HomeMy WebLinkAbout0012 MEGAN ROAD � .� Town of Barnstable Building
: .nxvarn Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and,this Card Must be Kept
Posted Until Final Inspection Has Been Made. ' Permit
s63q fff§
Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-19-1357 Applicant Name: Roland Langevin Approvals
Date Issued: 04/23/2019 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 10/23/2019 Foundation:
Location: 12 MEGAN ROAD, HYANNIS _. Map/Lot: 292-234 LL Zoning District: RB Sheathing:
Owner on Record: OMALLEY,ANN F Contractor Name. ROLAND LANGEVIN Framing: 1
Address: 1616 18TH ST NW,APT 611 Contractor License: CS=103861 2
WASHINGTON, DC 20009-2532 m Est. Project Cost: $3,951.00 Chimney:
Description: Air Sealing,Weatherstrip Door,Attic Flat cellulose Soffit Vents, Permit Fee: $85.00
Fiberglass to basement Sills,Ventilation Chutes, Insulate Bulkhead Insulation:
Door Attic dammingR-38 Fiberglass,Attic Hatch Seal and Insulate Fee Paid: $85.00
g l . � Final:
Date 4/23/2019
Project Review Req: -
' Plumbing/Gas
Rough Plumbing:
' - - — - ' Building Official Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within'six months after'issuance.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning bq-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public,inspection for the entire duration of the Final Gas:
work until the completion of the same. ,
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,permit.
Service:
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing
Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed _ Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site ti
Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
5�_
°F1HE r°�ti Town of Barnstable ,Permit#
Expires 6 months from issue date
Regulatory Services Fee
i
RARNsrABLE,
r M^� Thomas F. Geiler,Director /
i659" f fL
&
prED MPS
Building Division
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis,MA 02601
ww-w.town.barnstable.ma,us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY -
^� toot Valid without Red X-Press Imprint
n
Map/parcel Number al ( c;� Q 3
Property Address
Residential Value of Work Minimum fee of$25.00 for work under S6000.00
Owner's Name&Address ^✓��Q `r '
n t 5� 'Lyi41
Contractor's Name ��ksr{`�� r-� lR_.�1 Telephone Number
Home Improvement Contractor License# (if applicable) ) v
(21
Construction Supervisor's License#(if applicable)^ Lf L4
❑Workman's Compensation Insurance,
Check one: PERMITXPR
`KI am a sole proprietor °� ..d
❑ I am the Homeowner 20�0
❑ I have Worker's Compensation Insurance JUN
Insurance Company Name `T"IAIN OF B it 1 )!
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not stripping. Going over existing layers of roof)
t
Re-side
# of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum .44)# of windows
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
*"*Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License & Construction Supervisors License is
required,
SIGNATURE:
f
._ Massachusetts- Department of Public SafetN
Board of Building Rc ulations and Standards
Construction Supervisor License
License: CS 73449
Restricted to: 00
BRENDAN W BRIDES
16 WIDOW COOMBS WALK °
SANDWICH, MA 02563
Expiration: 4!4/2012
Tr{#: 21247
('ununissiuner ---
i
✓fie uuealt�i a ✓ aacu/�uaet�a
Office of Consumer Affairs&B smess Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
= Registration1.06561 Type: Office of Consumer Affairs and Business Regulation
s Expiration: 012 Individual 10 Park Plaza-'Suite 5170
:, a=
--___ Boston M.BR --- ,. A 02 DA � 116
N W -
ILLIAM BRiD�S
Brendan Brides 's
16 Widow Coombs IFt!a�lic
Sandwich, MA 02563'
Undersecretary Not valid without signature
0
The Commonwealth of Massachusetts
-� Department of hzdttstrtalAccidents
d Office of Investigations
J1 600 Washington Street
Boston, MA 02111
wwminass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: coo
'L
City/State/Zip:
`J �vt v� c-�t�. �� S63 Phone#: 1--)
Are you an employer? Check the appropriate box: Type of project(required):
4. 1 am a general contractor and I
1.❑ I am a employer with ❑ 6. ❑New construction
employees(full and/or part-time).* have hued the sub-contractors y
2�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 workers' 9. ❑ Building addition
[No workers' comp.insurance comp. insurance.1
5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
required.]
