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0611 SKUNKNET ROAD
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J �or - a. eT 'fefrIll F i. +a + s� JY tied.. ,�a x c a�: ,1 I-' ., ' l ��' P . ,+i� 4 + ; Tr+ , r'1 :^1 ,i^ a: it `� + { ` , - X ,�• �a5 11 �� [[)Y b e f, F "; f � �1 9 Y ,It ,,ltt�, 2 In f F c 4 Y' ':YA d�'fit' t• � r,i. 'U r it 1 + t F4 . 1 _ s� .N �. e . rF� - i,s1 j % + 1 ,!) i; a { y t i f - A :f € �, r• a � � Vw+ �� p } lk, t �� $ ,°.I Y. .f d i I + y J" r:, . t' 1 ."10, � w "` 9 k y ;+ ... a t 3' ,:.. a ,t y'p, t tt" _ of �y` � ,1. A +r_ d i i 11. A (, F' ni .rig. . y = _ .t, �,t it , l}":�( F F 4 �• ,i .1 I tgGo j } r 't rx 'n. r e _ ,,, r. F u. e ..,r:, ,'�.� f ". t i 3i ��t, °o ,r <w n r�k,'' x. Fla t`, i il" ,1 4� r { r,;. , ,a I. y ;,r# 1 f q' 4' '. - r�' 'k t It,' r tr r j 61 E 4 ',x ci -,, , r 1 F; % +, �11{': :,fir t, "� 1 *� 1 ,,, t t, 4., 'y x:t, i, S 4 !' T nA f 1�'- t f t N. .l fi, .} ! fr. q! 1. U r, 'if ° >i r' w e d qua i % -; k ®° �� r �Ntd lY} �y�`t 5 .'b!S•Ftt F f J _ 1' _ t �,. G Y s r. J p i , l` f .w ..0 'v t, 1. B ,r 'fit �' 11 a. r� A� e o- ro I R J ,. � ", �� �� q Y i r E / /` r If . ., 6 " 4,: ,� . —. .� '' . � r.'`- a v TOWN OF BARNSTABLE Permit No. - - -------------- Building Inspector Cash ----—------—-------- 61 OCCUPANCY PERMIT Bond ----------- Issued toy Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .................................................... 19............ .............................................................. Building Inspector - - FROM _ maw. 'P �— —1 - TOWN OF BARNSTABLE Mr, Francis Lahahte ne BUILDING DEPARTMENT a ' 67 MAIN STREET �YANRl�S, MA 02�! 'own clerk #d94'rww W&'+IYr.F ay As s-'�a'(R y.v►.m+.etc 4'"a� .� Phan:.775-1120 I SUBJECT: FOLD HERE DATE . • �.��. MESSAGE work his Ybeen campleted under Pet t.#�26703��: L. i, id), Y Please ,- el -B6nLL• n t K aE a•tiL+AM r Y - - �•a-;s'$:t,Al w-M+wtld.y'nxfi``yak i,�"a SIGNED .. , 'A DATE REPLY t ,. - •': , ]SIGNED .. Ne7=RtAl RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY _ PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. S Assessor's map and lot number ............................................ THE Sgwage Permit number ... ................................ ti ]DARNS ABLE. MASIL H use number t63 .........j�............ ................................................. 9. 0146 'Eo MAY TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .40 "ve ....................... ...&OA`��........................................................................ TYPE OF CONSTRUCTION ..... ........................................... .................................... �// ................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a.permit according to the following information: z21 C- Location .................. ProposedUse ... ...... ......................................................................................................... Zoning District ............. ..........�e ...............................................Fire *District ............................. Name of Owner �fVZ'..................Address 9................... ............... 4</-57- `7 /�;OAW/' - Name of Builder / ...........Address ......... .............. .......................................I................. Nameof Architect ...................................................................Address ..................................................................................... ca�,/C. Numberof Rooms ..... .:6� ................................Foundation ........................... ......................................... Exierior ........... ............................................................Roofing .......... 4,j IT ........"I'"",.................... Floors ....... ....................... Z. ....................................Interior ..... P,-7?-(5 C../ ........................................ 4 j- f a7( Plumbing ......... .. .................................................................... Heating ....n-1, ..................................................... Fireplace ...... ...Approximate Cost ...........3W;11. .................................... Definitive Plan Approved by Planning Board --------------------------------19--------- Area ..Offf9r.,— ................ Diagram of Lot and Building with Dimensions Fee .... ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH JqC) OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... ......................................................... Construction Supervisor's License ............ MA0NZ, Rl8ERT L. A--lG 8 � ` No ..... pa,mh for ____ � .......................... , Location J)Qt..�8x—.�1l.. _ ------���o~e�x��we------------ ' . ' Owner ' .. ---------' Type of Construction —..�raMe......................... -----------------------'--' Plot ............................ Lot ................................ ' Permit Granted .....July .l7�--'---lV 84 . Date of Inspection .................................... ` Dote Completed ....................................... , . ` //-n�� . ' . ` . . . ` ^ ' . ` ' ^ ' ' ' ' — | | | | Assessor's map- and lot,number, ..... lP K v y ,v r vQF THE F Sewage Permit ,.number, QQ./. . v E P ASS,'STABLE, 1 House number .... fl.:.:..................• ,tea G �� 0�6 IN IALLED IN COMPL TOWN: OF` BARNST�AB �� 1;' L MnZ AN' BUILDING,:: INSPECTOR APPLICATION FOR PERMIT TO ... .. ....... TYPE OF CONSTRUCTION ..r� .. ' ........................................................................................ - 5. . ...............................>I(P....K TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... ....... ......... of`� `t�C'✓..�..:.. .....4 ....S' =., ........ . .... .......................... Proposed Use ... ��..../R."!.!. .....D !�1 5 ....................................... Zoning District ................................ Fire District ... ✓V........ ...................................... j .... Name of Owner .d P^1 �c...l!..(. L.............. .......:..Address ...G�. ...Q9 S.l ..... '. '.................. r GasJ�✓ s �'�' .......'. ... 1 .............. Name of Builder .......... ..... Address ..© ��..5.�...... '. Name of Architect ..................................................................Address ....................................................... Numberof Rooms ......-5^......................................................Foundation ....................... .................................................... Exterior ..........W4?P ......................................... .. :Roofing .......... 