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'., 1, I 4 �p 99 ,; ° 4t I {1 t+''y °Ic1 ,','t teN ii' y J 4. n' 1 v� �Mvkst y„�il' & Y, w �2 V SSA Lti 4i�;w",- ,.n.,, aA-'I, „t. se.I,t u.4sh Q Y __ --- __ a#`_A p� s t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` Parcel l Application # Health Division ell� w/ve ' Date Issued Conservation Division MAR 02 2' Application Fee r0 Planning Dept. wNO, Permit Fee �� V Date Definitive Plan Approved by Planning Board Historic- OKH _Preservation/ Hyannis Project Street Address Ry ®�010 U aIg J g- Village C P, Aecu 1 112 Owner Qftk)Aom alb izan® C a_j4_2 q Address Ste Gie.nuk=d trl/e_ Telephone ::1-) -ram q-2 Permit Request 12�c .��. as, neeAe-d Q-Ck "L an Is �jG�n��c �A.4� � (a�(,���-:n� •c1, (' 'C�}S-�-c..�� \f[�n�-�'��.��of1 �5 -7 e� S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation '3qQr_-;.��Construction Type Lot Size Grandfathered: ❑Yes - ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family./14 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Rc�cM LanqeVdn Telephone Number 6�,-7 -74).6 Address A License # /6. o t Home Improvement Contractor# 7 Email sosegU f(0sola ez sav�LA tig�E Worker's Compensation # YWS :57/,o4 1,C7V ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /OSO r r VC-C -11W - -. A's4e Sfe SIGNATURE L DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED `f MAP/ PARCEL NO. �s i ~ADDRESS VILLAGE c ,r OWNER DATE OF INSPECTION: } FOUNDATION t FRAME INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL `t FINAL BUILDING t DATE CLOSED OUT t ASSOCIATION PLAN NO. f, :R A En iheerin RI E ' 8`flupant Ave.;South,Varmouth,MA 036W GCN,EMNG CONTRACT, 5flftti�6R(�2 f AX'(dUf)14R '3?lli ' :Page; t F'IZUGRAht;, TxfsCalrOnACT�f,1YT@,RfatirTatiETVYseIiRtSs:� - NGCCMES rota>:i oavts'n &israu€a�oR,wvwzas - r�S�Rtitktaad8w' . Ct19T03dtZi -.. ifNLNI`. �. nATE � CLtEYiTII,»» .•m4tMA%4R06R•.~ ' Gautam A Ganapathy (714M.3-08V 01/26i2017= 129660 26102 SERvtta:'5TR Gr 6E.:.t1MG:STkm 36 Glenwood Avenue 36 61CTmbob tAvenv SERVICE CITY.STATE.Bp' MUNG:am,SrArati ZIP Centervilic,N4A 0263? C n'teruille:4 A A2C32 JOB DESC PTIC)X AIR SL'Al ms:'pmvidc labor and matdrials to wul areas of ykrtii home 'this work will hepor(ramiad 51,tSS:fllp in cunctatwith the use ofspecial toots and diajyiaa is tests;0 assure thnt:yaur home-will be"Ith'Wh n-heatihfu)level ref air"Chtsn'gc And indnorapr quality,Matariuls to bc,u&cd to.ccil your haine cna is ctudc'cautks;+fnama,weathcrstrippitigiind other products,Nmiry; areas tut smliq ioclude air leakage to attics,Irzsements,attat6d gars es.and other unheated areas(windows arc nut j.'WIrdly ad4raasS.) (I S)'working From. -1.r.tluetign.iar caibic feet pact rrItnuzc tef-q)of air 061tnuion will occur,bu+the actual number ofebn:? nat stterantced: : s , AI[L Sti'ALLtt�u:Pravfdo.Isbpr anJ muteriata to insu+ll�?-ton'tvcattierstrippiirigaald a dobrsa� .o i2 dao s.ro.restnct:tir leak• e _ 51SS:411 - , 13r��ttL4C'r:lyati pf agruiid'mattrial>to tttstzcpl��t.t�J'luyaFbl'It aft utTu d batle to t70) d 8172,20` , ATTIC FLAT.$invade labor'dud matetiaLe to inssa11 a 4"loyer'of R-33 Cliam I Cellulose added 90 t 111 Q,),agaare feet"nf"opeit,atiie so C. S:1;dbS_2fi- VEN'l'tLATION:Provide labor sod nutterials to iiniialt(I insti tstih haih,ipbm' fau a ,. a Inactl uxhni'i?athose to,+x" g`. f`) vr!.NT moN f,rmxddc labor and m,7teri*jo Sa di ventilation chuites in(70)I enter bays to nitintaia air,t Inv.. S2400 . a ZX tS �;ttiCCYIIi '; RISE5 LinponrArt,�nDth"Ysrmunch;Vti Q2G6•t ENGINEERING �O NTR // SnR-SGl1;192C+ F;1�(4R1)�R�370" ` page z nus.to++ r is eus�eeo mra na�€'ss+uise;, NGCC7{{C+`5, Exalht:tit3m"a TNC CUSTOUM r6tt+kbRK,A3. Cuarootm. PnaNE DdYF: CLtCMt0, 14+0}'fK OttDCR. Gatttam A Ganapatily f714 2&3=C18!2 01126il-017 22;60 *'02 seawt&sTussT' eniswd:slP12er: 36 Glrnwo0d':Nvcnue 316,01 Iepw0od M'cui aenvice:rnrsrnle;ap ss€ttNccrrr sr�re;zm. - ` C6icrvillt,mA 02632 c~tterville,;fvt'A 02f32 lon mSCRT'T {)I!l IhGEl fIVl r RISE F nsincrrinFy.