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HomeMy WebLinkAbout0146 TOWER HILL ROAD �, ��� . � �' �� --^ ,._.. �. � ^. .... � __�..r Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 12/1/11 Town of Barnstable / Thomas Perry CBO f" Building Commissioner 200 Main St. Hyannis,MA 02601 ® v RE: Building Permits < a Dear Mr. Perry, N This affidavit is to certify that all work completed for 146 Tower Hill Rd.. Osterville has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-38 cellulose(upper ceiling)R-22 cellulose (slopes) Walls: R-13 dense pack cellulose Basement: R-19 fiberglass (box sill) All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey I J l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map N Parcel ApplicationZ2w06 4,& Health-Division • Date Issued Conservation Division Application Fee Planning Dept. Permit Fee �z Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address To weir- g I oa� Village s � Owner U krill ruse Address 95 d 1 FIL6+ 0546COle ko�j Odemll6 Telephone_ Permit Request e ,_)1 Asp e �-b SOo4eS ► ors ����; AaQc.P roe V r,04S a 1!1 7�ICG lG S 5 �j� ]c p�r [1 ��YI/X G7LT ��-Lp I� -�Rd? Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain _Groundwater Overlay Project Valuation 3 04 Construction Type Lot Size__ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family kf Two Family ❑ Multi-Family (# units) Age of Existing Structure 1 9 4 8 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ' ❑Walkout Q Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq�.)) Number of Baths: Full: existing new Half: existing ' Number of Bedrooms: _ existing _new 4 Total Room Count (not including baths): existing new First Floor Room Count, Heat Type and Fuel: 14 Gas . ❑ Oil ❑ Electric ❑ Other N r� Central Air: ❑Yes 1 (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 Wdl:Ctm �C�ws�.e. C� 8 Save L� nn IF Telephone Number Jr�g ` 3 7$" �3 r 0 Address C �� 5'�1n License # .L C a b S 0LJ A Yk(,M6wt Home Improvement Contractor# ( 6 3 Worker's Compensation # 7wG31 Q� 9:7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ) uAr mg tyJ SIGNATURE DATE R-3 , J FOR OFFICIAL USE ONLY APPLICATION# a DATE ISSUED : MAR/PARCEUNO.. ADDRESS — VILLAGE OWNER DATE OF INSPECTION: ':WF_OUN_DATION )A' v , FRAME 1 TINSULATION�: k.;?- FIREPLACE Fi ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS m: t ROUGH FINAL 4 ' sFLNAL• .._;DATE CLOSED.OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Inves#gadons 600 Washington Street Boston,MA 02111 www mass gov/dta Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatioa&dividual): MIC, aAei C 14 AS V cu c4e . Address: _ I -C_ ' (A uk ay'fi t4kabt3 � City/State/Zip: Yf�a maq:% � 62,(okf%one#: - 3 Are you an employer?Chec the appropriate box: Type of project(required): 1.M I am a employer with 4 4. ❑ I ant a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ 1 am a sole proprietor or partner_ listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' g ❑ Building addition (No workers' coriip. insurance comp.insurance.: required.) S. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 I.[]Plumbing repairs or additions myself. (No workers'comp. right of exemption per MGL insurance required.)t c. 152,§1(4),and we have no 12.❑ Roof repairs 1� employees. (No workers' 13.®OtltcrStlO'�Q,T1M comp. insurance required.) *Any applicant that checks box Al must also fill out the section below showing their workers'compensation policy information. +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit iniicatmg such. tr-ontractoa 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-contactors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. s Insurance Company Name: I PC, n o o a V -IO S y oo ce C o m p o1,11 Y Policy#or Self-ins.Lie.#- T W c. 3 a. 9 Expiration Date: 1 0 1 a 0`a, —Tower � I Job Site Add ess: 1� 6 f o w er �t 1'1`I i'<o a d City/State/Lip: Q s+er,r I lit, MR 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 D1A for insurance coverage verification. I do hereby certify under the pains d enatties erjury that the inforawtton providediaboYe is true and aorrecL S e r Date: 1 3 Phone 9 t Official use on{v. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i NYM AC RV CERTIFICATE OF LIABILITY INSURANCE D0/20ATE /DD011 10/20/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Shannon Sperrazza Risk Strategies Company PHONE (781)9B6-44O0 FAX o.(761)963-4420 15 Pacella Park Drive AEbm,)AgLESS:ssperrazza@risk-strategies.com Spite 240 INSURERS AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:Selective Insurance INSURED INSURERB:Safety Insurance Company 3618 Michael McCluskey, DBA: Cape Save INSURER C:Technolocjy Insurance Company 7 C Huntington Ave INSURER D INSURER E: South Yarmouth MA 02 644 INSURER F: COVERAGES CERTIFICATE NUMBER-CL11102041451 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBRTYPE OF INSURANCE POLICY NUMBER MMO/LDID MM/DDT LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES fEa occurrence $ 100,000 A CLAIMS-MADE Fx1 OCCUR CPPS1994480 0/16/2011 0/16/2012 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea .dent 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 6208200 1/6/2011 1/6/2012 BODILY INJURY(Per accident) $ X HIIR DS AUTOS AUTOS E AUTOSWNED PROPER PER'IDAMAGE $ X Underinsured motorist BI split $100000 300000 X UMBRELLA LIAB X OCCUR PPS1994480 0/16/2011 0/16/2012 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ C WORKERS COMPENSATION Executive excluded X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN from coverage E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) rWC3297972. 0/21/2011 0/21/2012 E.L.DISEASE-EA EMPLOYE $ 500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Issued as evidence of insurance. National Grid Corporate Services LLC d b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc. , and Housing Assistance Corporation are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. 