5/t��iS�T.....................:............................ t Floors er'pp ..........Interior F'�T..d.0 v............................................. i 9 l• �'�/ g Heating ..... Plumbing /.... Q!. " ................................................. t Fireplace ...... �5..................................................................Approximate. Cost .......... C�j. .............................................. Definitive Plan'Approved by Planning Board --------------------_-----------1 9--------. Area ................... Diagram of Lot and Building with Dimensions Fee .............................................p 4 SUBJECT TO APPROVAL OF BOARD OF HEALTH a 1 ,50 • 3`f lD�P OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS _ I hereby agree to conform to all the Rules and' Regulations of the Town of Barnstable regarding the above . construction. l ��JJ Name .. ....... +.:....... ..1.!5Z!e�/v...,......... Construction Supervisor's License MMNI, ROBERT L. . �N 26703 „Permit for One Story Single Family Dwelling _ ............................................................................... a • Location Lot...38, 611. ...Skunknett.'....Road.. , ...... ............ .... ................... ...... Centerville................................... _,r- ......... ! r r •�./ �. �♦ Owner Robert L. Manni / ......... , Frame of Construction .... r .+ Plot ............................ Lot ................................ j ;* r) ' Permit Granted `Tu1y..17.'.................1t9 84 Date of Ins eC or" e .....4ip/�!.....19S-Ifi VDate Completed ......... 1.9 �,.. -� 1 wf; l r, k M1• d�►'GCE / Y; rmor FRY LoT/1 AbT 4Or.AW /N FEOE)f4A, 000 HAZA AP ArVE' t N•. AS SlrVWN ON THE F£OEMAA, FkWP,1Afsa AAjCE RgTE A"P fOR TN£ roM'N Of �r COMAII/N/Yr PAW AP./lam. / t7 ER M N AV NORTH ARROW NOT'To w ,v .BE l/SEO ft7i4 SOLO MRAMM tj f 54 N /?0 `I ,00 7777LOT k 8 , y `I 1 �-oT i y a � o \Ry) 00 - (^ a • N y � n Co Nk : •.. �OT37 C � y VO ry A Z .V,r4A t'a Y't'! \ bt ke,tr A X f �" St7 8 co •��°ti �. _ _ ` rya .. 'r` • � ., ,,. � �--,i�� nwj R or ^A&w o Anraxpe Jow,# FOUNA4T/ON_LO_CA7r/ON PkAN A�>rwsMmEw o&^ryANO /S rm ME �OT:3g �CJ/11 ,e p • GE?E OF T/'dE QA#/C A/aG 9! UN®ER NO ---- -- C /1MJTA/VCE�1 ARC ®�`�J�'T� To AEI V T V I h1 ' x��� F®R FENCE�,�=;0�'AeG�, �/E®f�E�T, � • joy ,pol3T �I �/�(/i 4�r ' os .4R%Foff' LE E. ROBERT Gu+ 6 AM WO M AAG IWA�/�/►/���/ E ,:• v RAYMOND H /A-4: O�Z536 No,.21583 °X 1 IvArE. NEET� a} F . G/STE hp SURV A-4 Cam® a .4 �+r: P�,Ie19 sva t5 /jEe �l18¢ , zµ i Cam i `7073 � J C t r 1 G TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0I J 1>0$1 Permit# Health Division Date Issued - C� Conservation Division i, o3 Fee Tax Collector S11 11U Treasurer INSTALLED IN COMPLIANC Planning Dept. VIM TITLE 5 EWRONMEN'TAL CODE AN.D. Date Definitive Plan Approved by Planning Board T004 REGULATI033 Historic-OKH Preservation/Hyannis �.* C.Od y Project Street Address 1�0 Villagevv4 ((e Owner 13;e46- 6,6v," -- Address Telephone 1-50 Y - 4-2-0 __ silo F0 p v Permit Request Co,,,siy,if weal 44 AI A LPW% rail Square feet: 1 st floor: existing proposed a-`t 2nd floor: existing -7-2D proposed Total new-2i4D , Valuation Zoning District Flood Plain Groundwater Overlay Construction Type 000-b Lot Size 000 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a Two Family ❑ Multi-Family(#units) Age of Existing Structure 3 D Historic House: ❑Yes &1 o On Old King's Highway: ❑Yes 2No Basement Type: 2'Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2 new Half: existing new -- Number of Bedrooms: existing new — Total Room Count (not including baths): existing to new First Floor Room Count Heat Type and Fuel: a Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes CN'No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes Cl-eo Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size 9 g g 9 9 Attached garage:❑existing ❑new size Shed: a-bxisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use -- - - -- _ BUILDER INFORMATION Name iur,-I 6 Telephone Number ��IA Address r Zf A License# 6-5 M&ys ms Vtt�� �s Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r .g FOR OFFICIAL USE ONLY � � s PERMIT NO. DATE ISSUIED ,MAP/PARCEL NO. r ADDRESS VILLAGE OWNER - > DATE OF INSPECTION: FOUND , FRAME E, INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL P PLUMBING: ROUGH ' FINAL ' GAS: ROUGHI • = FINAL 4 FINAL BUILDING ' •' ` DATE CLOSED OUT x ASSOCIATION PLAN NO. E .. S` J r xi t l RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 .7 3 FEE VALUE WORKSHEET NEW LIVING SPACE H® square feet x$96/sq.foot= 2 3 [7 x.0031= -71 plus from below(if applicable) s ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) I ACCESSORY STRUCTURE>120 sq.f� >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= 3 o (der) x$25.00= Fireplace/Chimney (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 h (plus above if applicable) Permit Fee 6 10 projcost TabuM1Ib( • get Fads preeriptire paekaEa foraaa and TWO- mid'Reside dalSai�O��suds bLkXLMUM cwiing ' Glaring Glaring Ceiling Wall E7oor Bl wau dab FMd=cY' rea A '(•/.) U.valuez It value' R-value, &vsWd R Pacicaae m l to 6500 Ham D DxW Noses Q 12:'. 0.40 3E 13 19 10 6 19 10 6 Naaaal R 12•/. OSZ 30 19 6 �AEZTfi 3 f2:'. . OSO 3E 13 19 10 Wf N0=51 T 15% 0.36. 31 13 23 NIA 6 Noemsl U IS•/. 0:46 3E 19 19 10 MA WA tsA� v 13'/. 0.44 33 13 2S to 6 35 AFUE w 15% OSZ 30 19 14 10 WA Noreaai X 18% U2 '33 13 23 WA WA Nmm3d Y 19% 0.42 3E 19 21 WA 6 90AFUE Z I8•/. 0.42 3i 13 19 10 90 A AA tE'/. 0S0 30 19 19 10 6 1'. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): (� 5. SELECT PACKAGE(Q— AA-see chart above): wJ = NOTE: OTHER MORE INVOLVED METHODS OF DETE' G ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION- BUILDING INSPECTOR APPROVAL: YES: NO: q4orms4980303a Footnotes to Table J5.2.Ib: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylight and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area. expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-`value requirement. For example;3 ftl of decorative glass may be excluded from a building design with 300 ft of glazing area. z After January 1, 1999, glazing U-values trust be tested and documented by the manufacturer in accordance with are for the National Fenestration Rating Council (NFRC) test procedure, or taken-from Table J1.5.3a. U-values whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness, over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used).For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. if used Do not include Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (� )• exterior siding, structural sheathing,and interior drywall.For example,an R-19 requirement could be met EITHER by R-19 cavity insulation'OR R 13 cavity insulation plus R-6 insulating sheathiri& Wall requirements apply to wood-famestnt or mass(concrete,masonry,log)wall conctions,but do not apply to metal-frame construction. 