HomeMy WebLinkAbout0080 OLD SHORE ROAD C) Ids
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Shea, Sally
From: Shea, Sally
Sent: Wednesday, February februa 19, 02 20 4:30 PM
To: 'David Coleman' ,
Cc: Amara,William
Subject: RE: Hi Sally
I have spoken to Bill. Please contact the electrical company. I don't know if Bill will quicker. He is out straight with
inspections. He doesn't have any help this week.
Thank you
Sally Shea
Town of Barnstable
Assistant Zoning Admin/Lead Permit Tech.
508-862-4031
From: David Coleman [ma i Ito:coelect@Lomcast.net]
Sent: Wednesday, February 19, 2020 10:45 AM
To: Shea, Sally
Subject: Hi Sally
You can have fun with my many words, but this.is important. I got a call from a customer of mine of a cottage located at
80 Old Shore Road off Ropes Beach cotuit. He said a pole went down and said Verizon replaced it. Doubt full because it
looks private. From the street pole number 80/3 not marked but got off next pole number on main street Cotuit. From
that pole it goes underground to this new pole put in.At the base of this new pole is an old junction box.The street
power comes to this junction underground then goes under ground to a solar meter owned by Geyser at 64 Old Shore
road right next to the new pole. House is at top of hill building with many windows.This pole was set by whoever with
this junction box with street power and solar power sticking out of it with all bare conductors not taped or protected in
anyway. I would call to have shut off but Im sure bill can do it faster. I put caution tape because it was too scary to tape
these connections. No one living in the cottage and the solar meter is still energized off the street power with these
open bare cables.Confirmed still energized. Bill can call me if he wants @ 508-364-8456.Sorry so long sally but as you
know I cant explain anything with three words. If you can pass this on I would appreciate it asap.Thanks
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1
Shea, Sally
From: David Coleman <coelect@comcast.net>
Sent: Monday, March 02, 2020 12:19 PM
To: Shea, Sally
Subject: Hi Sally
Hate me if you will being a pain in the ass but I had given you a letter cancelling the permit at#80 Old Shore Road Cotuit.
I am adamant regarding this because the neighbor did not want the town on his property not the owner of 80 Old Shore
Road. Hes the one that hired me. It was to connect both services to a new pole. I told the neighbor he needed an
electrician to pull his side of the work permit noticing issues I did not want to be a part of.When telling him this he said
he didn't want the town involved because he had too much going. He told me to cancel the permit and he would deal
with the Eversource power coming in hot.Well I notified you way back so I have no idea what was done but I want
nothing to do with what ever was done if anything. I haven't heard a thing even if its that you will take care of it or let
me know of anything more you need from me.
Thankyou
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attachments or reply, unless you recognize the sender's email address and know the content is safel',
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Town of Barnstable 1 1 Bui d'ng
unaarsraet
Post This Card So That it-:is-Visible From the Street'- Plans Must be Retained on Job and this Card Must be Kept
Posted Until Final lnspettion.Has Been Made ,; it
r ° Where a cupant Certificate of Oc s Required,`�such,Building shall Not be Qccupied until�a.Final Inspection has been made.. ��
Permit No. B-19-4252 Applicant Name: HOMEOWNER IS APPLICANT Approvals
Date Issued: 01/10/2020 Current Use: Structure
Permit Type: Building- Deck Expiration Date: 07/10/2020 Foundation:
Location: 80 OLD SHORE ROAD,COTUIT Map/Lot: 036-060 Zoning District: RF Sheathing:
Owner on Record: MOORE, NICHOLAS C Contractor Name.h��,HOMEOWNER IS APPLICANT Framing: 1
S
Address: 33 PUTNAM AVE 4' ContractorXLicense: EXEMPT 2
COTUIT, MA 02635 ° Est. Project Cost: $2,500.00 Chimney:
y:
Description: Repair All Rotten Wood on Deck:Add Steppers Footings m=ihe Back Permit Fee: $ 110.00
Insulation:
of House' Fee Paid: $ 110.00
Project Review Req: - i Date: 1/10/2020 Final:
_ Plumbing/Gas
Oil
I
_ S
Rough h g Plumbing
Official
This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months afte�I� R�e. Final Plumbing:
All work authorized by this permit shall conform to the approved applicatior'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. Rough 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. t Final Gas:
The Certificate of Occupancy will not be issued until all applicable signatures by the Building-and Fire Officials are provided on this permit. Electrical
Minimum of Five Call Inspections Required for All Construction Work I `
1.Foundation or Footing - Service:
2.SheathingInspection
9 €`
p .
