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HomeMy WebLinkAbout0004 MASHPEE ROAD J I L1124 CAPE COD INSULATION IIS GAY7437 7t4A77(Sf INWAI SMA04M SUIT1N010 S411f OUIf1Yt IN51114}ION CtIlIN07 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: /y2• �o�/ 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 by a certified Building Performance .Institute *(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village ev7fw� Insulation Installed: .Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) (VOr ll Sincerely H ry I- ssi r, President pe C Ins ation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # G Health Division Date Issued J Conservation Division �� Application Je Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �N� Historic - OKH _ Preservation/ Hyannis `01 btn Project Street Address' Village Owner Address Telephone' Permit Request M- &- -,)VfZ6,; rZ alv5wiali �� ci �1a21d' •I_ EkV Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District �I Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family LAC Two Family ❑ Multi-Family (# units) Age of Existing Structure tt 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 *Jo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name h Telephone Number Address �� CAV License # U �p�Q f "�� Home Improvement Contractor# Email 8�u (K fdI(M f Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THISrr RpROJ CT WILL BE TAKEN TO SIGNATURE DATE 2 FOR OFFICIAL USE ONLY APPLICATION # 4 DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f DATE CLOSED OUT ASSOCIATION PLAN NO. Permit Authorization VNV mass save: Form PVOINDUMR Site ID: S00050143676 Customer: JAMES DRUMGOOLE I, JAMES DRUMGOOLE ;owner of the property located at: (Owner's Name.printed) 4 Mashpee Rd. COTUIT (Property Street Address) ' (City) hereby authorize the Mass Save Home Energy Services Program assigned.Participating Contractor listed below to ad on my behalf and obtain a building permit to perform insulation and/or weatherizationwork on my property. Owners Signature: awo 6a) Date: t 000000000000000000a000000000000000000000000000000.00000000000000000000 ' FOR CLEAResult OFFICE USE ONLY CLEAResult has assigned the following-Mass Save Home Energy Services Participating Contractor to the above referenced.project: C�or Cr'2. Old 3k;__P Contractor Date Of'0 CLEAResult • 50 Washington Street,Suite 30M • Westborough,MA 01581 • 1800-480.7472 For Once Use Only Rev. 102015 L. Massachusetts Department-of Public Safety Board of Building Regulations and Standards License: CS-100988 r " Construction Supervisor." HENRY E CASSIDY 8 SHED ROW � moll �� y WEST YARIViOUTH M�,, 2 p37k ' "� Expiration: missloner 11111/2017 Y I � � fin, "�. • •�� �� � Z Lit E�f.C/fiU� ��� /// Office of Consumer Affairs and,Business Regulation 10 Park Plaza - Suite 51:70 Boston, Massachusetts 02116 , . Kome Ianpro.vement Cor>tra'ctor Registration ReglstratloW 153567 Type;' Private Corporatlon Expiration: 12/15/2016 Trtt 259188 CAPE COD INSULATION, INC HENRY CASSIDY - ' — 18 REARDON CIRCLE . SO, YARMOUTH, .MA 02664 Update Address and return card, MRrl( reason for change. soa,1 0 2oM•05ni OAddress,, Renewal Employment �� Lost C, V/ce tpanr�raoouue�r•�C�a�C%�lwJJa•o�cWeG� ' Orree or Consumer Affairs&'Business Regulation License or registration valid forrindividul use only ,TOME IMPROVEMENT CONTRACTOR Before the expiratlon'date, If found return to;. eglstratlon; 1`53567 Type: office of Consumer Affairs'and Business Regulation j xplratlon,:.1' 'lt5(20:16 Private Corporallon '10 Park Flaw-Suite 5170 Boston;MA'021'16 ' CAPE COD INSULA11;�7N,INC ''> HENRY CASSIDY :•; : .',:; 18 REARDON CIRCLE', S0.YARMOUTH,MA 02604. Undersecretar y qNy 4wlut sign e- The Commonwealth of Massachusetts wZ Department of Industrial Accidents 'j Office of Investigations ==fi 600 Washington Street' Boston, MA 02111 wwfv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual); Address; /) >;110D A L4br 1 �. City/State/Zip; , ' ,, � � WlAvtm b Phone #: O Are you an employer? Check th appropriate box; Lr 1 am a employer with �� 4, [] I am a general contractor and 1 Ty of project (required): have hired the sub-contractors 6, [ .New construction employees (full and/or part-time).