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0573 MAIN ST./RTE 6A(W.BARN.)
�` U 4 X 1 r a IIII �RECYtlfp�o IIII UPC 12543 No. 53LOR r.co�5°�� HASTINGS, MN (Jn��'^A 7 �o�� �� Tznant �� �Cmer��- - - a c -d —_ i IME Y, Application number......0..-.1J-.3.3'7<.. ... ...... ..... ............ Date Issued........ ammsrABLz MASS. CFO MA'S a1639. OCT , -Building Inspectors Initials......�-00..................... Map/Parcel............ ................................ OF8ARAISI�BLE 1 TOWN OF BA STABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION L7PROPERTY INFORMATION Address of Project: - S73 Maim SI-- S44 NUMBER STREET VILLAGE Owner's Name: Phone Number Email Address: Cell Phone Number 7 Project cost Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: le cha 'Date: TYPE OF WORK Siding ❑ Windows (no header change) Insulation/Weatherization L'-Y'Doors (no header change)#__,2 Commercial Doors require an inspector's review Ell Roof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name ZA-el-n kfej Home Improvement Contractors Registration(if applicable)#_ 17 3 L q (attach copy) Construction Supervisor's License# Oq S_707 (attach copy) I Email of Contractor QSLiee� 6tyW; (. C b(n Phone number 'Vol- _1 2 L- I goo ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR tF THE suemcr PROPERTY is 11V A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *For Tents Only Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. XW®®D/COAL/PELLET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with.780 CAM the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICANT9S SIGNATURE Signature Date /0 —T—/9 All permit applications are subject to a building official's approval prior to issuance. I r 1 Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal B Andersen of Southern New England _ Y gl Dianne Walsh&Helen Wiinikainen ���� Legal Name:Southern New England Windows,LLC 573 Main St. �j�i RI #36079, MA#173245,CT#0634555, Lead Firm #1237 West Barnstable,MA 02668 w..... NE =.CEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)744-7513 Phone:401-349-1384 1 Fax:401-633-6602 1 sales®renewalsne.com C:7749942825 Buyer(s) Name: Dianne Walsh & Helen Wiinikainen Contract Date: 09/23/19 Buyer(s)Street Address: 573 Main St. , West Barnstable , MA 02668 Primary Telephone Number: (508)744-7513 Secondary Telephone Number: 7749942825 Primary Email: midi2000@comcast.net Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement , Document, the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $9,484 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $3,161 Balance Due: $6,323 Estimated Start: Estimated Completion: Amount Financed: $6,323 8 to 10 weeks 8 to 10 weeks Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on Financing the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: Depo paid CC bal paid GSky tax Barnstable Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER:Do not sign this contract if blank You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 09/26/2019 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal B Andersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature Cory Scanlon Dianne Walsh Helen Wiinikainen Print Name of Sales Person Print Name Print Name UPDATED: 09/23/19 Page 2 / 12 r Onion of Consumer affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Ciantractor Registration Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS, LLC=''-..:. =10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD,RI 02917 Scn i r, zoroi-osn 7 Update Address and Return Card. �Te �cvninn�,ccett�l��G�m:-%�rc�G%CGG: Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation ilaz4.5_== 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW-ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON• !,Q 10 RESERVOIR ROAD J SMITHFIELD,RI 02917 Undersecretary tiv , without signature Commo*nweatth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constrgjr,ts`6n `upe.rvisor CS-095707 � __ :. ; ��p i res : 09/08/202.0 SRIAN ® DENNISON . i - 8 BLACKWELE DRIVE -, CHARLTON MA:01507 1 Commissioner CIL The Comtrtoatweaidt,-ofitifassacltuseas Department ofZn&stria1Aecidenis 1 C'ong mess Stree4 Suite 100 Boston,MA 02114 2017 wwwBYIas .govldra A arkers' Compensation Insurance Affidavit:Buiiders/Contractors/ElectriciansMiLmbers. TO BE FILED WITH ME PER-sLrrTING AUTHORITY. Anolicant Information Please Print Leaibiv Name(Business/Organization/Individual):-- s U(,�'f'�<'0 q�. 