484 Main Street Hyannis, MA 02601-3698 AUTHORIZED REPRESENTATIVE Michael Christian/SMS ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 oninnst m Thu er`Mir1 nama anti Inn^a►a roniatarnri marirc of at npn — Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration j ' Registration: 164432 Type: DBA CAPE SAVE Expiration: 10/6/2013 Tr# 217656 MICHAEL McCLUSKEY -. 7C HUNTING AVE. _. . .... - ._ ... S. YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. DPS-CAI 0 50M-04/04-01 0 1 21 6 �_� Address F"i Renewal j.-J Employment Lost Card j j ✓✓ie �oa iaa %ff!eccll! _ Office of Consum er Affairs&Bu'siness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 164432 Type: Office of Consumer Affairs and Business Regulation Expiration: 10/6/2013 DBA 10 Park Plaza-Suite 5170 Boston MA 021.16 CAS SAVE MICHAEL McCLUSKEY 8201 S.HOURD CT if CHAPEL HILL,NC 27516 � Undersecretary - " - -g— ot valid without signature lassachusctts- Department of Public Safet Board of Building Retilations and Standards Construction Supervisor Specialty License License: CS SL 102776 �- - Restricted to• ICY r`. WILLIAM MC`CLUSKY 37NAUSET:ROAD k WEST YARMOUTH''MA 02673 . :, Expiration: 6/28=13 <'onnni��i'orr Tr#: 102776 CAPS 1 SAVE Weatheirization 508-398-0398 August 22, 2010 To Whom It May Concern: William J. McCluskey is are employee of Cape Save. He is authorized to negotiate contracts and building.permits for our.company. Michael McCiuskey Cape Save—Owner 919-593-5939 cell X Huntington Avenue, South Yarmouth,MA 026" TENANT/PROPERTY OWNERIAGENCY WEATHERIZATION AGREEMENT 1. The Parties to this AI�reem t are the following: L�fillf h' �f (hereafter known as Tenant), (print your tenant's name) (hereafter known as Property Owner) (print your name) and Housing Assistance Corporation (hereafter known as Agency). In consideration of the mutual promises hereafter stated,the Parties agree as follows: 2. The date of Agency's signature will be the effective date of this Agreement. 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property p located at(street, town) 4 /lJl��� f'�/Q1/(2�j, 5�2.r�1�/L ' , uni t#t# , and currently leased or rented to the Tenant: a) Enter the premises for the purpose of performing a Weatherization inspection. b) Enter the premises to perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection of the property and in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas of the building for the purpose of accomplishing the Weatherization work. The Agency and representatives of the Commonwealth of Massachusetts, Department of Housing&Community Development(DHCD) may further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The We work will be performed in accordance with the Property Owner's consent as further specified below: INITIAL:ONLY ONE OF THE FOLLOWINGA consent to performance by the Agency and its contractors of any eatherizabon work determined necessary and appropriate by the Agency as a result of its inspection of the property. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of work. I will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's inspection report and a statement of the estimated work and associated value. This additional consent will be sent under separate cover as Attachment A. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of the work 4. The Property Owner understands and agrees that any and all work, including related repairs for which the Property may also be eligible,will be performed at the Agency's discretion. The Agency estimated completion of the Weathenzation work by the end of 2011. 5. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency,the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where the Property Owner receives a written extension from the Agency,time is of the essence in the performance of repairs by the Property Owner. i 6. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel supplier/utility supplier as to the quantity of fuel/utilities used at the above address in each of the past three years and the future three years. The information is to be used only to determine the cost effectiveness of the Weatherization improvements. 7. The Property Owner agrees that the rent for the dwelling unit will not be raised because of any increase in the value thereof due solely to the Weatherization work performed. 8. In consideration of the Weatherization work hereunder, the Property Owner further agrees that upon the effective date of this Agreement and during a period extending through 2011/12, approximately one year from the time the work is completed, a) The present rent .f per month will not be raised for any reason. (The rent amount must.i a filled in). However,this Paragraph (8a)will be waived by the Agency in writing if,and only if,the premises are leased under a state or federal rent subsidy program, in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program Please state which Housing Subsidy program your tenant is on and through which Agency. b) The Property Owner will not institute any summary process action for possession except in the case of non-payment of rent or other good cause related to the Tenant(or any successor Tenant). c) In the event the Property Owner decides to sell the premises, Property Owner shall comply with one of the two requirements below: -The Property Owner shall not sell the premises unless the buyer agrees(with a copy forwarded to the Agency) in writing prior to sale to assume all obligations of the Property Owner set out in this Agreement; or --The Property Owner shall pay the Agency an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor. performed in the premises as of the date of sale. Said amount shall be paid to the Agency immediately upon sale. 9. (Applicable only if Tenant's heat Is included in rental payment and blanks are filled in) At the end of the period set forth in Paragraph 8 above, the rent shall not be raised more than % per for an additional period of one year,and the provisions of 8b and 8c above shall continue in effect for such period. However,the rent provisions of this Paragraph 9 may be waived by the Agency in writing if, and only if, the premises are leased under a state or federal rent subsidy program, in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. 