'The floorrequirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or`arages). Floors over outside air must meet the ceiling requiremeats. Ti:e entire opaque portion of any individual basement wall with an average depth less than 50%below grade.must mcct the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned br..,ements must be included with the other glazing. Basement doors must meet the door U-value requirement d-scribed in Note b. 'The R-value requirements are for unheated slabs.Add an additional R 2 for heated slabs. If the building utilizes electric resistance healing use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town see Table J5.2.la NOTES: a) Glazing areas and U-values are maximum acceptable levels.Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include smxtuaal components. b) Opaque doors in the building envelope must have a U-value no greater than �Door�m es do=o U value be tested and documented by the manufacturer in accordance with the NFRC test pro in Table J1.5.3b. If a door contains glass and an aggregate U-value raring for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c) If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). - 43 The Commonwealth of Massachusetts __ram ' - Department of Industrial Accidents °>_--._ — Of17ce oflavestipaUaos : . _ — 600 Washington Street T,. Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit ne: ✓v� hone 4 'SoeR4a&•JZO ir- j a homeowner perfomling all work myself. : I am a sole rietor and have no one working m' achy ///%/ %%// %%/G%////%//%////%%//%%/%%%%////%/%%%///%//G//%%%/%//%%%%%//O/�/////%%/%/%/////%///%G//%%/ an em`1 er zovidin workers' compensation for my employees working on this job. ::': ::•`:<:t:% :;`:;}.%'':<-`.?.'. :=:y;`; :: :::::::��: .;f:%;%::=::':r::;'::`:v�%: :c:'•':=::%': `:% >?`;::%:%:>:%�:n:::?:' ':: ::: is :?%: :;::?};:;::'i:$:::::':`:•'::.<}::`;'?,?:: 5......:......im ::•'.:`{::::=:;:a^:v:}::}r:<::}:x�::<•}3>:; y� :.rJ:.r}:;{-}n?,•:.r::r;%•:%..:....::J•::::.....::::.:•;{.};.}::�::::::.:r:;•:••:::•:4}:-.=•'• -,�:::;4}:•}:;r•xrr.•r•r;a:��:;:;%:::z't�:;}::::;;r;::;r• ............ ii}7F�.� ?�:!'::''�n;;,r.:;Y�f?�:'i:;':sji:;:',iii:(:F:;:vi:L:`�::$ii:ti>{:Sjiii:?v'iYy`•,:}::}i::':;y:;r.> ............................. 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F..x. : ....v.n.._.. .::..... r....................x:-; .r... .. .:...h•:}:::-nv.}�{:y{:::,w:::v::1• ........... ...... ....,.., .. :.............. ............ ..........,..... ...... 0�4V.#::J. <:.:�:?:;::.;;:,:•.;:::?.;{.;<i.:;•:?:;??.,•;:?:,.x??r:i.,.:.;;.:r:+i:;r;:;:';:4r?::S:i•J:-??•;::::.c;;:•;:•::}:;;:r} Failnre to secure cov"e as requited mtder-Section 25A of MGL 1S2 eau lead to the itttposition of uiminal penalties of a Sne up to S1,500.00 and/or one y 9 imprisonment as well as civil penalties in the form of a STOP.WORK ORDER and a 13ne of 5100.00 a day against me. I mtein derat>md that a copy of a&statemenimay be forwarded to the Office of Investigations of the DIA for coverage vetineation. I do hereby certify under the pains aloes of pedury that the information provided above is truo and correct Signature Date 3 Print name �� 6c Phone if JO oincW rue only do not write in this area to be completed by city or town ofiidal city or town• perntiNlcwe# OBtdlding Department ❑lAcensing Board ❑checicif immedlste response is required ❑selectmen's Office []Health Department contact person: phone othu'- 4rvibw 9195 Pi Information and Instructions sachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their lovees. As quoted from the 'law", an employee is defined as every person in the service of another under any contract ire, express or implied, oral or written. ?mployer is defined as an individual; partnership, association, corporation or other legal entity, or any two or more of Foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or tee of an individual, partnership, association or other legal entity, employing-employees. However the owner cf.a. fling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of ther who employs persons to do maintenance construction or repair work on such dwelling house or on the.grounds or .ding appurtenant thereto shall not because-of such employment be deemed to be an employer. 1 chapter 152 section 25 also states that every state or local licensing agency shall withhold the'issuance or renewal k license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has produced.acceptable evidence of compliance with the insurance coverage required. Additionally,.neither the unonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until eptable.evidence of compliance with the insurance requirements of this chapter have been presented to the contracting hority. plicants zse fill in the workers' compensation'affidavit completely,by checking the box that applies:to your situation and )plying.company-names, address and phone numbers.along-with a•certificate of insurance'as all affidavits may be )witted to the Departmen;of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and. to the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is ng requested, not the Department of Industrial Accidents. Should you have any questions regazding the"law I or if you required to obtain a•workers' compensation policy,please call the Department at the number listed below. ty or.Towns mse be-sure that the affidavit is'complete and printed legibly. The Department.has provided a space at the bottom of the Hdavit for you to fill out in the event.the Office of Investigations.has to contact you regarding the applicant. Please sure to fill in the perinit/licecn used a se number which will be s a reference number. The affidavits may be returned tn- eDepartment bymailor FAX unless"oilier`arrangementshave'been.made:-."�-.