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HomeMy WebLinkAbout0015 CLIPPER LANE p o _ 4 Town of_Barnstable Building Post This Card So That it"is Visible From the Street,-Approved Plans Must be Retained on Job and this Car w ea�vt;rn�a.e. : d Must be Kept �, ' ,¢ Posted Until Final Inspection Has Been Made. Permit t6+3p ♦ "� �a. 'Where a Certificate of Occupancy is Required,such Building shall.Notbe Occupied until a Final Inspectiomhas been made Permit No. B-20-1462 Applicant Name: Thomas Capizzi Approvals Date Issued: 06/11/2020 Current Use: Structure Permit,Type: Building-Siding/Windows/Roof/Doors Expiration Date: 12/11/2020 Foundation: Location: 15 CLIPPER LANE,CENTERVILLE _Map/Lot189-009 Zoning District: RC Sheathing: Owner on Record: MERTON,FREDERICK W& FRANCES V TRS Contractor Name'`-CAPIZZI HOME IMPROVEMENT Framing: 1 INC. Address`. 15 CLIPPER LANE ; 2 CENTERVILLE, MA 02632 -"" Contractor License: 1007,40 Chimney: Description: Furnish and install new entry door. Removalof old door " .Est. Project.Cost: $5,500.00 ( t Insulation: Thermatru SS(location is a front entry door) with side Imes: Permit Fee: $35.00 Project Review Req: Fee Paid: $35.00 Final: . ' I Date:.' 6/11/2020 Plumbing/Gas - } Rough Plumbing: 11 - i Final Plumbing: ' Building Official 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. � � Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open fog public inspection for the entire duration of the . work until the completion of the same. ""' `` Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of five Call Inspections Required for All Construction Work-1 Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT- DNE ' £ D`4.iY' c'aq jAl:++t T • § f � . 11/14/14 Thomas Perry, CBO Town of Barnstable Building Division 200 Main St Hyannis, MA 02601 RE: Insulation Permits Hear Mr. Perry, This affidavit is to certify that all work completed for insulation work at 15 Clipper Lane (application#201206733) has been inspected by a certified Building Performance Institute(BPI) Inspector. Ail work performed meets or exceeds federal and State requirements. Sincerely, et"I -t_ Conor McInerney ConserVision Energy C 376 ROUTE 130,SUITE C SANDWICH,MA 02563 508-833-8384 W W W.CONSERVTODAY.COM z TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map /a Parcel 00 Application # A � Health Division Date Issued (oh ��`1 ;'0) Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address S' Ch&Vf.4 ZAwE Village C, c o Tl✓y/�l� � Owner �v Cc�tv�G/� q h` rX4W41 S 1*V1V- Address r C 6Y101 lose Ce Kf r'dt%ie Telephone 5"01 7-- 7 G 9. 9 Permit Request / e Ite GC ex4S-let a D e C A R er-4 •L' ffcr,�� �'-¢hr� s�/�'� w i fy JrEL_r 41110 G JF4 d:✓c e45N6#s ` .Square feet: 1 st floor: existing //GO proposed O 2nd floor: existing proposed Total new Zoning District n C� Flood Plain Groundwater Overlay Project Valuation ` Odd•od Construction Type 4N00D Ii 4mt Lot Size �• Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 1767 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No ®'Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) y Basement Unfinished Area (sq.ft) Number of Baths: Full: existing z new 4 Half: existing new y Number of Bedrooms: 3 existing 6 new Total Room Count (not including baths): existing new 0 First Floor RoomCount Heat Type and Fuel: 4Gas ❑ Oil .