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0034 ELIJAH CHILDS LANE
�ELGA44 CAI QS, W - ` n ti e o 4 n +. r� Town of Barnstable B ��Ild PostThis Card So That it is Visible From the Street-Approved Plant-Must,be Retained on Job and this Card Mustbe Kept 1AAMLPosted Until Final Inspection Has Been Made ' ° a6s 1 ..., �„ ii 1 w,... ,, a a ,« _V �s� �:„" �,�,, ;�� ,fig� «y, :�a a G �44 ��s Y �..�� ��` Permit �} Where al Occupanccy'is Requ reds ch'Buildmg shall Not_be Occupied,until a Final Inspectionshas been made ��ll i11111�i lL Permit No. B-20-1987 Applicant Name: Thomas Capizzi Approvals Date Issued: 07/29/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/29/2021 Foundation: Location: 34 ELIJAH CHILDS LANE,CENTERVILLE Map/Lot: 171-256 Zoning District: RC Sheathing: Owner on Record: COVELL,WILLIAM H Contractor-Name.. HOME IMPROVEMENT Framing: 1 NC. Address: 34 ELIJAH CHILDS LANE 2 CENTERVILLE, MA 02632 Contra tor Li ! 100740 Chimney: Description: Replace entry door going into Breezeway room at front of ouse. Est Proje t Cost: $6,000.00 i. Insulation: Thermatru Smooth Star to match same as existing. In.Breezeway Permit Fee: $35.00 room replace 12 wide double hung window with Harvey lassie Fee Paid: $35.00 Final: white vinyl(UV 0.26)6/6 Grill pattern between the glass . Date 7/29/2020 Project Review Req: Plumbing/Gas Rough Plumbing: ' Final Plumbing: Buuilding Official This permit shall be deemed abandoned and invalid unless the work authorized;by this permit is commenced within siK months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws:anj codes. This permit shall be displayed in a location clearly visible from access street or road a i d shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: ' Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 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 Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 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" (as set forth in MGL c.142A). Fire Department Final: Building plans are to be available on site L All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �L S FAA— r i Town of Barnstable *Permit#" E41res 6 mouths from issue date I E^ XepgMalopry Services Fee + BARNSTABLE. p�q� . 6 "ORiehard AU i6gq. V.Scali,Director �� MIAMI`Ut Ahll1 kkh`j 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 Map/parcel Number , Not Valid Wthout Red X-Press Imprint � � � �•5 6 Property Address :3 q Ek Lj A W C 14 l 1 DS IAA)e [Residential Value of Work$ —IS"d t 0 U Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address W f 11 J Q t f 9 G o e 1I 3 1�_t l°JAI C N1LQ.S LtI/ Cp wielluille H4 e Zb 3;— Contractor's Name 0 w 4)-e✓ Telephone Number Home Improvement Contractor License#(if applicable) A)14 Email: Construction Supervisor's License#(if applicable) �h 4workman's Compensation Insurance ., K Check one: ❑ am a sole proprietor am the Homeowner ❑ I have Worker's Compensation:Insurance Insurance Company Name !'d Workman's Comp.Policy# !� Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction.debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side (4 NG elw vo URcplacement Windows/doors/sliders.U-Value (maximum.32)#of windows 00 fQt-1 REl/f rt "J111 D oct).`'ti �d"T(�v�✓ B i it #of doors: , ❑ 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. )re opy of the Im ement Contra rs License&Construction Supervisors License is uired. SIGNATURE: C:\Users\Decollik\AppData\LocalWicrosoftlWindowsl nporary In ernet Files\Cant t.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 The Commonwealth of Massachusetts --. Department of 1ndustrialAccidents 0 1 Congress Street, Suite 100 Boston, MA 02114-2017 �'� 5••'y www.mass.gov/dia 1j`orkers' Compensation Insurance A.fhdavit:,Builders/Contractors/Electricians/PIumbers. TO BE FILED WITH THE PERMITTING kUTHORITY. Applicant Information ,Please Print Le-2-iblY Name (Business/Organization/Individual): t WlA,Y (*O ilk`l Address: 3 `lL�;jF�ft. G/2t City/State/Zip: Phone#:a Are you an employer? Check the appropriate box: Type of project(required): L❑ 1 am a.employer with employees(full and/or part-time).