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Home My WebLink About0045 RIPPLE COVE ROAD 44 ,��d -,I �. � ; � III J i ��' r Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 3/25/19 Brian Florence CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 19-257 f . Dear Mr. Florence: - This affidavit is to certify that all work completed for 45 Ripple Cove Road,Hyannis has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. P 9 Sincerely, William McCluskey Town of Barnstable Building t Post This Card So That it is Visible From the Street=_Approved Plans Must be:Retained on Job and this Card Must be Kept MARK Posted Until Final'lnspection Has Been.Made. _�.�Z'Y11 s639 1 HJ i Where a Certificate of Occupancy is Required,;such Building shall Not be Occupied until a Final Inspection has been made. , Permit NO.. B-19-257 Applicant Name: William McCluskey Approvals Date Issued: 01/23/2019 Current Use: Structure Permit Type: Building-Insulation- Residential. Expiration Date: 07/23/2019 Foundation: Location: 45 RIPPLE COVE ROAD, HYANNIS Map/Lot 325-061 Zoning District: RB Sheathing: Owner on Record: DAWSON,BLAKE W& MANSOUR,-DEBORAH Contiactor.Nameg`-,WILLIAM J MCCLUSKEY Framing: 1 Address: 14 ELLIOT ROAD _: Contractor License: CSSL-102776 2 STERLING, MA 01564 '�F Est. Project Cost: . $5,000.00 Chimney: Description: Add R-38 fiberglass, R-42 cellulose, R-13 cellulose, and R 10 rigid Permit.Fee: $85.00 insulation to the attic. Add R-19 fiberglass to the basern6rit. Air seal FeePaid:" Insulation: ' $85.00 the attic plane and basement with expanding lfoam.,General Final: weatherization_ Date: ' 1/23/2019 Project Review Req: C Plumbing/Gas - �' Rough Plumbing: x Building Official Final Plumbing: A y " Rough Gas: Final Gas: This permit shall be'deemed abandoned and invalid unless the work authorrzed1by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application`and thdTapproved=construction documents for which this permit has been granted. Electrical All construction,alterations and changes of use of any building and structures'shali be in compliance with the locaf zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street.or road and shall be maintained open for public inspection for the entire duration of the Service: work until the completion of the same. Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Buildingand'Fire are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final: 5.Prior to Covering Structural Members(Frame Inspection) Health 6.Insulation 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). 0 t.-t:. s m �INE Town of Barnstable • *permit 13p� Expires 6 o the rom issue dat �Y Regulatory Services Fee e * BARNSTABLE, MAC'039. Thomas F.Geiler,Director RFD MA'S A Building Division , Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY IX / O//� Not Valid without Red X-Press Imprint Map/parcel Number l2t Property Address 9 -R-�� e N14CL Residential: Value of Work`` a A" Minimum fee of$35.00 for work under$6000.00 . Owner's Name&f Address Tk 11!11r2 S Cam'' a7 W-U^10n-. AvC- I rhaple�c+ud' 5 a��y� prink a HomeImprovement' Contractor's Name 199 Barnstable Road, Hyannis MA 02601 :Telephone Number 508 775-1778 Ext. 10 Home Improvement Contractor License#(if applicable) 103757 Construction Supervisor's License#(if applicable) CS-006643 nWorkman's Compensation Insurance ` Check one: ❑ I am a sole proprietor M. 2 4.2013 ❑ I am the Homeowner X] I have Worker's