3.All Fireplaces must be ins ected at the throat level before firest flue limn is installed Rough.
4.Wiring&Plumbing Inspections to be completed priorto Frame Inspection Final:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation
7.Final Inspection before Occupancy Low Voltage Rough:
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final:
Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
�THE
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Application Number...
XAMPermit Fee.................... ..................Oker F.
Total Fee ...........� ................. .............. .�..�.�.....TOWN OF IRM&STABLE Permit Approval by..... ..................On....��!'6 �..........
BUILDING PERMIT �a�e�........
Map:..........t/Y.............
APPLICATION
Section 1 - Owner's Information and Project Location -
Project Address_ 86 Village
Owners Named icl4oGn-5 G 1 W RE
Owners Legal Address 3 3 �
City State Zip 025
r
Owners Cell# 504?2--7qq q1 q E-mail C K0AkF90q ®'9 6i -)J,00;0
Section 2 —Use of Structure
Use Group t; ❑ Commercial Structure over 35,000 cubic feet
❑ Commercial Structure under 35,000 cubic feet
t -
Q� Single/Two Family Dwelling :
Section 3 — Type of Permit
❑ New Construction ❑ Move/Relocate ❑ Accessory.Structure ❑ Change of use
❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm
Rebuild 8 Deck Apartment El Sprinkler System
❑ Addition ❑ Retaining wall ❑ Solar
Renovation ❑ Pool ❑ Insulation
Other—Specify
F7Section 4 - Work Description ftSC
n!T 4t
I piU)
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r����� Tact nnriateri• 11/1 inns R
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Application Number....................................................
Section 5—Detail
Cost of Proposed Construction 7SOO'C�5 Square Footage of Project FT
Age of Structure 35 Yes Dig Safe Number
# Of Bedrooms Existing � Total#Of Bedrooms (proposed) Nb 01 M
(P P )
110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design
7
Section 6—Project Specifics
❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors
❑ Plumbing ❑ Gas ❑ Fire Suppression
i
❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom
Water Supply ❑ Public s❑ Private
Sewage Disposal ❑ Municipal ❑ On Site
d
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
Debris Disposal Facility: I am using a crane ❑ Yes El No
P
i +
' Section 7—Flood Zone
Flood Zone Designation
Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑
Section 8—Zoning Information
Zoning District Proposed Use Lot Area Sq. Ft.
Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site)
Setbacks Front Yard Required Proposed
Rear Yard Required Proposed
Side Yard _ 'Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No
Last updated: 11/15/2018
Town of Barnstable
Building Department Services DING DEPT.
KASL • Brian Florence,CBO
i6l � Building Commissioner AN 10 2020
200 Main Street,Hyannis;MA 02601
www,towa.barnstable.ma.us TOWN OF BARNSTABLE
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
3
1
1 / I
I ,as Owner of the subject property
hereby a ' orize 1 I M I ILIC� to act on my behalf
--in all matters relative.to work authorized by:this building permit-app'Lc--tion for. _.�•.__ _ � _ .,
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
;�spections A performod and.accepted.
Signatdre of Owner 7Name
hcant"
Print ame
'l/ G'v G'v
Date y
WORMS:OWNWERMISSION WI.S
Rev:0&/16117
I
t"
Town of Barnstable
Building Department Services
Brian Florence,CBO
Building Commissioner
.� _ 200 Main Street, Hyannis,MA 02601
aXAM www.town.barnstablemaus
a�
Office: 508-862-4038 Fax: 50&790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE
JOB LOCATION:
number street village .
[1O1M1G�/t�1\�llp:
name home phone# work phone#
CURRENT MAILING ADDRESS:
ci Amm state tip code
The current exemption for"homeowners"was extended to include owner cc-�u ied dwellines 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.
DEFIIV MON OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is;of 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
this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in
your community.
