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Home My WebLink About2439 MEETINGHOUSE WAY/RTE 149 UPC 12543 No. 53L®R Mpara pn NPa Town of Barnstable aG �' v`�t�>•� b Permit# Expires 6 from,issue date Regulatory Services Fee * snarrSrAsr.F, MASS. $ Richard V.Scali,Interim Director Building Division Tom Perry,CBO,Building Commissioner 'Q 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ��- Not Valid without Red X-Press Imprint Map/parcel Number �j`,{� � � Property Address 3 7 /�? Ce f'r 1 �� CS ("' \0 - J� P rtY C_ F A y ❑Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 —� Owner's Name&Address /3 A /L,Y 6- �®(/�� a ZAA-1 ry Contractor's Name�,(�/0 �C'/�C(� �/ PQ /JA/Z.CL�14 Telephone Number 5 c1,/1;7- c%/7 9 Home Improvement Contractor License#(if applicable) Email:1,.J (,�JAT7A yC�1041/�Le9//0Z ,414 Construction Supervisor's License#(if applicable) T/S' 'O 'f X-PR ' __ NWorkman's Compensation Insurance Check one: NOV 2 2 2013 `❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name LEI CW-P i S'Uh✓/�ii�/G� /��3.6v� y Workman's Comp.Policy# r/1; j y 0/ I q 7 i—/3 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 C=� ��s�d YW ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 re fired SIGNATURE: � ', W Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 l . :. . . ... .... .... e Co; moynveaUh ofMassachusetts Deparhnent of I'aums& al Accidents Office rrf lnvestiga ony 660 WaThington Street Boston,MA 02111 wn minasmgo Idia WorIsers' Compensation Insurance Affidavit:Builders/Contractors/EAectricians/Plumbers Applicant Information Please Priaf Le?ibly Nam cat /a ant on/rnd;>ri�an: loll ,off Q I J�kC_ Addrm: City/StatE/Zip: JG:S f`t f n, DI! 'I) Phone Df Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ I am a general contractor and I 6- ❑New crostruct ion employees(full and/or part-time.).* have hired the sub-contractors 21 I am a sole proprietor orpartner listed on the attached sheet; 7_ ❑Remndeliag ship and h2rve no employees These sub-contractors have g_ ❑Demolition w for me in an capacity. employes and have workers' working Y � tY- - 9_ ❑Building addition [No workers'comp.insurance comp_msurancf required- 5. ❑ We are a corporation and its 10_.❑Electrical repairs or additions ] officers ha��e exercised their 1T_. Plumbin repairs or additions 3_❑ I am a homeowner doing all work ❑ g P tion er MGL mysei€[No workers'comp- �t of F F 12..M Roof repairs insurance required,]F c- 152, §1(4} and we have no employees.[No workers' 13_❑Other comp-insurance required-] *Any gTUo nt taut checks boat;rl must also iffl out the section below showing their wa lei,compeasaGog polity iofntmatioa �Homeawners Who submit this a$idzm is ffcating they are doing all Wm k and then bae outside cont owturs nit submit a near afdmit indicating saw tnctnrs chit check this box most attached as additional sheet shmciag the name of the ssuti moors and state Whether ornot those or dties hive employees_ If the sub-contxactuts hale employees,they must provide their workers'comp.policy number. I am an employer That is pratadnrg tt orkers'colt ponsvdion insurance for my employees: Belotr fs the pogcy andlob site innformatfom Insurance Company Name: Policy#or Self-ins-Lie.#: V 7 m q 01 (— q qot ^/y�J Expiration Date:d/ -0/ Job Site Address: 14 11 M 6 2[ //-!0- J d U.SC 41 A S' CifWState/Zip: Ug��,W Aj/ Ak 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 head to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-yearimprisonment,as well as civil penalties in She form of a STOP WORK ORDERand 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 veriffcation- I do hereby certify under thepmns andp aitfes ofpedw y that the inforrnadion provided b t above is true and correct. Sirmature: C/U Date: A""/ o_7 Q Phone#: 6-1a Y O,&W use only. Do not write in this area,to be completed by city or town off'ciaL City or Town- PermitUcense# fssmng Authardy(circle one): 1.Board of Health 2.Building Department 3.Cltyffown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other r .. r Information and Instructions Massachusetts General Laws chapter 152'requires all employers to provide workers'compensation for their employees. Pursuantto 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 repay 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 IocaI 