00 bt,} t-na Address: CiVState/Zip:S M t-7V1't7 e- I/?! OZQ I 7 Phone#: 4/0 l—Z?4-- ? 9-0 y Are you as employer!Check the appropriate box: Type Of project(required): 1. I am a employer with ;W+' mployees(full and/or part-time).* 2 am a solo proprietor or partnership and have no employees working for me in 7. C]New construction any capacity.(No workers'comp.insurance required] 8: Remadelin; 3. 1 am a homeowner do' all work m self 9. ❑Demolition � y (No workers'comp.insurance required.]� 4.M I am a homeowner and will be hiring contractors to conduct all work-on my Property. 1 will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.0Pltrmbing repairs or additions S•Q I am a;enerd contractor and I have hired the sub-conawtors listed on the attached sheet These sub-contractors have employees and have workers'comp.insraance.t 13. Rollo f repairs r/ CC]We are a corporation and its officers have mYemised their right of-emptioa per MGL c. I¢ er Q,4 0 lit,§1(4).and we have no employees.(No workers'comp.insurance requited.] Iirr a 14 c1-t e-V:i 'Arty applicant that checks box gl must aLsa M 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. rCeatractom that cheek this box must attached an additioml sheet showing the name of the sub-contracmrs and state whether or net those entities have employees. Ifthe sub-coauactUls have employees,they must provide their Mears.comp.policy number. I am an eftrpinyer that is providing workers'coirrpensation insurance for my employees Below is the policy mid job.cite informafiol Insurance Company Name: r l,G aA 1(�O_ �p - � W Policy#of Self-ins.Lic. 1k1C�4�l���'7� Inp?7 Expiration Date: Job Site Address:_ S 7 11.4 i n S-t . City/State/Zip: c✓.Ira sl 6 I.c t A Attach a copy of the workers'compensation policy declaration page(showing the policy number and expire on date). Failure to secure coverage as required under MGL c. 132,§25A is a criminal violation punishable by a fine up to S 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce under the p ' penalties of penury that the infarn adan provided above is byre and correct Si Date: -/ Phone#: Official use only. Do not write in ddis area to be completed by city or town offtctaL City or Towo: Permit/License b Issuing Authority(circle one): 1.Board of Health 2.Building Department J.Cityfr6wn Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone • r-CEP_A?� CERTIFICATE OF 'LIABILITY INSURANCE DAT=(11,MIDDIVYYY) `�1 1 12/28/2013 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 CoBiz Insurance, Inc. -CO NAME: 1401 Lawrence St., Ste. 1200 PHONENo. o E • 303-988-0446 A c No:303-988-0804 Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURERS AFFORDING COVERAGE NAIL N INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER a:Flremens Insurance Company of WA,D.C. 21784 Southem New England VVndows, LLC. dba Renewal by Andersen of Southern New England INSURER C:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER 0: Smithfield R) 02917 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:787175890 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 I DD SUER . POLICY EFF POLICY EXP L TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDYNEWY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3150728 1/1/2019 11112020 EACH OCCURRENCE 51.000.000 CLAIMS-MADE a OCCUR PREMISES Ea occurrence $300.000 MED EXP(Any one person) 3 1o.000 PERSONAL&ADV INJURY $I,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2.e00,000 O. X POLICY❑JET LOC PRODUCTS-COMPIOP AGG S 2.000.000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 I 1/1/2020 COMBINED SINGLE LIMIT(Ea $1 0 0 0 X ANY AUTO BODILY INJURY(Per persona ALL OWNED SCHEDULED BODILY INJURY Par accident) $ AUTOS AUTOS ( X HIRED AUTOS N NON-OWNED PROPERTY DAMAGE 3 AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR CPA31S8728 1/1/2019 1/1/2020 EACH OCCURRENCE 315,000,000 EXCESS LIAR CLAIMS-MACE AGGREGATE $t5,000,000 DEC) I X I RETENTION g B WORKERS COMPENSATION INCA315872924 V1/200 UV2020 X STA TE OR