-� ie Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. ease do not hesitate to give us a call. he Department's address,telephone and fax number: " The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Iovestloquons 600 Washington Street Boston,Ma. 02111. fax#: (617) 727-.7749 phone#: (617) 7274900 ext. 406, 409..or.. 375. q The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Peter F. DiMatteo, 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: JEstimated Cost Address of Work: Owner's Name:' L� lea �e(a�,� ��, Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit, Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. z SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor me Registration No. OR g1orms:Affidav :rev-122001 f .. rod 001 Shed r aoumir tor F.1 � _ - t o , ® Gil -` 64± 00 i P f ... � `� `` ` • Imo, _ e _ - ® r— � lid , ........... ... for g 435b / , ......... i4� food,ftduc9nrlo:. .� �e PAOU a T. J here cer 1 tea pacrion .,� ., + � � Rovere b !rihe d elUma fim does no cfaU see ,a s x.ca Y #too& hward,=a W4K M e¢�G�e c of v-r9 05 en4 liv t tbavOP the dwettang, do'-,c�C" tocat n_q f5y.IM0 in,e ra ' the dune ncortsf+ tlort wilt. x'�spect ttprtorl dtvrlertsiet I S¢$t9 i"CTnrrit5 or 7S f�a "•�rrl.: vnolat� n.eMZrCQt'Ytote Scale: 1" =�Q !j t' b , underM .C-aw ut.�. 4DX<%CCCtLbTV'7. Die N f�C, _ 5, Sip II PLEASE NOTE: The .Structures as shown on this plot plan'are approximate only. An actual survey is necessary for a precise i driermination of the building location and entroachnnts, if any exist, either war across property tines. This plan must not be used for recording piirpns or for use in preparing deed descri?+ion.r and must not be used for variance or building plan i 1 purlxtars. This plan must not he used to locate property lines. Verification of building locations, property lint dimension, fences I; or lo+t anCiguradon can only be accomplished by an aceuratt instrument survey which may reflrct different information than what is shown hrre(m. Please note that this is "NOT A 301JI lDARY SURVEY" and is 'FOR MORTGAGE PURPOSES ONLY'. .,.,COLONIAL LAND SURVEYING COMPANY, INC. a: 269 Hanover Street -• Hanover. Mass. 02339 Phone. 617-826-7186 Fax: 617-826-4823 SENT 508-420-5680 TO 5084286131 7/22/2003 6:52 PIS Page 2 i BOA ID OF BUILDING REGULATION'S License CONSTRUCTION SUPERVISOR it I Nurnber O 057540 rl I BrrGhti ��"`12t'c611� 5 ` -71 y3 Tr.no: 10550 e I Ex►'I� ` 1 � 0 r Restric#ed IG f •` DAVID J GADY e I I TIMBER LANE A`iU`48 Administrator MARS TONS MILLS, ` - 71 N y R } c - b a . W. x + � n. a t ✓. >°o7rvnco7uoea� o�/�aaaac6uaeda Board of Building Regulations and Standards g a HOME INIPRQ VEMENT CONTRACTOR j i Regsca 9 4561 r, plT��t ;f /2003 �. Ijddividual y DAVID GADY CAf2�TEM"I David Gady i 121 Timber Ln r � Marstons Mills,MA 02648 r Administrator ' w r, : s •, o� The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis,MA 02601 862-4038 790.6230 PLAN REVIEW ner: W o Q C c_ Map/Parcel: l Co 9 0 L 0 0 ;ct Address: l o 1.+�(/Ly1 Q.`� �� Builder: following items were noted on reviewing: O-v- C` A i )h r�i..c� ��7�►v, .. IV 2 b ca v- S I j l01 1 , :wed by: Town of Barnstable Regulatory Services 9BAMSKAMTABMg* Thomas F.Geiler,Director 1639.�'OIED MA'S 1k Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 x Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder _ G.1tia,,lo,� I, ��`d`" , as Owner of the subject property hereby authorize ��"�a ��' CO"' to act on my behalf,' in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Own r Date Print Name Q:FORM&OWNERPERMISSION l �a - mod -qG The Town of Barnstable Department of Health, Safety and Environmental Services = •LABIA Building Division MAM j, 059. ,0�' 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: O ei /0- 9 Name: �Gsa �/� J : C g �2 L G.S Phone#: s d Fl 1/2 0 S !o �a Address: u,t,/�'IV Jul �11 C rti i •►� !/, L C E' Type of Business (,ylr o l e � LGrs �g AG. --Map/Lot: /0//. DO INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4.1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwellingwhich are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup trick not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering Applicant:.- Date: Homeoc.doc i � f / Town of Barnstable *Permit Expires 6 months from issue date Regulatory Services Fee $25.00 Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not-Valid-with-out Red-X=Press Imprint - Map/parcel Number H 006 Property Address 611 SKUNKNET ROAD; CENTERVILLE, MA .02632 X❑ Residential Value of Work $4,088.00 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address BRENDA J. CHARLES• 611 SKUNKNET ROAD• CENTERVILLE MA 02632 Contractor's Name__ RISE ENGINEERING; A DIVISION OF Telephone Number _ 401-78473700 THIELSCH ENGINEERING Home Improvement Contractor License# (if applicable) 120979 EXP. 3/25/2010 Construction Supervisor's License#(if applicable) :2Workman's Compensation Insurance X-PRESS PERMIT Check one: ❑ I am a sole proprietor 2008 ❑ I am the Homeowner AUG — 4 ❑X I have Worker's Compensation Insurance TOWN OF BARNSTABLE nsurance Company Name THE PRESTON AGENCY Norkman's Comp. Policy# 02 .WB NL0984 EXP. 04/01/09 �opy of Insurance Compliance Certificate must be on file. 'ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to - 1 ❑Re-roof(not stripping: Going over existing layers of roof) ' r �I t ❑ Re-side �; ® Replacement Windows. U-Value .34 (maximum.44) tv N; 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conse ation,etct�o {� Cai ,rr,----� ***Note: Property Owner ust sign Property Owner Letter of Permission. AM ED Home Impro ment Coonnnttract s License is required. COPY ATTACHED IGNATURE: :Forms:expmtrg STEPHE HIKES tvise071443 The Commonwealth of Massachusetts Department of Industrial Accidents, " Office of Investigations 600 Washington Street Boston,MA 02111 s www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers . Applicant Information Please Print Legibly Name(Business/Organization/Individual): `RISE Engineering; A Division of Thielsch Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone#: 401-784-3700 •or'800-422-5365 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet..t �• ❑Remodeling ship and have no employees These sub-contractors have 8.,❑ Demolition workingfor me in an capacity. workers'comp.insurance. Y P h'• 9. ❑Building addition - [No workers'comp.insurance 5. ❑ We are a corporation and its - required.] officers have exercised their 10.❑Electrical repairs or additions right of exemption 11. Plumbing r on per MGL repairs r 3. I am o addition❑ a homeowner doing all work g ❑ g s I P P P g , myself [No workers'comp. c. 152,§1(4),and we have no 12. airs Roof re ❑ P insurance required.]t `• employees.[No workers' comp.insurance required.] 13.