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HomeMy WebLinkAbout0416 OLD OYSTER ROAD k� (o old OvLler )Q R L 10 f4 4 Q- Town of Barnstable � W Building RMAtv�rn Post Thi`s.Card;So That it is?Visible From the"Street Approved Plans Must,be�R,eta"ined on Job.and;"this Card.Must be Kept,'- p MAs3. Posted Until Final Inspection,Has Been"Made Permit s6+3q. Where a Certificate of Occupancy is Requlred,�such"Building hall Not be Occupied until a Final Inspection has been=made Permit No. B-20-1333 Applicant Name: Thomas Capizzi Approvals Date Issued: 05/29/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/29/2020 Foundation: Location: 416 OLD OYSTER ROAD,COTUIT Map/Lot 022 035 Zoning District: RF Sheathing: .... Owner on Record: CULVER, ELLEN S&JOHN E TRS Contractor Name:`,CAPIZZI HOME IMPROVEMENT Framing: 1 INC. 2 Address: 394 OLD OYSTER ROAD Contractor License 100740 COTUIT, MA 02635, Chimney: Description: Furnish and install 4 windows using Harvey Classic Low E iri Garage. Est. Project Cost: $ 11,000.00 Replace one storm door at rear of house. Permit Fee: $56.10 Insulation: 3 `Project Review Req: GLAZING REPLACED IN HAZARDOUS LOCATIONS AS DEFINED . Fee Paid: 556.10 Final: IN 780 CMR MUST BE TEMPERED OR EQUAL. Date.' 5/29/2020 Plumbing/Gas �� Rough Plumbing: l Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by-this permit is commenced within six 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. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for'public inspection for the entire duration of the 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: 1.Foundation or Footing Rough: 2.Sheathing Inspection ` 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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 Building plans are to be available on site _ Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �t r Town of Barnstable *Permit#C26 0 n- �p �[ Expires 6 months from issue date ulatory Services Fee awxrvsTnace FEB ler,Director AP A,F15 T� 7 200puilding Division wnl op Bloom Perry,CBO, Building Commissioner ' �egeet,Hyannis,MA 02601 www.lbwn.bamstable.ma.us Office: 508-862.4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ',! , �� Property Address l \to 0 W_�� [13-R-esidential Value of Work 7 5-00 , Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I m a sole proprietor c I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name. Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) []Re-roof(stripping old shingles) All construction debris will be taken to ra �� i'Yi- C,�G �:4J . ❑ Re-roof(not stripping. Going over existing layers of roof). Re-side Replacement Windows/doors/sliders.U-Value (maximum.35) *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. SIGNATURE: Q:\WPFILES\FORMS\building permit fomtis\EXPRESS.doc Revise020108 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/rndividual): C 1_,.; o • w ��— •AAoress: ?� City/State zip:� � Phone.#: SD Are you an employer?Check the appropriate bog: Type of project(required):, 1.❑ I am a employer with 4• ❑ I am a general cor<tractor and I * • have hired the sub-contractors 6. New construction .' "employees(full and/or part time). Remodeling ; 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet. 7• ❑ � ship and have no employees . These sub-contractors have 8. ❑Demolition �vorldn for me in ffi capacity. employees and have workers' g Y P ty #• 9. ❑Binding addition [No workers' comp.insuuance comp.insurance. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.Lit'I am a homeowner doing eg-work . officers have exercised their 11.❑Plumbing repairs or additions ' myself[No workers'comp. right bf exemption per MGL 12.[]Roof repairs insurance.required.]t c. 152, §1(4),and we have no e ] employees.[No workers' 13.❑Other- comp•insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homaownera,who submit this affidavit indicating they are doing all work and tlien hire outside contractors must submit anew affidavit indicating'such. tContmet o s that check this box mutt attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they roust provide their worker,comp.policy number., I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site, information. Insurance Company Mine: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address- City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure,to secure coverage as required ender 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 WA for insurance coverage verification. ' I do hereby cerkfy under the pains and penalties of perjury that the information provided above is true and correct Signature (Q �P.