TH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000.080 OFFICER/MEMBER EXCLUDED? N❑N I A (Mandatory in NH) E.L.DISEASE.EA EMPLOYE $1,000,0o0 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 00Q000 C Pollution Liability 793007334coca. 1/112019 1/1/2020 Each Occurrence $2,000,000 Claims-Made Policy Deductible $25.000 Retroactive Date 06/20r1013 ' DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE N4� � ©1988-2014 ACORD CORPORATION. All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 11/13/17 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 NOS$P4NS RE: Insulation Permit 17-3408 �O� Dear Mr. Perry This affidavit is to certify that all work completed for 573 Main Street,W. Barnstable has been' inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Town of Barnstable w Building t ��� : Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept BARN6 Posted Until Final Inspection Has Been Made. °r ep39. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Permit -Final Inspection has made. , Permit No. B-17-3408 Applicant Name: William McCluskey Approvals Date Issued: 10/12/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 04/12/2018 Foundation: Location: 573 MAIN ST./RTE 6A(W.BARN.),WEST BARNSTABLE Map/Lot: 133-015 Zoning District: RF Sheathing: Owner on Record: WALSH,DIANNE E WIINIKAINEN& Contractor Name:�WILLIAM J MCCLUSKEY framing: 1 Address: 573 MAIN STREET Contractor License: CSSL-102776 2 WEST BARNSTABLE,MA 02668 T Est. Project Cost: $5,000.00 Chimney: Description: Add 2" rigid insulation to the crawlspace and attic.Add R-37 Permit Fee: $85.00 cellulose to the attic.Air seal the attic plane and basement with Insulation: Fee Paid: $85.00 expanding foam.General weatherization. Date: ; 10/12/2017 Final: 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. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shah be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. - s---y"`�y 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: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT I w Town of Barnstable REC ` eA `& ' 200 Main Street, Hyannis MA 02601 508-862-4038 s63q. Application for Building Permit Application No: TB-17-3408 Date Recieved: 10/3/2017 Job Location: 573 MAIN ST./RTE 6A(W.BARN.),WEST BARNSTABLE Permit For: Building- Insulation -Residential Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-102776 Address: West Yarmouth, MA 02673 Applicant Phone: (508) 398-0398 (Home)Owner's Name: WALSH, DIANNE E WIINIKAINEN& Phone: (508)362-4995 BOYNTON, (Home)Owner's Address: 573 MAIN STREET, WEST BARNSTABLE, MA 02668 Work Description: Add 2" rigid insulation to the crawlspace and attic. Add R-37 cellulose to the attic. Air seal the attic plane and basement with expanding foam. General weatherization. i I;-- Total Value Of Work To Be Performed: $5,000.00 -a --3 77 v Structure Size: 0.00 0.00 t,.)0.00� Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: William McCluskey 10/3/2017 (508)398-0398 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $5,000.00 j Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 10/3/2017 $35.00 XXXX-XXXX-XXXX- Credit Card 0299 Total Permit Fee Paid: $85.00 10i3/2017 $50.00 XXXX-)DM-XXXX- Credit Card 0299 7 3 , THIS''IS NOT A'PERMIT ;.r s,t �1►�, Town of Barnstable . *Permit# 6- - V/l) Building Department Services Expires 6moVejrom su.ed.T s x Brian Florence,CBOMAM 4,PRFS� 1639. ,��' Building Commissioner '0h�o t ur 200 Main Street,Hyannis,MA 02601 OCT0 www.town.barnstable.ma.us 3 2017 Office: 508-862-4038 TOWN O 8AHNb4A.d _790-6230 MI EXPRESS PERT APPLICATION - RESIDENT::IAL ONLY 7. 460Not Valid without Red X-Press Imprint Map/parcel Number Property Address 453 C M u RC H S r yi 6AA&)ST74,BC6 E Residential Value of Work$ 7 0 0-0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address R I C H R 2 b 7• R I C H M O,Q D ¢53 cHu2GH ST w, MA 02-66 s Contractor's Name Telephone Number $0 8 36 Z-5 6 8 5 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance + Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 12U me512 yL ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ 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 sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:IWPFILESTORMS\building permit forms\EXPRESS.doc 08/16/17 Q ?Tie Comwomvea/th of-4&Fsadrusetts . Department of gndus&hd Accidmz& QJTwe ofInvestigaliam 600 Washuigton Street BasWn,AJA 02111 mmumassgovIdia Workers' Compensaf an Insurance Affidavit;Bmlders/ContractarsMecfricLmL%M% tubers APPUcant Infarmation Please Print E bIY Names Ad&ess: 4 5 3 e N v 2c-H 57- CitylStat eta: Iy 13A��N ST�tB LE o L 6 4 B Phone ik S y t3 . 