVER,MA 02721 Undersecretaryt signatu ��-:d tcsnslis 0,;1 j ye A r �)1�81E'REVeFb '�il Co�sstEaner 0880 s.r 1r1! ,.tiY. BOAS— 0'77 Solar0ty March 24, 2016 s C3 Town of Barnstable ATTENTION. BUILDING DEPARTMENT 200 Main Street Hyannis, MA 02601Ln RE: 90 Mitchell's WaY, Hyannis annis f r— ,...n Permit No.: 201507787 Our Job No.: JB-0262135 NOTICE OF CANCELLATION This letter is to certify our proposal to install Solar(PV) at the above- referenced property has been moved into a cancellation status. SolarCity Corporation,and Joseph DaLuz will not be moving forward with the proposed installation at this time. We would greatly appreciate reimbursement for the permitting fees paid, but understand that the town will not refund any fees. If you have any questions or concerns, please don't hesitate to contact me. Thank you for your attention to this matter. Sincerely, - Cheryl Gruenstern Cheryl Gruenstern Permit Coordinator cgruenstern@solarcity.com Direct Line: (508) 640-5397 112 Great Western Road,South Dennis,MA 02660 T (888)SOL-CITY solarc'tty.com %05500.AR M-8937.AZ ROC 243771/ROC 245450.CA CSLB 888104.CO EC8041.Cr HIC 0632778/ELC 0125305.DC 410 514 0 0 0 0 8 0/ECC902585.DE 2 01112 0 3 8 6/T1-6032.FL EC13006226.HI CT-29770.IL 15-0052.MA MC 168572% EL-lZWR,MD HIC 128948111805.NC 30801-U,NH 0347C/12523M.NJ NJHIC#13VH06160600/34EB01732700,NM EE98-379590.NV NV20121135172/C2-0078648/B2-0079719.OH EL.41707.OR C8IB0498/C562,PA HICPAO77343.RI AC0047M/Reg 38313.TXTECL27006,UT 8726950-5501,VA ELE2705153218.VT EM-05829.WA SOLARC'919OVSOLARC'905P7,Albany 439.Greene A-486.Nassau H240971000Q Putnam PC6041,Rockland H-11864-40-00-00,Suffolk 52057-K Westchester WC-26088-1-173.N.Y.0#2001384-0CA SCENYC:N.Y.C.Licensed Electrician.#12610.#004485.155 Water St 6th Fl..Unit 1D.Brooklyn.NY 1120t#2013966-0Ck All loans provided by SolarCity Finance Company.U.C. CA Finance Lenders Licerue 6054796.SolarCi ty Finance Company.LLC is licensed by the Delaware State Bank Commissioner to engage in business in Delaware under license number 019422.MD Consumer Loan License 2241,NV. Installment Loan License IL11023/1171024.RI Licensed Lender#20W1O3LL.TX Registered Creditor 1400050963-202404.Vr Lender License#6766 TOWN' OF AARNSTABLE BUILDING PERMIT APPLICATION .t� o ' Map O� Parcel \a. Application # 60/ Health Division Date Issued 11-17— /5 Pic Conservation Division Application Fee�/�'�] � Planning Dept. Permit Feet , � 'T Date Definitive Plan Approved by Planning Board Historic - OKH O _ Preservation / Hyannis Purh Project Street Address Village ` \ V Owner c ) c Address 'e/S Telephone ()S (9 Permit Request s�cc�Nec.- CG �c Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation a�LOpyr Construction Type Lot Size Grandfathered: ❑Yes ANo If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure c5 Historic House: ❑Yes Ik(,No On Old King's Highway: ❑Yes Flo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing _ new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new — First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: ExistingA&New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new si Pool: ❑ existing ❑ new sizva Barn: ❑ existing ❑ new siz Attached garage: ❑ existing ❑ new sizAtshed: ❑ existing ❑ new sizeoOther: :. Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ;Zf-No -If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name Pk ljaWyl �; Telephone Number (o L-(0• Address License# Home Improvement Contractor# Email C /0 �5o)&Ac : cw�- Worker's Compensation # ALL CO RUCTION DEBRIS RESULT G F OM THIS PROJECT WLL,,BE TAKEN TO 0- GI.u.vn05[C� a ( SIGNATURE DATE 1 ,t FOR OFFICIAL USE ONLY -_ K APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER 1• DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT t _ ASSOCIATION PLAN NO. I - q , l oF�t .r *Permit Town of Barnstable' # t 00 Expires I months rom Regulatory Services issue date m Fee a? �� t aARNSrABGE, ERMrp mas F. Geilerj Director g Buildin Division SEP 1 8 2008 P Tom Perry, CBO, Btiilding Commissioner TOWN OF 8ARNSr 00 Main Street, Hyannis, MA 02601 Ag E www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERN41T APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 2-- Property Address4D`Yy` ,—, C Y\� 1`S w — Residential Value of Work e::k2S (Z _ Minimum fee of$25.00 for work under$6000,00 