� l 0 a�uP� Date ���• 0 Phone Official use only. Do not write in this area, to be completed by city or towmofficiaL 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 Cont"act Person: •Phone#: �: '; .C` Town of Barnstable ti Regulatory Services sn MAS& Thomas F.Geiler,Director o;ArA Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for pen-nit please complete the Homeowners.License Exemption Form on the reverse side: QTORMS:OWNERPERMISSION - Town of Barnstable �OFZME Tp�� Regulatory Services + BARNSTABLE, = Thomas F.Geiler,Director y MASS. 1639• p.� Building Division lf0 FAA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: `� 0& ao z, f number street village "HOMEOWNER": �iA t7~U��2� 0'y-.Z�C7 . name home phone# work phone# CURRENT MAUNG ADDRESS: 3 C(Ll o ec A,, P=Q . 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 su ep rvisor. 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 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. Q:forms:homeexempt rn EVE� Town of Barnstable *Permit# GCf G D� Expires 6 m n[i from issue dale Regulatory Services Fee - BA" �� � omas F.Geiler,Director 1639. �� Building Division rF0 MA'I A FEB 2 7 2008 Tom Perry,CBO, Building Commissioner TOWN OF BARIVSTAB 200 Main Street,Hyannis,MA 02601 LE www.town.bamstable.rria.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address �C residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ���r✓t ��t - Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ iam.a sole proprietor 12-11 the Homeowner , ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35) *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. SIGNATURE. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations i d 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: n t ��-c" a City/State/Zip: 2 Phone F 42&� P 12 69 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 .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, ❑Demolition working for me in an capacity. employees and have workers' g Y P h' t 9. ❑Building addition [No workers'-comp. insurance comp. insurance. 10. Electrical repairs or additions quired.] 5. ❑ We are a corporation and its ❑ P 3. ' 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption'per MGL 12.❑Roof repairs insurance required.]t c: 152, §1(4),and we have no employees. [No workers 13.❑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 sub-contractors 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. 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 DIA for insurance coverage verification: I do hereby certify under the pains and p(e�nalti_es of perjury that the information provided above is true and correct �Signature: 1p��, - t� Date: -�U7 r7 JO $ Phone#: 5V_R- Lf<�L 9 q�3� 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#: yw v ti Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. in the service of another under an ee is defined as ...evepersonY contract of hire, Pursuant to this statute,an employ "...every 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 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 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-contractor(s)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 maybe 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 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: 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 Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia J oFt�tom, Town of Barnstable Regulatory Services r i ces $'MAS& 'E .Thomas F.Geiler,Director i639. 10� ArErya Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601r 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 property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name P If Property Owner is applying forpemlit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&O WNERPERMISSION Town of Barnstable {, 'THE r, ti�P o� Regulatory Services anRrtsTAat.e. r Thomas F.Geiler,Director 9 MAS4. 0.19. Building Division lF0 � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 wwNy.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 2 ©Drr JOB LOCATION: H t(D Oy OU.e- ro-0011- ^ l4— number ,, (� street LL village "HOMEOWNER": 11&� t 1 XN��I �D �Sy { name a �, (� home pho-tene,# p'� n work phone# CURRENT MAILING ADDRESS: 3-l4 ak l/ j S` !' 