❑ Electric ❑ Other C) Central Air: U(Yes ❑ No Fireplaces: Existing / New e Existing wood/coal st e: 4-,7es LI- o Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn:��existing ❑ newa size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals.Authorization ❑ Appeal # Recorded ❑ CD Commercial ❑Yes d No If yes, site plan review# Current Use sib tilt r4 mil y me, Proposed Use APPLICANT INFORMATION - -- - _ (BUILDER OR HOMEOWNER) Name ✓.44-t S 14C Ca,J w1-4C„4 Telephone Number 5 4 d" W 5KY La•?izzi 4ern2 Vv1vo&1ewovr Address License # Ci 5 0 7626/ G v5- N ✓howb Ru Home Improvement Contractor# ! o�1 y I ► Worker's Compensation # W1416o�0ry;1a�aa/i ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO %0W It OC 4RAI44VAjei�/ SIGNATURE DATE G 7/ - 1 R FOR OFFICIAL USE ONLY y s. i t APPLICATION# DATE ISSUED MAP/PARCEL N0. " ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: rFOUNDATION- 'ass 0115711Y FRAME Zs" N ~ INSULATION FIREPLACE F ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH 6 `FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1 •• ee o rlvesti rztions g Congress Sfreet,Safe 100 Boston; 1 021��-20 7 - w�vw mass govldic Workers' Compensation Insurance Affidavit:Builders/Confractores/EIec€il 'an.s/Plumbers applicant Information Please Print-- bly Name(Business/organization/indiyiduaI}:Capizzi Home Improvement Address:1645 Newtown Road _ City/Mate/Zip:Gotuit, MA-02848 Phone#-508-428-�9518 -Axe you an employer?Check the appropriate box: 40+ 4• I Typd of project(required): 1.[✓]•I am a employer with ❑ gin a general contractor and I employees(fall and/or pat-t*time).* have hired the sub-contractors 6: w construction 2.E 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. employees and have have _. o wor -ers-comp 7insurance e. --- - --- required.] 5• ❑ We are a corporation and its 10.(]Electrical repairs or additions •3.fl I am a homeowner-doing all work officers have.exercised their Plumb mg repairs or additions myself [No workers'comp, right of exernption per 1VIGL li 12.❑Roofrepairs, a 152;= 1 4 ;gild we have no . ..` insurance required]fi . -.. § O • : :.... .. . employees:jZ�l o w.orkers'. 13.[]Other comp.insurance required.1 Aria .acant that checltt;box#1 must also fill out the sectiop,below slioFring their workers'comperisafion policy information," # y pF77 �o eown71 ets who submit this affidavit indicating t-hey are Ming 0 work.aw their hire outside confractors must submit a new affidavit indicating such-TConii-4gtors that check this box must attached an additional shoet'showdhaa ae name of the sub-contractors and state whether or slot those entities have employees. If the sub-contractors have employees,they mustprovide their workers'comp:policy num-bei. X...&z•an enriployer that is providlAg workers'comensation insurance for my employees, Below is the polzcy and job site irif orr"adon- fni urauce Company Name:Associated Employers Insurance Company. -Policy#:orSelf--ins.Lic.#:MC50-10.547012011 . - Expiration.Date: Job Site Address:/ S� C// �t 7 L&AI e City/State/Zip: e,i t v U Attach.a copy of the workers'coX pensation-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 6f a fine tip to$1,500.00 and/or one-year inaprisoninett,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. . 14 Fier eby cerffy under the paint andpenalties ofperjury that the in provided above,is true and correct Si ature: IDate: ,l Phone#: 508-428-951 ff Official izye only Do not lvrite in tFiis area,to be completed by city or.town official C' or Town:City PermitUcense# Is Authority(circle one): 1-Board of Realth 2.Building Department 3.Cityl-Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6: Oth-er Cdntact Person: Phone - 1 CAPIHOM-01 APELL CERTIFICATE OF LIABILITY INSURANCE D TE(M272;3') THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s� PRODUCER NAAME- Ann Pell R ers&3 ray Insurance Agency,Inc. PHONE FAX 443344 A/c No Exr: A/C No:(877)816-2156 South Dennis,MA 02660 ADDRESS,apell@rogemgray.com IJSURERIS)AFFORDING COVERAGE NAIL a INSURER A:Main Street America Assurance Co. INSURED INSURER B:Associated Employers Insurance Co. Capiai Home Improvement,Inc, INSURER c: Capri Enterprises,Inc 1645 Newtown Road °V�R�D' Cotult MA 02636 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS2 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICYNUMBER MIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL UABILrrY MPB1075H 61=013 6/8/2014 PREMISES a occurrence $ 500,00 CLAIMS-MADE J OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,001 POLICY X PRO- X LOC $ AUTOMOBILE LIABILITY COMB N1 SINGLE LIMIT $ 500,00 A ANY AUTO M1 M28044 6/8/2013 6/8/2014 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS eracddent $ r $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS-MADE CUB1076H 61812013 6/8/2014 AGGREGATE $ DED X RETENTION$ 10,000 $ VWORKERS COMPENSATION X VI C STATU- OTH- AND EMPLOYERS LIABILITY TORY LIMITS ER B ANY PROPRIETORIPARTNERIEXECUTIVE YIN N CC50050105472013A 12/26/2013 12/25/2014 E.L EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? a N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMB $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Alin Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601-0000 AUTHORED REPRESENTATIVE 6kA 9 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD a Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates. STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT WE, FREDERICK&FRANCES MERTON, OWN THE PROPERTY LOCATED AT 15 CLIPPER LANE IN CENTERVILLE, MASSACHUSETTS: I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FORA BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,:THE MASSACHUSETTS STATE BUILDING CODE: . .SIGNATURE OF OWNER: OWNER'S ADDRESS: 15 :CLIPPER LANE, CENTERVILLE, MA 02632 OWNER'S TELEPHONE: 508-827-7629 - LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: . APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd.;Coti it, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: iJassachusetts -Department of Public safety I N Board of Building Regulations and Standards s r Constuction Superr-isar License:CS-076261 73 FEARING ING)fig )�� � West Warehmn RU 02576 r .. .NO ExP iratioi Js4w .� Commissioner �'0l9372f195 , UVOffice of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration `100740 Type: 10 Park Plaza-Suite 5170 Expiration 6/23/2014; Supplement Card Boston,I6IA 02116 CAPIZZI HOME'IMPROVEMENT„ANC.: JAMES MCCORMACK —, 1645 Newton Rd. 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EMENNOMENENNNESEEN ME MMMMMMMMMMlM No EM ME ONE MMmMMmMMM 0 WE NO MMMlMMMMMM NO mom MMMMMMWMMM MME■NE���ME!=MMMMMMMMMmMMMmMMmMMm NO■ ■iiui�iiiiiiiiiiiiiiiei���ii= �■ SOME llMMMlMMMMMMMM ME MMMMMMMMMMmMMMMMMMMMMMm MMMMMMmMM ME1 OMEN MMMMMMMMMMm SO ME MMENNNNEENE ME m SO mmmom SEEMS MMMMMMmMMMMMMM ■ ■■■■s■■■■■■ MMMSmMMM mom I ME SOMME mom ii iiiiiu=mmoim=i�■iii=■ i MM iii� �i� � i�u'�iiiii�=�i�i�i��i�iiiiii�i�■i c") <� A 114.98 N� MBLU 189-009 ��`�� �If 15 CLIPPER LANE BARNSTABLE, MA EX. SHED EX: DWELLING acQ_ All REPLACE 14'x16' DECK cP WI TH 14'x20' DECK cA� SEPTIC FROM ASBUILT ON FILE AT THE TOWN HEALTH DEPARTMENT BUILDER TO CONFIRM CERTIFIED .PLOT PLAN MERTON RESIDENCE I CERTIFY THAT THE IMPROVEMENTS SHOWN OF M 15 CLIPPER LANE HAVE BEEN LOCATED BY A FIELD SURVEY. ��P� gss9cy BARNSTABLEDRMA q. Res o� G DATE.• MAY 26, 2014 ROBB �, JOB #: S092 c .SYKES SCALE: 1"=.30.' DWG. CPP No:. 35418 EASTBD UIVD �,a *LAND SURVEYING, INC. P.O. BOX 442 ROBE SYKES, P.LS. DATE: FORESTDALE, MA.`02644 508-477-4511 ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ^p PP J ` Ma Parcel OL) A lication / v vv Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board � I)?'12 Historic - OKH _ Preservation / Hyannis Project Street Address C �'`��cw,c Village Owner 'Fmaje c,r—Y, (fie e-1co-c\ Address \� \, -C 1.-.o.Ae Telephone Permit Request kark C.e\\v.\cse A-o CLOg gN ,"�c,� vs:�tk�c c'rc� 9 CJ�S2.MC,(1'�C. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation \ Soo.o. Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) t 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 �om Coin a Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other = C> Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal suave: §EYes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: . existing❑ rg;v size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other o Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑ Yes ❑ No If yes, site plan review# Current Use Proposed;Use. . APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name C (\INd C C:= �t C Telephone Number Address u::4. C_ License # 'I $ ��ss AAA C)W S 3 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE 1 OWNER DATE OF INSPECTION: I - FOUNDATION FRAME INSULATION t , f FIREPLACE ELECTRICAL: ROUGH FINAL t . PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL - FINAL BUILDING DATE CLOSED OUT �,. ...�.•- �' ASSOCIATION PLAN NO. rX- ' The Commonwealth of i1'Iassachusetts Department of Industrial Accidents Office of.Investigatipns I C6.4gress Street, Suite.100. Boston, MA.0211440.17 www.mass.gov/dice Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant'Information Please Print Legibly Name(Business/Organization/-Individual):CONSERVE ENERGY,INC, d:b.a CONSERVISION ENERGY Address: 376 ROUTE 130,SUITE C City/State/Zip:SANDWICH, MA 02563 Phone M 508-838-8384 Are you an employer?Check the appropriate box: Type of project,(required): 1: 'I am a employer with 61 4, .❑ 1 am a general contractor and I employees(full and/or part tithe,). * have hired the sub-contractors 6- ❑New construction 2.❑ 1 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 hie in any capacity. employees.and have workers' jNo workers'comp. insurance comp. insurance. y, ❑ 811ilding addition required.] 5. ❑ We are a corporation acid its I0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing,a,lh work officers have exercised-their . 1 I.❑Plumbing repairs.or additions myself. [No workers' comp. right of exemption per MGL 121.n.Roof repairs. insurance required.]t C. 152, §1(4),and we have no employees. [No workers' 13..© OtherWEATHERIZATION comp, inst.trance required.] *Any applicant that checks box#1 must4lso fill out the section below shoiving.their workers'compensation policy information. t Homeowners who submit this affidavii indicating they are doing all work anti 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-conaractors and state whether or not those entities have employees. hf the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'comrensafioh insurance for my employees. .Below is the policy and" site information. 'Insurance Company Name: SELECTIVE INSURANCE COMPANY OF THE SOUTH' Policy#or Self-ins.Lic.#:WC7956539 Expiration Date:3/15113 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 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 allay 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 sins and, enalties ofee!Luiij that the in orntation.Provided above is true and correct. Si' aturc' ` , Date`.'.... [ Phone#;508-833-8384 Official use on&, Do-not writean this area,to be completed by city Or town uffcittl. City or Towm: Permit/License# Issuing Authority-(circle one): T.Board of Health 2. Building Department 3.City/'I'own Clerk 4.Electrical Inspector .5.Plum6ing.lnspector 6.Other Contact Person:- Phone#: Client#:68880 CONSER - ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMiDDiYYYY) 0311512012 THIS'CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,.EXTEND OR ALTER THE COVERAGE AFFORDED,BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),.AUTHORIZED REPRESENTATIVE OR.PRODUCER,AND THE:CERTIFICATE HOLDER.. — — IMPORTANT:If the certificate holder is ADDITIONAL INSURED the policy(ies)must be endorsed.If SUBROGATION IS WAIVED subject to- theYerms and conditions of the policy,certain policies may require an endorsement A staiemenron this certificate does not confer rights to the certificate holderin.lieu of such