* 7. ❑ New construction 2Q I am a sole proprietor or partnership and have no employees working for me in a capacity. [No workers'comp. insurance required.] 8. Remodeling 3. a homeowner doing all work myself [No workers'comp. insurance t . 9. 0 Demolition p rance required.] 4.7 I am a homeo Amer 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 sale proprietors with no employees. 11.❑ Electrical repairs or additions ' 5.7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12. Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.t 13.7 Roof repairs 6.❑We are a corporation and its of5cers have exercised their right of exemption per MGL c. 14.E Other �� �10- 152,§1(4),and we have no employees, [No workers'comp. insurance required.] Al t *Any applicant that checks box TMl 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 employees. If the sub the sub_contractors and state whether or not those entities have -contractors have employees,they must provide their workers'comp.policy number. I a-n an employer that is providing workers' compensation insurance or information. f MY employees_ Below is the policy and job site Insurance Company Name: N� Policy# or Self-ins.:Lic.#: Expiration Date: Job Site Address: -3 �L! '!i Ch l d f L��e._ L City/State/Zip: e'P�TPdUtll�ls� Attach a copy of the workers' compensation policy.declaration page(Showing the policy number and expiration 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$250:00 a day against the violator.A copy of this statement,may be forwarded to the Office of Investig coverage verification. ations of the DIA for insurance I do hereby certify under the p a enal 'es of per' y that the information provided above is Prue and correct. S imature: Date: -7/31 > /17 Official use only. Do notwrite in this area, to be completed by city or town offciaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Towu CIerk 4. Electrical Inspector 5, Plumbing Inspector 6. Other Contact Person: Phone#: I Town of Barnstable Regulatory Services p4 Richard V.Scali,Director Building Division BMWS'ABM Tom Perry,Building Commissioner 163- A`e� 200 Main Street, Hyannis, MA 02601 ur/c,lf www.town.barnstable.ma.us If C? Office: 508-862-4038 Fax: 508-790-6230 --------------------------------------------------------------------------------------------- HOMEOWNER LICENSE EXEMPTION DATE: 3 2 v/ Please Print U , JOB LOCATION: l/ 4 hl C it VJ I-A •e- C,,w7re ,%A number street village 1-I0M,EOWNER": w//lIAq 0 d1f !7 I �Y U f L✓ name home phone# work phone# CURRENT MAILING ADDRESS: (7ijrP✓y/f/e city/town stale 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 hue 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. r ' The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection edur and requirements and that he/she will comply with said procedures and requirements. Signature of Ho owner 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 personas 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. 3 •t?yL-nDeoc>M Lan �-.. I . l�AfZR,4c G�LI�.JL>El�. L Q A 0 ���.�j � 4 US4 t C7L>C� 6AL- J&>0 V570 - =SPc>wAl_ SIT l0oo G&I-, L UVWALL NGE.A c trj0 -S-W. � nl �3 / • gvT-7-o�vt O.e�a So ��. .I ` ' �� {' � � ' G..,C> sue'.,t 5o C,.11 v To'f- L -nEswN = 425 Tt>`{'a t.• pa.�t_�(. Fl..otiv � _3,3p E.'F'U. .. � � . Z¢ • �. 1 4 ? k ' �'` tdc#�24(T49 ��•� 1 T5 P-: "' 9 9 Top rwa,- J :. 4 Pp& iw. CyAL. Z / 'Sox T �c I PIT 'A 8 S,Tocd� E IZfa LOCATIo" GE•NTePVk�-Lff uosMhLr �G Cw �{ 7 l A T Tt-1[.- Gov bA otJ 5.l-tow t.► PL A tJ R L F C .t.i L C' T tat.l7l_�1_t �«n,tic�t_��s wl~►A Ta�:.: 5tv .t_tw� L o L)ICGA•rR�6.iTs of TNt�. I -�owU c= $ARt�1 -t`A'GL 'a PL 13K. 343 Pc-. ,5' 4 i 'RC_GISt"C=iZi�U 1_A1-1CJ �Ut'_�%c- uc� 05'TECV1Lt.0 o ILrCAS;,. Itrfi�Jt✓ C:�li' t .it.�'.• :T��Ls JFSF_-T�, �i��GwLD n.pc> tCn.tit-r A fisi( l',L: W��Gc� :Tci t�C:TIC:MI�JI.:: !1.�D'C' (..iN``� LAN i • - .. `. � „�•"”'• TOWN OF BARNSTABLE Permit No. ------213.r J' • r Building Inspector I swrr.n Cash ----___-- 9. OCCUPANCY- PERMIT Bond __ �111flW "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector:No building shall be occupied until a certificate of occupancy has been issued by the•'Building Inspector." Issued to -Alan Small i Address tester 'illy lot ,f54 34 'Elijah Childs L�ne. C&kervi L4 Wiring Inspector .