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs of additions
right of exemption per MGL
o_yvorkers'_coznp,. _.__.. 12.❑-Roof.repairs . ..._
insurance required.] t C. 152, §1(4), and we have no (`jam
employees. [No workers' 13.® Other
comp. insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. if the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Beloit/is thepplicy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration.page(showing the policy number and expiration date),
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250,00 a day against the violator., Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct.
Sig-nature: f��,A
- Date:
Phone# �vr6 1.-} 2� , � 1 u j
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3, City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Information. and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for.their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual,partnership', association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant'of the
dwelling house of another who employs persons to do maintenance, construction or repair.work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a`license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,IAGL chapter I52, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence.of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP)with no employees other than the
members or partners,are not required to carry workers compensation msu rance. If an LLC of 1;T P does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials;
Please be.sure that the affidavit is complete and printed legibly,- The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to-fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may'be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home.owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 4-24-07
� � wwtiv.mass.gov/dia
I
I-
BRIDES-BUILT
RESIDENTIAL CONTRACTING AGREEMENT
Registered home improvement contractor in Massachusetts,106561
Date:May 28` 2010
Read this agreement and make sure that you understand it before signing it.This agreement has legal force
and effect and binds those who sign it.
Notice:All home improvement contractors and subcontractors engaged in home improvement contracting,
unless specifically exempt from registration by provisions of chapter 142a of the general laws,must be
registered with the Commonwealth of Massachusetts.Inquiries about registration and status should be
made to:The Director,Home Improvement Contract Registration,One Ashburton Place,Room 1301,
Boston,MA 02108.
This contract (hereinafter referred to as"Agreement")is made and entered into on this 28'day of May,.
2010,by and between Ann O'Malley,12 Megan Road,Hyannis,MA(herein after referred to as
"Homeowner")and Brendan Brides of 16 Widow Coombs Walk,Sandwich,MA 02563, TeUFax 508 420
5141(herein after referred to as"Contractor').In consideration of the mutual promises contained herein,
Contractor agrees to perform the following work:
1.DETAILED DESCRIPTION OF WORK TO BE PERFORMED
Contractor agrees to perform in a good and workman like manner all work described below:
• Rip and replace three sides of white cedar sidewall shingles
• Install Weather Trek house wrap under shingles
• Shingles to be Clear Extras
• Shingles applied with galvanized 1"3/16 staples
• Replace four rake ends with Azek brand PVC trim
• Remove all construction waste
• Building permit included
La DETAILED DESCRIPTION OF MATERIALS TO BE USED
Materials to be used in performing the above described work consist of the following:
• "Extra"white cedar shingles
• Azek brand pvc rakes
2.PRICE
Contractor agrees to do all the work and supply the materials described in section 1 for a fixed price of
$6,200
3.PAYMENT
Payment will be made as follows: Initial Deposit$300
Upon starting work:$3000
Balance upon completion:$2,900
4 COMMENCEMENT AND COMPLETION OF WORK
Contractor will not begin the work or order the materials before the third day following the signing of this
Agreement,unless specified here in writing.Contractor will begin the work on or about Second week of
June 2010 August,barring delay caused by circumstances beyond Contractor's control,the work will be
completed within one week.The Homeowner hereby acknowledges and agrees that the scheduling dates
are approximate and that such delays that are not avoidable by the Contractor shall not be considered in'
violation of this agreement.
1 Owner Initial:
Contractor Initial:—
5 INSURANCE
Contractor will be responsible to the Homeowner or any thud party for any property or bodily injury
caused by himself,his employees or his subcontractors in the performance of,or as a result of,the work
under this Agreement.Contractor agrees to carry insurance to cover such damage or injury. Specifically,
liability insurance,workers compensation insurance.
6 SUBCONTRACTING
Contractor agrees that,not withstanding any agreement for materials and/or labor between Contractor and a
third party,Contractor is responsible to Homeowner for completion of all work described in a timely and
workman like manner.
7 CONSTRUCTION RELATED PERMITS
Aquisition of Building Permit will remain the responsibility of the Contractor
S MODIFICATION
This Agreement,including the provisions relating to price(section 2)and payment schedule(section 3)
cannot be changed except by a written statement signed by both Contractor and Homeowner.