3 6 Z- 5 6 8 5 Are you an employer?Check the appropriate born: ' Type of project(required}_ L❑ I am a employer-with 4. ❑ I am a general contractor and I 6. ❑New eonshucfaon employees(full and/or part-time).* 'have lired the sub-coatmcton 2.❑ I am a sale proprietor orpartuer- listed on the attached sheet 1- [].Remodeling ship and have no-employees These sub-cau ractars have $., Demolition wading far me in any capacity. employees and have waters' 9 ❑Building addition Q g'imp ;eestuance comp.mcnra=r Z required-] 5. ❑ We are a corporation and its 10❑Electrical repairs or additions 3. I am a homeowner doing all wcnk officers have exEmised their 1 L❑Plumbing repairs or additions. myself o worrkers' �bL of ezflempfiou per MGL 17 Roof repairs ; nce required_]T c.152,§1(4k and we Have no employees.[No wodmrs' 13.❑other comp.insurance regui ] 'Any a pyffntcbedsbozff1nmsialso!roarA&e:secfambdowshuvmigdmkwm2eWcompensati peEcyinfarms6im I E€omeoW—Whu subamt dtis a UW9M&CTtM9 they aredoing allwak Sag&enhire o decAII1tT1IIt imS—st MTM=aaaW affidaeirt mdicabng d+rh tCoatmctmSbat,barbtldsbunmastattached=additimsal shad dbmrmgthem—ofthesn6-cowwwAo and statewhethnornotftseeufitieshwe emphuees. 1fthesub-c==ct=hate employees,theyn=pzavidedLeir warms'gyp•policy aim I am art ernplayer tliat is prQuiding workers'compemsrrtimi insurance for my,emploj,em Relow is the policy and job site information. Insurance Company Name: Policy or Self-ins_Iic_ Expiration Date: Job site Address- 453 eHURr-H 57 w 6A 4J5TA&-6city/Stafel7.tp: MA 0264(.8 Attach a copy ofthe workers'compensationpolicydeclaration page(showing the policy,number and expiration date). Failure to serum coverage as required under Section 25A of MGL a 152 can lead to the imposition of criminal pensitH s of a fine up to$1,50a 00 and/or one-year imprisonment as well as civil penalties in ihe form of a STOP WORK ORDER-and a Fine of up to$250-00 a day against the violator. Be added that a copy of this statement may.be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification I do hereby cewfj,undff the pains andM,ahU415pa ry that the infarwratian prmied abacus is hue and correct Sionature: e-1 Date: 10 3 k 7 Phone 0 O,f dal use only. Da not wr9e air this area,to be completed by taty artown airciat City or Town: PerruibUcense 0 Issuing Authority(circle one): I.Board of Health 2.BurTdmg Department 3.C tylFawn Clerk 4.Electrical hispector S.Plumbing I inspector 6.Other Contact Person: Phone it: Information and Instructions Massah G Bseft e ersheral Laws chapter I52'rmquirm an employ to provide workers'compensation for their en�Icryees. c . Pmsaantto this sf9t3te,an EZrq7Iayse is dewed as.-_.every p=63:L in the service of another under any coact of him- i express or i uplied,oral or writtm"' An.enrplvyM-is defined as-an individual,partnership,associetiom,corporation or other legal entity,or any two or more of the fAregoing augagedinajointmizzImisq,and including the legal 1-1-esentafives of a deceased employer,ur the receiver or trustee of an individual,partnership, association or other Iegal entity,employing employees. However the owner of a dwmIlmg house having not more than tbrw apartments and who resides therein,or the occupant ofthe - dweIIing house of another who ennploys persons to do maintenance,constract+on or repay wmic on such dweIling house or on the grounds or building agpurfenm-dthereto shallnotbecause ofsach employmeutbe deemedto be as 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 notproduced acceptable evidence of compliance With.fihs hisurance.coverage require&" Additionally,MCH-chapter 152,§25CC7)states-Neither the conTrionwealth nor any ofits political subdivisions shall enter into any contract for the performance ofpubho work until acceptable evidence of compliancewith the insormc.6.. requn emeafs of dais chapter have lieu presented