endorsenierit(s). PRODUCER CON NAMEACT I Rogers&Gray insurance:Agency;.Inc. PHONE -- FAX 434 Route 134 E 91.140 »h 508 398-7980 f : South Dennis,MA 02fi6.0 ADDRESS -'-- ---- ---- 508 398-7980 INSURERS)AFFORDING COVERAGE k1Alt d i INSURER A Selective Ins.Co Of the South .................... INSURED INSURER B Con-Serve Energy,Inc.. r-- -- — -- 376 Route 130.STE C I INSURER c Sandwich,MA- 02663 INSURER D INSURER E. I i INSURER F: (- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED'BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR'CONDITION OF ANY CONTRACTOR OTHER DOCUMENT'WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE,AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS.SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IINSR ADDL - — POLICY EFTYPEFISUNC SUB F POLICY E%PLTR DPOLICY NUMBER. M )i "U—M"ITA A GENERAL LIABILITY X S2011299 UJII412012103J14I20131 EACH OCCURRENCE I O 000 X COMMERCIAL GENERAL LIABILITY' e ## I OAMA�E TO RENTED f I PAR€MISES Ea occurrence) S 100,000 CLAIMS•MADE17X OCCUR MED.EXP(Any one person) s$1O OOO !' PERSONAL&AOV INJURY _-x 000 OOO 'GENERAL AGGREGATE_ '}s3,000,O00 GEN'L AGGREGATE LIMIT.APPLIES PER: - i i PRODUCTS-COMPIOP AGG�.�83,000,000 X POLICY' !PRO LOC' I }S 1 AUTOMOBILE LIABILITY. IC OM SINGLE LIMIT -- - f l I Ea accident 'S ANY AUTO �. l ).BODILY INJURY(Per person) $ ALL OWNED —1 SCHEDULED + - AUTOS s t AUTOS { I 1-BODILY INJURY IPeracadent); $ NON-OWNED f} PROPERTY OAMAG E HIRED AUTOS AUTOS I S — i Per accident § A UMBRELLA IAB IX IOCCUR X , 920.11299 31W4 O12 i 63/1412013 EACH OCCURRENCE i $1 000 000 -X EXtESSi,IA6 CLAIMS-MADE i AG.GREGATE. s3000000 DED_ X-RETENTION EO.._ A WORKERS COMPENSATION. WC7956539 31141201.20311412013 X ._wcsTAru"•- :oTH-1 AND EMPLOYERS'LIABILITY Y IIT WC ANY PROPRIETORIPARTNERIEXECUTIVE j ACCIDENT. E s...CACi' $1 00000— OFFICER/MEMBER EXCLUDE.D7 5,I N I A (Mend'atory In NH) { �Ee_D.ISEASE_EA EMPLOYE.' 51 OO OOO :.Ayes;describe under t ` DESCRIPTION OF OPERATIONS below. l I E.L.DISEASE-POLICY LIMIT:�$500,000 _. S i , i DESCRIPTION OF OPERAMRS I LOCATIONS I VEHICLES;(Attach ACORD.101;AddlOonai RemariwSchedula,if more space issequired)- Excluded Officers under'workeis'comp:Co.nor;and Courtney McInerney. Blanket additonat insured'Coverage applies under CGL. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering;Ine. SHOULD ANY OFTHE'ABOVEDESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN 1.96 Francis Aye: ACCORDANCE WITH THE POLICY PROVISIONS: Cranston jtl 02910 -AUTHORIZED REPRESENTATIVE - ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 Of 1' The ACORD name and logo are registered marks of ACORD. #S788991M78898 DD R V CO �1 Massachusetts -Department of public Safety .j Board of Building Regulations and Standards • ((AWrni:60❑Suprh kor Speolilty License: CSSL-102778 CONOR D MCINFRNEY r`L 39 SIASCONSET:DRIYE SAGAMORE BEACH MA� 2i62 r 1;. Expiration Commissioner 08119/2014 f✓'�o Sumer trlairs Rrltu7s�ness egr7a ion License or registration valid for individul use only 'r4 HOME IMPROVEMENT CONTRACTOR before the expiration date.. If found return to: ' t4. ? Regisfrabon ,;171.251 Type: Office of Consumer Affairs and Business Reulation �� . Expiration 3/1/201.4 Partnership 10 Park Plaza. Suite i170 COIU'SERVE ENERGY r s CON OR MCINERNEY' `'� 3,76.ROUTE 130 SUITE SAN.DW ICH,MA 02563 # ---•_. . � ��t t,' Uadersecretiry ;� Not yard without srgoature y+ I�Itk y Y(IP i� a ,.• 4°41' y '• �� All' , r� AC � at f;1�. {, •fit, � i '' t,4,s C'` 1 s{-y. s'�• t , yi ! $L�(p' !�1:f. �ea f 'i t f t t o S ✓r I'� p' , as Y� L .� te1 ��, Ir�lpa� � s' +�1k 1A� 'F s:s� �r{f,l;{+ �, ��+T';k} �+{#{a";• r'�!34,i ti ,�` e �•'11f ql{'i, ti!', �,'. t t i..�'� 4 '�,pi 'y t { i,jl ►.}, ti� -. ti- 1 L , yy '1 F y t l''(OOiwner s N ame) ) � dd in ;�� ;• I,rei.� i s � �%��1Z��J I'i:.