Compensation Insurance; T A.L'M Mutual Insurance Co OWN OF BARN Insurance Company Name STABLE; „f 7004943012013 k Workman's Comp.Policy:# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box),. Yarmouth Transfer Station ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane'nailed)(nof stripping. Going over existing layers:of roof) Re-side #of doors Replacement Window /doors/sliders.U-Value •_�302 (maximum .35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S.and inspections required. . Separate Electrical&Fire Permits required. '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 thgUlme Improvement Contractors License&Construction Supervisors License is r SIGNATURE: C:\Users\decollik\Apppata\Local\MicrosoMWindows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012. f ` The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations 600-Washington Street Boston,MA 02111 www.massgov%dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AlbuGcant Information Please'Print Legibly Name(Business/OrganizadonMdividual): .Sprinkle-Rome Improvement 199 Bamstable.Road ' Address: _ s City/state/Zi : H annis, MA 02601 Phone#: 50.8 775-1778 Ext.10 Are you an employer?Check the appropriate box:: 4.. r I am a eneral contractor and 1 Type of.project(required): 1.[XI am a employer with 10-12 ❑ g. 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 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 �' _ 9. Q Building addition [No workers' comp.insurance comp.in urance. required.],. , 5. 0 We'are a corporation and its, 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp:` right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no " employees.[No workers' 13. OtherSi ( "J.. comp.insurance required.] *My 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 If the sub-contractors have employees;they must rovide their workers'co li 'number: w °'employees. emP oY eY P mp.po'cy ' I am an employer that is providing workers'compensation insurance jor my employees: Below s the policy and Job site; Information. Insurance Company Name: AIM•Mutual Insurance Co.'; Policy.#or Self uis.Lic:#: 7004943012013 Expiration Date; 1/01/2014 Job Site Address: 1S ecwte_ true � City/State/Zip:•(tq&IA, MA Oa(o!J( Attach a copy of the workers'compensation policy'declarati on-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 verage verification. I do hereby certi u enalties of perjury that the information provided above h true and correct°'` Signature: =Date:.. Phone#: . 508 775-1778 Ext. 10 Ojj'lcial use only. Do not write in this area,to be completed by city or own bfficial 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#:.: THET Town of'Barnstable Regiaiatary Services sniiTisr�as `MAMThdmas N.Geiler,Director Building DiAs o i Tam Perm,Banding Gonnxussi�ncr, 200 Wiii Streel;.lyannis,MA 0260 'wwwto�vnbarnstuhle.ma,us . Office: 508-862-4038. Fax: 5087790-6230; Propeit- 0.wnetr Mips ( oi-np,lete and Sign Tbls":'Secfiion tf Uin:g ABuilder e y. - ..... V.Nl.l> _, er of the subiect ro e I F �.�Y berebyauthorize Sprinkle Homedmproyement to act on my behalf in A matters:relative to work:authoritedl bytl%s bad.ng perriut application for N (Address d job) atwe of OwnerL7ate Print Name: _ In- if Pmedy Owner is"applyr lg fo r per=t please colete he Homeowners JC,I,c.ense: Exezm tion Fcizzn on:the reverse side. . .: h1Y1RM�t7WNFRPFRM.iCC1l}N '.' ;:' si'; . .