to tine c0131120tirIg authoity." Applicants PIease,fill oil the.worlsars'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), ad&mss(es)and Phone nnmber(s)along with then'ceitEcate(s)of fi=n nce. Limited Liability Compames(LLC)or Limited Liability Partnerships(LIP)with no employees other than the members or partners,are not r6quired to carry workers' compensation insurazm If an LLC or LLP does have employees,a policy is required. Be advised that this affxdayk maybe submitted to the Department of Industrial Accidents for confirmation of insnzance coverage: Also he sure to sign and date the affidavit. The affidavit should be-retnmed to the city or town that the application fur the permit or license is being regaested,not the Department of. BadastriaT Accidents. Shouldyou have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-ftmmed companies should enter their self fi sarance license number on the appropriate line City or Town Officials Please be sure that the affidavit is complete and pried legibly. The Department has provided a space at the bottom of the affidavit for you to fM out in the event the Office of Investi�lions has to cort ct You regarding the applicant Please be sure to fill in the paamL/licrose mnnber which will be used as a ref=mce n unben In addition,an applicant that must submit multiple per ntUcense appliteiions in.any grvea year,need only submit one affidavit mdicatng current policy information(if necessary)and under"Job Site Address"the applicant should write-all locations in (City or txnwn)"A copy of the•affidavit that has been.officially stamped or masked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fatm *perm p or licenses_ A new affidavit must be fMe d out each year.Where a home owner or citizen is obtaining a license or permit not related to any bvsincss or commercial ventme (ie. a dog license or permit to bum leaves etc.)said person is NOT rmp*ed to complete this affidavit: The Office of Investigafions would I&D to thank you in advance for your cooperation and should you have any gczes(ians, please do not hesitate to give TS a call. The Departments address,telephone anti fax number - tj[of MassachusaM , Departmmt cif hi�i��c�ir r�}Accidents toe ofestg`ktioa �Q4 WaaftatQn Stream R MA 0�1ZF•'. Tc1.4 617' -4900 oxt 4-06 or 1477 MA&S� Fax 617'27'749 Kevise 424-t)7g� I . �"E Town of Barnstable Building Department Services ` Brian Florence,CBO ►`� Building Commissioner 200 Main Steet,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section ' If Using A Builder as Owner of the subject property hereby authorize to act on my behalf; in all matters relative to work authorized by this building permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant t Print Name Print Name Date Q:FORMS:OWNMERMISSIONPWIS Rev:08/16/17 . Town of Barnstable Building Department Services dF Brian Florence,CBO ' Building Commissioner , 200 Main Street, Hyannis,MA 02601 BAMOMEM nsAM www.town.barnstable-ma.us M� Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EJZEIY MON / Please Print DATE. )o/3! 1-7 JOB LOCATION: 433 c N u ACC 5 T i y BA R-tiJ 5 TA B L E number street village "HOMEOWNER^: R I C HA�e i� R I CHMo&yp 508 36 Z- 56 B S name home phone# work phone# CURRENT MAILWG ADDRESS: 4 S 3 CGLI V jZC S 1 i.c.) nit A- oZ 6 6 8 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dweWM 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 pro c sand that he/she will comply with said procedures and requirements. Tel Z ,P Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMMON The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFII.ES\FORMS\building pemut•fnmu\EXPRESS.doc 08/16/17 Assessor's map and lot number .................... *THE TO Sewage Permit number ....�1................................... de i '` o� I EAWSTADLE, i House number .................. ..2 .. ........"...... ro Mb 9 m� ... ................:........ y TOWN OF � :BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......... tl .1 � � ......... ' .! e-....a� ... .^..` ............. TYPE OF CONSTRUCTION ......�e ............................................................................................................... u �. ..................................aq TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for la permit according to the following information: Location .......