Q:\WPFnF"ORMS\building permit fnrms\WRESS.doc
09/16/17
Commonwealth of Massachusetts
x Division of Professional Licensure
? Board of Building Regulations and Standards
Const\ 64I. bp.�rvisor
f
CS-068126F.I � 4pires: 04/02/2020
TIMOTHY S HOLME
16 QUARTEkFAASTEF{
BREWSTER M"`i331 � * S?+
OISS�730
Commissioner VL -
} Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
*,PE:LLC �
Reoi__fn`� Expiration
1fi9?18— = ,07126/2021
SUNWIND,LLC �gf '
TIMOTHY HOLMES " �f j
300 CRANBERRY' lG1iUV; Y
ORLEANS,MA 02653 Undersecretary.
DURABLE POWER OF ATTORNEY `__
KNOW ALL MEN BY THESE -PRESENTS, that I, Nicholas C. Moore, of
33 Putnam Avenue, Cotuit, MA 02635, do make, constitute and appoint
Clayton Moore of 3040 Falmouth Road/Rt. 28, Osterville, MA 02655, as '
my true and lawful attorney. '
In the event that said ,Clayton Moore is unable to act as my
attorney, then -I hereby constitute and appoint Jason D. Moore of 33
Putnam Avenue, Cotuit, MA 02635, to be my attorney.
I further constitute this`"instrument to be ,a Durable Power of.
Attorney, pursuant to Massachusetts General Laws, Chapter 201B,`
Sections 1-7, and in so doing, declare that this Durable Power of
Attorney shall not be affected by my subsequent disability or
incapacity. I hereby`authorize him for me", in my name, - place and
stead, to act for and represent mein all and any transactions
connected with and, as may .relate to the conduct of my personal and
business affairs.
The lapse of time from the execution of this Durable Power of
Attorney to the exercise of the same, 'shall not ,render this Durable
Power of Attorney terminated or invalid. `
I give and grant to my aittorney full power and authori-ty to draw
checks upon any bank, against any funds deposited to my credit with
them, to endorse checks and all instruments for deposit or otherwise,
to enter any safe.-..deposit box'; to make gifts or -to convey such with
or without consideration, and to execute any forms, papers. and
"e
memoranda which may be necessary in connection with the conduct of
my personal and business affairs.
I give and grant to my attorney full power and authority to sell
and to sign, execute, act and deliver any a.nd. all, coritracts, and to
act in all ways and to deal° with all my property, both real and
personal, and with all rights ofinterest °in it possessed by me .with
respect to any such property, - in every way and all -lawful ways in
which I myself could deal with such property.
My attorney may. from time .,to time appoint one or more substitute
attorneys to have any and'. all of my _ attorney's power hereunder, ,
including the power of substitution, and my attorney may revoke any
such appointment or substitution.
r .
I hereby covenant and agree with my attorney and with all persons
dealing with him on the faith of his Durable Power of Attorney,°that
I will and my heirs, personal . representative s) shall' confirm all
acts proposed to be done on my behalf _by my attorney, in good faith
and without conclusive proof of my death , or incapacity or the
termination of this Durable Power of 'Attorney; and.� I will and shall
indemnify and hold harmless' my attorney (and also all person dealing
with my attorney) for and from any loss, cost or liability caused by
such acts or by any lack- of sufficiency or authority of my attorney
in respect thereto.
My attorney shall- have the power generally to say, do, act,
transact, determine, accomplish and finish all matters and '.things
whatsoever, relating to my personal and business affairs as fully and
effectually and to all intents and purposes, as if I might accomplish '
the same personally.
In witness whereof I .have hereunto set my hand and seal this
19th day of October, 2018 .
Nicholas C. Moore
A AFFIDAVIT
We, the undersigned witnesses, each declare in the presence of
Nicholas C. Moore that neither of us has been named as Attorney or
Alternate Attorney in this Durable Power. of Attorney and that neither
of us is related to himby blood or marriage.. We further declare
that the . Nicholas 'C. Moore signed this instrument as his Durable
Power of Attorney in the. presence of each of us, that he signed it
willingly, that to the best of our .knowledge, he is eighteen (18)
years of age or over, of sound mind 'and under no constraint or undue
influence. f
19
Wttne
Witness
COMMONWEALTH OF MASSACHUSETTS
Barnstable, ss.