�Unrestricted Builditligs of my use group which "'OnMin INS than 35•OW catbi,fw(991m3)pf: Massachusetts..- Department of.Public Safety enclosed Board of Building Regulations and Standards .y a License: CS406W BRAD K 92110"' l90 LOTEIkOPS •4 Failure to possess a Current edition of the Msssachusettsm W BARNSTABLL►MA` State Building Code is cause for revocation of this license. For DPS Ucensms information visit: www.Mass.Gov/OPS =x 0f raUor Commissioner 10/08/2013 0MCc of Cossomw Affairs&_Besiiess Regulation License or registration valid for individul use only ti IAIPROVEYENT CONTftACTpB before the expiration date. If found return to: '.;103757 Type: Otfiee,of Coosusaw Affairs and Business Regulation x tpiratloa. :7AM14 PrivaRe Caporatior, 10 Park Plash Suite 5170 Boston,MA 02116 .� SPRINKLE HomE IMPROVEMENT,INC: Brad Sptinlcle 199 BanIstable Rd. Hyannis,MA 02801 Undersecretary Not va1M wi signature t SPRIN4 OP ID`DS . oRv� CERTIFICATE OF LIABILITY INSURANCE ; ,''�°; Z 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 car dficaba holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WANED,Subject to the terns and conditions of the policy,cwtsln policies may require an endorsement. A statement on this certificate does not confer rights to the• certlfleate holder In Neu of such PRODUCER Phone:608-7754M B,y 8 Sullivan ins Agency 88 Fa6rto 0 Road Fax:OB-M-141 No. Hyannis,MA 02601 llCauey A.Sulliven wsu AFFORDING COVERAGE NAIL: INsirr:ERpAssociated Industries of MA INTRO p SprinldBarrtstable Improvement pro vement Inca wsuime e Hyannis,MA 02601 INSURER C INSURER D - , INSURER E ' 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 CONTRACTOR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.'ROM vim " TYPE OF INSURANCE .'POLICY NUiSIMLIIUiB GBiERAL LIAOLJIY ,. EACH OCCURRENCE'- S COMMERCIAL GENERAL LIABILITY MAGE TO REWED PR $ CLAIMS-MADE F—IOCCUR MED EXP one ) S PERSONAL&AM INJURY S Y GENERALAGGREGATE $ GEM AGGREGATE LIMITAPPLIES PER: Fn PRODUCTS-COMPI�AGG i POLICY LOC i AUTOMOM IJABLITY SINGLE LIMIT Ifta=ftt) s ANY AUTO BODILY INJURY(Per person), S UT�ED SCHEDULED A BODILY INJURY(Per acdoent) S HIRED AUTOS AUTNO ED U S UMBIRIM"LIAR OCCUR EACH OCCURRENCE. .$ EXCESS LIAB CLAIMS-MADE ' AGGREGATE. RETFNTIOW s i AHD PJWLOYERb'LMMBYJTY YIN I T . . �IMF� A ANY PROPRIETORIPARTNO DMUTIVE AWC70UMM2013, 01/01H3: 01/01M4 EL EACH ACCIDENT i 600, OFFICERIMEMSER EXCLUDED? 0 NIA M(Mand"y anti M E.L.DISEASE e EA EMPLOY $ �I), . 4. PTI OF OPERA tiebwr E.L.DISEASE-POLICY LIMIT, $ 800, DESCRrYW OF OPIRAMW I LODATMM I VOMXU~ACORD 1I"Addp wA Rumrb Sdw&",M m N spew Is nqukem CERTIFICATE HOLDER CANCELLATION "SPRNKHO . SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE .EXPIRATION'DATE THEREOF, ;NOTICE WILL BE.DELIVERED IN ' Sprinkle Home Improvement,lnC ACCORDANCE WITH THE POLICY PROVISIONS;' -Margo Mack, AUTHORIM INBarnstable Rd. REFREB@ITATNE Hyannis,MA 02601, Kelley A.Sullivan 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD �F SHE The Town of Barnstable • BAMSTABLE. • 9g, 16 9. ,0�' Department of Health Safety and Environmental Services AIEDMo'�°' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 • Building Commissioner SHED REGISTRATION ocation of shed(address) Village 617- 3 2f- o 9-9 f Property owner's name Telephone number X/a 0,;2 0 6•/ Size of Shed Map/Parcel# 163��5 Si ature Date ( yannis Main Street Waterfront Historic District? IAzo Old King's Highway Historic District Commission