�73........mv4,in.. .1: ..................... ProposedUse ...... .......ti...` 4 ......... ...i(j� M........................................................... ZoningDistrict ....................�..................................................Fire District .............................................................................. Name of Owner b.11.oae.. mad. ...�N��n� t►.11. .Address �Z3 C n S .,....W. .............................. .... .... .... Name of Builder ............Address ..... Name of Architect cti� . c,11 ,�^-............Address ..2..9 f.A.A Number of Rooms .. ... .......� ................................Foundation ... .......`M.qx :................................................. Exterior L�t�JC $�; �e Roofing � A ....'... 4.................... .....n.4. :0.......................`.............. ............ Floors Ctd`" <Z ..U........5\. f ..;�. ,, !!;kJ'...........Interior ...C4;f pgk.....SNTOzgt..!`.�'��:`5..................................... } � "�' C�e� � ccVt�l ®fieeL Heating .................. ................... ............. ..... ....................Plumbing ........................... ............................................... Fireplace ....... .p.§$� � ....�, J ,S .Jz- `ii.`...Approximate. Cost .........j...... ,��`�........................................ f ql� Definitive Plan Approved by Planning Board ___A�Aa_______________-9 L-I__. Area ........f ..................... Diagram of Lot and Building with Dimensions Fee ..... ... .... ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH de-\ a f' dro } OCCUPANCY PERMITS REQUIRED FOR NEW D 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 ...0.0 .. ..... rJNEN, ~~A~E . . ' N6 .������— Permit for . -----. . / . ' . ^ ----_-----^--~~�.,~^-------.. ` - Location ...ST1»8ain.3tre.et......... .................. - ^ . ~ " ' ~ . ` - . . . � . . ` . ~ ^ - ^ -Permit" Granted ...—P^—`,�------'., -' . ' - }oha of In spectio ----.--'lg ~ ' ' �)o/e Completed ----- --'lV ` � ' . � . . . . ' . - . - ^ - ' U . � - ` , ^ Assessor's map and lot number ............... 1...... THE Sewage Permit number .... /............................................... 3 133 Z STODLE, i f House number .................. .:7. ................:....................... 039. 39 a. TOWN.. 'OF BARNSTABLE' BUILDING INSPECTOR ' APPLICATION FOR PERMIT TO .....��-�.JA;I.QC,�, �. Jr�......... ......................................... � ............ - v TYPE OF CONSTRUCTION ..... w. .. ................ M1` .................................. ..................................... .........1.. .................................19.1?. TO THE INSPECTOR OF BUILDINGS:- The undersigned hereby applies for a permit according to the. following information: Location .......573.........M.c .i.r 5.N..........�,�. \.,A) Q...................................................................................... Proposed Use Zoning District .....................,/..!.........................................Fire District .................................................. ............................ Name of Owner 1..I.q!�I�.Seam".�. .0 .,.e.K1N y.eT? :Address ..... 3.... .`.l1..... ..! .. r Name of Builder ....�. > .. .r�S.�^............Address .....2'D5 Name of Architect .....\,��.f��! 1�.c...,n..Cc,.0.s o.f ...........Address ............PN:7 Q.RA,,r,!s�...... Numberof Rooms ..........�....... .................................Foundation ... ...........�oc ................................................. Exterior ....u�t�J� ,5�;�s��e,1............:... ....: �''�. \ .4\....... ....... ,��. ....................... .. U ;..Roofing 5 1n Floors Cgri>e� 5� fNCNP. �l�ar..........lnterior ... 41. e ......�, mse xs--Jc:� .................................... ..................................................... . ...... �". {- rat......L... ...........ef......Plumbing ..........:n................ Heating .......... ....... ... ...........�....... ................................... Fireplace ....... h�Q ....V✓o� S ....e, ti".? `��.... Approximate. Cost ............. . ..O�J..................................... x, .. Definitive Plan Approved by Planning Board _______ _ _—-----------19 P__ __ . Area ........... ..