�''�t r 1t��f; ,tryr,,;��>} ,� owner of the property Iodaated at ft {t .SYyI,, j' It ,tlFi ��P i �,fe(P,roperty Address) + , Y z .,fir ��`�x'i, - .,'(Property AdX. ��•�.�.+� t.��,", �11 ¢ ';. � t` t!t k,y, ty�� I 6��:q 1 i�it�e i t�,"{-;,' '�• f1i y fat I p a i 1 hereby authorize t � r' ';,(Subcontract ) ,l ri„ Iu` k, �,i 1,,v;11, q ft , s an authorized subcontractor for 13,I;SE Engineering to a,c pn my pehalf to obtain a building "(F v ,k permit and to performtw' on my�,property. ' 'Owner's ,PSignature to _4I;J Date rr �ii t ' �'. ii i y` f;pfj filft �( . .........., 3 4 .r °uPn. Pont ,.. vvek - . - � V1[ra Hom •F - _«- �..:.-'tC:�7L°`.:"'�.r 'h� - x �fe1t.t 10!u.tf�'1' ' dYe'" fi .. Y � piiT4N[i 'lrM4flPYUCF.L'4�M� n �. ___ _ the mirottes cif science- Thew X Y r 3 M1 , 8 _ The mirnrle_sIof,scjencc-,7_ r s _ r�< tip. v� ,r..\� ,t� >:..:.g•`°:a:�'"`-`t. .��.Y+{[R, "T��:i" '-' � "-�,1,.r�Y�r 4. Q�p.✓y •:! `mod•A'}di`�''//..r)Jsd. /��� .P.7"y�r �»d, t+�s^". I!';! =�+��'y{� °"et.+=*��_,,,.`.. .. ...<{�,y .-��% `.��r r d'r�.,.!�p. >„. ,:. `he. C,� w �`• r -„_. MVe'r �. f. .y 1+°''.�"! :}t.,t, J 'j {�}•Y1?. 5: Y'6+�Y'(f{.1- d ! J �?, �':n.. 'I '^"'s �. .Y'w .w-.,._ Jy,e. Yr vr� y/ ''fir M�.... ,iY • d y.: 9s' , ,7 {M,Sli.l. '� f, M .�� '7` >: �; f /'.i f .. ,,\t\i \..:. 'k�.� y 4 '! � • � �...w�,r��,i'. ��,,•.� �' _ '. e.' .- ��'y �f'l' ,�{� � �.�r p ?.- n: i .... X..�� �.+,h WJ "S.._«.„..d a.r��'-� � ,1.Y`r�'iil.;�yt' `7'Y• C`�J �$ �� ' � �'�'4�i4.'�,. L � d �� i �' t'/ �r f/r' '��:� t.�r�t..•�� .� �. �, i t ..::"'�, �vc��! 'r►'ti^,�{�'�� rr �, '��'i.r,�.�` :r r' +l•'� �`'7 _ �� ^+ �c �� ,:; 's`'�'�'�'�.�' �►'a. fir`; s"�1la ''�•� t N` i. .fi l '^' A i$` tYd �.•-_ '`kw ram' ✓ +. q;�F t. l�wtw.d. A- i Vr jk TY Vvek yy S yay • y .. r K 31 y� '� • ��T��r"��,1'',, ��,ri;�t. i ,�L�. ►.i S'• { .:. .gip. '"�,�y`"<, ...r r ���� w'� .-�. } inn k. .� � �±a�•x�, *�.��. � t`� Si..ee. ✓� �M`} �"d-' . (" TOWN OF BARNSTABLE BUILDING PERMIT GEOBASE ID 11003 1 °009 PHONE. ADD: .15 CLIPPER LANE. ZIP j;CENTER I LLB - LOT SIZE LOT 56 BKDEVELOPMENT DISTRICT CO DBA PERMIT 77508 DESCRIPTIO14 CONVERT GARAGE INTO FAMILY ROOM PERMIT TYPE BREMOD TITLE . RESIDENTIAL ALT/CONV CONTRACTORS: PROPERTY OWNER Department of. i ARCHITECTS= Regulatory Services I TOTAL FEES: $164.76 If BOND COSTS $16,89B.00 f CONSTRUCTION �F 434 RESID ADD/ALT/CONY 1 PRIVATE +► BMWEITABIA mass: �.z6g4:say �DN1A�' BU D . GD S -N BY .� DATE ISSUED . 06/25/2004 EK.PIRATION DATE THIS PER CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY:OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AND FOR ALL CONSTRUCTION WORK: WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS 'ARE BEEN MADE WHERE A C REQUIRED FOR HAS . ERTIFICATE OF OCCU- 2.PRIOR TO COVERING STRUCTURAL MEMBERSELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION 4PPR VALS 1 erg M OY ? 13 64 LL C&7��31oy 2 2 2 1 9,10 i. 9 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I 2 B WD PF HEALTLL/� OTH SITE PLAN REVIEW AAPPPPRROV ontractjnL g �u -gistered cei N"- do not have access to the guimnly tpd (as set forth in MGL c.142A-Y I WORK SHA L NOT PROCEED UN PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED E STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS fEOLNPHONEORWRITTENNOTIFICA- TION. NOTED ABOVE. f-T gl:Gv,) of TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ` s Map /' Parcel Permit# , 07 T%9. Healtf Division L J O "►- i 6�a Date Issued (011 S)'Ov Conservation Division (01JVY. Application 44*2-f-160 Tax Collector �/� �//O Permit Fee 553,38 Doul e Treasurer r im /��Le el-4. ScPTIC SYSTEid LI US o'L-`. �b Planning Dept. WSTALLED IN COMPLIAN TITLE S Date Definitive Plan Approved by Planning Board l-WRONNIENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIOMS ✓dv\q rouA. Project Street Address Village / Owner P/Eace- Address Telephone ( / 