�Yil1 aFtRt},atl�4pplivable,digibit,incentivo,sjw,,his+psJtanCt_ y9tik-wi4l ltc billed dntp the E3et'amouni.- S[t+5 00 (utTtnliy ±br elgi6tt mrastits Natiatiui CtritdntTris.7S�a iuuKttivc,nitt;Eo_,€xteed 5 (}UOprr tnttyttfr year:untl an imam€iFc.of''Ct1(1`Ig far the,Air Sealing measures. ' For the safety Find hwnih➢f ymur h€ine s indoor u`rqualky,wc'imght 1+t'cohdneting blower tlunr dtagncritSw a=-ttte,Fiv tlR4ila ait:ilrnv sn'. your hutne both,Ueforc the witic is b�epa,aitd eflor the wenth difitian woric is tampRu(lot.6'6 crnnduetcd 4.rasbew.Us is prLsent).WWc- wi1Falso caudttci Fi diagnixtie'.tssesssrtent oFtht crutthustlnn lirtrrs in the Czlfaust Am-.GPYOU rliqung system anti kpti7,fieatzr:"l l is bag D value of$00 and is nt'no com,tfi yo€t Iltc Vcmtu will bo secured by Qtci€mtulatioi cobtfattar'tltis has r mlue.(if5?5 and is�t no wi t to you it tia thototrwownce alit rcsponsihility to close trio thixpermit.by c€uimidhg thctr nittn ir y r.,•at the ebtsi'l�•ti an of this"A'6xk:. ` TOW: �3f,AiI�9 7{3 F'rtigQanl:In enilve:;* $2-022 76 Glstotner:TOtal: $2:93 WE AGREE NEIZMY Ta F:URJ4W4%SERVICES.C0i CETE,tN ACC0 DANCE%*M ABOVE SPECIF.ICATIONS.FOR`TktE'.S 40r - 'Fair Htindrdd Eigtity4wo 9 93t100 Dollars 5�32 433; OPONFi+17.L iNSPEwTl6M'Aua di''PNouAL OYtH6E ENDMEEtuM3;CU'StOMEN At3REE6 TO PEVIt AMOUNT DUE t#rV�€a:1MFtar,ESY OF to Y2,RL t3E e,NA9OVS sIaNTKY QN QNii; U#PA;b OALAna Aftck AOA1'9.1EG FffiVCR�e..P.Dtt ImpDirrmi INMiIif3lATICM bN O€iARdNTE86.luGi7fS aP REtaSiaY.:E1tNEDUtitHS A CYiNrttACTOR'RE€Vf8TRA7NIN' w:.,. "+ .,�,e 1 6RL'.ED.S.RATURL 1US?,C 4-1.9 dtfR 9 CLEPTAJI# Z 2�c porL nm4toMTwstetnvnevfmroaiivn¢v,tiaiPrtosfevr�owsriva- � :oA�eopdretardrtte - ,�accEPrAMceoreof+'fnAci'':rNEvaiFsotEs;sreni:curlirasi?mz :nrrkttfs: "" 30- DAYS) AR .SAT IVACTeRY To US AND AAE HWDY AtCVnEJ,YOU C AUttt6MZeDTd OdniE NYtWC, P'AS SPECI Ft,PAYMENT, 'de MAVVA6'Outl �6tIf stable:0 MASS. R3&W 'V,S-au E?ue�ttar 'DIISC23C1 "!`tivaYexrp,I3t�'#�Si�n�Ctianstu�sic�ntr - Office: 508-a62-10 5 9#: 2 t} PropeltyOwnermwt ;op ax Sra'i"hise€ ic. ► ter Ale loy2.utht�ze s xll. atteis ke VIZ rz� "r auraatizct,tsy.skis bslcfits axis applic; fcar: s �'•Pacil'{ races are the resat of usxy_ e }aZct. 'c �ls Are not W.be filled orut+iLwill efci Ilspectiom are perf6imed=d ac,(c7elpt i. iCaatrs c C?w Szztuz"10 `` ic �r a " hint.Namerini a a 4 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MatAchusetts 02116 Horne ImprovemokONtractof Registration Type Corporation , INSULATE 2 SAVE , INC. -� RegtstraUo'A n 1so4 - xpiratlon 12/28/201$ 410 Grove St rt Fallhver, MA 02720 d W 4 jJ seat c, zorh-osnl "x Update Address and return card. Mark reason for change, Bs. e,.s ai ❑ rti la ment ❑_L: st Card tV/!Za �?o9�anrtraiZtucrr��:tz�c�vF�eka�Cir�tt.5r�!u Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for lrtdfvidual use only r TYPE:Corporation before the ekpiration date. If found return to: - fation Exoiration Office of Consumer Affairs and Business Regulatl6n 18077 12128f2018 10 Park Plaza-Sutta 5170 s .