�' { y Inspection date /7.-�—S�! Plumbing Inspector ,+� .d'. '. Inspection date Gas Inspector s Inspection date ±3 f% tai?l v ,VEngineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING- INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. d - Building Inspector 7 JAssesigu s map and lot number .../..l ..............:.............. .�, t ..� # THE • SYSTEM ropy ypF 'Sewage -Permit number 81.. ...... SEPTIC:S M MUST S ro`�P INSTALLED IN C® PUANCE ._ , 33AUSTAUBLE, House ri mber ...........n"- ..... ........ '. o roes i! ) ���'�$ TaLE 0 39 °IRONNIENTAL ODE AND '°�-MAI A" t TOWN. OF BARNSTABLE RM It D I N71 INSPECTOR , .G Ej APPLICATION FOR•PERMIT TO O: r TYPE OF CONSTRUCTION . ........ .. ... .. •� f Q(j x ....... ...�.............19. ... TO THE INSPECTOR OF BUILDINGS: The undersigned here y applies for a permit according he f tlowin infor tion: 5—/1 ......... ... Location ....: .;1.:7:..... ........... , ProposedUse .. .�� ... ... .................................................... . ... „ Zoning District Fire District Name of Owner ... ......... ..................Address Nameof Builder .......................... ...................Address ...... ............ ........ ...................................... F Nome of Architect ......:.............. ......... ......... .......... . .......Address ............. .:...,...............................,........::.... ........... ... Number of Rooms .......... ..............:.... ::............ Foundation ... . , .............................. Exierior ... . .. ...:.................................................... ............ � ..... � .. .. ....Roofing. .. .,3 ... �. Floors .......�% ...'.'.'Z................... ......... ......... . ....... ..........Interior ....... ......... . . ....... ... Heating ...�..�.�9.............. ..........................................Plumbin g .. ..e� .." . ....................... ...... Fireplace ... /... .... .. .. ...........................Approximate Cost ... l .Z ).......17.......... .. Definitive Plan Approved by ning Board _______________________________19________. Area t. .Z- '.............`............ Diagram of Lot and Building. with."Dimensions Fee 36 Y ............... ........... SUBJECT TO ..APPROVAL OF .BOARD ,OF ,HEALTH:, Q pv P1 _ r . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... ...... .................................................... y _M� LL, ALA J `232163 Per Jit ' :tr�ry. ,No ..... ......'. m for �i��...S _ S1 ngle ...L2snrel.li ............ 4g r 1 Location ... ...3.4...El.i}4ia...C. Id. Ln: Centerville ......... ............................................. . ............ - _ Owner Alan Small.................................... `f •Frame • `F r • w TYPeoff Construction ........:.....................:�......... _ -, { ' !41� t < 11 ......................................................... ........ Plot ............................ Lot . ' .... ................. 4 - Permit Granted July. 6' .............19 Date of Inspection .......1.9 ` Dam Co+ plea d _. *� `'PERMIT REFUSED t, 19 , �' �_ { 4. ... c .................................... ....... S r ...... ZIP- ............................................................... . j.,. 5 � '' •) Approved .`............................................ 19 ('l= ...........t ................................................. ' Assessor's map and lot•number 1A A► O �S'ewage Permit number .... J,r................................ BAWSTADLE, i House number ............ . ..... . yo NAM .. .............................................. 1639• TOWN OF BARNSTABLE • �t BUILDING INSPEDTOR APPLICATION FOR PERMIT TO .......f...............' '.sr . ...,,f_� TYPE OF CONSTRUCTION .................................. —.. .. t...:` ......f ................19. .. . TO THE INSPECTOR OF BUILDINGS:. The undersigned hereby applies for a permit according to the following information:. Location ...........: ... .... ..... . . ........................... .:.{............?:::... �!.............. ..r..rl 1.....r` '................................ ProposedUse ... ....`...............`....... ...