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Home My WebLink About1525 MAIN ST./RTE 6A(W.BARN.) o l!U UPC 12543 No.53LOR ' HASiT4UGS.. MN t t Application number.. ............................................ Date Issued............... .�/./. .�. .. - AM Building Inspectors Initials............ .. MA'S ��nn� ff�� pp ►!�!� O bAR �FABL� Map/Parcel....... ......�..�..................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: l So? S V44L.. NUMBER STREET VILLAGE Owner's Name: Gut-dace & Phone Number re y-,n 2- .Email Address: p S O Cell Phone Number N 1-2 Proj ect cost $ Rom t, ;�� 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: Lp . Date: V(01 1 TYPE OF WORK EB Siding 0 Windows (no header change) # ED Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review E-1 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name TA*,f,% P xw%,aA ko Home Improvement Contractors Registration(if applicable)# 1 613 G 2k (attach copy) Construction Supervisor's License /o f?S5-3 (attach copy) Email of Contractor Co— Phone number 77 y- 023�— 7 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *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 *WOOD/COAL/PELLET STOVES 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 V. Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR 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 APPLICANT'S SIGNATURE 4 Signature _ Date av All permit applications are subject to a building official's approval prior to issuance. 0 v " a ent of RubticSafetY t Massachusetts'-Dep rtm t .iBoard'of Building Regulations and 5fanda� . CnnstructionSupervisor License:CS-108553 < i i. JAl•1ESPICARIEDLO` 10 ROLLING RIDGE _ . Sandwich MA_02363 av 0 Expirat�Gg v_ ' 0112512.. . t;omrtNissioner i Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement=Contractor Registration Type: Individual JAMES J.PICARIELLO' "j�_ Registration: 182362 Expiration: 06/15/2019 DB/A PICARIELLO CONSTRUCTION �' a 10 ROLLING RIDGE LANE SANDWICH,MA 02563 \y `Sr.� 'cc•- Jc� -- Update Address and return card. Mark reason for change. SCA 1 Q 20M-05/11 li n 672e�po-nrmranwer..�.C/c o�C�lcmaar�rmelYd . Office of Consumer Affairs 8 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only yam` TYPE:Individual before the expiration date. If,found return to: ,",_Registration Expiration Office of Consumer Affairs and Business Regulation _ __51.82362,_ 06/15/2019 10 Park Plaza-Suite 5170 JAMES J.PICARIEL60e�i� !:�: Boston,MA 02116 D/B/A PICA RIELLdsi O TRUCTION =fir._`-- JAMES J.PICARIELLO :_-::',,.`,' 10 ROLLING RIDGE'IANE � V _ SANDWICH,MA 02563 Undersecretary; NOt Valid without signature i'r � { r The Commonwealth of Massachusetts Department of Industrial 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): sMhGc. f�f_&os--c.Mc) ('O`c)& ?:r,4c%-eA10 Address: to (ZoML,,, R+rJ�. City/State/Zip: Phone#: 77 R3,3 - I7q 11 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 �,/ployees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.[2 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers 9. ❑Building addition [No workers'comp.insurance comp.insurance.t 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 employees. [No workers' 13.F9 Other rjJt'!n, 1 &4-4&J9 r 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. $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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name:�;SSOCIa�3 a,rS �•ra•.� � gaw► Policy#or Self-ins.Lic.#:IAk_'C.-,Sao^ Sa 14 73,- c?o►g (A Expiration Date: Job Site Address: "n ...1— (eft City/State/Zip:k j S &lQ..a„s, a L%A,8.1(c(y 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 t ains and penalties of perjury that the information provided above is true and correct Signature: Date: 71691 doh a Phone# 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 Contact Person: Phone#: 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,MGL 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 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 insurance. If an LLC or LLP 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 burn 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 Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia °*THE, Town of Barnstable *Permit# ti Expires 6 mon s jr i sue d r °^ Regulatory Services Fee 1�$ Thomas F. Geiler,Director • i°lEn ray Building Division JUL 0 9 2012 Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601. www.town.barnstable.ma.us TOWN O RJR Office: 508-862-4038 faic"5`08r f4E EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid wit, ut Red X-Press Imprint / Map/parcel Number l 9 7 PC v Property Address /,f2&r > Residential Value of Work l Minimum fee of$35.00 for work under$6000.00 Owner's Name & Ad ess 0 Contractor's Name Telephone Number ��= '�lQ Home Improvement Contractor License#(if app cable) Z 4 Construction Supervisor's License#(if applicable) �� ❑Workman's Compensation Insurance6 Check one: I I",V/40 ❑ l am a sole proprietor I am the Homeowner have Worker's Compensation Insurance Insurance Company Name o Work man's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) . CV—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. SIGINATURE. - - - - - - -- - - - - - - QAWPFILES\F0RMS1building permit formAEXPRESS.doc Revised 070110 NThe Commonwealth of Massachusetts f I Department of Industrial Accidents Office of Investigations IF 600 Washington Street Boston, MA 02111 www.mass.gov/dia y Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organiz ion/Individual): ' Address: lu" � ' City/State/Zip: 4Phone #: �� t Are you an employer?Check the appropriate box: Type of project(required): I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4), and we have no 12�pof repairs insurance required.] t 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. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. L/J Insurance Company Name: '��✓/-'' Policy#or Self-ins. Lic. #: — QQ Expiration Date: Job Site Address: ,ll� �� 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 certi under the pains a penalties of perjury that the information provided above is true and correct. Si ature. Date: Phone#: frog 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 Contact Person: Phone#: 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, MGL 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 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-contractors)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 insurance. If an LLC or LLP 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 burn 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 5-26-05 www.mass.gov/dia Jul. 9. 2012 11 : 01AM No, 2184 P. 1/1 coRo® CERTIFICATE OF LIABILITY INSURANCE 7/9/2012 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 pollcy(les) 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 endorsements). PRODUCER CONTACTTimothyLovelette NAME: Marshall K Lovelette Insurance Agency Inc. PFA A"Ic°No Ext: (508)775-4559 AIC No): (508)775-4577 396 Main Street E-MALADDRE timothy@loveletteins.com P.O. BOX 836 INSURER(S)AFFORDING COVERAGE NAIL s West Yarmouth MA 02673 INSURERA AEIC 0006 INSURED INSURER B: Thomas Hilchey INSURER C: 82 Old Chatham Road INSURER D: INSURER E: Harwich MA 02645 INSURER F: COVERAGES CERTIFICATE NUMBER:CL127901037 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 LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMA V SINGL LIMIT - t Ea accident $ ANY AUTO BODILY_c NJURY(Per person) $ ALL OWNED SCHEDULED BODILY, (Per accident) $` AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ •7 UMBRELLA LIAB OCCUR EACH 0`CCURRENCE.-,. $E' EXCESS LIAB CLAIMS-MADE AGGREGATE $•'} DED RETENTION$ 77 A WORKERS COMPENSATION WC STATU- OTH- 7 AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PRO PRIETORIPARTNER/EXECUTIVE[flY/N E.L.EACH ACCIDENT�r $ 100 000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) C5009790012012 /13/2012 /13/2013 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes.describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION (508)7 90-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 367 South Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 John McShera/JOHN ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and loqo are reqistered marks of ACORD ° t • i T rati Town of Barnstable Regulatory Services HARNSTASC E v MAS& g Thomas F. Geiler;Director 9- Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject.property hereby authorize y�� to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job)_ Sig tore of Owner Date Print Name If Property Owner is applying for permit please complete. the Homeowners License Exemption Form on 'the reverse side. of r Town of Barnstable YK*E Regulatory Services s-rABLF- Thomas F. Geiler,Director BARN HAIM i639. ,�� Building Division . �bPr fD►�{° . Tom Perry, Building Commissioner 200 Main.Street, Hyannis, MA.02601 www.town.b arnstable.ma.us Offi e,: .508-862-4039 . Fax: 508-790-6230 1107%�OWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: - number strcct village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state rip code The cur'ent 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. DEFINTI ION OF BOMEOWIVER 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.constrycts more than one home in a two-year period shall not be considered a bomeo*mcr. 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. SignatbTe of Homeowner Approval of Building Official . Note: Three-family dwellings containing35,000 cubic feet or larger will be required to comply with the State Building Code Section 127:0.Construction Control.. 140MEOWNER'S EXEMPTION .The Code states that: "Any.homcowner performing work for which a building permit is required shall be exempt from the provisions of this section.(Seetion 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." lvlany homeowners.who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Rcgblations 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 icspoanbilitics,many communities require,as part of the permit application, that the homeowner certify that he/she undcrstaads the rrsponsibilitics 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 formkertiiiication for use in your cornrnunity. r .. Massachusetts-Department of➢ublic Safety Board of Buildin, Regulatiouis and Standards License: CS 34718 THOMAS A HILCHEY : 82 OLD CHATHAM RD HARWICH,MA 02645 !y �� Expiration: SfIQ 13 Gfl�e��onvriuNaineaz/�`7_` License or registration valid for indMdul use only Oda of Consumer Affairs&Bosines5 Rcgotation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR-.Type. Office of Consumer Affairs and Business Regntation Registration:(-'Il0649 10 Park.Plaza-Suite 5170 j Expiration: ledanduat Briton,MA 02116 - ; , THOMAs a HILC$-j', THOMAS HILCHt "Mm bj 82 Old Chatham Rd HARUNICH,MA OZti45'��y Undersecretarq Not valid without signature