10. The Parties agree that the terms of this Agreement are incorporated into any other lease or agreement between the Property Owner and the Tenant,and between the Property Owner and any successor Tenant, and if there is any conflict between the provisions of this Agreement and the provisions of such other lease or agreement, the provisions of this Agreement shall govern. However, if such other lease or agreement, including without limitation a lease or agreement under state or federal rent subsidy program, contains stronger protections for the Tenant,such stronger protections shall apply. 11. For breach of this Agreement by the Property Owner, the Property Owner shall reimburse the Agency in an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed on the premises, as well as attorneys fee and court costs- The Property Owner may also be liable for damages to the Tenant in accordance with applicable law, in such instance, the Property Owner shall reimburse the Tenant for attorneys fees and court costs. Without limiting the foregoing, the Agency may at its option terminate this Agreement, by providing written notice to the Property Owner and Tenant, in the event of breach by the Property Owner or Tenant 12. Performance of the Weatherization work hereunder by the Agency is contingent upon the availability of funds to the Agency from the commonwealth of Massachusetts and the federal government, as well as the eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written notice to the Property Owner and Tenant if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. 13. The Parties acknowledge that this Agreement is under seal. It is intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement Praperty Owner's ' Jf i oV -_ � Signature: { -Date:",! Phone: 3 '= ` �� - �� Address: `�� 64-C7 Tenant Signature Date C� Agency Signature Date y - oF r Town of Barnstable *PermitFapir DID Regulatory Services Fe 6m°°hs o�n a ate a • � a IAt;N6rA1LE, s 1639. ,� Thomas F.Geiler,Director Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma us Office: 508-8 62-4038 Fax: 508-790-623 0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 1 Not Valm with,",Red X-Press Imprint Map/parcel Number Property Address D S Q TT l,(,('I'— I�JQ,L,� !� f Y�C��?51 Ul!� Y ►'` I F� `�C To Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address v 1`(ID J Contractor's Name Telephone Number6()V•4/7-/217S Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: - "' ��,"''•-`� El am a sole proprietor �`' �' �' I am the Homeowner N Q V 1 8 2011 I have Worker's Compensation Insurance TOWN OF BARNSTAB E Insurance Company Name . 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) ❑ 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. 3IGNATURE: �J I-4—AS, 2:IWPFII,ESIF0RMS\6uilding permit formskEXPR.ESS.doc tevised 070110 The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 63S - City/State/Zip: s f Phone #:�� �(�{ - f' rf F2F you an employer? Check the appropriate box: am a employer with 4. E] I am a general contractor and I Type of project(required): employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction . 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance.# 9. ❑Building addition required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no 12.0 Roof repairs employees. [No workers' 13.❑ Other comp.insurance required.) 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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 Below is the policy 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 Of5ce of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and nalties of perjury that the information provided above is true and correct Signature: / Date: Phone#: c • �� 9 — S 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): I.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: �b I"E'ew.� Town of Barnstable L = Regi lato Servic r3' es `erg Thomas F. Geiler,Director .,► Building Division Tom Perry,Building Commissioner 200 Main Street;Hyannis,MA 02601 .www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623 0 Prop Owner Must 'f Comptete an Sign.This Se tion, If Usin' Buflder I, a Owner of the subject ptgpetty hereby authorize to act on my behalf, in all matters.telative to work authorized by s building permit (Address of Job) **Pool fences and alarms e the responsibility of the applicant. are not to be filled before ice is installed and pools are not to be ools Utilized until all final iris 'ections are performed p ed and accepted. Signature of Owner i I Signature of Applicant Print Name Print Name Date i Q:FORM&O WNERPERMISSIONPOOLS �1HE Town of Barnstable Regulatory Services R"NSTABLE, + Thomas F.Geiler,Director y unss. 1639. �'� Building Division °lfp► {A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 wR'v►'.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION I Please Print DATE: JOB LOCATION: number� ���1G�S I IS street village "HOMEOWNER": E— n ame home phone# work phone# CURRENT MAILING ADDRESS: <- (02� city/town �I� MA city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides.or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) • I The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and r ements. 7Signature(TomeownerJ Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1:1--Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowher certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue-is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:fornrs:homeexempt