❑X Other REPLACEMENTWS WIND IL *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: The Preston' Agency Policy#or Self-ins.Lic.M 02 WBNL0984 Expiration Date: •04/01'/09 Job Site Address: . 611 SKUNKNET ROAD ,; City/State/Zip: CENTERVILLE, MA 02632 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 it 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 in ndpenaltie perjury that the information provided abov is true nd correct Si ature: - Date: 7 R Q Ste en41ines - : Phone 401-784-3700 or. 800-422-5365 Ext. 117 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 'I Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M 08/04/2008 13:38 FAX 4017843710 RISE ENGINEERING Z 002 ACORD__ CERTIFICATE OF LIABILITY INSURANCE oPID C= DATE(MMIDDI/08 THYEL-1 04/24/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Preston Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Greanwich RI 02919-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE NAIC�I INSURED INSURER A: Hanford OndarLrara Ina- cc INSURER B; Hartford Casualty Inauranoa Cc Thielsch Engineering, Inc wSURERc: Beacon Nfutual 195 Frances Avenue INSURER D: North American Capaci Cranston RI 02910 INSURER E:- COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI4E 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPEOFIN9UMNGE - POLICY ATE MMIDDfYT onTE MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 COM 04/01/08 04/01/09 ED A x R urence 5 300,000 CLAIMS MADE X�OCCUR MED EXP(Any one person) S10,000 PERSONAL H ADV INJURY $1,000,000 GENERAL AGGREGATE 5 2,000,O00 GEN'LAGGREGATE LIMIT APPUE$PER: PRODUCTS.COMPIOP AGO s2,000,000. _ POLICY X j �T LOC Em Ben. 1,000, 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT XJANY AUTO 02UENTD4850 04/01/08 04/01/09 (Eoaccident) 51,000,000 B ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per pereon) 3 HIRED AUTOS BODILY INJURY (Paraccidenl) § - NON-OWNED AUT05 - PROPERTY DAMAGE S (Per acddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC E8 AUTO ONLY: AGO S - - - EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE d S10,000,000 $ X OCCUR CLAIMSMADE 02XHUUF'6573 04/01/06 ,04/01/09 AGGREGATE �1:0► 000,000 RDEDUCTIBLE X RETENTION $10,000 S Cs7 .f WORKERS COMPENSATION AND - X TORY LIMITS:I ER I EMPLOYERS'LUIBILITY ,f�� .(— B" 02WBNL0984 04/01/08 04/01/09 E.L.EACH ACCIDFNt a 500,00"0 ANY PROPRIETOR/PARTNER/EXECUTIVE. -- C OFFICERlMEMBEREXCLUDED? 54703 04/01/08 04/01/09 E,L.DISEASE- PLOYEE S-J;00 00 If Yas.describe under - SPECIAL PROVISIONS below E.L.DISEASE.PO CY LIMIT 5 00,0J00 OTHER N 5 D No Amer Capacity DVL000022001 04/13/08 04/13/09 Prof iab C:2,0 ORC.000 O � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDOR5EMENTI SPECIAL PROVISIONS (*Except 10 days for non payment of premium) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUINO IN5URER WILL ENDEAVORTO MAIL 30* DAYS WRITTEN Town Of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SHALL Building Division IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR 200 Main Street Hyannis MA 02601 REPRESENTATIVES. AUTHP��2°h P�TNP_ ACORD 25(2001108) ^Q^x 0 ACORD CORPORATION 1988 RISE ENGINEERING f` AGREEM NT 4 A division of Thielsch Engineering THIS CONTRACT IS ENTERED BETWEEN RISE AND THE CONTRACTOR FOR WORK AS DESCRIBED BELOW 1341 Elmwood Avenue,Cranston,RI 02910 R I � (401)784-3700 FAX(401)784-3710 CASE 094178 Page 1 IT IS AGREED THAT: CONTRACT DATE CONTRACTOR 0996 RISE window 07/18/2008 ADDRESS , AUDITOR John Casanova FOR THE CONSIDERATION NAMED HEREIN,SHALL PERFORM IN A FAITHFUL AND WORKMAN LIKE MANNER THE FOLLOWING WORK AT THE ADDRESS INDICATED BELOW: CLIENT NAME Brenda J Charles _ CASE ADDRESS 611 Skunknet Road J 094178 Centerville,MA 02632 PROJECT NO HOME (508)420-5680 WORK,0 X- RIS-81-08-6415 CELL FAX FURNISH AND INSTALL: 07/23/20081:52:23 PM Install(8)new white vinyl"DESIGNATE II"double hung replacement windows with new interior stops. Contractor is responsible for all material delivered and installed in connection with the above work. Any deviations from the above specifications must be authorized by RISE personnel. Contractor reaffirms the covenants set forth in its Application for Participation.Violation of any such covenant is breach of this Contract. Contractor Shall indemnify and hold harmless RISE,its employees and its agents from and against all claims,damages, losses and expenses,including but not limited to attorney's fees,arising out of or resulting from the performance of Contractor's work under this contract. RISE Authorized Signature Contractor Authorized Signature DATE DATE 07/23/2008 1:52:23 PM r 4 RISE ENGINEERING Federal ID#05-MS629 RI Contractor Registration No 8186 A division of Thielseh Engineering MA Contractor Registration No 120979 J CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,RI 02910 Q (401)784-3700 FAX(401)794-3710 CONTRACT n: i`Page 9 IBIS E THIS CONTRACT IS ENTERED INTO BETWEEN RISE - - ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW .. CUSTOMER PHONE DATE CIieM 0 Brenda J Charles (508)420-5680 06/26/2008 094178 SERVCCI_STREET BILLING STREET 611 Skunknet Road 611 Skunknet Rd SERVICE CITY,STATE.ZIP BILLING CITY,STATE,ZIP Centerville,MA 02632 Centerville,MA 02632 - r JOB DESCRIPTION RISE Engineering will install(8)new white vinyl"DESIGNATE 11"double hung replacement windows. Includes: 7/8"double glass 2 layers of low E coating,Argon gas fills Overall U-0.31 "ENERGY STAR" Welded sashes and welded frames f r Block and tackle balances �. Night vent latches Tilt in ability of the top and bottom sashes No grilles between the panes of glass ` Charcoal aluminum latching half screens s L . Price includes new interior stops for the the windows Any painting or staining that will be necessary will be the client's responsibility This will include the removal and disposal of the old windows and any storms. Insulation and caulking will be installed to provide a weather tight seal. Removal and reinstallation of window treatments such as shades,blinds,curtains or interior shutters are the home owner's.responsibility. $4,088.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Thousand Eighty-Eight&001100 Dollars $4,088.00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 90 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION.SCHEDULING.AND CONTRACTOR.REGISTRATION. k DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES t � i , O O GNATURE•RISE ENGINEERING � OMER ACCEPTANCE i Jqel NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE , — � ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE 6 �''�/"C.