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 nunber(s)along with their ceri_ficate(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 insurmce 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 Lndustrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials " Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of kvlestlgatxans 600 Washington Street Boston,IAA 02111 TeL A 617,727-4M W 406 or 1-$77 MASWE Revised 4-24-07 Fax#617-` 27- 49 wWW ma sxnvlciia i Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-076146 WOJCIECH J_P3WOWARci; kgoo 4 TANNER IUD r. WEBSTER MA 01115170, Commissioner Expiration 01/02/2014 0Mee Vf Lon�=MWA— Au'�ines�Tion� HOME IMPROVEMENT CONTRACTOR Registration: 149606. Type: Expiration: 26/2014. Private Corporatior 0NSTRUCTION=IN S WOJCIECH PIWOVUARGZYK 4 TANNER ROAD WEBSTER,MA 01570;. :f Undersecretary /� r l CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) TIFICATE IS ISSUED A3 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS IREPRESENTATIVE IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS),AUTHORIZED OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the pol)cy(les)must be endorsed. if SUBROGATION IS WAIVED,subJeetto the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endomeme s. CONTACT PRODUCER NAME: OXFORD INS AGCY PHONE FAX 300 MAIN ST (AIC,No,Ext): (AIC,No): E-MAIL OXFORD_.MA 01540 ADDRESS: 25DJF INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA i INSURED W P I CONSTRUCTION INC INSURER B: INSURER C: INSURER D: 4 TANNER ROAD INSURER E: WEBSTER.MA 01570 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS T ERTIF THE PUU_C_1ESOF 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L ItPOLICY NUMBER (MWIDDIYYYY) (MMWMYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE Is COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED S CLAIMS MADE MOCCUR. REMISES(Ea occurrence) I ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY 0PROJECT LOC RODUCTS-COMPIOP AGG S AUTOMOBILE LIABILITY COMBINED SINGLE $ LIMIT(Ea accident) ANY AUTO BODILY INJURY $ ALL OWNED AUTOS (Per Pef5On) SCHEDULE AUTOS BODILY INJURY $ HIRED AUTOS (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Peracdden0 EACH OCCURRENCE $ UMBRELLA LIAB OCCUR AGGREGATE I$ EXCESS LIAB CLAIMS-MADE I$ DEDUCTIBLE $ RETENTION $ ' WC STATUTORY OTHER A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YIN UB-9901L942-13 01/01/2013 01/01/2014 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE NIA E.L EACH ACCIDENT S 1,000,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S 1,000,000 (Mandatary in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT 13 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. 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. AUTHORIZED REPRESENT U� I _ gh ACORD 25(2010I05) The ACORD name and logo are registered marks of ACORD 1888-2010 ACORD CORPORATION. All rightssreserved. FORM OF CONTRACT THIS AGREEMENT,designated No. MH2439-Roof-2013 made this Twenty Third day of October in the year, Two Thousand and Thirteen,by and between W.P.I. Construction, Inc. hereinafter called the"Contractor"and the Barnstable Housing Authority, a public body,politic and corporate, organized and existing under the Housing Authority Law of the Commonwealth of Massachusetts,hereinafter called the"Authority". WHITNESSETH,that the Contractor and the Authority, for the consideration stated herein,agree as follows: Article 1. Statement of Work. The Contractor shall furnish all Labor,Materials, Equipment, Services and Insurance and Perform and Complete all work required by and in strict accordance with the Specifications for the Roof and Gutter Replacement at 2439 Meetinghouse Way in West Barnstable,MA, dated September 2013 and addenda Numbered None and the Drawings referred to therein,all as prepared by Richard Mahoney 216.Palisades Circle Stoughton,MA, said Specifications,Addenda and Drawings are incorporated herein by reference and are made apart hereof: Article 2. Time of Completion. The Contractor shall commence work under this Contract on the date specified in the Notice to Proceed and shall fully complete all work hereinunder within the time stated elsewhere in the HUD-5370 General Conditions. Article 3. Contract Price. The Authority shall pay the Contractor for the