` ................................................................................................................................ Zoning District ..... ... . ................................Fire District .............................................................................. ................... Name of Owner ................................................. .........Address �. .. �.. / ;fr.............................. Nameof Builder ....................................................................Address ................................................,................................:.. ..�,. , Nameof Architect ..................................................................Address ...............................:.................................................... Numberof Rooms ...............................................................:..Foundation ........:....,..........:..................................................... Exterior ............... ..................................................................Roofing ............. ...... ,........., ......................................... Floors ::.............................................Interior ......... .................................... Heating ....... .:...:.....�:.....:..........,.............................Plumbing ..... , r.... . f. :...:...:..`' ................................. Fireplace ................ `{ Y J`:' ................ ........................Approximate Cost ..... 'f ' - r, ............................... -------------------19--------. Area •( /_. .... f Definitive Plan Approved by Planning- Board _____________ -. .�........................... Diagram of Lot and Building with Dimensions ,' Fee ` < SUBJECT TO APPROVAL OF BOARD OF HEALTH i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...: (f� r.!...... .......:....:...-':.......'`...................... ^•SMALL, ALAN A-171-256 No .2.3263 .. permit for ,One Story Single Family Dwelling r Location ...Lot #54 34 Elijah„Childs Ln'... ...................... Centerville ............................................................................... t Owner ..Alan. Small...... .......................................... Type of Construction F.rame... ....... ............................. ................................................................................ Plot ............................ Lot :.............................. Permit Granted July 6, 19 81 Date of Inspection .......... ........10 Date Completed .........:............................19 PENT REFUSED ........................... ................................ 19 .......................... ................................................ ........................ ..................................................... .......... .... ......................... .... ............................ Approved ................................................ 19 ............................................................... ............................................................................... TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0 Parcel 2�� ,r "r,� ,� iST :BI� t_ Application Health Division „1 10 9' + 6 Date Issued 2Y .fJllie Conservation Division ( Application Fee Planning Dept. , . Permit Fee A 0-00 Date Definitive Plan Approved by Planning Board"'" s10, Historic - OKH Preservation/ Hyannis Project Street Address 3 y L..�TArN C_0l L g$ L.*N( Village t N7eR vi//G Owner w� �Lr tn� �' COv� Address 3 y f I TA 14 C N i L D 5 LArl e Telephone 77 Y f 9 y of Za .e-rt fic✓Ji'//e , IY4 02,4 32. Permit Request f3` i )Ad °`- F IA-r FC KM Pack in rKo � f 01 titoU l•e- `h 1:7n VVr y t,e x,a zv y ��P 12c,X 9AAA6-t, 'Square feet: 1 st floor: existing 13LG proposed u/4 2nd floor: existing N14 proposed O Total new 0 Zoning District R C Flood Plain Groundwater Overlay Project Valuation �910�� a Construction Type Woao 4*04C Lot Size y Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ;9� Two Family ❑ Multi-Family (# units) Age of Existing Structure ) 9 J'/ Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: U/Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area(sq.ft.) U Basement Unfinished Area (sq.ft) 3 b Number of Baths: Full: existing Z new 4 Half: existing new Number of Bedrooms: existing G new Total Room Count (not including baths): existing to new y First Floor Room Count Heat Type and Fuel: VGas ❑ Oil ❑ Electric ❑ Other Central Air: C/'es ❑ No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes dNo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: dexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes UAo If yes, site plan review# Current Use - /IAI!