�'�'``�-'�:a� ,��' ��_>sr'�rr�' 9��`�s!�°�``L'., J'�y'� <<":��/J�.+`i.�lF•4 INE l Town, of Barnstable Regulatory Services JUL 3 0 2008 yMASS. Thomas F. Geiler,Director F �'AEEpMp�&,� Buildin 'Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.u§ Office: 508-862-4038 Fax 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Brenda J. Charles , as Owner of the subject property g�SEE i eerin ' A Division of hereby authorize .Thlelsc -ngine ling to act on my behalf, in all matters relative to work authorized by this building permit application for: 611 Skunknet Road; Centerville, MA 02632 (Address of Job) 7 �� 0 � Signature of O ner Date Brenda J. Charles Print Name , . F Q:FORMS:OWNERPERMISSION i Division of Thielsch Engineering,lnc R I S E 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02910 Board of Building Regulations and Standards License or registration valid for individul use only , HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:, 120979 Board of Building Regulations and Standards EXPWAt►on 3725l2010 Tr# 263460 One Ashburton Place Rm 1301 Boston,Ma:-02108 Type Pn-ate Corporation THIELSCH ENGINEERING r STEPHEN HINES, 1341 ELMWOODAVE;;�===,:; CRANSTON,RI 02910 Administrator Not valid without signature F 401-784-3700 800-422-5365 Fax 401-784-3710 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION w.7r s 3,,. Map_ .(.S 1 �-f Parcel o a o Application # II Health Division ate�IssuedIb 611 )31 m Conservation Division Application Fee Planning Dept. D11/ o!e m t,Pee� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner c.e.. a `,Ws Address Telephone % "4yN Permit Request o 72, -Ira Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation bD 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.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing z. new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas 3-611 ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Gm.�cvZ .�._c....s ,s6.n Telephone Number mock- %33- Address si >.b E .3 n License # .o L� 8 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1� u1 t ' FOR OFFICIAL USE ONLY 4• APPLICATION# DATE ISSUED ' MAP/PARCEL NO. ,�s . • ems. ADDRESS VILLAGE r` OWNER r Lr DATE OF INSPECTION: y — FRAME s a INSULATIONS' i" �i't ,, •.�)ttLgl' 3` FIREPLACE ELECTRICAL: . ROUGH FINAL ` f PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING _'-• DATE CLOSED OUT �, ASSOCIATION PLAN NO. OWNER AUTHORIZATION FORM I, Brenda Charles, Owner of Prooem located at 611 Skunknet Centerville- hereby authorize ConserVision Energy,to act on my behalf to obtain a building permit to perform work on my property. Owner Signature _ . Date l� 712��,y B Massachusotts -Department of Public Safety .E3oard of'Building FZeulaticrr?s and Standards C ctj6n Sit Ch isor Sine �i11t .aanvtru 0 CSSL- m$License: a+ti CON OR D MCL1qikNEY 30 SIASCONSET,DR1 ¢` SAGAMORE BEACH. 62 I:XpiratiOt CIt1lfTti55l 04/19/2016 ::///r.�(,trliilrrrtrirter�t�r cx.¢/{&rrrl�rratf< Office of Consumer affairs&Business RegulAtion License or registration valid for I dividul use only r„ ME IMPROVEMENT CONTRACTOR ezpiration.date. If found return t0 before the gistration 171251 Type:: Office of Consumer Affairs and Business Regulation xpiration: 3/1/20116 Partnership to Part:Plaza Suite 5170 Bos ton,MA 021.1E CON-SERVE ENERGY CONOR MCINERNEY `376 ROUTE 130 SUITE C SANDWICH.MA 02563 tary Not.,valid without signature = The Coin alth o -saehusetts Departtnent of Irzclustrtal.9cc tletrts Office ref lovcrsdt�ruttons G(JO Was{rtn�ton Street Bostof>z: A U2.171 wrifw.rnass Kor</tltu Workers' Compensation insurance Af>�dst BuilderslContractorslE ectricians/Ptunabers Applicant Information Please Print:G dbly Name (Buatness/Oi-grinizationlindividual)'. CongerVision Eilefgy Address: 376 Route 13.0 80te C City/StatefZ►p; Sa,ndwich,..MA 02563` Phone #: 508-833-8384 Are you an employer?Check the appropriate box. Type:of project(required). 1,5 I am a empll>yer with. $. 4. Q I atTi.a gen.cral cCmtractor and f 6 Q New construction employees(full and/or part-toney. have hired the.sub-contractors 2;❑ C ton a sole prapritinr.or partner listed on therattacti:ed sheet: 7. [Q Remadeling ship and have no employees these sub-contractors have. 8. .0 Demoiltion: working far:nie in.any c apac ity workers' camp insurance.. 9. E] Building addittan [No_workers' l,trap:,rnsurl�icl 5_ ❑ We are a corporation and it4 required.]. officer s havecxtircised tlle,ir 10'.[] Electrical repairs or additions .[] T,.am:1 homeowner.doing all�varh right:of exemption:per.t U I !.Q I'luinbing repairs or addit ans. myself:[,No workers comp: C. 152 1(-l),and Svc have,do 1.2.0 Roal:;repatr insurance required:)-} employees.[.No workers ` t3. Ocher Weathenzation : come. rnsurance re cared. p ., tl: .. . 'piny applicant lltal Checks box must also fits at-ncc section below fio+ving their•workem comncn:,atiun ltulicy infornmtio tMonleuwoeis whti'ubnln thus affidavit indicating t:hcy are•doing all work and trim hire ulsidc.cbiitraeturs nitrst Sulimit.a nc:w tiffidavit[ndtcatitt Such,. tContractors that eheck thix bay roust alluciied an additional sficvt showing tine narnc of(tie sub-cont N-avid l►heir u=orkerS'rnrnp poliey infonnatitrn. l ane an employer that is providing ivorkerti',compensation insurance for my enepluyees. .Below is the policj,and jpb.site ire or»eation, insurance:Companyi`ame.. CS&S/WQRKCOMPONE f olicy k or Self-ins..'Lic 601.1316349 _.Dxpinfiow Date 03/11/2015 Jot). Site Address citylStaterzio'- AtCach a copy ofahe workers' compensation pone, .q ration,pAge(shaNing the pole,} number:nnd expiration.dafe): Failure to secure coverage as required under Section 25A,of MG.L e. 1.52.cars le;id to the inlposittori.O,criminal penalties of a: fine up to S 1.500.00 and/or one-year imprisonment as well as civil penalties its the fat rr of a S7FOP'IVORY.ORDER:and a fine of up to$250.00 a day against the'violat'or. 13c adi iced that a copy at tIZic state meat may be forivardc d to the ofirc c of. investigations oftic DIA for insurance coverage.