`.- , 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. T. Q Remodeling shipand have no employees These sub-contractors have 8. Demolition � working for me in any capacity. employees and have workers' comp, insurance.$ 9. [] Building addition [No workers' comp, insurance P� required,) 5 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their I❑ l am a homeowner doing all work . . 1 l,❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required,) t c. 152, §1(4), and we have no employees, [No workers' 13, Other_' JO comp, insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. .t Homeowners who submit this at`�-'idavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attaghed an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that Is providing workers'compensation insurance for my employees. Below is the policy and job site information, t, Insurance Company Name; Policy # or Self-ins, Lic, #; t �iE 0L j9?I Expiration Date. i /hk Job Site Address; _ � � �-C/ City/State/Zip:69, Attach a co of the workers' com ensation policy declaration page (showing the policy number and expiration date), copy P P Y P � ( g P y p' ) Failure to secure coverage as required und6r.,Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to $1,500,00 and/or one-yeari�,nprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250,00 a day against the violator, Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurar4 coveralze verification. I do hereby certify d the pat an penalties of perjury that the information providedfbo Is true and correct, S i nature. ° Date: 21C. Phone#; 7 Official use only. Do not write in this area, to be completed by city or town official, rt. City or Town: Permit/License# Issuing Authority (circle one): 1, Board of Health 2, Building Department 3, City/Town Clerk 4, Electrical Inspector 5, Plumbing Inspector 6. Other C'nntact Percnn! 1)1, no u. CAPECOO.27 BDELAWRENC 04 Ro° CERTIFICATE OF LIABILITY INSURANCE DAT30/20lYYYY,— � 613012015 THIS CERTIFICATE IY ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, TI•11S CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR'ALTER THE•COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(I0$)must be endorsed, If,SUBROGATION IS WAIVED, sub)ect to the terms and conditions of the policy, certain pollclea may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s), PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc, PHONE FAX 434 RIB 114 A/c No r(877) 816.2156 South Dennis,MA 02660 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NaIC n, INSVRERAI Peerless Insurance COmpany•see LIBERTY MUTUAL IN$VREO INSURERB,ATLANTIC,CHARTER INSURANCE GROUP Cape Cod Insulation,Inc, INSURER C 18 Reardon Circle INSURERo: South Yarmouth,MA 02664 -- INSURER E: INSURER F l 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 PERIOE INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM*OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH/TAIZ 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, INSR LTR TYPE OF INSURANCE POLICY NUMBER MMIODM-YY MMIO /YY P LIMITS A X COMMERCIAL OENERAL LIABILITY I ` v` EACH OCCURRENCE $ 1,000,( CLAIMS-MADE a OCCUR C6P8263063 04101/2016 04/01/2016 -PREMISES Ea occurrence $ 100,( MEOEXP(Any oneperson) $ 5,( PERSONAL&AOV INJURY $ 1,000,( GEN'L AGGREGATE LIMIT APPLIES P.ER: X jECT LOC GENERAL AGGREGATE $ POLICY a 2,000,( PRODUCTS•COMPIOPAGG $ 2,000,( OTHER: $ AUTOMOBILE LIABILITY $ Ea aocld.0l)I GLE LIMIT ANY AUTO BODILY INJURY(Pet person) $ AUTOS AUTOS BODILY BODILY INJURY(Pe(accident) $ . HIRED AUTOS AUTOS VNEO PROPERTYO AGE AUTOS Per a id nI $ VMBRELLA LIAR 'OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS•MAOE 'AGGREGATE $ OEO I I RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y/N STAT TE oR _ B ANY PROPRIETORIPARTNERIEXECVTIVE WCE00431901- 0613012015 0613012016 OFFICERIMEMBER EXCLUDED7 NIA E.L.EACH ACCIDENT $ 1,000,( (Mandatory In NH) - Ilyyesdescribeunder E.L.DISEASE_-_EA EMPLOYEE $ 1,000,( DES�RIPTIONOFOPERATIONS,belo%v E.L.OISEASE•POLICYLIMIT $ _ 1,000,( DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES'(ACORD 101,Addltlonal Remarks Schedule,may be attached If more apace Is required) Workers Compensation Includes Officers or Proprietors, Additional insured status Is provided under the General Liability and Auto Liability when required by written contractor agreement with the Certificate Hold CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED Ir 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, South Yarmouth, MA 02664 -AUTHORIZED REPRESENTATIVE --, r ©1968.2014 ACORD CORPORATION, All rights reserved, ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD �tie Shed OF BARNSTABLEPermit BARNSTABLE. TOWN MASS. _ 6� sprF A Permit Number. Application Ref: 201506030 20152735 Issue Date: 10/02/15 Applicant: REGAN, JOHN P & TRACY W Proposed Use: Accessory Structure Permit Type: SHEDS 200 SQ FT &UNDER Permit Fee $ 35.00 Location 4 MASHPEE ROAD Map Parcel 019152 Town COTUIT. Zoning District RF .Contractor PROPERTY OWNER Remarks 11 x 18 SHED ti Owner: REGAN, JOHN P & TRACY W Address: 188 ISLINGTON ROAD NEWTON, MA 02466 4' Issued By. JL POST THIS CARD SO THAT IS VISIBLE FROM THE k1WEET I CD 10hJ;5- Town of Barnstable I"E'' Regulatory Services 4 Richard V. Scali,Interim Director 03 snxrisras �►,► Building Division 9��.E, Ai�Mpya Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 0 PERMIT 03FEE: $ SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less Location of she (address)• Village cc,u n (� aer 77V-- 541- (Y�) a Pr erty owner's name Telephone number /I x 0 q Size of Shed Map/Parcel# Si re Date 6 1 Hyannis Main Street Waterfront Historic District? 1 Old King's Highway Historic District Commission jurisdiction? n Qu If over 120 square feet,you must file with Old King's Highway ..a TonservatiorrCommission'(signature is requir-id)---�— C Sign off hours for-Conservation 8:00-9:30&3:30-4:30� PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:110413 FILE NO,jfifiglk O LOT 47A NIF BUZZARDS '. BAY GAS CO, LOT F .F.i a n Z6"* LOT E 8.�'yd '• ~`e T, o i 35.53' MASHPEE ROAD OF SU9JEC'• aFU#?F.(iTY AND (!PEOI L Aril' LHAZAI I IN n JOHN 5, . SPECIAL f!'rUD NAZ�+RD AREA C3 LAIJRETAN1 ASi 910Wt'i ON fl.MA MAP 1 ry 34311 RtFL`I�ENCIii BELOW, MORTGAGE ONDER C9� SURM�{ - use ---- TSB A7`ib I FS LALil,�ll R5 wow Cv.ASSCK AI lS,INC i DINA B.. 1ivT1PiT', Q. A EjucAxSuRI-%llve T�,3 n��f;l sued C0"?ANY0F'.80Sf0'V 5�1 Ccocotfi Sates c:ti flaur bVui ofs,non 071)Bt (�fvtltemn.MBA P(746 P im commTUTION BLVD. 9Uri'B D (p)3084 9_950i1 (p)i0x-LtSN 0059 wlvw.mewwstl.w.et+ro ltltANlf7.1l1; NA_.02030_—._--..-. ._. -- ;Elnaf�;muawrstlswcgm _--- 137 ,OEGO FAx.;(609)=-4911 � �89 ,ygy�q , Pig THERE ARE NO CEEDEO EASEMENTS IN INSPECTION,i66�IIT� PLAN THE ABOVE fC€F'ERLNC£D RESPECT OR rE. � ___. EucRoacHMENTs >+��+ REsn€rr TO ADDRESS: t r EXCEPT AS STATED (JN THE DEED OF LLNDL'R: �� RECORD SHOWN. ATTGRNEY;, 2 - THE LOCATION Of THE DRELLINO AS OWN€W?At�Q!NTHIA CAN ANIf�1 _-- ___�_...r SNOW+ HEREON EITHER WAS IN COMPLIANCE WITH THE LOCAL ZONING APPLIL''ANT; . ------�- BY-LAWS IN EFFECT WHEN DATL, 9( �� `� ®T_SCA•LE:. COUNTY:�ARNS�_— CONSTRUCTED (WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS Ut+REGIS�E�'Ea LAND ONLY), OR IS EXEMPT FROM VIOLATION _ _ PACE: 1. ._r.,.....w• ..,.,.., ENFORCEMENT ACTION UNDER MASS. G.L. DEED B?OK:.�Z�.�.,.,,., ..,.,m; .,„..•,.,,.....,,•-- .00D HAZARD iNFQ:. FLAN BOOK: xR .