/.0 r,4m14 y Irerfi dlemn / Proposed Use r1;1 q le. `Rm� AZ-C/hxrw,L APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name Zl�1/1AIN Ceot -` Telephone Number Address 3 y Eli j4# cl i�OJ LqNe License # A✓®A Home Improvement Contractor# 'd®A Email Worker's Compensation # A/1A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO auJr! PA b41fu�r- Wlt ! .' SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE . OWNER {; c' DATE OF INSPECTION: FOUNDATION FRAME �I I'? 152. o S I o Its INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING; l D'ATECLOSED OUT F ' ASSOCIATION PLAN NO. i F Li CIS gk li DIVISION �x S g C- p IAJ 6 A,4, ( s}�' v� s"i Si 6lfv� e)N41 wNWS fly oy /,V 1. IL: J q S'f l 0 s : IJ O G+tZ [2/i=r` C5 N 13 /3 r= o i- l.�'�'�,�1� ��,+�'�, �nC 4-1 Pi-2 t�U u s C We? C ti l L � mac: car is 47 Alegi G FQ S 1:TS J v �•p' ''D '6 osr .u,•A S�4 lO"' sTr7 GGJ ft' cn J' , {.. ( off 77 � d iePd/rluOPI v"9n% k k°{ f d n per Al f�Cd.t �✓Il ; *i'1 c A) 1-1,4 N G G6'21 , r i r, p Jac O G•## � 5.off .:�- ,� x� -• '?, vR/L4CC � CY) 4) += v� t3 yl lv 'fi r ry n t=/K.E 77 ez c...,l�L=.l.r CN�illt_�{ - =.:� •�'�WC'DC�M ry .... f , f '-J-+- rFF'j-tC 1'�h.l�! .. ���nJ irj� ��� • A.9r 6.P.D. 97A.�' To r'A L- 'r->ESl6W _ .425 Hact-►p spa' Li N4[f;24048 � At Ss, C�1 P . _7 v ;4�`�33'�� � ,icy!► ... .. .� ;� ---._. 1 - 4 low qua !�o o. LL 46 �^ Logil� =J•O�e tuv.• 9Z•o •St1B60/c.. 4'PpG a157 Iw• Gay. �o'g iav -Boy. 9�;G. .S nc Io ,;: TA 04 K -iF d I 000 9G of u 1w. , Wt w i I WAWC .L8 STOWE. qQ o FL C-C GCAt_t= I'�_�10 .�n:-t-E✓ 1:.!. L.�' Fov t),4-n oN 511ow u w i T A TI-,' T �row►J c L PORN Tf�z L5 C � gQXTC1Z :RCGISrc-_ G-D 1A 4�1 G `Sljt'_v'�-�iit�. 05 TC,V-VIL.uG. ICJ r 'Jritt_1;� :�rucf.is��� ..Ttar:� iaF�',:,(-�, Silcwt� n.Pt�l I GA.F�ITe ALAN T he Uommonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,ALL 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Coat Name(Business/Organization/Individual): �iU I �!t Q Irj �' Address: 3 Y E�I�A� fEflAaS IAI City/State/Zip: C e N f t ea Ode 11'# sZ b f�r Phone#: 17 y q 1 Y_o 9 z b' 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 ?.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [kRemodeling ship and have no employees These sub-contractors have g. ❑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. 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.[00ther comp.insurance required.] /a.'1irarm /�e.ftveev 1AW4 Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ,ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have nployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site :formation. isurance Company Name: olicy#or Self-ins.Lic.#: Expiration Date: :)b Site Address: 3 L v Cki I ad I- City/State/Zip: e K+tyi 1 �� ,ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of westigations of the DIA for insurance coverage verification. do hereby certify under t payn�p.en of perjury that the information provided above is true and correct. i ature: Y /"V � Date: O � G q hone#: 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#: Town of Barnstable Regulatory Services oFtME Richard V.Scali,Interim Director Building Division * snxivsznBis ' Tom Perry,Building Commissioner MAM 9 163y. �0� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: G b/0 yea Ole Please Print JOB LOCATION: 3Y EhJ411 tM l oS Id Ce~'erV/'Ile / Af4 number street village "HOMEOWNER': W/I//,4N 0. C e✓e// y1 y/ O Si.23 name home phone# work phone# CURRENT MAILING ADDRESS: Cegee11d,,%/t/ Af4 ozd 8z•. 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 ,( ri7 Signature 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 mapcare t amend and adopt such a form/certification for use in your community. ion System June 4,2015 -- ------....... 