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 requirements. _ �\�,0 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 fonn/certification for use in your community. Q:fomrs:homeexempt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map (D aQ Parcel ® J� Application# Health Division Conservation Division P, Permit# 9/ 3®2— Tax Collector Date Issued 041— Treasurer Application Fee . Planning Dept. Permit Fee C70 Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address `4'/6 0 d �s/- C/- LL Village C o T o i / 6 Owner 0 /7 h -r CL,� I v e-r Address 6)_1d_()[1&.k1_ Telephone — /3 Permit Request &J7 c: r l'aa d,03 Al'�(?/-/a Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation GCM construction Type rC-M e- Lot Size /G— Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family X Two Family ❑ Multi-Family(#units) Age of Existing Structure 30 Historic House: ❑Yes >(No On Old King's Highway: ❑Yes >1 o Basement Type: ull PKIZawl ❑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 av-�2_ new Total Room Count(not including baths):existing �� new�_ First Floor Room Count Heat Type and Fuel:*Gas ❑Oil ❑Electric ❑OtherCt'ce—c4n Central Air: ❑Yes '>6o Fireplaces: Existing New Existing wood/coal stove: ❑Yes VNo Detached garageXexisting ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: i Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ i Commercial ❑Yes XNo If yes,site plan review# co o;C w Current Use Proposed Use —' BUILDER INFORMATION w 3� Namei7rrOPi_���5 � Telephone Number r gel— AV AddressT o Aa� " � � License# _ Os (.f 4/5 Home Improvement Contractor# 60 D Worker's Compensation# LJA-- rMIMA6—y-015 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO d(,Zn-7_to�s 4-./- 0 C �— SIGNATURE DATES - 1 t ' s FOR OFFICIAL USE ONLYa PERMIT NO. r DATE ISSUED 1 l MAP/PARCEL NO. "• ADDRESS VILLAGE I r OWNER DATE OF INSPECTION: _ FOUNDATION FRAME • ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL I GAS: ROUGH FINAL FINAL BUILDING 5 5- Z% %(o /mc—/— 0d1 DATE CLOSED OUT ASSOCIATION PLAN NO. oFtHE Town of Barnstable Regulatory Services - yBMW ssBLL Thomas F.Geiler,Director / Building Division ; Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT 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:re,n6L 00Cf e-f �a�- C i S fi Estimated Cost 4 ®®® � 0 G f born On Address of Work: �/ (p (9�[l� /���,5 fCr �Q r� cy y• �r ``- D�(o �5 Owner's Name: .,To n n Ple Date of Application: %a3 9 a I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Jctb Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: #7. 0G� Date tontractor Name Registration No. OR Date Owner's Name Q:formslomeaffidav Town of Barnstable Regulatory Semces sue• $ Thomas F.Gailer,Director i639•A,� �on►ea Building Division. Tom Ferry, Building Commissioner 200 Main Street, lipoatis,MA 02601 www.town.bmmstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Vsing A Builder 0 eJ1e as Ov.Mer of the Subject property herebp authorize _ to act on my behalf, co04, in aR matters relative to work authorized by this building permit app�cation for. (Address O ob) co I Signature of Owner Date Print Name Q-r010E:0wxMKRMISS10ma V4 Cc IL sg?, � ! "�` ..-' .�4;�,r�eor►acae���'�G4',. c�cea�..a�i.: Board of Sn Iding Regulationj aad Standards ' �+ HOME IMPROVEMENT CONTRACTOR, Registration: 10960B Expiration: 9/21/2006 Type: Private Corporation A I:ENTERPRISES INC. PETER POMETTI 140 RIVER RD G4-.o-� -+.✓ COTUIT, AAA 02635 Adminfstrator OF= kl�ilst#3 REG{31:ATi6 4 1:4rrerras: c ra i T�OgS—UPER- Nufflb •:.:C* 850457 ` Hi j 0411-WI.90 v ® 04MV20 29 309 m - ru i PETER M POli+i °Ti- PO 90X 2006 A COMMMA02635 A - gr cr W m T � N N i m _! e ?;:,'*:';• � ro��"`�"&�-��"�" 9k�'iV3h. fx'�?§�-'�-� .r-1', ,. - _ -.,a .d't?k ,� ..�... 'r�h>- _ :. +�:v,' r .. .. _ - � _�X1?�1.!•lG.—Lloui�...�\.l._'t?`5....__. ._ ... � - --��o��q`LC17. .�lw,Z._ �LA•n)..----- , t,:a�, NoVE: TIO ['.{•t/r"6GS T-0 Ums-r Fo—, MNI Ai 6 _ ?2.'Pf pt)EIIL� •%J<•l1�• - - v -11 -DLCIA P-1 . I Q 0 lool -. i�' { (:cis:. r. j� - . •�-- ^eL',v.,.�'•N.�. , � �— tl ' ry NCv� OA' -{Iivf. - hl s ti j y r _ • Al. { •l : 1 . I .. x ! I .I l - _ - ---f —1`--mot ��� .._,��>• --� — _ — ..... ` w r i 7ot-fu t '.b"tL�7.1 C�Jl_�rE-fL SCALE:YLt {FG:,c APPROVED BY: ORAWNBY SUIS REVISED L1l fo OLD U`(5Tl- �d ORAWIND NUTABER FL-t3