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Home My WebLink About0250 CAP'N CROSBY ROAD So C�t. h � C�sb a � � � � . . ._ �. �,,. ..� r ,. ` _ '. _ w .. � - , ;y o .. ... d _ .. o .. .. .. .. � � - � } .. F .. Ito Gaczs.nos� 6lztat�c.�z. . : .• .. ..:N `�: .. ! "A" �- 1 Z:adl L.�! 1r c.�OW a 110 K 3 • sso 6•Pv ��LZ:; . �•¢ '.1 TAa.iV s _SSO j 197G a� • �i5 6.t?t7 pPcTa o.R �• ? � I� ' _ U S� t 00� 64 t_. . . : _..__-_ _._— .._: ' _ -Inc - - - %• - - -�_ � - �'�i7! �IS t ar-wat.L. -Z.S A • . 3"7S Gs.P.t7. 8 f �'�ID . `� ;: _+. 1 .0 TeJrA er v t=ste,►.1• d S�.pa. „� ✓i,� - ti �`�+r- � '�r''- TbTo t_ '041 t_%( FLDW • 33D 66P.'D: a } G�.lZGDtATIOtJ tZeT1✓ . - . q Of ILA AL ihR( r YLAJON ,. .t . _o 7T, is •f-5T 'fir rms7;1� Tor >•�b ,EL• id 4'Awa i -Box : : •n••G Sepnc 1►!vC l -rANK l000 PI '! 3 PQrp�'tL� LoGATIOW .40 T. y FAQ 'tZMFctZE�.ttt? GGIZTt 1( TkA'r TNr. Fvu0tuAT!" %Howl.! 1-IF:Q�aa1 GcaMPL�(S WITH T4.a: SIDE.LIWC-- AND SCTC►AGK �'C4Ut�ENt�1.1j's OF TNG i .�.' TowU otr �3Aehl'�A-its A"t> t 6 : . 1 �oN VI(_i_Pa4 g LOCATED• W I T141 L T WX-- Va-oo't?) Cy,, Re6tSTCRcD 1.A�..Jp St)eVcYotZ• 't WIS nt_A-W is LJOT ZoSr-v vN aN o5TF-P-V%t_t.G a MASS. iw-q-euMC1.IT' euc:%/cy T��L-. oFC,�T�. StdGwl.D aNPI_tGA.tiIT ..�>r c•.r u-r.eo ro rnercr_M'%4= LOT -A-IN�:> AVi� �AUK TOWN OF BARNSTABLE Permit No. Building Inspector Cash OCCUPANCY PERMIT Bona No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. 19...... .........._........................ ....... ..... ._ Building Inspector Asses or's.map and lot number ..�./..3/�'/.�. :IC THE Sewage Permit,number — �� vl�j Ir ....49C2.:n ........... .... �' J �/ Y OF O t House number .......:..... .../-1��!...........'.........c::...... ° i' JIk1 ® '^ rasa LE' r! �� J7 m. '�t639. 00� �? E��'�C�,�CJifif rAar TITLE � owaYa� TOWN OF B.A�R.N S TA¢ � �� „� r r; t UUILDIM INSPECfiO APPLICATION FOR PERMIT TO construct _s:i? g.�, ...forma.-.y....hQme...:....................................... TYPE OF CONSTRUCTION ..woAd..JEr.ame. ............' ¢ ................................................................ . February. ..........................19..A2. TO,THE INSPECTOR OF' BUILDINGS: The•undersigned hereby applies for a permit'according to-the following,information: Location ....Lot...52 Captain Crosby'-Rd.•...Centervill, ,,,, A,r,,,,;,,,,,,,,,,,,,,,, Proposed Use .....single familx reSidence....... ......r. ........Fire District G.� t.�X�a.�1.�-Q.s kervz]le............. Zoning District ........................................... Mr. Robert Renna Name of Owner ...........Address ......:..:..L.e;KiX19t.Q�.A...M: .:................:'. " Name of Builder David Trust ........Ad"dress P�:R. ...$4 ..�k2.fz.,...Centt~rvilly;w, :.MA.. w Nameof Architect .................::.........:..::................Address ...........................................::.................................... ..................... Foundation ......09I cret.e......•......:.. Number 'of Rooms ......:Six'..:......'.....: ............................ cedar shin Les ...Roofing asphal.t...shingl.es.............................. Exterior .................................�. carpeting - < f Floors ...........................................................Interior ............drywall... :............................ 'Heating ....f..h.w.....bY....oll.. Plumbing ........ G ............P..V.. .. Fireplace ....br1Ck &. bI.Q.rKl. ........... ....... ....Approximate Cost ......$4la,.oao..... ,r f . ' ......... Definitive Plan Approved by Planning Board _._f_ _____________19________. Area or - ..:.,��.�..��-floor... Diagram of Lot and Building,with Dimensions Fee' SUBJECT TO APPROVAL OF BOARD OF HEALTH 6�Q OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .....,.�� r .�.:.................. RENNA, ROBERT 23791 One & 1/2 Story 0 ................. Permit for .................................... Single Family Dwelling ................ . ................................................................ Locati6n'.. Lot 052 250 Captain Crosby Rd.;-1 .........................................Captain Centerville Owner .....Ro.ber.t...R.enn:�............................. ..... .....e. .. .......... Type of Construction ........Frame " .................................. ................................................................................... Plof. ............................ Lot .....................L ........... A February 5 82 Permit Granted .................................. 119 7 Date of Inspection ........................... .......19 Date Comp I te d .. ........... 9 411 JA 7- Assessor's map and lot number Qy�s THE T04! `off y�♦� Sewage Permit number ...R..��....:-:..�.,�:..................:....... 33AR3MULE, i House number ............. .. .................................... . ro rasa po,039. 0� �EQ MO a, TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO cons :ri('1l , ... f.am o v, bi,.e........................................... ..... ...... �ic _ ..TYPE OF CONSTRUCTION .t-, .a...E,- m ........................................................................................................ Fc ....................... ...............19.. .�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby- applies':for.;a .permit, according to_the` following information: . Location ....Lot...52 Ca ptain...Crosby..Rd ...Cent rui 1 t ':...M.A...................................................................... Proposed Use .... i.nal,e fatsli1.y...Xesi.denCe........................................................................................................... Zoning District ..s.'.f...r........................................................Fire District Dnt en !.I.emQ:Rt.mr 7 l . Name of Owner M ......Robert...kenna...........................Address ...........z; ,i,?�;�x1 fin.....?cA...................................... Name of Builder' David Trus.t......................................Address ' (�� F3*ax. 4?h t`r�ntr�r; 1 Mn Nameof Architect ..................................................................Address .................................................................................... 4 Number of Rooms .......S.iX...................................................Foundation .....c?0n(,rPt-A .. .................................................................... Exierior cedar shingles Roofing carpeting Floors ......................................................................................Interior !�?nVx.a.1.j....................................................... Heating ..........`.......r:.`.....?...�............................................Plumbing ........................................................ Fireplace ....k?r..e:� F...hl r�r.k ...... ,........Approximate Cost ...•.. 4R, , (1n ..:. ..........:............................ • - ...:.... .. .. ................... .. Q Definitive Plan Approved by Planning Board -------------------_-----------19________ . Area �I3't'�f1�ipr Diagram of Lot and Building with Dimensions Fee :.: .... ... ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH �,JQ 3 G x� G ' /Z W ,,,o 0 VL 1L r� J OCCUPANCY PERMITS REQUIRED. FOR NEW DWELLINGS i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......... �....... :C:r...:.. .... ..��,.ry--.................... RENNA, ROBERT A=193-176 193- No 23791 permit for ..•,ne & 1/2 Story Single Family Dwelling l-"Lot #52 250 Ca tain Crosby Rd. Location ........................................ :. q. . n.......... Centerville ............................................................................... Owner ......Robert Renna .................................................. Type of Construction ...... rame ............................. ................................................................................ Plot ............................ Lot ................................ Permit Granted ..... February 5, 19 82 Date of Inspection ....................................19 Date Completed ......................................19 00,/10 s . 