�cri.fcation: 1:d4 hereb tiff: der th p.'its ridnenaltres:ofpetjury that the infurnralion provided above is true aced; orrec t. Date: 0 Icial nee cinhyt. Do nat writem hi's,arecty.hi be completed bp city 6r toter Official. City or Town:; PertnitJl icenre Issuing Authority(eircle one): 1.Board of Nedl. .2..Building[)ep:irtment' Z City/Town Clerk 4 Elecfrical lnspecfor �.'Plutnbing tnspcetor 6.Other . Contact Person: Phone#. f `Ado CERTIFICATE OF 0 117 LIABILITY INSURANCE DAT3/17Di'I2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO,RIGHTS UPON THE CERTIFICATE HOLDER:THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE.A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT; N the certificate holder is an ADDITIONAL INSURED,the policy(les)must be.endorsed. If SUBROGATION M WAIVED;subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement an this certificate does not confer rights to the certificate holder In lieu:of such endorsements). PRODUCER NAME; - CS$S/WORKCOMPONE PHONE Pam` PO BOX 946680 (AIC,No,Erl): (A/C,NO); MAITLAND,FL 32794.6580 E-MAIL ADDRESS: Phone-877-724-2669 INSURER(Sj AFFORDING COVERAGE NAIC# Fax-877-763-5122 Continental Casualty Company 20443 INSURER A INSURED .INSURER Bs. - .. CONSERVISION ENERGY iNSURER'C 376 ROUTE 130 Continental CasualtyCompany 20443 SUITE C. IN5URERD: p .y .. - SANDWICH,MA 02563 INSURERE;Continental Casualty Company 2t)443 INSURER F: _ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TFIIS 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. SPOLICY L LIMITS LTR TYPE OF INSURANCE fNSR WYo POUCYNUMBER NMDM}tYY1'Y M _ AN t� GENERAL LIABILITY EACR OCCURRENCE $1rOt101000 - COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300,000 PREMISES(Ea omurrehepi... CLAIMS A1ADE OectiR MED EXP(Any ona wsan) $10,000 A Y N 6011316336 03/11/2014 03/1112015 PERSONAL Al)V INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE.LIMIT APPLIES PER, PRODUCTS-romPIOP AGG $2,000,000- POLICY PRO- I.00 . JECT COMBINED SINGLE.LIMIT $1,000;006 AUTOMOBILE.LIABILITY (Ea accident) _.. BODILY INJURY(Per perwn) ANY AUTO ALL OWNED '— 'SCHEDULEU. -BODILY INJURY(Per acddwo - A AUTOS AUTOS N N 6611316335 031/1/2014 03111/2015 _ -HIRED AUTOS AUTOS WNEO. P(;OPCRTY OAk1AGE (Pot acadeni) UMBRELLA LIAR OCCUR EACH OCCURRENCE 1,000,000 D EXCESS LIAB CLAIMS-MADE N N. 6011316352 03/1.1/2014 : 03/11/2015 AGc,PEGA3;E 1,000,000 DEO RETENTIONS 10,000. - . WORKERS COMPENSATION WC STATU- OTH- TOF1Y LIMITS ERAND EMPLOYERS'LIA8ILITY . ANY PROPRIETORIPARTNER)EXECUTIVE- YIN F_t.EACH ACCIDENT $100,000 E OFFICERPAEMBER EXCLUDEW N N 6011316349 03AV2014 0311112015 $100,000 (Mandatory in NMI E.L.DISEASE-EA EMPLOYEE - it Ts,deswiut under $500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES[Attadh ACORD lot,a ililib sal Rimers Sciw(1uin,i(;Itlory space ss regWted) Certificate Holder is added as an additional insured as provided in the blanket additional insured endorsement. CERTIFICATE HOLDER CANCELLATION RiseEngineerin THE EXPIRATION OATETHEREOF NOTICE WILL BE DELIVERED LED BEFORE 9SHOULD ANY OFTHE 1.341 Elmwood Ave IN Cranston,RI 02910 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD c�cases Aft, + .. _Y 4 r' Aw 000 q$'- 0AY conowY _n LL i F _ 11/14/14 Thomas Perry, CBO Town of Barnstable Building Division 200 Main St Hyannis, MA 02601 RE: Insulation Permits Dear Mr.Per ry, This affidavit is to certify that all work completed for insulation work at 611 Skunknet Rd (application#201407530)has been inspected by a certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds federal and State requirements. Sincerely, ( N -1 . a v Conor McInerney ' ConserVision Energy 376 ROUTE 130,SUITE C SANDWICH,MA 02563 508-833-8384 WWW.CONSERVTODAY.COM t� * n ` Barnstable ' c4 � � To w of B arnst 1 ab e e Tres 6 mo s rom iss e d �.� Regulatory.Services fee saaxsTaez.e, Mass. Richard V.Scali,Director 16;9• iOlEon+or° Building Division f Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.m6.us Office: 508-862-4038 'Fax: 508-790-6230 EXPRESS PERMIT APPLICATION : RESIDENTIAL ONLY e ® Not Valid without Red X-Press Lnprint Map/parcel Number Property Addlress Skor\K(n&- "-Residential Value of Work.$ &;Oct® Minimum fee of$35.00 for work under$6000.00 Owner.s Name&Addresses CbV- Ik J 0,t t 0`0z- T Contr tor's=Name Telephone Number Home Improvement Contractor License#(if applicable) 'QEmail:'=C e,y�_.�rc� �q"t q9 2� CCi)m Qas Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance , e Check one: (�• ❑ a sole proprietor e�n . yLam the Homeowner ElI have Worker's Compensation Insurance MAR 1 02 T QIV O . Insurance Company Name '` .4 n Workman's Comp.Policy# " Copy of Insurance Compliance Certificate must accompany each permit. 4. " Permit Request(check box) v ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not:stripping. Going over existing layers of roof) Cp_'Re-side ❑ Replacement Windows/doors/sliders.U-Value " (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must signProperty Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. . SIGNAT_URE.� - Q:\WPFILES\FORMS\building permit formsTXPRESS.doc 01/25/17 T7ze Commompeakh a,JfM ssccssadmsetls rt D3epar&neut of radustrial Acciderafs OjTwe of rn> gatirrns 600 Waslriingion Street -- Bastan,MA.02111 , Werkess' Ii Iusu-=ce Affidavit:13mlders/(�antractarrs/ElecfricianslFhunhers Applicant Iufmmafraa Please Print F IIv .Name. J=bya I�j 1 r-IA3d� [oV►1 Sk��,�� he-f TZ�I r-.City/Stater D,;1•6 3 Ph -4 7 74- Q 3.`z3 - O Co ( / "Are you an'e*loyer?.Checicthe appropriate bom Type of project r I.❑ I am a 1 with 4 ❑I am a general conbmctar and I e 1 { ecli en b ❑ employees(fu11 andfor part time * have hirectthe sub-contFactm 6_ 1+Ie�u oomsi�r�cF�an 2.❑ I am a sale proprietor orpmtaer- listed vathe attached sheet 7_ ❑Remodeling ship and have no employees . These sub-cantractars have 9- n Demolition wod-img far me is any ttg. e=p tolen audhave wormers' 9:.0 Building additioni [NO jyp�r {g'coQlp_ s ante camp-insurancf # 5- ❑ We are a-corporatiom and its 14❑Electrical repairs or add'slxl ons retma h 1 officers have exercised their 1L Plnmbin r airs or additions t 3: lama a homeow�r doing all _ . 0 g eP . _- - fioa per M(M trzpself.[No workers''c'°mF- .. �t of egemg g 13-�Roafrepaits'. innx=e reed_]i c.152,§1(4h andwe have no employees.