„ Boston,MA 02116 INSULATE-2 S AV 'lPltgj t Roland Langevin „ 410 Grove St FellriVer,MA 027�2�3 / All �- Undersecretary Not valid without signature Massachusetts Departmeat of Public Safifaty i bard of Su.ilding Roguloflons and Standards + License: CSA03861 Consfructiori Suwvisot ROLAND LANPEVIN k r FALLRIVER"MA 027 r " " �.d �pirafictn„ t omm[ssloner 0 9124 12 0 11 i ® DATE(MMIDD'YYYY) 4c�oRo CERTIFICATE QF LIABILITY INSURANCE, 11/30/ 6 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'H.OLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED;the.poiicy(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): CONTACT 'RODUCER NAME: Anthony F. Cordeiro Insurance PHONE 508 677-0407 FAX N (500) 671-640.9, (Ala NQ 171 Pleasant Street ADREss: hsouza@co rdeiroinsurance.com Fall River MA 02721 , INSURE S AFFORDING COVERAGE NAIC# INSURERA:LibertV Mutual Insurance. _. NS URED 1 NSEERInsulate 2 Save, Inc. INSt 410 Grove St. INSURER`D. Fall River, MA 0272C INSURERE:- INSURER Fr. OVERAGES CERTIFICATE N UMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WrfH 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. „,._ ____...,..... -POUCY EFF- `T POUCY 0X1` - �SR ADOLSUBR POLICY NUMBER MMIDO/Y) MMIDDV.YYYY LIMITS TR TYPE OF INSURANCE I O A GENERALLIABIUTY Y Y BKS 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 000 000 GE TO RENTED $, 300 000 X COMMERCIAL GENERAL LIABILITY BEIdISE&--(E�l2uJLRe05 ) -- CLAIMS-MADE F_xJ OCCUR ME EXP(Arty one person) S. PERSONAL:&ADV INJURY $ ; 1 OOO-OOO GENERAL AGGREGATE $. 2,0 0 0 `0 0 0 GEN'L AGGREGATE L MIT APPLIES PER PRODUCTS-'COMP/OP AGG $ 2,000,000. }{ POLICY PRO Lam. $ MBINEDSINGLELIMIT A AUTOMOBILE LIABILITY Y Y BAA 56418,,741 12/10/16 12/10/11 Eaaxiaeri il 1'000!1 000 BODILY INJURY(Per person) $ ANY AUTO ALLOWNED AUTOS SCHEDULED BODILYINJURY(Pera0d(16ll) $ X PROPEMYDA RAGE $ I X HIRED X NO OSWNED Per accident AU A OCCUR Y SO 5871 12/10/16 12/10/i7 EACH OCCURRENCE $ 2 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE' $ 10,0010 DED RETENTION$ A }WORKERS COMPENSATION KS 56.418741 12/10/16 12/10/17 X WC.STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTNE. E.L.EACH ACCIDENT S.•,-_ 500r000' OFFICERMIEMBER EXCLUDED? N 1 A (Mandatary In NH) E.L.DISEASE=EA EMPLOYEE.$: 50 ,000...''r If E E.L.OISEASE-POLICY LIMIT..$-, 500 000 CDRIPTION OF OPERATIONS below DESCRIPTIONOFOPERA-nbNSILOCATtONSIVEHiCIES (Attach.ACORD101,Additionat Remarks Schedule,if'morespacelsrequred) Proof of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANGELIU.D.6EFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE'POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION G Map Parcel Permit# Health Division " 6 0, Date Issued00 G.onservation Division. Q� Application Fee Tax Collector Permit Fee D Treasurer SEPTIC SYSTEM MU Planning Dept. INSTALLED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND i=Historic-OKH Preservation/Hyannis TOWN REGULATIONS - ` Project Street Address Village Owner�/Qr1��� �C�//i%,r��}/ Address Telephone Permit Request Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation, Construction Type, Lot Size /g6 Grandfathered: ❑Yes ❑ No If yes, attach supporting doc mentati OAa Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) < r Age of Existing Structure yo'{ %�i S' Historic House: ❑Yes �No On Old King's High y: ❑Y s' Qt;No -v Basement Type: gFull ❑Crawl ❑Walkout ❑Other _ N A Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) tn °D C7% rn 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:10* %­000 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 Xexisti ng ❑new size Shed:❑existing ❑new size Other: /-qk/f��G'�f Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes )4/No If yes,site plan review# Current Use Proposed Use I! ��(/lf Y�%L�.UILDER INFORMATION Name Oil//�G /o�/s/mod Telephone Number �W,? Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECTWILL BE TAKEN TO SIGN UTA RE DATE �`a' f t FOR OFFICIAL USE ONLY _ w � i PERMIT NO. DATE-ISSUED k MAP/PARCEL NO. 1 ADDRESS-' VILLAGE OWNERr DATE OF INSPECTION: FOUNDATION C�r -� 'd67 FRAME 3 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL m " FINAL BUILDING DATE CLOSED OUT �n - �" -3 ASSOCIATION PLAN NO. rr+ 0 yv.. ry, ic9 co m M i _ The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street � Boston,Mass. .02111 WorkersWom ensation.•Insurance Affidavit-General Businesses +y.,.F 3r%`�,��� F/ tie. .f "� F/f// � .r. "•; � .,.• . y. _•�—•��dk1 � • address: state:- �� a :D�elz . hone# ® �� work site location(full address): ❑ I am.a sole proprietor and have no one Basiness Type: ❑Retail❑Restaurant/BaF/Eatibg Establishment ' working in any capacity. ❑Office❑ Sales(including_Real Estate,-Autos-etc:) ❑I am an em to er with em to ees(full& art time�: �Other - / ��%%/O//%//O//%/%///MEMO%%/��/%�%%/ I am an employer providing workers' comueasation for my employees worldng on this job.. comvany•namet '' "'"'• �` ' "` `�•' I�reS i•%�. i L:.4. �l.t.<:.• . insuratice.cot I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: ¢DIDDeIIV 17HI11'CC t' insurance co. - olic # .4 i :�.•�:;:a;.: i L •.rl t%' Y a..e:: ale:.CUIIIA DV'n - address:. . C1tV:: P&One#¢ ,. ... insurance rb. . . .:, .:.. .. .._ :'.::..., •`''' :#`;olic.' 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 S1,500.00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that ta copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under thepains and penalties ofperjury that the information provided above is true and correct Signature �- Date Print name Phone# official use only . do not write in this area to be completed by city or town official city or town: permit/license# []Building Department ❑Licensing Board LO eck if immediate response is required ❑Selectmen's Office (]$ealth Department ct person: ___ - -_ _ phone#; ❑Other Sept 20D.3) Information 'and Instructions. Massachusetts General Taws,ch4apter�152 section 25. equires all employers.to provide workers' compensation for their.. nployees.. As quoted from.the"law", an employee is.defined as every person m the service'of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or mgre of the foregoing engaged in ajoint enferprise, and including the legal representatives of a deceased,employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. 'However the owner of a dwelling house having not'more than three apartments and who resides therein, or the.occupant of the dwelling house of.: another who.employspersons to do.maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such.employment.be deemed to be an employer. MGL chapter 152 section 25 also states that'every. state'or local licensing agency,shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.cbmmonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage regwre& Additionally,neither the commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until m pliance with the insurance requirements of this chapter have been presented to the contracting . acceptable evidence of co authority. Applicants Please fill in .the workers' compensation affidavit completely,by checking the box that applies to your situation..Please supply company name, address.and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department-of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and 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 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. City or Towns . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for.you to fill out in the event'the Office of Investigations has to contact you regarding the applicant Please be sure to Olin the permit/license number.which will b6e used as a reference number. The.affidavits may.be:returned to the Department by.mait or FAX.unless other arrangements have been made. The Office of Investigations would like to thank ybu in advance for you cooperation and should you have any questions, please do not hesitate to give us a call The Department's:address,telephone and fax number: The Commonwealth Of Massachusetts- IDepartment.of Industrial Accidents Bt(tcce at levestl�tlens 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ezt:406 r of r Town of Barnstable N Regulatory Services BARNSUMr a, Thomas F.Geiler,Director p ' ' JAN Building Division QED NIA' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permit no. Date AFFIDAVIT HOME Ry2R0VEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: �Ol✓ 2,6 Estimated Cost DOD• Address of Work: Owner's Name: Date of Application'. I hereby certify that: Registration is not required for the following reason(s): _ []Work excluded by law ❑Job Under$1,000 []Building not owner-occupied NOwner pulling own permit Notice is hereby given that: p . 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 UNDERMGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Contractor Name Registration No. Date OR a Owner's Nam Q:forms-.homeaffidav �e1 d c I_ I �- ILA ' 71 lz ol i i I � �! I ► I � I I I �' I I I d �., r.. THf 1pyy� The Town -ofBarnstable BARMASS. Department of Health Safety and ]Environmental Services MASS A Mp�° Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 PLAN REVIEW Owner: ] Ma /Parcel. l� 1 p c� Project'Address.,, Q_Cnw�p� Ve. Builder: The following items were noted on reviewing: lrl 2. '1 i Reviewed by: 4p Date: q:buil ding:forms:review f Repilgtory Services sauvsrna ; • .._.. r.'ThomAs F Geiler •Director: . ATt sa s��� : . . . Building Division : . . _. . . . sc rr►a , . 200 Main Street, Iiyannis,MA 02601 www.town.barnsfable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: _ L� Ci �� �� number street �T�� L� �i village name home phone# work phone# CURRENT MAILING ADDRESS: cityhown 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 strictures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall pot be considered a homeowner, Such "homeowner"shall submit to the Building Official on a form acceptable to the Building"Official,thathe/she shall be responsible for all such work performed under the buildin 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'Tomm of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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 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:homeexemot ,�,�P6N�' v.�'�'ak.�E F��,fs" ��c.��rr..�ea��l/,�'. /TviY •c�Dr�is�.f/�OiY ' s'a � �8'-�s3/ 3���/��✓ae��/ ` ,�._ . � � � i + � � . , � . �. ! r � � � • f--/9 � ` f � � ! � ; � , � � � , a f � , � � � i � � � � � � � � � a ' � � � . � \ � � 7 � ; BARNSTABLE �.s , HOUSING AUTHORITY . LEASED HOUSING DEPARTMENT TELEPHONE(508)771-7292 146 SOUTH STREET•HYANNIS MA 02601 ZONING VERIFICATION TO: Barnstable Building Inspector FROM: Leila A. Bruce, PHM, Leased Housing Coordinator RE: Uerifying legal rental unit Date: DRAFT Address: Village: Unit type: a-�' Bedroom size: The owner of the aboue listed property is entering into a contract with us for the rental of the property as listed aboue. Please uerify by signing below that the unit is legal and meets all zoning requirements for a rental in the town of Barnstable. If it does not, please list reason here: Tha you for your ssistance in this matter. Sign ture Print name Date MRVP Section 8