3A7 VA) \ Ic Permit Request �C' /1�6� � � IA / o Square feet: 1 st floor: existing MOO proposed 2nd floor: existing -proposed Total new Zoning District Flood Plain Groundwater Overlay ,Project Valuatlrh z�&. Construction Type Lot Size Grandfathered: ❑Yes' ❑No If yes, attach supporting documentation.. Dwelling Type: Single Family 54"' Two Family ❑ Multi-Family(#units) Age of Existing Structure 30 Historic House: ❑Yes Flo On Old King's Highway: ❑Yes 0'*N'-o Basement Type: 9'61 ❑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 (a new V I First Floor Room Count Heat Type and Fuel: "Gas ❑Oil W Electric ❑Other Central Air: 11 Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ff<0 Detached garage:❑existing O new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:Mexisting ❑new size Shed: existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION �Namezlne�e, GGc��r/ Telephone Numbe(�� -a-7— 76,70 Address 161' Aedot License# Home Improvement Contractor# Worker's Compensation# x ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO�DcPI'1211�7781/J e SIGNATURE DATE l0 —DS� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ? ADDRESS VILLAGE , OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ~_ PLUMBING: ROUGH FINAL- GAS: ROUGH FINAL. S FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. - 1 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00c7" Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE " QQ 4-a.3776 —square feet x$64/sq.foot= 64< (° x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) �s2..3f6 Permit Fee prof cost • Town of Barnstable ' �YISE fok� • -� o� pegulatory Services. i Thomas F.Geiler,birector STAB Building Division . rFD µpi , Tom Ferry,Building Commissioner • 200 Main Street, Hyannis,MA 02601 , Fax; 508-790-6230 Office: 508.862-4038 p eimit no. Data ZfP A.'�•1nA�T OR LAW SMFLEMNT TO E ERMST APPLI ATZON ' MGL c 142A requires that the"reconstrmctiou,alterations,renovation,zepair,modemiza io occu ied ion, •irxzprovemen�zemoval,demolition,or construction of an additionto any pie-existing owri P b�,�g containing at least one but not more than four dwelling units or to structures",bill are adjacent to cestered contraction,with.certain exceptions,along with other such zesidenca or building be done by z requirements, (f!/6c - tim4tq3 costtill (P _ Type of Work; dress rk f Wo o _ Ad , �/Gff D Owner's Name;_��� . hcation; Date of I hereby certify that: Registration is not required for the following zeal on(s): , [(Work excluded bylaw ' []lob Under$1,000 , [�],,�' ding not ovmer-occupied VwBner pulling own permit Notice is hereby given that: OARS PULLIN G THMR OWN PERMIT OPt D R OYEMEN')'W Old D 0 CONTRACT NOTRM ORS FOR.A.I p,,CAB,•LE jEONIE MU ACCESS CT THE AmITRATION PROGRAM OR GUARANTY FUND UNDER MGL c,1h2A. SIGNED UNDBR?BNALTM8 OF PERJURY Thereby apply for&permit as the age-At of the o r: Contractor Name Regishationl`Fo. 0 1 ,,Gck-ems 0 Owner's Name The Commonwealth of Massachusetts —�� Department of Industrial Accidents wee OfAm"MrM 600 Washington Street Boston,Mass. 02111 Workers' Coin ensation.-Insurance Affidavit-General Businesses FMMI name• `si,,. .`��J�� 1�f4�'•. '� 0 state: / V.`�i zip: e9 hone#rX Q` 'Jd7 767 work site location(full address)• / /,�Gi�6q/J1E 0��� I/�L �/I r� ❑ I am_a sole proprietor and have no one Business Type: ❑Retail❑Restaurant%Bai/Eatibg Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) ❑I am an em to er with em to es(full& art time). Other //%%%��%%��/%/ /%%%%%/.r��.��,/%%%%/ %%/��/%//% I am an;employer providing workers' compensation for my employees working on this job.. company Ilame ' - - • t. eaare Ss.` c . . phone#.::.• � .. tS' ` „'.' '• ... . i.n' ,v insurance.co::.....:.�:.......: :. I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: company name` -- address:. - `hiin #� cite p .. iioll insurance co. ' • -.... ._•.