� ----PAGE 46_ _ LLTT(5)t --- NF.: AI 0ATV):1/zAw— PLAN NUMfiER:_ OF12I2 MMUNITY E 1.:1CA11i)N Of TNF: I;wtiL. 1^'G SIIOwfv RE�Y�J�� {7��' LAND CERTIFICATE OF T�1E:_� — ASSESSORS MAP: ca FAI'. WITHIN !a F'CCIAi. F!()GC REGISTRATION f3C��K:..,-^,.._.._._ _. P'AGE�:�..._�•-�.m�m^---_.« YpID 'TUNE. PLAID NUMBER;_. - LOT(S):.w.'. � � f�LOc LOT: TI OAGE IERAL NO�`(t)TF+E OECLARAl10NS MADE k80VE ARD�ON,TpE NORMAL STANDARD OWIS OF MY AF CARE OfATION,aEG151 REGISTERED LAND SURVEYOR 5 PRACTICINOAND BELIEF AS THE RESULT OF A GINT4 SSACHUSETTS )E NEY, N-:I'I' IMe FF:IJI,T 01' AN INSHROO NT .+llt(VF. V ,tE REPARING ,LARA.TIDNS ARE �.4ADE T�OTRU THE ABOVt ON, (4)N RIDC CLIENT TKM OFONLY P!';S OF I LINE DIMENSTQN5IS OATF- y6Ul CIN�AOrFS TS, FENCES OR LOT I CQNFICURATIONQMAY USEOR IN! IACCOMPLISHEDDBY AN ;QRIPTiONS OR FOR S . . ., . - -. - °FzK l Town of Barnstable *Permit# 7S Expires 6 months from issue date Regulatory Services Fee t PERMIT Thomas F. Geiler,Director - �A 63 9• ,� Building Division rfD MPS s FEB 2 4 2009 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLE 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 l t j Property Address ❑-Residential Value of Work P J3 v Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �4� J1�i/) lie Contractor's Name I `,) x ?el elephone Number 75 4 Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor El Yam the Homeowner I have Worker's Compensation Insuranc Insurance Company Name P Y Workman's Comp.Policy# ��(i L6 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 L Y kn- ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. d SIGNATURE: / Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 ✓fie -C�o:m��wm.�uea/� o�.-/�,aaaae�u�ael�a Board of Building Rcgulal ons and Stan6r5s License or registration valid for individul use only HOMkIMP,ROVEMENT CONTRACTOR before the expiration date. If found return to: y,b Registration::, 105548 Board of Building Regulations and Standards Expiration 7%;17/2010 Tr# 27197.6One Ashburton Place Rm 1301 �rrL Boston,NIa.02108 T Ypa DBA i , VILLAGE.CRAFT-BUILbING&R,E�YIODELIM8 MSael Doi iva. g $.SANTUIT RD. r --- ----- -- - CQ. UIT,MA 02635 � Administrator,: Not Valid without signature J , i '`'' IVlassachtisetts- Department of Public Safet Board of Building Regulations and Standart Construction.Su ervisor P License License: CS 50234 Restricled to:. 00 . MICHAEL` DELUGA . 568 SANTUIT RD -" COTUIT, MA 0263'5 Expiration: 7/9/2010 (:'unuuissioncr ' Tr#: 30003 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' + 600 Washington Street Boston, MA 02111 ;• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ' Address: U City/State/Zip: �Y/ u 14' Phone.#: 7�� 7Ieu an employer?Check the appropriate box: Type of project(required): am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2:❑ I am a sole proprietor or partner-' listed on the attached sheet. 7. .❑,Remodeling ship and have no employees These sub-contractors have - 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers'comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑P Bing 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.[_1 Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: k✓6Z � `/ / Expiration Date: / ;f Job Site Address: City/State/Zip: a t� Attach a copy of the workers'compens7tion 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby certify under t e painsVaneties of perjury that the information provided above y�t�Mi correc� Signafore: �l) Date: 12 vC Phone Official use only. Do not write in this area,to be completed by city or town of-ciaL ..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 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more -----of the foregoing-engage -m a-Joint entepnse`;and melu�uig-tlie legal=represen-tatrve�of-a=deceased=employer,_or_-the���___.