9 WARRANTIES
The Contractor warrants that the work furnished hereunder shall be free from defects in material and
workmanship for a period of.One(I)year following completion and shall comply with the requirements of
this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,
his subcontractors,employees or agents,is discovered within one year after completion of any job,
including clean up,the Sub-contractor shall,at his own expense,forthwith remedy,repair,correct,replace,
or cause to be remedied,repaired,or replaced,such damage or such defect in materials or workmanship.
the foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. .
All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the
manufacturers of such equipment,which shall be and are hereby passed directly through to the
Homeowner.Under such manufacturer's warranties,the Homeowner may be required to register or mail in
a warranty card or other evidence of ownership and use of such equipment in order to activate such
warranties.The Homeowner's failure to mail in or register such documentation,which failure voids the
manufacturer's warranty shall not create any responsibility for the Contractor to warrant such equipment.
j
This warranty gives the Homeowner specific legal rights,and Homeowner may also have other rights
which vary from state to state.Under Massachusetts Law,sales of goods carry an implied warranty of
merchant ability and fitness for a particular purpose.
10:COPY OF AGREEMENT TO BE GIVEN TO HOMEOWNER a
This agreement is governed by the Laws of Massachusetts.It must be executed in duplicate,and an original
signed copy hereof given to the Homeowner at the time of execution.No work under the Agreement shall
begin prior to the signing of the Agreement and transmittal to the Homeowner of a copy thereof.
11.STANDARD EXCLUSIONS,
Unless specifically included in the Detailed Description of Work to be Performed section above,this
Agreement does not include labor or materials for the following work:Plans,engineering fees,or
governmental fees or.perinits of any kind.Testing,removal and disposal of any materials containing
asbestos('or any-other hazardous material as defined by the EPA).Custom milling of any wood for use.in
project.Moving Owner's property around the site.Labor or materials required to repair or replace any
'Homeowner supplied materials.Repair of concealed underground utilities not located on prints or
physically staked out by owner which are damaged during construction.Surveying that may be required to
establish accurate property boundaries for setback purposes(fences and old stakes may not be located on
property lines).Final construction cleaning(Contractor will leave site in"broom swept condition").
Landscaping and irrigation work of any kind.Temporary sanitation,power,or fencing.Removal of soils
2 Owner Initial:
Contractor Initial:
I
under house in order to obtairi 18 inches(or code required height)of clear space between bottom of joists
and soil.Removal of filled ground or rock or any other materials not removable by ordinary hand tools
(unless heavy equipment is specified in Detailed Description of Work To Be Performed),correction of
existing out of plum or out of level conditions in existing structure.Correction of concealed substandard
framing.Rerouting/removal of vents,pipes,ducts,structural members,wiring or conduits,steel mesh .
which may be discovered in the removal of walls or the cutting of openings in walls.Removal and
replacement of existing rot or insect infestation.Failure of surrounding part of existing structure,despite
Contractors good faith efforts to minimize damage,such as plaster or drywall cracking and popped nails in
adjacent rooms or blockage of pipes or plumbing fixtures caused by loosened rust within pipes.
Construction of a continuously level foundation around structure(if lot is sloped more than 6 inches from
front to back or side to side,Sub-Contractor will step the foundation in accordance with the slope of the
lot).Exact matching of existing finishes.Public-or private utility connection fees.Repair of damage to
existing roads,sidewalks,and drive ways that could occur when construction vehicles or equipment are
being used in the normal course of construction.Septic inspection or update.Residual costs caused by
engineering or architectural changes.Cupping of oak floors due to excess moisture from basement
underneath.
12.SPECIFIC ITEMS NOT COVERED BY THIS AGREEMENT
• Any landscaping
• Any painting
13.CHANGE ORDERS '
All Change Orders must be written up and signed before commencing any work.Contractor will
make a good-faith estimate to determine approximate cost of new work before getting a firm price
from subcontractor.