� .................... Diagram of Lot and Building with Dimensions Feer. . SUBJECT TO APPROVAL OF BOARD, OF HEALTH ? q i � OCCUPANCY PERMITS REQUIRED FOR NEW DWE LI GS I hereby agree to conform to all the Rules and Regulations of the.Town of Barnstable'regarding the dbove construction. Name .............!..!".L<..�... .. ? l . Construction Supervisor's License ... .. .4 M..... NEN, MANE S. A=133-15� No .26.4.08..... Permit' for ....... . .... ..................... Single Fair4y..�;L ................ ................. ..................... Location ....5.7.3..M.ain..Street... . . .. .. ...... ............. West Barnstable ............................................................................... Owner .......Diane S. Wiinikainen .......................................................... Type of Construction ...T);AM............................. .................................... ....................................... Plot ............................ Lot ................................. Permit Granted .... ....10 j, .......19 84 ................... Date of,Inspection ....................................19 Date Completed ....................................19 4 THE r Town of Barnstable *Permit# 6) o �•� °k1 Expires 6 monthsfrom issue date Regulatory Services Fee _ snatvsrnar.E. s ,0� Thomas F. Geiler,Director ATEo�,t a Building Division . Q Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma..us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION = RESIDENTIAL ONLY �--7 0( - Not Valid without Red X-Press Imprint Map/parcel Number Property Address 7 h S W- �5 wr R S A- Q o L c ©Residential Value of Work 16 3 O (3 Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address CL h W G US b Contractor's Name ►'►-�ol r--1-lYt-,P-4q c S C hS Telephone Number S 0� _C1 & Home Improvement Contractor License#(if applicable) 0 S® ��l Construction Supervisor's License#(if applicable) l U `7-] C/ d -PRESS PERMIT ❑Workman's Compensation Insurance JUN 2 3 2010 Check one: TOWN OF BARNSTABLE [j�-I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) [�]c Re-roof(stripping old shingles) All construction debris will be taken to bL%1v\pS `r 1 03 \6gt"LowS LhC( ?,(J Sao C.u 5 s c -r- 1 N q ❑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. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 090809 f at The Commonwealth ofMassachitsetts Department of Industrial Accidents Office of Investigations 600 Waskington Street Boston, MA 02111 yy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Address: [o `L W I V% 1ne.c.K (0 'QocQS S e-r Vn 0i City/State/ZipQmcQ S S e., •m c, C yy;rC1 Phone #: 5ak TG 1- 'Z.cf 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-ti have hired the sub-contractors.. me). 2.®"I am a sole proprietor.or partner- listed on the attached sheet. T ❑ 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.# 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 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' 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. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-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 Office of Investigations of the DIA for insurance coverage verification. 1 do herebycertify cinder the painsan�d-peenalties ofperjury that the information provided 1above is ftrue and correct. Signature i\����` Date 6 `�-� L Phone#: r 0 '9- 5-�-�`3 �� 3-C1 Official use only. Do not write in this area, to be completed by city.or town offcciaL I City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and ffistructions rk n for their Massachusetts General Laws chapter 152 requires all employers loprtherservioce of anoth P underoany contract plhi e, Pursuant to this statute, an employee is defined as "...every person 1 express or implied, oral or written:" her An employer is defined as "an individual,partnerslYip, as cithte n al rporesion 0 entalives of legal deceased employer, °oheore of the foregoing engaged in a joint enterprise, and including g receiver or trustee of an individual, partnershi , athoerapartmentt1O and who resides des he or other legal e'nhity, rein, or he occupaying employees. nt of then