4, TOWN 0► S RNSTAR v RISE Z .!�3 MAY 0 : 19 Division of Thielsch Engineering,Inc. 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island02910 ` DIVISION May 1, 2013 Thomas Perry, CBO Town of Barnstable Building Division / 200 Main Street Hyannis, MA 02601 V _ Re: Insulation permits Dear Mr. Perry, This affidavit is to certify that all insulation work completed for 250 Cap'n Crosby Road has been inspected by a Building Performance Institute (BPI) certified Professional. All work performed meets or exceeds Federal and State requirement. Sincerely, Erik Nerstheimer Supervisor of Installations, BPI certified Building Analyst Professional and Envelope Professional, RISE Engineering, a division of Thielsch Engineering, Inc. 1341 Elmwood Avenue Cranston, RI 02910 401-784-3700 •800-422-5365 •Fax 401-784-3710 111123 - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel x��d' ;Application # 00 f00 53`f3 Health Division Date Issued � 11( a Conservation Division Application Fee Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board /01 ��° Historic - OKH Preservation/Hyannis Project Street'Address 250 Captian Crosby Rd Village Centerville Owner Justin Waskiewicz Address same Telephone 508-360-6182 Permit Request air sealing, insulate attic, kneewall areas, install 1 attic access hatch, 4 soffit vents and 1 insulated exhaust hose Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2940 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 o g Q Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stoR Cj:�(es ❑ No rn 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 ❑ C" r �c rn Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RISE Engineering Telephone Number 401-784-3700 Address 1341 Elmwood Ave, Cranston, RI 02910 License# 100459 Home Improvement Contractor# 120979 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ----- DATE f 0 I Erik Nerstheimer for RISE FOR OFFICIAL USE ONLY .APPLICATION# "1 DATE ISSUED MAR/PARCEL N0. 3 1 ADDRESS VILLAGE OWNER t DATE OF INSPECTION: ..FOUNDATION : FRAME a INSULATION.! FIREPLACE t ELECTRICAL: ROUGH FINAL r' t PLUMBING: ROUGH FINAL GAS:—Ei rk6,. ROUGH :6Y'I- . ..r. FINAL i J FINAL BUILDING -: `'�'•'- '.. �' i t I` :...DATE CLOSED OUT ,4 ASSOCIATION PLAN NO. iµ RISE ENGINEERING Fede►aI ID#05-M5629 RI Contractor Registration No 8186 r A division of Thielseh Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,RI 02910 (401)784-3700 FAX(401)784-3710 CONTRACT K .m.uee i.•.Mwh�"a.. -. . . R I S E Page ,1 THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER - - PHONE DATE Client 3 - Justin Waskiewicz (508)360-6182 07/16/2010 111123 SERVICE STREET BILLING STREET 250 Capt-crosby Road 250 Capt-crosby Road SERVICE CITY,STATE,ZIP BILLINO CITY,STATE,ZIP - - Centerville,MA 02632 Centerville,MA 02632 JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing. 20 man hours. $1,320.00 RISE Engineering will provide labor and materials to install a—8.5"layer of R-30 Class I Cellulose added to 112 square feet of floored attic space. $134.40 RISE Engineering will provide labor and materials to install 2.25"R-10 semi-rigid fiberglass board insulation to-132'square feet of kneewall _ area. $356,40 RISE Engineering will provide labor and materials to install a 11"layer of R-38 Class 1 Cellulose added to 576 square feet of open attic space. $691.20 RISE Engineering will provide labor and materials to.insulate the back of 2 existing kneewall access hatch(es)with 2.5"rigid fiberglass board insulation,and seal the edge of the hatch with weatherstripping. $170.00 RISE Engineering will provide labor and materials to install a new,finished plywood,attic space access hatch.The hatch will be insulated, RISE ENGINELxING ral ID#0s-040s629 (� (�� R�® ntractor Registration No 8186 w A division of Thielsch Engineering n L'.� E.0 V ontractor Registration No 120979 1 ! C ontractor Registration No 620120 �r U1341 Elmwood Avenue,Cranston,kl 02 (401)784-3700 FAX(401)784 1 JUL 23 "2070 ON TRACT. R/�C THIS ONTRACT IS ENTERED INTO BETWEEN RISE .ENGI .ERING AND THE CUSTOMER FOR WORK AS ENGINEERING IBED BELOW CUSTOMER „ d� .