-__::�._ ----- receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house.of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,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 or partners, 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 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 of Investigations 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 must 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 future permits or licenses. 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 (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: P The:Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Re✓ised 11-22-06 Fax#617-727-7749 wwwrnass.gov/dia t tHErO�ti Town of Barnstable Regulatory Services • a r a 9saRxgat s$' Thomas F.Geiler,Director 1619. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder AV'% , as Owner of the subject property hereby authorizeb to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address 6of Job) 12A IA 6 Signature of Owner Oate Print Name ' If Property Owner is applying for permit please complete the. Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION Town of Barnstable Hof SHE Tp�y OT Regulatory Services R&RNsrwsr e, : Thomas F. Geiler,Director bL4-9& fni",0� Building Division Tom Perry,Building Commissioner _200-Main-Street Hyannis,M-A-0260-1----- vrww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER'* name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)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 verformed 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- 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 homeowncrs who use this exemption are unaware that they are assuming the responsibilities of a supervisor(sec 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 foim/certifi cation.for use in your community. Q:formts:homeexempt WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company Burlington, Massachusetts (800) 876-2765 NCCI NO 40959 POLICY NO. I WCC 50061 1 401 2008 ITEM PRIOR NO. I WCC 5006114012007 1. The Insured Michael Deluga dba Village Craft Building&Remodeling Mailing Address: 568 Santuit Road Cotuit MA 02635 (No. Street Town or City County State Zip Code ® Individual ❑ Partnership ❑ Corporation ❑ Other FEIN 04-3182146 Other workplaces not shown above: 2. The policy period is froml2/23/2008 to 12/23/2009 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item&A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 10 0,000 each accident Bodily Injury by Disease $ 500,000 policylimit Bodily Injury by Disease $ 10 0,0 0 0 each employee C. Other States Insurance: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual of Annual Remuneration Remuneration Premium INTRA 355380 SEE EXT NSION OF INFORMATION PAGE Minimum premium$ 500.00 Total Estimated Annual Premium $ 2,691.00 As indicated,interim adjustments of premium shall be made: Deposit Premium $ 2,839.00 ® Annually ❑ Semi Annually ❑ Quarterly ❑ Monthly MA Assessment Chg. $2,344.00 x 6.3000% $148.00 This policy,including all endorsements,is hereby countersigned by 10/09/2008 Authorized Signature Date GOV GOV KIND PLACING CLAIM NAME SAFETY STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP Malcolm&Parsons Insurance MA 5645 7 504 Agency Inc WC 00 00 01 A(11-88) 6 Freeman Street-P O Box 527 Includes copyrighted material of the National Council on Compensation Insurance, Stoughton,MA 02072 used with its permission. THE TOWN OF BARNSTABLE 2 . BARNS MUL .TkUL 1639. BUILDING INSPECTOR 17MO APPLICATION FOR PERMIT TO ... .......... 1 4.,�.................................................................. TYPE OF CONSTRUCTION ..........L.Q.Q.Q ......7t N",c................................................................................ .........Alo....d...........?-...z........ ..............TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....40 .... ......4 15A -J`ru I-r.....eo A C67 a,. .............................. ........ ............................................................... ProposedUse ........... F,4Zq j..J .. . ..................................................................................................... Zoning District .........P,..�......z ..............................................Fire District .........(.2,0-I-02.1�............................................... ... .. .. .... ............. ..... - —TZ0t-v.P-iev- 41V6)Aoi,4 F Name of Owner .................................J....................90.6.1c"/Address ....... ......1!�O.TL..................... Name of Builder ...S.O.bkl.4...... k.C.......Address ...... ......./,A.P4.�...... .......... Name of Architect ...........5A.M.�............A&).O.ti..........Address ................................................................................ Number of Rooms .......6.....kqanS.................................Foundation ....PO.Qek. OQA! A%krk ..................... Exterior ....... ...... .................................Roofing ....... .................................................. Floors ........................ ......q A6.9.0-0.N........................Interior ........ "I I'L ....9R(.14�.................................... Heating ....... .............................................Plumbing ........PkA ......4....(�D.104.1�................... Fireplace ........ ........(e 9A C�':K)................................Approximate Cost .0-3.0)o2.0......00............................ Difinitive Plan Approved by Planning Board --------------------------------19--------- /�z � �� e- Diagram of Lot and Building with Dimensions X. P4, < < m 4 0 44 0 0< , ra C, 4� �\ z C3 44 46- ) (70 2L, 9 Lu, a. MA59ptL 4C� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......... ................ ... ..... ................................. r /7 XSZ... Boden, Frederick & Paula No'.156 ... Permit for . ildin ... , ans.. am7,1.Y�x.Q 1dence.'............................. r - + Location ..I§rrA..Mashpee Rd ' Cgtu�,t ........................................... r` _ Owner �Z'�S��X'7.��5..$�..�,��,1.. e�?................ . . Type of Construction ....Frame........................... .............................................................................. w� .. it Plot ............................ Lot ................................ 4� - _ Permit Granted .Novembex..22.. ''.19 72 _ IW �. 9 Date of Inspection l Date Completed .:... .. ...73�.......t..19 PERMIT REFUSED - s _. 1 ................................................................ 19 T ............................................................................... ................................................................................ / L ` ............................................................................... ............................................................................... ` rt f - Approved ................................................ 19 ............................................................................... z ............................................................................... t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map � Parcel Application # 0 1 Health Division b 3 � i' Date Issued Conservation.Division 4, Application Planning Dept. _, Permit Fee �d ' Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address L4 11 ., Village Ce'F.ti f Owner L*w Address tr� L .� a e d a 4�Ne L � F Telephone te Q g'3 2 VA 1 `L_ Permit Request •r �.e,��.