Owner's Name & Address -d :S t' 7 L j U Contractor's Name k)-fx V1 _ Telephone Number S6 61 Home Improvement Contractor License# (if applicable) ❑Workman's Compensation Insurance Check one:. ❑ I am a sole.proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp, Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check.box) t 'n Q Re-roof(stripping old shingles) All construction debris will be,taken to �CW ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value —(maximum .44.) *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: O I. Q:\WP I CItTORMS\building permit forrns\EXPPESS.doc Revi se020109 d - TAe Corn.rrtanweaZfh of Masscxchusetts Department of lndustrW Accidents Office-of Irtvesfigations 600 Washington Street Boston, MA 02111 • _- www.mass.gov/diet Workers' Compensation lnsi7rance Affidavit: Builders/Contractors/Electricians/Plumbers A.pplicant Information Please Print Le1?ibly Name (BLisintss/- nizafiontlndividual) - Address: � n �����•�1.1 �)� City/State/Zip: Are you an employer? Che k the appropriate bow Type- of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction . employees (full and/or part.timc).* have hired the shb-contractors 2.❑ I am a'solc proprietor or partner- listed on the attached shcct 7. ❑1_modeling ship and have no employees These slob-contractors have 9. 0 Demolition, e wor working for me in any capacity. employees and havkers' 9. ❑ Building addition i [No workers' camp.-insurance comp-insurance.$ 10.� Electrical repairs or additions S. We arc a corporation and its 3.i; am a homeowner doing all work officers have exercised their 11-0 Plumbing repairs or additions myself [No workers' romp. right 6f exemption per MGL 12.0 Roof repairs ,i in urancc required-]t c.152, §1(4), and we havc no eruploye workers.' cs. [No 13'� Other comp.;nm,ranec required_] *Any applicant that chmks box#1 mutt also fill out the section below sbowing tbcirwork='compals:afion policy infmT mtiorL t Homeowners who submit this aff davit indicating tbey arc doingall work and thin hire outside contractors must submit anew affidavit indicating such. tCantraetnrs that eb=k this box must atlaebed an additinna]sheet showing the name of the sub-_mtractm-s and state wbctbcr or not tbosd e d6cx have a�loyecs. Tf the sub-c ac ontrtors have ernployccs,they mutt pravi&their warkcrs'comp.poF cy mm�bcr. I am an employer tkaf is providing workers'compensation insurance for my empCoyeem Hcrcw is the policy and jab site ' information. .. Ins rancc Company Name_ Policy#or Sc1f--ins.Lic.#: Expiration Datc: Job Sitc Address: City/5tateJZip: Attach a copy of theworknrs' compensation policy declaration page(showing the policy ri mber and expiration date). Failure to sr,=c.coverage as required under Section 25A of MGL c. 152 can lean to the imposition of criminal penalties of a 5=up to $1,S00.00 and/or one-year imprisonment, as arcll as civil penalties in the form of a STOP WORK ORDER and a fu of up to MOM a day against the violator. Be advised that a copy of this statrmcrit may be forwarded to thn Office of Investigations of the!)IA for•inenranrc coverage ycriRration. - -_ I do hereby ce under the pa" sand penalties of perjury that the information provided above is true and correct Si c: Date:bl — Phonc O j7dal use only. Do not write in this area, to be completed by city or town officirzL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. bty/Town CIerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Phone#: Town of Barnstable y Regulatory Services Thomas F. Geiler,Director + BARNSiABLE, Building Division PTfD �a Tom Perry,Building Commissioner . 200 Main Street, Hyannis, NIA 02601 www.town.barnstebl e.ma.us Office: S08-862-4038 Fax: 5.08-790-6230 HO114EOWNER LICENSE EXEMPTION a1 Please Print DATE: I I r V JOB LOCATION: r cA h /I n r � nurrbcr sty t 41age "HOMEOWNER": c—I o S u Z name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code 'FLL The current exemption for"homeowners was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OLD HOMEOWNER Person(s) who owns a parcel of land on which he./she resides or intends to reside; on which there is,or is intended.to be, a one or two-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 building permit. (Section 109.1,1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimurn inspection procedures and requirements and that he/she will comply with said procedures and requirements. Si r of Hom owner Approval of Building Official PP g Note: Three-family dwellings containing 35)000.cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.13-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would Hrith a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that hdshe understands the respongbiIitics of a Supervisor. On the last page of this issue is a form currcndy used by y several towns. You may care t amend and adopt such a forrn/certification for use in your community. -THE r, Town of Barnstable Y Regulatory Services 1F i BARNSrABLE, Thomas F. Geiler,Director rFo � Building Division , Tom Perry, Building Commissioner 200 Main.Street, Hyannis, MA 02601 www.town.barnstable.ma-us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using .A. Builder as Owner of the subject property hereby authorize to act on my behalf, in all.matters relative to work authorized by this building pernut application_for: (Add-ress of Job) Signature of Owner Date Print Name l ase complete the Homeoamers License for permit e If Property Owner is applying o p p p Exemption Form on the reverse side. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION '�✓ G��/"' Map :a)or Parcel 6 f y Permit# 7l Health Division ScDate Issued Conservation Division oil d H03 SEP -g RN j; 42 Fee_ �, A Tax Collector _ 1 g D� Treasurer VISION gA'.I.E®IN CCMP UANCS Planning Dept. VV71;TITLE 6 E'"POMENTAL,CODE AND Date Definitive Plan Approved by Planning Board TOWN PEON ,e L.,.IONS Historic-OKH Preservation/Hyannis Project Street Address 1 I� �I�n-c I I U)q�) f. Village rnl a-n'h ►S, Owner /�sr��n ��( �-►��- Address Telephone So Permit Request Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new�U Valuation Zoning District _Flood Plain Groundwater Overlay / Construction Type +_ { e , Lot Size Grandfattiered: W Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 43 Historic House: ❑Yes 2 o On Old King's Highway: ❑Yes G Wo Basement Type: 0f uII ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing P, new Half: existing new Number of Bedrooms: existing 7 new — Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas Er6i-I ❑ Electric ❑Other Central Air: ❑Yes 1144`6`_ Fireplaces: Existing ✓ New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use- - = -- - BUILDER INFORMATION I , Name as,, Telephone Number775��6GJ Address CJJ %idle f/ AM1 License# l Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY ` PERMIT NO. BATE ISSUED j a 41AP/PARCEL NO. w ADDRESS VILLAGE + i OWNER DATE OF INSPECTION: FOUNDATION D !J S o O FRAME 71t/O { INSULATION oe j, � s' FIREPLACE k ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH:i <o FINAL ; a FINAL BUILDING DATE CLOSED OUT , -1 C t ASSOCIATION PLAN NO. r : r 'I • The Commonwealth of Massachusetts Department of Industrial Accidents oxce oflfiresmosdoos 600 Washington Sheet Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit h name: s , I location: city phone# 2^1 am a homeowner performing all work myself. ❑ I am a sole vrorfietor and have no one workin in ca achy I am an employer roviding workers' compensation for my employees working on this job. ::::X. : :::: : cam an >nam ;i'v::ii............ i::is :>.+. _::.si. j;':�:;`:;i:�: i:':i•:::�i% �i'.::±5?::2::ii Yv ii:`:,':is;:;:;:y;::i:>:ji:)::j:i::i�'��: j:%:%<::::::iii::ii`:t is is i::i: :i42Ci: Fi'j::is:':::}::}::::::i<: v:•. g dress.:;> oe cl IIh n iMal ratice of cv circle one)and have hired the contractors listed below who I am a sole proprietor,general contractor,T2�m:#L=o have n polices: the following workers compensation p <::<::>:;:::;:<::;;;;:. coman :.: :::.:.::.:.::. ::.;:,.:;:.:::.:....:. ....:< - artdtess ..................:.: .... ..:.. ::::::..... oet ::.: .::. :::::::::................:...........................:............:::::..: X. ............ 'ltisiuranc h .............. EEL=c an .n :...::.::....:.: address.::: _.... . .: - < :::........ ::..........:::::.:::::::::::::..:.:::::..::::..:..:.:............ ::::: . .........:::..::•:..::::.::.:.......... ::...::: :•:.....:......:::::::::..... :::::: .... :...::.:.::....... tl . ..... �•::.,•:.: .....................................:...:::::::::::.�:::::::::::::.;;:;;�;:�;;:;:oii;;•risoi;isis� EL M :::: : ..... ........ ...:.....................................:.................:......................:.............::........:.....a::.vv::+n:::.vr:.:r.:v:::::�:�::::::::.:r::r::::nvr:::::::::�::::::::::::•::::::.�:::::::::::::::::::i: ............................................:::::::::::.�::::::::::::::.iiii:iL:�iii:•iii:4i:::iiiiLiiiiiii:Lin:v:�i:�::4i}i:•:i•is4?ii:?:•iiii:C�i?:.................................................. �::::•::::.�:::::::::::.�:v::::::•::..........:!i{4::::.•..:�:::" ' : :iiGii:C•:�i:::F:ii �J::ii:i?�i:iJ:?-i:•i:<:•ii:•i::•r:•::::ij::ii:v:+:ii:i•�}?':}iiii:::•'i?i'i'i O� ::Si: v;:.i'., :}i;i}ij:}:�:�:�:.i:;:��?:�:;::�i: } :.; Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a One 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 One of sloo.00 a day against me. I understand that a COPY of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is trw and coned Signature Date Print name se v Phone# 1,111111111111111 EMISSION Econtactperson: ly do not write in this area to be completed by city or town official permit/license# ❑BuR&ng Department ❑Licensing Board mediate response is required ❑Selectmen's Office C3Heslth Department phone#; ❑Other (Jevued 9/95 PJA) J Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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,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 insiirance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for-confirmation of insurance coverage. Also be sure to sign and ed to the city or town that the application for the permit or license is date the affidavit. The affidavit should be return ty pp the `law or if you . Should you have an questions regarding Y Industrial Accidents g � being requested, not the Department of Y. Y� are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the.appl icant. Please be sure to fill in the pe6m license number which will be used as a reference number. The affidavits may be returhE to the Department by mail or FAX unless other arrangements have been e. -.-..-._.._..._.,._............._....,........a The Office of Investigations would like to thank you in advance for you 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 Industrial Accidents Office of Initestlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 I 1 , Town of Barnstable °^ Regulatory Services BBB $ Thomas F.Geiler,Director s639. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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: Estimated Cost Address of Work: 6T6,N-y). -)rki IL Owner's Name: 005,P i ` 01 tjZ, Date of Application: I hereby certify that:. Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 [Building not owner-occupied Owner pulling own permit Notice 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.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Date 0 er's Name Q:forms:homeaffidav f o ^ r m - o- f Town of Barnstable of tt+e rq� . Regulatory Services sAzstvsTAsr t; Thomas F.Geiler,Director MASS. 9Q, t6 9. ,�� Building Division QED MA't A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATIO ell OJ OA4 7;t�l number- street �/ village . "HOMEOWNER": �i( 50 74S '�(�61 name home phone# work phone# CURRENT 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 homeowners to engage an individual 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 reside,on which there is,or is intended to be,a one or two-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 building permit. (Section 109.1.1) — The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,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 requ' meats. Si f Ho eowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner 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 the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, „ Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner 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 t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt MAIN ST. o PA9� LO B.R.B. , I B.R.B. SC MAP co a - --- - - - 0 o z JOSEPH a DELORES DALUZ o , � BK. 1438 PG. 808 o ' co 60 i -..� N61°24' 200± , 9,725f ' .P._ N61024'50''E 18v ' v i � 'gra,� cx- . 1.1 to N CID` LOT 2 Z — 29,216 S.F.¢ SHAPE 16.9 ' A%, All ,10 . B:R.E3. B:R.B. .CIA l,�a N - a 10064. TO IffE DELORES' HOLDEN , BK 3263 PG. 124