` ,PHONE e'DATE - Client p Justin Waskiewicz x (508)360-6182,.: 07/16/2010 ;, 111"123 SERVICE STREET ." - .. " 'BILLING STREET 250 Capt-crosby Road R 250 Capt=crosby Road SERVICE CITY,STATE,LP - - - �eiWNG CITY,STATE,EIP Centerville;MA02632 Centerville,'MA 02632 JOB DESCRIPTION weatherstripped and held closed by eye hooks. (Wood surfaces will be unfinished. Prime coat and/or paint is not included.) % s $100.00 RISE Engineering will-provide labor and materials to install insulated exhaust hose wlroof mounted flapper`vent to exhaust existing bathroom fan(s). $100.00: RISE Engineering will provide labor and materials to install'4 .4"':X 16"rectangular,white aluminum soffit vents to increase ventilation in attic areas. ' $68.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$2,000 per calandefyear.Also includes all bf the air sealing costs. t -$2,535.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Five&0011OO Dollars $405.00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY _ UNPAID BALANCE AFTER EO DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. D OT N THIS CONTRACT.IF THERE ARE ANY BLANK SPACES ` • r � HORME 1ONATURE ISE GIN ERING - '+ Cu, ER ACCEPTANCE. - - NOTE,THIS CONTR�Y BE VMDRAWN BY US IF NOT EXECUTED WITHIN• DATE OF ACCEPTANCE n _ r ACCEPTANCE OF CONTRACT-THE ABOVE PRICES, PECIFICATIONS AND CONDITIONS ARE V SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS. - AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE h - A( A. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(.Business/Organization/Individual): RISE Engineering a division of Thiel ch Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 ' Phone#: (401)784-3700 or 1-800-422-5365 Are you an employer? Check the appropriate box: Type of project(required) 1. I am an employer with 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 2. 0 I am a sole proprietor or partner- listed on the attached sheet. ❑,Remodeling ship and have no employees These sub-contractors have 8..0 Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.t 9. 0 Building addition required] 5.0 We are a corporation and its 10. 0 Electrical repairs or additions 3. 0 I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL 11. ❑Plumbing repairs or additions insurance required] t c. 152, § 1(4),and we have no 12. 0 Roof repairs employees. [no workers' X Other Insulate comp.insurance required.] 13.P �i *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContactors that check this box must attach an additional sheet showing the name of the sub-contractors and state#hether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.' V I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins.Lic.#: 3730961-00 Expiration Date: 1/1/11 Job Site Address: CQ� QS City/State/Zip: Attach a copy of the workers' compensation polic eclaration page(showing the policy number and expiration (date).' Failure to secure coverage as required under Section 25a of MGL 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 $250.00 a.day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certi and the ins ena)ties ofperjury that the information provided'above is true and.correct. Si nature: '� Date: Print Name: Erik Nerstheimer Phone#(401)784-3700 or 1 800 42? 165 extIll ' 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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: AC®RD CERTIFICATE OF LIABILITY INSURANCE OPIO 47 OAlE(MM,DD,YYYY) PRODUCER' TH I EL-1 04/13/10 The Preston Agency Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Dsvision Rd Suite 303 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Greenwich RI. 02818-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE INSURED NAIC-# INSURERA: Zurich-American Ins Co. Thielsch Engineering, Inc INSURER 8:. Thielsch Group Inc. A0 �'iO•^Lu•z•nt•• s W.blli.ty Hi Tech R6AIty Inc. INSURERC: North