�c e ,_��-o c o 11�.p•. ec�� 1 0 x t q- Ac'�u.ht� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total-new Zoning District Flood Plain Groundwater Overlay c� Project Valuatio Construction Type ' Lot Size 20 4 L Se + Grandfathered: ❑Yes ❑ No If yes;`attach pporti Ln n CLIMentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) w Age of Existing Structure �� Historic House: ❑Yes A No On Old King's Highw�. ❑qP No Basement Type: ❑ Full ❑ Crawl Jd Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) f Number of Baths: Full: existing "L 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: b Gas ❑ Oil 0 Electric ❑ Other Central Air: 0 Yes 18 No Fireplaces: Existing t New Existing wood/coal stove: 0 Yes ❑ No Detached garage: ❑ existing 0 new size—Pool: ❑existing ❑ new size — Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: z c.✓ r i ve w NPR✓ Zoning Board of Appeals Authorization 0 Appeal # Recorded ❑ Commercial ❑Yes XNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number S yMg L 8o B'4 Address loo N,.915jae t_ License # O4ii4 a �&/M"F o r k �4L Home Improvement Contractor# k_f31,q DL67 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Zz o Y FOR OFFICIAL USE ONLY APPLICATION# t } QATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME AfXAt 7/xa fag, K&rc INSULATION FIREPLACE ; ELECTRICAL: ROUGH .FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL . FINAL BUILDING r DATE CLOSED OUT ` r _ f ASSOCIATION PLAN NO. t. of T Town of Barnstable Regulatory Services 2iARM9TASM �. ,,� . Thomas F. Geiler,Director . � Building Division Thomas Perry, CBO,Building Coimmissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us 'Office: 508-862-4038 Fax: 508-790-6230 PLAN RENEW Owner. �ey`Z Map/Parcel: Project Address I '` _�d - Builder: / CT The following items were noted on reviewing: p 7 0.r r-S P S f TI C-�6 �K ROX W-Mfn L E-rs Reviewed by: Date: 7 h4 B(P Q:Forms:Plnrvw The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual): l<jJ i ,� t-e.�✓ �c9 t%%kVNA- h Address• v m - n C, -1 City/State/Zip: I T Z[.75� Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.El I am a employer with � 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2�I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me m any capacity. employees and have workers' 9 0 Building addition [No workers' comp..insurance cow•insurance.$ required.] 5. F1 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions I. [No workers' crimp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4), and we have no 13.0 Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. if the subcontractors have cmployws,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: . Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to.the Office of _ Investigations of the MA for insurance coverage verification. I do hereby certi under pains-and penalties of perjury that the information provided above is true and correct Si ature: Date: LL _ Phonef: 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 Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express-or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representative's of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons_to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant.thereto shall`not because of such'employrnent be deemed to be an employer." j.MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to,operate a,business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally, nor any of political subdivisions shall y,MGL chapter 152, §25C(7)states Neither the its enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,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 or partners,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 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 of Investigations 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 must 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 future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hke to thank you in advance for your 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 Gommonwelalth Of Massachusetts - Depad ment of Industrial Accidents Office of Intvestigations 600 Washington Street Boston, MA 02 111 TO. #617-727-440.0 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia �oFTHe tO�ti Town of Barnstable Regulatory Services �" MASS."BIE�; Thomas F..Geiler,Director 1639.rFOMA'�A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject 1 t hereby authorize a r.