14.DEVIATION FROM SCOPE OF WORK
Any alteration or deviation from the Detailed Description of Work to be Performed referred to in this
agreement involving extra costs of materials or labor(including any overage on allowance work and any
changes in the Detailed Description of Work to Be Performed required by governmental plan checkers or
field building inspectors)will be executed upon a written Change Order issued by Contractor and should be
signed by Contractor and Homeowner prior to the commencement of additional work by the Contractor:
15.EXPIRATION OF THIS AGRREEMENT
This Agreement will expire 15 days after the date at the top of page one of this Agreement if not fast
accepted in writing
b -the Homeowner
P Y
16.ENTIRE AGREEMENT
This Agreement represents and contains the entire agreement between the parties.Prior discussions or `
verbal representations by the parties that are not contained in this Agreement are not part of this agreement.
17. DISPUTE RESOLUTION AND ATTORNEY'S FEES
Any controversy-or claim arising out of or related to this Agreement involving an amount less than$5,000
(or the maximum limit of the court)must be heard in the Small Claims Division of the Municipal Court of
the county where the Sub-contractor's office is located.Any controversy or claim arising out of or related
to this Agreement which is over the limit of The Small Claims Court must be settled by binding arbitration
administered by the American Arbitration Association in accordance with the Construction Industry
Arbitration Rules.Judgment upon the award may be entered in any Court having the jurisdiction thereof.
The prevailing party in any legal proceeding related to this Agreement shall be entitled to payment of
reasonable attorney's fees,costs and expenses.
3 Owner Initial:
Contractor Initial:
E�
bb
Homeowner's signature - Date signed
Homeowner's si natur Date signed
Contractor's signature D to sigAed
4 Owner Initial•
Contractor Initial•
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
' Map Parcel Permit#
Health Division Date Issued
Conservation Division Fee
Tax Collector V :
Treasurer
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address Mean.Z6.
Village Vc, zn vi
Owner Qaj r i L- a 'Ma I r_ v Address
Telephone S
Permit Request S e ' Roo-r- rI
Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new
Estimated Project Cost O Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family LY/ Two Family ❑ Multi-Family(#units)
Age of Existing Structure/r�.� Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
Basement Type: mull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) /ooa
Number of Baths: Full:existing new Half:existing new
Number of Bedrooms: existing new
Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: 9'Gas ❑Oil Cl Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool:Cl 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
BUILDER INFORMATION
Name t C Telephone Number 77.5-0�,6
Address License# S 6.53
Home Improvement Contractor# 6 7
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Q C_a r 5 Dvzn fX'�P y'
SIGNATURE DATE 14 ,46(f / /
A .
r FOR OFFICIAL OSE ONLY
t _
PERMIT NO. '
s •
DATE ISSUED
MAP/PARCEL NO. ,
r
ADDRESS y , VILLAGE
OWNER
DATE OF INSPECTIONS
f
FOUNDATION
FRAME
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INSULATION
a
' FIREPLACE
4
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ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
` DATE CLOSED OUT
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ASSOCIATION PLAN NO. `
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The Commonwealth of Massachusetts
- Department of Industrial Accidents
_ — 600 Washington Street
-= ` Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
fe: t Lhar .G
location: a 1
city k� i 1 3 phone# 775 ' 096 _�
❑�I am a homeowner performing all work myself.
(� I am a sole p etor and have no one workingin anv acity
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I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors VINAMMINAM
listed below who
have
the followingworkers' compensation polices:
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insurance /
Faunre to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to s1,So0.00 and/or
one years'imprisonment as well as civii penalties in the form of a STOP WORK ORDER and a One of S100.00 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 hereb certify the and p of ee jury that the information provided above is true and coned
7
Signature Date
Print name
Ph=# 77-5_ � '6
official use only do not write in this area to be completed by city or town official
city or town: permiNicense 0 ❑Building Department
❑Licensing Board
❑checkff immediate response is required ❑Selectmen's Office
❑Health Department
contact person; phone M, _ ❑emu
(fevned 9/95 PIA)
The Town of Barnstable.
» RAM&A M •
9�AMAS&; ��� Department of Health Safety and Environmental Services
rED MA'S A Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 50&790-6230 Building Commissioner
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
i
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:�°(��� Estimated Cost So
Address of Work: /r`� ��ia v�
�4
Owner's Name:
Date of Application: 47
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.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent r:
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Date Contractor N ff' Registration No.
OR
Date Owner's Name
q:forms:Affidav