American capacity _ Cra Frances Avenue INSURER Hartford Insurance Company , Cranston RI: 02910 ' INSURER E: ' COVERAGES ------------------ THE POLICIES OF INSU2ANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH.RESPECT70 WHICH THIS CERTIFICATE MAY BE ISSUED OR M•1Y PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IF75R-2iU0 LTR)NSR TYPE OF INSURANCE ,P000Y NUMBER GATE(MMID'DM') DATE(MhUDp ry) LIMITS GENERAL LIABILITY EACH OCCURRENCE s 11000,000 A X COMMERCIAL GENERAL LIABILITY 3730962-00, 04/0 1/10 O1/O1/11 UAIVURPREM9E3 DEaoccurence) s300,000 CLAIMS MADE a OCCUR MED EXP qn.one arson b v person) 510,000 ---------- PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s 2,0 0 0,0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY }{ PRODUCTS-COMP/OP AGG $2,0 0 0,0 0 0 JET Loc Emp Ben, 1,000,000 AUTOMOBILE LIABILITY � ' A X ANY AUTO COMBINED SINGLE LIMIT- s2,000,000 3730963-00 04/01/10 01'/0i/11 (Ea accident) ALL OWNED AUTOS { - SCHEDULED AUTOS BODILY INJURY(Per person) 'f HIRED A.LROS BODILY INJURY NON-OWNED AUTOS BODILY Ice'd@N), ` I PROPERTY DAMAGE 1Per accioenl) GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT g - ANY AUTO - OTAERTHAN EAACC $ AUTO.ONLY: AGG EXCESSlUMBRELLALIABILRY EACH OCCURRENCE . ; 10,000,000 B X OCCR �CtAIMSiW(7E LIMB 9263637-00 04/01/10 OT/O1/11 AGGREGATE' $ 10,000,000 DEDUCTIBLE 4 X RETENTION $10,000 WORKERS COMPENSATION AND I,. EMPLOYERS"LIABILITY - X TORY LI,,ITS EP. A ANY PROPRIETOR/PARTNER/EXECUTIVE 3730961-00 04/01/10, 01./01/11. E.L.EACHACCIDE14T s`i'_ 00,000 OFRCER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE S 1,000 000 SPECIAL PROVISIONS below E.L.DISEASE-POUC'Y LIM11T :{ 1,000,000 OTHER - C Professional Liab DVL000026800 04/01/10 04/01/11 " Prof Liab 2,000,000 D � Leased/Rented Eqp 02UUNTD5678 04/01/10 04/01/11 Equipment 100,000 OESCRIP TION OF OPERATIONS I LOCATIONS I VEHIC LESY EXCLUSIONS ADDED BY ENO OR SEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESE V ACORD 25(2001108) cD ACORD CORPORATION 1988 liFu�r.:J'p 'a'Se. .� ll�a a a_{rfk I� tFl��, .� T�F✓ �.lri{ �i ) 4i!aif4� - �.� t .:r•'j �li l�hSiif 'u t� ili ;{ 1 �y�. .1.,. Nt _�TrEP r .r � U{�ED,!SJNAME T24i1e1 �ih�yt {i ' nGr °lrn tFli 1{17344s. 1 OF ID'27#!� !1 Jrs , DATE Q4/12/ O t;. ... Also for RISE Engineering, a division of Thielsch•Engineering,. 3nc. Gaskell Associates_, a division of Thielech Engineering,; Inc. BAL Laboratory, :a division of Thielsch Engineering, Inc. , ESS Laboratory, a division of. Thielsch Engineering,, Inc. ALCO Engineering, a division of Thielsch Engineering, .Inc. Water Management Services, a division of .Thielsch -Engineering, Inc. 1 • Y OXe Off e o onsumer 'A(a4nusihesseguon 10 Park Plaza- Suite 5170 Boston, ssachusetts 02116 Home.Improve ontractor Registration Registration: 120979 Type: Supplement Card z ,' ��, Expiration: 3/25/2012 THIELSCH ENGINEERING ERIK NERSTHEIMER M 1341 ELMWOOD AVE. CRANSTON, RI 02910 K 0<" Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CA1 0 50M-04/04-G101216 ' .. fie �animaruueall� � � , Office of Consumer Affairs&Bu in Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: f Office of Consumer Affairs and Business Regulation Registration�.79: TYpe: .10 Park Plaza-Suite 5170 Expira 12 Supplement Card Boston,MA 02116 THIELSCH ENsI ERIK NERSTH „f 1341 EL'MWOOD CRANSTON;RI 0 Undersecretary Not valid without signature i arc I Ul i The Official Website of the Executive Office of Public Safety and Security (EOPS) Mass.Gov Home Public Safety Department Of Public Safety Licensee Complaints License Type Construction Supervisor . License#1 100459 Restriction WS,IC Name Erik Nerstheimer City, State, Zip North Scituate, RI, 02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee- Back To5earch Board of Building Regulations and Sta-ndnrih t g 1,.. I U-Cense or registration valid for individill use only HOME IMPROVEMENT CONTRACTOR I i = i before the expiration date.'If found return to: Registration. 