On this 19th day of October, 2018, before me, the undersigned
Notary Public, personally appeared Nicholas C. Moore, and the said
witnesses, who proved to me through satisfactory ' evidence of
identification which was O photo identificationCq personal knowledge,
to be the persons whose ,names are, signed 'on the preceding or attached
document, and acknowledged to me-that t ey signed it voluntarily for
its stated purposes. '
\i;1i:tillif4 jr,r
John J. Spi 1 e, I Notary Public
pa �y�iS tp'v Jbm4CJ
:v�Fq 0 Commission xpiration: 1-14-22
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1 �AV? IA ►L-1n1�S
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�-L So�csc�Qs L{ I 15) -o Aj
SCANNED
1AN 17 2020
Registration valid for individual use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
1000 Washington Street -Suite 710
j Boston,MA 02118
Not v Id wi out signature
Construction Supervisor
Unrestricted-Buildings of any use group which contain
less than 35,000 cubic feet(991 cubic meters)of enclosed
space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Call(617)727-3200 or visit www.mass.gov/dpl
The Commonwealth of Massachusetts
Department of IndustridAccidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le6bly
Name(Business/Organization/individual): !i,.l ) r,s& L L
Address:
City/State/Zip• p,Us rt 6 Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.[]I am a employer with- pZ 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. El 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 any capacity.acitY• employees and have workers'
t 9. ❑Building addition
[No workers'comp.fimmn� comp.insur-ance.
5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
required.] ofcers have exercised their I L Plumbing repairs or additions
3.❑ I am a homeowner doing all work ❑ mg rep •
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 ,Q r°JIeU
comp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowner;who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such.
:Contractors 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-oontractors have employees,they must provide their worker:'comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name: . L 7 ��
Policy#or Self-ins.Lic.M Z D O 2S 2^,;d/MExpiration Date: 0/
Job Site Address: &m(r Z-e City/State/Zip: / Oo2-IJ3�—
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 nenalfies ofpedwy that the information provided above is true and correct
Si Date: 021°
Phone#• 3
Oj,j kial use only. Do not write in this area,to be completed by city or town of trial
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 id 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 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 constrict 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 numbers)along with their certificate(s)of
insurance. Limited Liability Companies(LLQ 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 sire 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 mmmber listed below. Self-insured companies should enter their
self-irommce 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 fbr 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 N[mwhusetts
Dq=tmemt of Industrial Accidents
Ome of Investigati
6W Washington Street
Boston,MA 02111 -
Tel.#617-727-4900 ext 406 or 1- 77-MASSAFE
Revised 4-24-07 Fax#617-727-7749
wtzvw.m gov/dia
Application Number...........................................
f
Section 9- Construction Supervisor
,NainE - - Telephone Number SZ -aa/ -6 3�6
`Address f/ 61
City /�/> r� State Zip G�
,License Numbe License Type Expiration Date
Contractors Email �/�o r, vS S�,.s ; �L L�.G,. Cell # �� -a 6- 3.5'o
-- - --7
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable:Attach a copy of your license.
all c-Dv;�
Section 10-Home Improvement Contractor
Name- -- i�/✓, LIt C Telephone Number
Address CitK ®G'/ems State &L Zip 0o� 3
Registration Number 1619 ;W Expiration Date 2 C-oZ d6Z f
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C...
Signature -'`Date
Section-ll=Home-Owners License Exemption
Home Owners Name:
Telephone Number U 6>W q qq/q Cell or Work Number Od eZ7'1 L I q
I understand my r o " ilities under the es and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Mass S t ilding o I understand the construction inspection procedures,specific inspections and
documentation a e7 Town o arras ble.
Signature Date
. AP I T SIGNATURE
Signature Date. 24�p4E7-za 9
Print Name PA) Telephone Number
50 I-Igly
E-mail permit to:
Last updated: 11/15/2018
Section 12—Department Sign-Offs
Health Department ❑ Zoning Board(if required) ❑
Historic District ❑ Site Plan Review(if required) ❑
o
Fire Department ❑
Conservation ❑
•
For commercial work please take your pla
ns directly to the fire department for approval
Section 13— Owner's Authorization
L , 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
j
Print Name
i
,i
• y j
Last updated: 11/15/2018
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