jurisdiction? /fib Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE AB COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. C THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg 2 STANDARD LEGEND NOTE:not all symbols will appear on a map O MAP 325 ° GOLF COURSE FAIRWAY AP32 5 6 2 ^,, �� EDGE OF DECIDUOUS TREES 3 - 2 # 3 7 M _= EDGE OF BRUSH ORCHARD OR NURSERY 320 Y V-7-7 EDGE OF CONIFEROUS TREES r \_ MARSH AREA • •— EDGE OF WATER l7 ---= DIRT ROAD ` DRIVEWAY E--PARKING LOT PAVED ROAD DRAINAGE DITCH r - PATH/TRAIL MAP 5 PARCEL LINE ** MAP 110 --MAP# Q 7 Q 21 - —HOUSE NUMBER HOUSE NUMBER 144 OP 32 5 � 2 FOOT CONTOUR LINE-fie— 10 FOOT CONTOUR LINE MAP325 1 /\4.9 SPOT ELEVATION 00o STONE WALL 54 # 5 -X—X- FENCE # 338 - — RETAINING WALL i F I RAIL ROAD TRACK STONE JETTY M P 325 SWIMMING POOL PORCH/DECK (" �] 0 BUILDING/STRUCTURE # 54 F4=p- DOCK/PIER/JETTY � HYDRANT e VALVE o MANHOLE o POST O" FLAG POLE T O W N O F B A R N S T,A B L E G E 0 6 R A P H 1 C I N F O R M A T 1 O N S Y S T E M S U N 1 T .� SIGN ® STORM DRAIN M PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Plonimetria(man-mode features)were interpreted from 1995 aerial photographs by the James r TOWER 1"=100'scale map and may NOT meet of property boundaries.They are not hue locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE w ' 0 20 40 National Ma Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetria,topography,and vegetation were mapped to meet National Map Accuracy Standards 1 INCH 40 FEET* enlarged sca e. on the map. at a scale of 1°=100'. Parcel lines were digitized from 1999 Town of Barnstable Assessor's tax maps. -0 LIGHT POLE o ELECTRIC BOX ...\Barn\sitemaps\Public\m325.dgn Oct. 13, 1999 13:20:18 Engineering Dept.(3rd' loor) Map Parcel Dermit# f A q-3 7 1:�- Hou se_ # , Date Issued Beff - ) „ Fee S 2�,d-b i THE Taw£initivP Plan AnnrnvPd by Planning R..nr�l l9 � - � � , - - BARNSTABLE . MAS& TOWN OF BARNSTABLE 'E°" '� Building Permit Application s Project Street Address�bs r Village Owner L, Address :Telephone f �—q—0 g 9 f� l''to Permit Request t First Floor square feet Second Floor '' t square feet PConstruction Type �0,404: &1 1 lel&1 P Estimated Project Cost $ %00,0, Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family f Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes a-Ko On Old King's Highway ❑Yes 244o Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New `Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) // ❑None `` ❑Shed(size) UPI Klwv-h �J� �o��'�'a�f°� ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information _,Name�.�i�,/h �..��O ,�i•�. Telephone Number Address Tra�,�,r,o� License# Q y yz S / Home Improvement Contractor# L9 T 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 SIGNATURE 4d' DATE `BUILD MI E F ��ON�W- GASON(S) A _ FOR OFFICIAL USE ONLY _ PERMIT NO. DATE ISSUED' _ � .. � - ,. - _ � } = -. '�j • - ..MAP/PARCEL NO. f •; - • •r _ - � s -_'_ ^• _• ... .�. T _ �� . r ADDRESS F- ' VILLAGE" OWNER 1 DATE OF!INSPECTION: FOUNDATION FRAME INSULATION 3 _ FIREPLACE f ' s ELECTRICAL: ' ROUGH FINAL--- PLUMBING: ROUGH • FINALA i A . 'FINAL 1 • GAS:,' ROUGH FINAL BUILDING = - i t 7 I DATE CLOSED OUT ASSOCIATION PLAN-NO. r r } f - w t . -. • __ Tlrc• �!