120979 I' Board of Building Regulations and Standards Ezp rat`i:o:n::= `3.25/2010 i:;' One Ashburton Place Rm 1301 TYRe uP'Plement Card T^t st�3l,Ma. 021.0.8 w- -- f=: IELSCH ENGINE-AJ^J., V IK NERSTHEI'MfR= s _ ; 1 ELMWOOD.AVE`=-; ANSTON, RI 02910 administi:;icor Not valid without signz �re 4 • u hrtp://db-state.ma.us/dps/liccletails.asp?t)ctSearchLN=CSL 100459 K NAT=24531 - 1 r Town of Barnstable *Permit# 46 0sys Kvpires 6 months from issue date Regulatory Services Fee JK ��- Thomas F.Geiler,Director Building.Division30`� 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 Not Valid without Red X-Press Imprint Map/parcel Number Property Address X-b rA, DJ w Ca6 U ce V' l R ❑Residential Value of Work �,J 600 (o Minimum fee of$25.00 for work under$6000.00 bed �► fl Owner's Name&Address .ii s �b`/ A I Contractor's Name Telephone Number 70� V Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance -PRESS PERMIT Check one: ❑ I am a sole proprietor AUG 2 9 2007 RI am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ZRe-roof(not stripping. Going over existing layers of roof) [2 Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this pemvt does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc." 11.E ;! ***Note: Property Owner must sign Property Owner Letter of Permission. y' ,' T A copy of the Home Improve ent Contractors License is required:.- L;JL'u SIGNATURE: Q:Forms:expmtrg Revise061306. ` y -- : The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 A www.mass.gov/dia Workers"Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):. •Address: cia'o r✓ 6t1. OV Vim/ City/State/Zip: ctn y \4 Phone.#:S��J ao-� Are you an employer? Check the appropriate bog: Type of project(required):, 1.❑ I am a employer with 4. ❑ I am a general contractor and I have hired the stub-contractors. 6. ❑New construction . . employees(full and/or part-time). � 2.El am a•sole proprietor or partner- listed on the-attached sheet. 7. NTRemodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 .❑Building addition [No workers' comp.insurance Comp, insurance.$ equired.] 5• ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.IM I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right 6f exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' A3.❑ 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 sbowing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must providb 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. Insrrrance Company Name: Policy#or Self-ins.Lic.#: 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 tip to$1,500.00 and/or one-year imprisonment•, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certify ur der thepains and p en aldeis of perjury that the information provided above is true and correct: Signature: Date: 0- d ( _ Phone#: " Official use only. Do not write in this area,'to he completed by city or town ofciaL City or Town:. Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f - - *THEJr, Town of Barnstable Regulatory Services BARNSTABLE, : Thomas F.Geiler,Director alas. �pT 059. A.�� Building Division Foy Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION' Please Print DATE: JOB LOCATION: „/J lJ C��Q '� I.ULUL plj 1� �`QAYAI- number L street L village (� .HOMEOWNER": �Q�t-I� 'l 8 ��'��1J� 771I—d F-,l�e K name /•- Lho' a phone# work phone# CURRENT MAILING ADDRESS: CKA44W yh b 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 requir en . Sig ture of Homeowner 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. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ' Application# J� I Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee *t-25,00 Date Definitive Plan Approved by Planning Board C6`rJvm116d#— Historic-OKH Preservation/Hyannis Project Street Address Village ta 2— Owner Address sh i), Q Telephone Permit Request D ►y CQ i C,�A!