[1<Tawo'k=, 13-0 Other cony-in�required-] ��Y aPF dot cbed1xbaa ffl mast also fiIIat the sectiaabciowslu iug fheitwodcexs'camp a�pn�gi o�sumi #Eaurea=ers,p6a submit dais affidaed indxxtmg they axedaing sgwaaic anddumhue outside CaMb=t+xMMSt submit anew affidaeit'mdirrik sack - ZCa A chedtilds box must att2r'h as additional sheet sb WI=gti+enameof the si1F-c0Mtscma.Xad statelrhethe;ar not fhnse eatifiesbame employees.if the mi7b- atactashnmmnployea%theyM=stP=-i&Yheir wadEE&cmmP•PGRFnumbem I am arm eeipr tlitrt i�prauidirtg�varkers'eotrrperrsrd¢�rt irtszirarrce,fir�r}n empFn}�ees $eloav is iiTte�gvtic,��arui job�_ , tnformrdian - . . . Insurance Company Name: _ -Policy,41 ar Self-its€Lic- ��piratiaaDate_ Job Site Address` Cidyl5tafel7sp: Attach aropy oftlie work-ere compensationpoEry declaration page(showing the policy mimber and expiration dafe).. Failure to secure:coverage as.requiredunder Section.25A of M-GL c.15'7 can lead to the imposition of crimirzai peoalt a of a lime ap#o$1,50G.0D ar d.1or one:yearimpdsonment,as well asrivil peualg,-s in$re form of a STOP WORK ORDEAand a title of up-to$250-00 a clay against the violator_ Be advised ffi-at a copy of this sWernent msaybe fxwarded to the Office of, Itrvestigafions ofthe DIA for insramrice coverage vetifrcation- I'do[wr &y car#jyj ruder paum andparrahYzs a.fpzr rur'that thir informafydaprmi1wabmv is.true raid carrect a�at use arrly �Dd trot�>"rFte tm flits yea,tar 5e crrrupieted by czfp artetrri a,�j4ciQL '_ City or Town — PerndtMicense;g LW3 Mg A UflMrity(ch-de One): L Board of Hwl& BTslmg DLFartmeat 3.CRyfrumm Cterk 4 Electrical LwpecWr 5.gh€mbmg Inspector b.Other Contact Person: Phow#. Information and Ms-ructions ' m w��compensation for their M13ployees- & ��,;,-«e:tfs G=em Laws Isz regtm�s aIl euqIoyers P�� � Parma ntto this sue,an.MTqTInyee is defraed R&,,_eV=ypersoniia the service of aznyffier under any ofhire, =P=SS oriapliaA oral orwchmf AIL CMrq7&YEr is def 3Zd as ran indrvidnal,parine2shp,aMDCi fion,CDIporaiion or other legal e�y,or any two or more of the foregoing=agaged m a Joint ,and inchulmg the legal sepresentafiyes of a deceased ea[ployer,or the receiver or trast=of an individual,pale,association or of -erlegal entity,emPloying c=P10yees- However fhe owner of a.dweIIjnghonse havmgnotmare than three ape meats andwho residestherein,or the occapant ofthe- dw Mag house of another who employs pemons to do cm,con stT"rt;on or repair wolk on such dwelling house or ort the grotmds.or budtTmg app thereto onn not becanse of such employmmtba deemed to be an eozployer." MM chapter 152,§25C(6)also sf3tes that"everysta a or locaI Rcenshig agency shall wMhold fhe issuance or renewal of a license or permit:to operate a btrsmess or to consfract buildings is tfie commonwealth for any applicant:who has notproduced acceptable evidences of compliance with the;T,strranre.covexagerequired_ Additionally,M(H-chapter 152,§25C(7)states�Ncxthrrthe co�-wealthnor 6gy ofifrpoIitical subdivisions shaU ems into any cont[:actfortheperfmm=ce ofpnbhuwarkuaI acceptable evidenm ofcomplian.ceviithfhe;,= am. regnsem=ts of this chapter have been presented to the ca—*� anfhoIXty_" A-pp4cwrfs Please fill o-cIt the worj=' compensation affidavit comple#ely,by g me boxes that apply to YDT r situation and,if necessary,supply sab-coutractor(s)name(s), address(es)and phone numbers) along with fficir cerrfificate(s) of ras[n-ance_ LanitedLnhRrtp Companies(LLC)or LmmtedLiabfityPerbu= zps(LU)witb-no employees other than the members or parfam-s,are,not rammed to cagy wo33ce&romPmsafim ja mmce. If an LLC or T T P does bate =ployees,apoIicyisrtquired. Be advised that this affi&-vitmaybesnbmitr-d to,theDeparfinentof Indusftial Accidents for confnmation of m MU-,n=coverage Also be sure to sign and date-the aMdavit The affidavit should be renm te:d to the city or town that tho application for the:permit or license is being regaestr no t the D PP arbnenf of ; Tnft ai 14_ccid=t9- Shouldyou have any gaCSt3. s regarding the Iaw or ifyon iris rrq=r to obtain a work=' compensation policy,please call theDeparfinemtattiie number Eytedbelaw SeJf-inset-edcomp.aoies should enterth5ir self--insara ce license nzaber aa the appropriate line. City or Town Officials _ Please be sure:that the aidavit is complete andpratfed-legibly. The Departneuthas provided a space at the botIna of the affidavit for you to EL out in the event the Office ofuVestigatians has to coMhr tyouregazdmgthe applicant. Please.b e sure to fill in the pennitllicense munber which will be used as a refercace nmmber. In-addition,as applicant e -ceose Iitations many given year,need-only submit one affidavit mdicafmg=mt that must submit nlultroI perm aPP - p olicy mfornation Cif necessary)and under`rJob Site 1a�i ess"the applica should wade"all locations in (city or e or tnvm be vided to the :. ed or mazked tli city mm-y PrO town)_ Acopy of the-affidavit that has been officially stamp 1�'. appIicaztft as proo�t3�at a valid affidavit is on file for future petatits or license~- Anew affidavitmust be filled out eiarh year.Where a home owner or citizen is obtaining a license or permit not related to any bnsio=or commear ial ve�u ' (ie_a dog license orpenDrt to bum leaves etc.)saidpersou is NOT rcT*cdto co�lete this affidavit: The Offi=oflnvesfigatinns wouldhimto tliankyoumadvance for your cooperation and shovldyouhave airyqacstxcns= please do not hesifate to givens a call. The DeRad =fs address,telephone and fax _ 'F1�e C-W nWwn of M =CELU s . _ e�cif�id�al Aocicl�nt� 4-WawmabDn S Ba MA 02.111 Fax It 617-727-7749 Reviseat424-07 gav Town of Barnstable Regulatory Services MAse• Richard V. Sca14 Director &63s~ .� Building Division. . Pant Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property,Owner Must Complete and Sign This Section If Using A Builder ka. LIN as Owner of the subject property hereby authorize �"w to act on my behalf, in all matters-relative to Ark authorized by this building permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools 4 are not to be filled or utilized before fence is installed and all final inspections are performed and accepted:, ' Signature-of Owner Signature of Applicant ' Print Name Print Name ti Date , QXORMS:OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services c; 'THE Richard V.Scali,Director 1 Building Division * z►sxsr�sc.E. « Paul Roma,Building Commissioner 1639. �� 200 Main Street, Hyannis,MA 02601 ° www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print ° 17 CRA JOB LOCATION: /� s/�v l�n e l` ���bra v,We ,, :. —number.,„ . . —village "HOMEOWNER": be-brA jitfkllace -F. ` home phone# work phone# , name, . .. [r.__ CURRENT MAILING ADDRESS: 's/l un /C 2d a„4e; Ile b 3 �� city/towm state [°"zip"code x _ - _ , .. 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 reqqrjaents,and that he/she will comply with said procedures and requirements. signature omomeowdeAA 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,Rifles&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:\WPFU,ES\FORMS\building permit forms\EXPRESS.doc 06/20/16 /r I ef ............. .... __ _ .-. _.N.. .,. x-.--., E., .... ....,... .. q _. 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