11 is not adequate for legal Map:171 Parcel:256 -gements beyond a scale of Selected Parcel Owner:COVELL,WILLIAM H Total Assessed Value:$254300 s. The parcel lines on this map W ,E They are not true property Co-Owner: Acreage:0.57 acres Abutters / physical features on the map Location:34 ELIJAH CHILDS LANE Buffer `' �� r 4 S or Code- + a3' 2 L Prescriptive Residential Wood Deck Construction Guide Based on the 2009 International Residential Code guard decking ledger board N fasteners existing house floor construction 0 9 post st ledger board attachment attachement to existing house P rim joist joists 0 a beam post#o-beam connection (flush,tight bearing) " 2 footing joist-to-beam post connection This document is subject to updates and revisions.To ensure that you always have the latest version of the: document,follow this link to download a free copy of the most current Prescriptive Residential Wood Deck Construction Guide:ham://www.awc.org/Publications/DCA/DCA6/DCA6-09.pdf. For information about copyright permission and hyperlinks,follow this link: hftp://www.awc.org/CopyrightDisclaimer.html. Additional questions: http://www.awc.org/HelpOutreach/helpdesk/index.htmi or 202-463-4713. Print Page Page 2 of 4 • Sales History-Map/Block/Lot: 171 /256/-Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: COVELL, WILLIAM H 2O11-10-26 25786/312 $267500 GOSDIGIAN,ROBERT G& CLARE T 2007-11-01 22447/233 $304000 KIRK,KATHLEEN M 1988-08-15 6402/256 $155000 GREEN,DOROTHY 1987-07-15 5818/231 $1 GREEN, MURRAY& DOROTHY 1981-10-16 3380/10 $0 • Photos 171 /256/-Use Code: 1010 • Sketches -Map/Block/Lot: 171 /256/-Use Code: 1010 14 54 4 rGAR 22 BAS j 'BMT. -4 14 aIgI4,. 40folEo 4 Pht TFoR.n As Built Cards:Click card#to view: Card #I • Constructions Details -Map/Block/Lot: 171 /256/-Use Code: 1010 Building Details Land Building value $ 101,700 Bedrooms 2 Bedrooms USE CODE 1010 Replacement Cost $116,848 Bathrooms 2 Full 0.57 http://www.townofbamstable.us/Assessing/printl5.asp?ap=0&searchparcel=171256 6/4/2015 TO Vi OFN C � COD �� INSULATION 15 A 1 , 7tv EIN" ' FIBER OLASS Sttimti55 SPRA1'TOAM 9YSPENDEO BARS GUTI ER) INSYEATION GEIlIN05T,- -696-6611 , Co Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: l Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected b. a certified p y Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village 4I 3�l1, J Insulation Installed: Fiberglass Cellulose. R-Value Restricted Unrestricted Ceilings ( ) ( X) O ( ) O Slopes . (X) ( } (3v ) o.<B) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) Sincerer He y E Ca sidy r, President Ca e Cod sulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_/J Parcel Application,# Health Division ' '' Date Issued r� Conservation Division Application F;a/ Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board '71z-4112 Historic - OKH _ Preservation/ Hyannis Project Street Address � ��/� G'�rS ZI e ` Village z!5*7�, Owner l L��,9t� ���P// Address -S Telephone?,7��'9 a :?OP Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiorl S�dO, d Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a," Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes Ulo 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: 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 vl��'� �l`�et���A� f� Telephone Number Address G1A/l /DZ-, License # Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE r DATE i i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED s` MAP/PARCEL NO. i ADDRESS VILLAGE L ' OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE { ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING c DATE CLOSED OUT ASSOCIATION PLAN NO. 5 1 t OWNER AUTHORIZATION FORM l I 1 ; l / 'ate rl e' l (Owner's Name) owner of the property located at /(Property Address) (Property Address) B � hereby authorize ecu e cc (Subcontractq an authorized subcontractor`for RISE Engineering, to act on my behalf to obtain a building permit.and to perform work on my property. Owner's Signature 4 Date I RF 0v[9 IN UN 2 9 '2012; 'I 1 O.Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC 4 5N 4 ARMOUTH RD. --- HYANNIS, MA 02601 ----------- - ------- ___ --- _...