the owner of a dwelling house having not more than air WOT dwelling house of another who employs persons toy Il not because of succonsce, h temploymection or nt be deemoed to bedaneempl yerse or on the grounds or building appurtenant they L MGL chapter 152, §25C(6) also states that"every state Or local licensing agency shall )vithliold 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,MOL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public-work until acceptable evidence of compliance with the inst.rrance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out.the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), addresses) and phone number(s)along with their cerlificate(s) of insurance, Limited Liability Companies (LLC)or Limited Liebsat Partnerships iona tnersh PS(e. if an wit or h no ern does have her than the members or partners, are not required to carry woployees Ot rkers comp of employees,•a policy is required. Be advised eha te. i Alsoidavit be surge to signay be bantdted date the the affidavit ntThe affidaviilshould Accidents for confirmation of insurance coverage. be returned to the city or town that the application for the permit or license is being requested,not the Department of u are quired to n a workers' Industrial Accidents. Should you have any questions the regarding mber listed belop� YSelf-insured compares should enter their compensation,policy,please call the Department a self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Dnpaos has contact provided YQUT a ding the space at he bocttom of the affidavit for you to fill out in he event the Office of lnvest g Please be sure to fill in the.permiUlicense number alion nt s in anch y be used need only submibone affidavit indicater. In addition, an pngrcurrrent that must submit multiple permit./license apph Y g (city or policy information (if necessary)and under"Job Site Address" the applicant should write"all locations in 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. Anew affidavit must m 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,a a dog license e 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 www.inass.gov/dia OF SHE Tp Town of Barnstable regulatory Services gARNSPABLE Thomas F. Geiler, Director 9 RAM Eo�. INS Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 -wwtv.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230. Property Owner Must Complete and Sign This Section If Usin .wilder pa��/Jjl LI)• )� as Owner of the subject property to act on m behalf, hereby authorize_/ �-Y� �� / y in all matters relative to work authorized by this building permit application for: ' J (Address Job) Signature of Owner Date Print Name If Pro:pert_Owner is applying for permit please complete the Homeowners License Exemption Form on the.reverse side. , 4 Town of Barnstable P OF THE Tp�� o Regulatory Services " Thomas F. Geiler,Director ' BAartsTABLX. MASS. Building vision . v� 1639. �e� Bldi g Di PIfD 1 v'y A Tom Perry,Building Commissioner. 200 Main Street, Hyannis,MA 02601 ynvw.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPT]ON Please Print DATE: JOB LOCATION: number street village „HOMEOWNER": — - name home phone 11 work phone 11 CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0.Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions. of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as'supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often resuhs in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\VvrPFILES\FOR.MS\homccxcmpL.DOC lvl issachusctts Board of BuildinDtl)`J11mcnt ot,Public Constructio Regulations; Sat, License- n Supervisor tnd Standards ns:- CS 50341 License 'Restricted to: 00 ROSERT MART/ PO BOX 242 NEAU POCASSET „ MA 02,559 4 Expiration: 7/14/2010 f Tr#: 404 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR J 'License or registration valid for individul use only before the expiration date. If found return to: Registration: 107740 Expiration:=' Board of Building Regulations and Standards 2010 Tr# 272387 One Ashburton Place Rm 1301 _ YPe__Pa�nership Boston,Ma.02108 MARTINE AND SO AU — Paul Martineau — c 1036• .�--- arlows LandingzRd;. �; Pocasset, MA 02559 AdministratorIC� `''� _ Not val-�id without signature - I