^!. P'Wwd' ®S Square feet: 1 st floor:existing ��e� proposed_� 2nd floor:existing _6 proposed e— Total new 1`aY Zoning District Flood Plain Groundwater Overlay �ProjectValuation � Construction Type Lot Size 15, 1 1KAQ_ Grandfathered: Yfes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family V Two Family ❑ Multi-Family(#units) t Age,-of Existing Structure Dy Historic House: ❑Yes U o On Old King's Highway: ❑,* Basement Type: ❑ Full ❑Crawl G�'INalkout ❑Other Basement Finished Area(sq.ft.) ;36 Basement Unfinished Area(sq.ft) 3 3 Number of Baths: Full:existing new d Half:existing 1 new Number of Bedrooms: existing_ new 0 Total Room Count(not including baths):existing �_ new ® First Floor Room Count Heat Type and Fuel: ❑Gas it ❑Electric ❑Other Central Air: ❑Yes Flo Fireplaces: Existing New Existing wood/coal stove: LW Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:O'existing ❑new size Shed: xisting ❑new size Other: — Zoning Board of Appeals Authorization{ ❑—Appeal# Recorded❑ Commercial ❑Yes o If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Y-�,0 —d 956 Address MCA,PV('yJ,�c�i�(Z� License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Tm•r� �a �;\\ SIGNATURE DATE I FOR OFFICIAL USE ONLY r PERMIT NO. ' I ` DATE ISSUED , MAP/PARCEL NO. i ADDRESS VILLAGE OWNER ' 'r1 'DATE OF INSPECTION: Y FOUNDATION FRAME INSULATION 1 , FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH- FINAL F GAS: ROUGH FINAL FINAL BUILDING 7 DATE CLOSED OUT ASSOCIATION PLAN NO. Department of Industrial Accidents Office.of Investigations- 600 Washington Street t Boston,MA 02111' wM ,Y• www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kpnlicant Information Please Print Legibly , Vame. (Business/orpnization/Individual): Address: 1 190 cAphW City/State/Zip: q y 1�� yYl O d(o Z Phone#:_ ►re you an employer? Check the-appropriate box:. Type of project(required):- 1 I am aemployer with 1 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors ElI am a sole proprietor or partner- listed on the attached ?sheet $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance: 9. ❑ Building addition [No workers' comp. insurance 5• ❑ We area corporation and its �Iam ired.] officers have exercised their 10.❑ Electrical repairs or.additions a homeowner doing all work right of exemption per MGL 17.❑ Plumbing repairs or additions myself. [No workers' comp.- c. 152,§1(4), and we have no. 12.❑ Roof repairs insurance required.] t employees. [No workers" 13 ❑ Other comp.insurance required.] ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: iomeowners who submitihis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such mtractors that check this box must attached an additional sheet showing the name of the sub-contractors and their wormers'comp.policy information . im an employer that isproviding workers compensation insurance for my employees'Below is the policy and job site Formation. ;urance Company Name: licy#or Self-ins.Lic..#: Expiration Date:- b Site Address: City/State/Zip: tach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ilure to.secure coverage as required under Section 25A of MGL C. 152 caii lead to the imposition of criminal penalties of a e 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office of restigations of the DIA for insurance coverage verification. 'o hereby certifyipper the pains and penalfirs of erjury that the information provided above ' true and correct attire:. Date:* 9l�e� one#:. d 7 Do 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#: Information and Instructions iassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. . arsuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, rpres s or implied,oral or written." °� artners.. , association,corporation or other legal entity, or any two or more m employer is defined aa- an individual, ... P f the foregoing-engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the eceiver or trustee of an individual,partnership, association or other legal entity,employing employees. However:the wner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the welling house of another who employs persons to do maintenance, construction or repair woik-on such