__-.-._-- ;Update Address and return card.Mark reason for change. �� Address A Renewal (_I Employment LJ Lost Card JPS-CAI Co 50M-04/04-G101216 - Oftice F 01 •umer Affairs�`Bus'ne ReguI tion License or registration valid for ir.di��idu! use HOME Paftl �I" �' ;Z"� �z before the expiration date. If found return to: } _ Registration: 153567 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite 5170 \' Boston,MA 02116 OD INSULATION;'I'NC HENRY CASSIDY 455 YARMOUTHR.D; HYANNIS,MA 0260.141 Undersecretary t alid ith t si ture '- Mas achusetts-J)cpartment of Public Safeth Board of Building Regulations and St:intlar' Construction Supervisor License ' License: CS 100988 HENRY CASSIDY 8 SHED ROW r. WEST�,ARMOUITH,,MA 02673 c Expiration: 11/11/2013 ('urnuri..i,ncr Tr#: 7620 The Common ii- ,01ih of Massachusetts Department Industrial Accidents W Office cif'l a vestigations w 600 W'4zshington Street h Bosturc. MIA 02111 ayo W W I I'.11 N.ISS.goh/Ella Worker's conipensation Insurance Affttf�o,�it: Builders/Contrac tors/Electricians/Plunibe I's applicant Information Please Print Legibly t Name (13usiness/0►ganization/Individual): I Qk1 C- 0tyls[L-ILCIZIP:�XCI Vl n (5 ))IA ate? _--- Phone#: .S R- '77 6 - z Are you an employer? Cheek the appropriate box: Type of project(required): NX l l am a employer with_..,__ �l © ❑ I am a, n :1 contractor and I have 6. New construction eulployees (full and/or part-time).* hired the snl,-contractors listed on 7. F] Remodeling the attached sheet.$ i am a sole proprietor or partnership These sub o.)mractors have 8. [jDeniolition and have no employees working for employees :mil have workers' comp. 9. Building addition tilt;in any capacity. [No workers' insurance:.-1 10, ❑ Electrical-repairs or additions WHIP insurance require([.] 5. We are a cot'poration and its 11: Plumbing repairs or additions��----JII officers Ira v� exercised their right of , L._ l ant a homeowner doing all work exemption per IVIGL c. 152§(4),and 12. Root repairs myself. [No workers' comp. we have.110 employees. [No workers' 13. Ocher / ,ePIz ct� insurance required.] fi comp. iusur:ntee required.] j ".Any applicant that checks box#1 must also fill out the section below slio\vi,,L their workers'compensation policy information. t tlumcomwis 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 attach an additional sheet showing tlt.-until(of the sub-contractors and state whether or not those entities have employees.If Lk sub contractors Have otitptoyees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site inf iwination. Insmance Company Nance: l .ice U t cxVlee C--4 ), Policy#or Self-ins. Lic. #: �(L� d�.') � C L_ Expiration Date: Job Site Address: _ _ City/State/Zip: Attach a copy of the workers'compensation policy declaration page(,crowing the policy number and expiration(late). Failure to secure coverage as required under Section 25A of MGL c. 15'c;ui Icad to the imposition of criminal penalties of a finis up to'$1,500.00 aud/ur one-year imprisonment,as well as civil penalties in the form of a STOP 4V0RK ORDER and a fine of up to$250.00 a day against the violator.Be advised that a i:opy Of'this statement ma e forwarded to the Office of Investig:uiuns of the DIA for insurance coverage verification. I do here c i under the ins and penalties of'perjaty.that the information provided above is true and correct. Sibnaturc: Date:� /7� /z-- Phone#: C Official use only. Do not write in this area, to be completed b}•,city or town official City or Town: _ 1'ermit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/' 'overt Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Jul. 2. 2012 3: 1)PM No. 1605 P. 1 Client#:4597 CONSUL ACORQ,., CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNM) 07/02/2012 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 holder is an ADDITIONAL INSURED;the policy(ies)must 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(s). PRODUCER NCONTACT AME: Mar Bret Young Rogers&Gray Ins.