►.,ti / to act on my behalf, in all matters relative to work authorized by this building permit application for: LA (Address of Job) Signature of O ner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. n-PORMQd1WNPRPRRMLQ.RMN. F SHE Tp Town of Barnstable P4p �� y o� Regulatory Services BARNSTABLE Thomas F.Geiler,Director MASS. p�plF 6.9. A��� Building Division DFM Tom Perry,Building .Commissioner : 200 Main Street, Hyannis,MA 02601 R mv.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less-and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 1 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. fies that he/she understands the Town of Barnstable Building Department The undersigned"homeowner"certi 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/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. I{ ,+ a l ✓�ie (�arr�nvaruuecr�u2 d��� JaacluION `2 J� ` ' I BOARD OF BUILDI G REGULATIQNS aI ,License CONSTRUCTION SURERVISOR IJ t :I Number CS. 094639 i ,J * Blrthdat e 07/01/1950 { u + Exp�res"07/0 20,10 Tr:,no 94639 1 N, l i" _ Re's ricc_e-d,0 I<EVIN JyFAIR Z•N I' _100 kMERSD ROAD:= YARMOUTHPORT, MA 02675 Commissioners' L ''�' ✓�ie Vr an�nu�ou�iecr�C�i a�✓�.,' �,�uc°` \' Board of uuiIa. Reg�il�no t r $ POME IMPROVEMENT CO�!'TPPr f0 , l Ftegistrat�on153'i9 2031 6 k fF Expiation ,1,6/2008 Tr# � ` Type Indiuidu t KCVIN rIR 4 x � f YAR 110UY1,f CR' MA-02675J A lmtm-trafu i • r FILE ,NO.;�, . i.07 47A N/F BUZZARDS BAY GAS CO, ��•, LOT F 3G�? 2 S.F:t Ln LOT E u; .piu A n .� 135.53' Z MASHPEE ROAD �[� SUTlJEO' s�FCN�.RP'Y AND J��HN S. 1PwE,tun0 A0f.' LOCATED IN A F!QOD HAZARD ARrA o LAURETANI Aa 13100 ON Q,.NA MAP /J 34311 "' RkrCiiENL'Eit iELO�, MORTGAGE WIND SURU�{ Aotplans-com wl �413'AN0 062" OWNE,I�C. P 0LXsLALjKlERS AumcA,vSuxma)rve C0A#PANF0F'B0Sf0'V SSS coccor 1 Swm It F*r 1'S33 Nub suvct tro lismo,MA01T46 Walietc,MA 0MI ml CON!MTUTION BLVD. SUHT O �P)]Od a39�yOi� (�)Si3K GOSH aDSB -` "ANKUN,.MA 02035 _ _ -w ina�gr+etsowrsil w.c{an �owrvN+c+sowabll.w.cum - 'c MORTGAGE � CTI PLAN THERE ARE No ERIENGi1 EASEMENTS IN THE A9DVE F1EF'ERENCED D£€U OR ENCROACHMENTS W,,H RESPECT .0 ADDRESS:4M&rijK.lDAD,, --•---—— EXCEPT AS STATED ON THE OEEQ OF RECORD SHOWN. ATTORNCY:""­L � - ---- THE LOCATION V THE DWELLINO AS OWNER eAj "INF��� ��I�� __. �_... S"Qwm HEREON EITHER WAS IN I$E COUPLIANCE N1TH THE LOCAL ZONING APPLICANT; 4. •-- --_ BY-LAWS IN EFFECT WHEN DAT£;• I I I 2Qg7_ SCALE:, .COUN7Y:jARKjAl ____ CONSTRUCTED (WITH RCSPECT TO STRUCTURAL SETBACK REQUIREMENTS UNREGISTEP D LAND ONLY), OR IS EXEMPT FROM VIOLATION K; pACE:�.t. ._�:......���w. , .,.o ENFORCEMENT ACTION UNDER MASS. G,L, .00D HAZARD INFO:. DEED e;.o �_,..,.,�,..,.,m.._,_�:_ At L)ATZO:1I2/� FLAN 200K:2 . - PAGE:46_._ LC�!(Sj; MMUNn'T F`ANI`I.:, �t I i .l _ PLAN NuMRER:._ ..�..�--- of -- G sl-IC)AN REGISTEREC: LAND CERTIFICATE OF T+TLE:- .___ ASSESSORS Efi I'AI . 41';l•IIN A ::I'F.CIAL `LOGD R£GISTRATI00 8C K "�__ _-__� 19AGE'....._�.� ZA.RD ZONE'. -� PLAN NUMBER:_ IFA_L NOTES: O) 1NE OECLARATIDNS MADE ABOVE ARE ON -HE BA, Cf MY KNQMREOC�, 1NFORNATION, AND BELIEF AS THL' RESULT OF A MORTGAGE INSPECTION TAPE i 1EY, N 1T lii's FE!-1 11.1' Ul AN INSiR0YVNT 'UKVEY MADE TOO, NORMAL STANDARD OF CARE OF REGISTERED LAND SURVEYOR5 PRACTICINO IN 1iA5SACHUSFTTS. (R} :LARA.TIONS ARE ?MADE TO THE ABGVL NAMED CLIENT ONLY.=S OF hS DOTE. (3) THIS PLAN WAS 140T)JADE.FOR REC:oRDiNG PURPOSES, POR LISE IN PREPARING DEED ;CRpr05 OR FOR CONSTRUCTION, (4) VERIFICATION$ OF P!")PERTY LINE DIMENSONS, BUILoIN^ OFFSETS, FENCES, DR LOT CONFIGURATION MAY BE ACCOMPLISHED BY AN _.- I - I : - 1 ,:. 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