dwelling house din appurtenant thereto shall not because of such employment be deemed to be an employer." the grounds or building pp �r on gr . AGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold,the issuance or enewal of a license or.permit to operate a business or to construct buildings in the commonwealth for any ipplicant who has not produced acceptable evidence-of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states`Neither the commonwealth nor any of its political subdivisions shall ',nt.into any contract for the performance of public work until acceptable.'evidence.of compliance with the insurance equirements of this chapter have been presented to the contracting authority." 4,pplicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if. accessary,supply sub-contractors)name(s),address(es) and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members orpartners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of h Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office oflnvestigatiors has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that Est submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"*the applicant should write"all locations in ' (city or town)."A copy of the-affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that-a valid affidavit is-on file for;futaire permits•or-liaenses..A new affidavit must be filled out.each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (ie. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would h'lce t o thank you in advance for your cooperation and should you.have any questions, please do not hesitate to give us a call The Departments address,telephone and.fax number: The Commonwealth of Massachusetts . . : Department of Industrial.Accidents ..Office gf Investigations ' 600-Washington Street. . Boston,MA 02111- " Tel. #617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-727-7749 . wised 5-26.05 www.mass.gov/din °-YME, Town of Barnstable Regulatory Services s • BAW ABM ' Thomas F.Geiler,Director y rsass. � 1639. N, g BuildiIl Division ac�►► Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date �56 AFFIDAVTIL HOME EMTROVEMENT 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 excep'Lbons,along with other. requirements. Type of Work: J4 Estimated Cost_ Address of Work. P- I Owner's Name: Date of Application: I I I hereby certify that: Registration is not required for the following reason(s): ❑ ork excluded by law [vob Under$1,000 []Building not owner-occupied r []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 Signature Registration No. OR . Date Owner's Signature Q:wpfiles.forms:homeaffidav Rev: 060606 i G ............ .... L� 1 vl� was le ` P`T Ia y�4 P�r Spacer- __--_ i ti Town of.Barnstable Regulatory Services 9B"K AM Thomas F. Geiler,Director En M9+" Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 NOTICE OF CHANGE COMPLETED APPLICATIONS WILL START AT THE BUILDING DEPARTMENT FOR PROCESSING EFFECTIVE JUNE 19 2006, The Building Department is requiring a NON-REFUNDABLE APPLICATION FEE to be paid upon receiving an application number. All applications (Building, Gas, Plumbing and Electric) must include a current copy of license, Workers' Compensation Insurance Affidavit and Certificate of Insurance. Thank you q:fb=1changes6/1/06 Town of Barnstable y�P Regulatory Services BMWSTABLE, : Thomas F.Geiler,Director 9 MASS. �A11639• p,0 Building Division fD MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: I IF)* JOB LOCATION: of 7 y,� W kk V,1 number ) street village W"HOMEONER": fZ n_�—[,�,h & YAO- 0 77y a 3"96 name home phone# work phone# CURRENT MAILING ADDRESS: s mnn_i! 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 minunu inspection pr cedures and requirements and that he/she will comply with said procedures and requir ents ' S a7t e of Homeowner i 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 Slt.l�t� FL�MII.`� - 3sznot, �• f . LI► t�tL+! 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