-So.Dennis PHDNE 506-760 4602 434 Route 134 AIC No Ell): ArC No: 877-816-2156 E-MAIL South Dennis,MA 02600-1601 508 398.7980 INBURER(9)AFFORDING COVERAGE NAIL 8 WtURERA:Peerless Insurance 18333 INSURED Gape Cod Insulation Inc INSURERS:Evanston Insurance Company Atlantic Charter Insurance 455 Yarmouth Road wsuRERc: Hyannis,MA 02601 INSURERD:Commerce Insurance Company 34754 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 CONTRACTOR OTHER DOCUMENT WITH 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. TYPR OF INBURANC� ADDINSR W D POLICY NUM13ER POLICYIYEFF POLICYEYYY UMIYfi A GENERAL LIABILITY CBP9263063 (MVIOD4101/2012 04/01f201 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY PREMISES ENTER $10O OOO a occurrence CLAIMS-MADE aOCCUR MEDEXF(AnyonsperaoA) $5000 t.RRSONALd,ADVINJURY $1000000 GENERALAoaREOATB $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PFR: PRODUCTS-COMPIOPAGG $2000000 POLICY PRO- LOC $ p AUTOMOBILELIA131LITY 12MMUCKVMK 4/01/2012 04/01I201 EaamcadeDSINGLELIMIT 1000000 r ANY AUTO BODILY INJURY(Pcrperson) $ ALL OWNED k ULED AUTOS BODILY INJURY(Pataocidenl) S I—X HIRED AUTOSNEDPROPERTYB X UMeRBLLpLIAUR XONJ453512 4/01/2012 04/01/201 EACH OCCURRENCE $1 000 000 EXCBSB LIARMS-MADE - - AGGREGATE $1 QQQ QQQ QED I X RETENTION 10000 $ C WORKERSCOMPeNBATION WCA00528802 6/3012012 06l30/201 X WCSTATU. OTH• AND EMPLROYE7RS LIABILITY �( OFFICFW EMBOER EXClU6 f 9 ECUTIVE N/A E,L,EACH ACCIQENT 1 OOO OOO (Mandatory in NH) E.L.DISEASE EAEMPLOYEE $1000000 It yes,describe under DESCRIPTION OF OPERATIONS befow �r E.L DISEASE POLICY LIMB $1 00O OOO i DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES(AUaah ACORD TO1,Addlilanal Remarks SCheduls,II more space le required) "Workers Comp Information°'A . Included Officers or Proprietors Certificate Holder is Included as an additional insured undor General Liability when required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION Cape Cod Insulation,lnc SHoULD ANY OF THE AeoVE DESCRIBEED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL aE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 Of 1 The ACORD name and logo aro registered marks of ACORD #383849IM83848 MEY ; Opt Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee 02 7,62. %639. $ Thomas F.Geiler,Director s '�E°►AA` Building Division X-P P F R_ T . g Tom Perry, Building Commissioner S F p j 5 2GO4 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax, 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERNIIT APPLICATION - RESIDENTIAL,ONLY Not Valid without Red X-Press Imprint Map/parcel Number %1 U� v Property Address �.S C'J 1 I Il V u� , , .Residential Value of Work 6Soo Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 1 �. Contractor's Name �e ir9-r� Telephone Numbed Home Improvement Contractor License#(if applicable) Contraction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner y I have Worker's Compensation Insurance Insurance Company Name C-9 Workman's Comp.Policy# 79"t6 /eo 4 s 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 L4/►164-,L.Jt 61& ❑Re-roof(not stripping. Going over - existing layers of roof) ❑ Re-side ❑ Replacement Windows. 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: roper t ro rty Owner Letter of Permission. Hom ro ors License is required. Signature QTorms:expmtrg .,Revise063004 Fraser Construction Roofing & Siding Specialists FRASER CONSTRUCTION Warranties the shingles and labor for 10 years. FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. CERTAINTEED Warranties the shingles and labor 100%for the first 5 years, and then on a pro rated basis for 30 years total if the shingles become defective.` I CERTAINTEED Warranties the shingles to be ALGAE resistant for a full 10 years. { • 1 Any deviation or alteration from above specification will be executed upon - written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw.this' _ proposal. 3 FRASER CONSTRUCTION: Carries Workman's Compensation and Public Liability Insurance on the above work. _ DATE OF ACCEPTANCE: 000, SUBMITTED BY.- Homeowner = aser O structioil i • � Board of Building Reguiations and Standards HOME IMPROVEMENTCONTRACTOR Licens Reg�stratton -1,12536 before Exp�rat,�in2005 Board 4�TYpv fl�q One A FRASER CONSTR Boytot DEAN F RA WTI N eQ .;_ SER I71 TARRAGON CIR COTUIT,MA 02635 . Administrator