//r1rt1Ulrlt'CUltll u�':)trrssrrc•Iruscttr • Depurtryrcfrt of ludustrial Accidents z , ;= + !tzrn („ 0lficEa!l�yesrl�atlans '� . �'•: j _� bull 11 a.v1zhi ruir Sircer :4 4 Btrstoir.MaY.. 0111 Workers' Compensation Insurance ARdavit `1(i�iiic ntinftirmati�n Plc'tse PRTNTIe�'mv Marne �4"J 11-14 Y- 1;`L//O nc�•inrt• t t .r�. , firm•� � � �� I m a 110MAwner performing al1 wort:myself_ m a sole proprietor and have no one working in an}• capaciry I am an employer providing workers' compensation for my empiovees`working on this job. t t cmm�nns' n tm( 1 ( S 7tl(Irrcc• ' ties•• nitnnc�• • in-mr^nrr n nniiry 0 1 am z sole rrourie:or. ,encrai contractor. or homeowner(eircie on ra e) and have hired the contractors listed be:o«' 'a'r.e the "OHONvin_ workerj' compensation polices: Cmmnnns Maine- . a(Irlrr<c• Ctr nflnnt'd' nnliCP� - s. inctrnrr n _ •—• ennininc arnt•• - atltlrr<c• tin•• nhnnc�• in,mrnnrr rn. 1lrcfs additional shttt if necessary'.__�..._.. �.•• ....... -- •• ••.... _ ......... •...._...... _�.►....,..,.—_:.' _^�.,•".:.-:air ...:..,..._ '>__�.�'_r...a►W.� .war, F:ttiurc to secure cnveraIIe :is required nucr section_SA of NGl. 152 can lead to the imposition of crtmnal penalties of a line up to SLUU.UU anurcr unc%cars' imprisonment :ts sell as civil Penalties in the form of a STOP WORK ORDER and a fine ofSI00.00 a day against me. 1 understand that- cop} of this S(atcmcnt ma% be fur+s•ardcd to(he 011ice of Inrestitstions of the DIA for coverage verification. 1 do hercnr ccniir t,,uier the prrirts nerd penaitics ojprrjun•tirar tllc irtjormariorr prorided above is true and correct. �� _-`� • Date ez Z.1,rc�` z 9 Phone# tin P ' oRciaiwa nh do tint sprite in dtis area to be eompleteti by tiny or town otTicial tits nr tms n permitilicense ti r;tluildinz:Department at.iccnsinc !Board � — .heel;if im(nediatc resnunse is rcuuircd Q'Sclectmen•s Orrice t.. (health Department . phone is• nUthcr rant:;: r.crertn• i THE T� The Town of Barnstable 1'" e�' Department of SeaIth Safety and Environmental Services 9. Building Division 367 Main Street,Hyannis MA 02601 Raiph Crosser. Office: 508-790-6227 Building Cc= Fax: 508-790-6230 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, modernixision, ng conversion, improvement, removal, demoliticonstruction f = addition I to owner occupied building containing at least one but not more dwelling units contractors, r to structures which are adjacent to such residence or building be done by registered th certain exceptions,along with other requirements r Type of Work: Est. Cost Address of Worst• Owner's Name ^ Date of Permit Application: a s� I hereby certify that: Registration is not required for the following renson(s): Work excluded by law _Job under SI,000. —Building not owner-occapied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEE OWN PERMIT OR DEALING WLTH UNREGISTERED.CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT FUND ORK Do UNDER MGI.O 14ZA � ACCESS TO THE ARBITRATION PROGRAM OR GiJA �'I: SIGNED UNDER PENALTIES OF PEP-My I hereby apply fora permit as the agent of the owner. Ary Registration No. Dare Contractor Name . ' ;a. �� J �/LC U/OOY!/IltlY�2LIICQAti/L d�✓!/GC7.Q6CLCiLL[l�llP.� "'�,-- .. if DEPARTMENT OF PUBLIC SAFETY {! , CONSTRUCTION SUPERVISOR LICENSE 7 3 _ Nu�ber� Expires: ,}� . Restricted To �: 00 �.; ' KEVIN M STFIERRE vow X el 47 RITA:AVE . SO YARMOUTH, NA '02664 lit 1��C ,j T�/\s(l\\t k� ✓ti{e � ke�:l�asladFi ; " RegS° iew xP LA `x,in KVItT RE y ;�c6�n�p Yi lm� ri QZJ a. 1. Vl- o OIL z ' o � �V O -J .J v 3 J O z o Q J 0 � o 4 ' J r � 1 v 0 1 c a C Jk tw o o 61, � I Cl) llr\ do :_-----------_........ .__.._ __. _.__._ -_---__-__.-. ry Ilb AtN