-.._ .. c e eiie� -- -- — - - ---- comp Dy D address:. .Y city�: :phone# 0'.0 iDSUl'BIIC..CO' ORE Failure to secure coverage as required under Section 25A of.MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ce under the ' s and penalties of per'u that the information provided above is true and correct 6 it-o Signature.. Date _ . Print name / `L'L 6'U Phone#( e9Z— 7�_76.70 official use only do not write in this area to be completed by city or town official e- city or town: permit/license# ❑Building Department *� ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office- []Health Department contact person: phone#; ❑Other (revHed Sept 2003) r . i Information and Instructions Massachusetts General Laws chapter 152 section 25.requires all employers to provide workers' compensation for their. ' employees. f ' As quoted from the law', an employee is.defined as every person m the service'of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, ' any two or mare of the foregoing engaged in ajoint 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.occupantpf the dwelling house of another who eniploys.persb ' to do maintenance, construction or repair work on such dwelling house or on the grounds or binding appurtenant thereto shall not because of such employment.be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation..Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Deparhnerit of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. . City or Towns . Please be sure that the affidavit is complete and.printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail of FAX unless other'arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number: . The Commonwealth Of Massachusetts Department of Industrial Accidents . 8tttce of leirestlgatiens 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727.4900 ext.406 r , cdrrBst�ter37 `��csxfl k'utlx T"I.Ie xS 7,i11( gaizd lYl . a far Oan sad T�a•i{"s�a�Y�ldRtttirl T3ui1ditt2p p�C�p{xyre pxrkxg ' '' lYlrlttM •S� gcsting/0001ing Ikk rZtmw �pnsexis �ca4�n CUdn Gla�ng y Iuc� R•yalae; R-Y�Iucs R a t • Image VOL to 6500 gatlttg Deem px�Q I9 I2'!� 0.40 31 I9 t4 10 i5 AM 0.52 30 13 19 (Q Ngrrnal 12'!. 0,50 33 13 NIA NSA Narma! 5 I5'!. V6 33 19 19 1Q i5 AFLTE T r 0.4 3� 19 2S NIA NIA • i5 AM I5 b U IS'!a 0.44 33 19 15 10 ?tamsal Y I5'I. N/A 041 30 23 NIA t�atm�I 032 31 14 25 NIA NIA 90AFLM % 1sY� 0.42 33 13 19 1Q 6 gC1.AFLTE Y 1s'!� 0.42 lE (9 (4 (0 0d0� 30 ADDRE55 OP PROPERTY: '� 2 • SQ�JARE FOOTAGE OP`ALL �gP,tOR`xf�.LL5. SQL FOOTAGE OP ALL GLAZING; 3. Q AREA(91 DNIDED 4. ova GLAZI2*1 ' ' �:sea Ohart abaY6�: , ' G•17,�GY kEQUMMENTS •�yOTE: OTHER MORE nvOLVED METN'ODS 0 AOE A p,RE AVA�,�LE, ASS.u51�oR T�� V�D�G�SP11C'COR APPROV�L;: � f � NO; YES, q•farn�3•�$0303s ' CF 1ME � Town of Barnstable Regulatory Services BARNSTABIZ Thomas F.Geiler,Director 039. A.�� Building Division Tf0 MA't 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 JJ C� Please Print DATE: P ® / JOB LOCATION: 1-5-- num/ber street / village "HOMEOWNER": name r �/y ') home phone# work phone# CURRENT MAILING ADDRESS-._; W!7, 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. 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:fonms:homeexempt 3 } / ter',.• 9 I OWN- 771 r Nk- m ��o ' Cx�s��� e Nil I I TIE, Gib I le;,le0o'ele Tel CGoc1 ® t �s dd o _ o7l, dA 17791f /7J TrP� x 12 cz, ' Ao zx 17 �ou/S Go,,n i �u t :n u/h e•-e (If� C�aor .� 3 -n`yr •4Mlt2weR..dtFl4 0 �. DIV Y ,?`:'x »x-dk {rx+e`-,+d6G '"�eyw§e.s<a .-y.^o:Mi!n.awkeae'Y': �' •:. D,.f1, �+'e Ore y .,p rev y �Dr.0 D a •n`� "".�: . !U ''JJ � 4 r . n :dwx`e •'s Y,,s °�.,'^,,,� 4. :.p tea-� l�+s„" � ., � �,, � :; •..y � -_p C � � 7R fi.'� axe _® ® ®, �° l� �I ° e y TV --7,�� -X � r _.,�, -a .. 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