performance of the Contract, in current funds, subject to additions and deductions as provided in the Specifications,the sum of Fifteen Thousand Nine Hundred Dollars($15,900.00). Article 4. Contract Documents. The Contract shall consist of the following: A. HUD-5369 Instruction to Bidders. B. This Instrument. C. General Conditions(HUD-5370). D. Form of Non-Collusive Affidavit. E. Technical Specifications. F. Drawings. This instrument,together with other documents enumerated in Article 4,which said other documents are as fully a part of the Contract as if herein attached or herein repeated,form the Contract. In the event that any provision in any component part of this Contract conflict with any provision of any other component part,the provisions of the component part first enumerated in Article 4 shall govern, except as otherwise specifically stated. The various provisions in Addenda shall be construed in the order of preference of the component part of the Contract which each modifies. IN WHITNESS WHEREOF,the parties hereto have caused this instrument to be executed in four original counterparts as of the day and year first written above. W.P.I. Construction, Inc. (Contractor) Attest By: Title: Business Address 4 Tanner Road (Number and Street) Webster MA 01570 (City) (State) (Zip Code) Certifications certify that I am the of the Corporation named as Contractor herein, that C,QLv-� -PC cbt,.�oaY L Vvho signed this contract on behalf of the Contractor,w then rQs��1 — of said Corporation,that said Contract was duly signed for and on behalf of said Corporation by authority of its governing body, and is within the scope of its corporate powers. (Affix Corporate Seal) Barnstable Housing Authority 146 South St. Hyannis, MA 0260 ►,0 I J By: '4� Title: CASEY HARDELL Notary Pu lic COMMONWEALTH OF MASSACHU.. . MY commission Expires f�ctober 3,2019 J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��' Parcel �3$ (#� �,(, Health Division Date Issued 3Q 13 Conservation Division ` Application Fee Planning Dept. Permit Fee �J Date Definitive Plan Approved by Planning Board ok. Historic - OKH _ Preservation / Hyannis Project Street Address oJu 39 MF-F;,Nq k44u5 (A)aV Z RT 1 Village (A)F-STi 2AA0:5TPifiLP- Owner 116 A goa, A.vi" Address i V6 SourN � 9vi9.�N��./'!�� 9 Telephone 503 - 17/- 7 ask Permit Request E.- 105'.ALL POP-C K 1)a5T F.V iSTI r%)q"' 'REPAIR oPsE �x6•, -�T. DEC& _60X e wn .TOi,S% Square feet: 1st floor: existing L9jtGproposed 2nd floor: existing proposed T otal new 0 Zoning District$ 'O° Flood Plain Groundwater Overlay `-' `� _ Project Valuation ��• Construction Type mod VRArmE 'f 0 w ; Lot Size Grandfathered: ❑Yes N No If yes, attach upportih6 do mentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) o� P� )s,-> OFi:►c Y � Age of Existing Structure 1350-i G3 YRs Historic House: 0 Yes ❑ No On Old Kin( 's Highway: LPes W No Basement Type: ❑ Full 51 Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) CRAQc-52pere- Number of Baths: Full: existing el new Half: existing new Number of Bedrooms: 4 existing _new Total Room Count (not including baths): existing �new First Floor Room Count Heat Type and Fuel: ❑ Gas ® Oil ❑ Electric ❑ Other Central Air: ❑Yes 0 No Fireplaces: Existing 0 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 r (BUILDER OR HOMEOWNER) Name i LUPIM T FOGAR i Y Telephone Number _508- �I ��' OG `��(. 'Address q 6 Ve F_M£+EP_ COUT-T License# CS FA- 0 6Li GIL15 (OSTc 2 VI LLF (Y)A O o_1Z 55 Home Improvement Contractor# 150207 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING ( r F''R'OM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE � �.3 t ' FOR OFFICIAL USE ONLY r; APPLICATION# DATE ISSUED r K MAP/PARCEL NO.. i s ADDRESS VILLAGE OWNER 4 I t$ DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH I FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO.,- t k c as ' Dep=*ent oflndustrial Accidents _-Offzce-oflnvestigations-- —._. _...--- --.._......- - 600 WashhWtoh Street Bostm;'MA 02111 - www.mass govli is . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plwmb'ers Applicant Information PIease Print Legibly -Name(Business Tm1izatiMdn, ividU0): 7 FQ G f-191-V Address: A E R CIS' Ci /State/Zi : tc. (39A65 Phnnt, g- 8-06' F re you an employer? Check the appropriate box: Type of project(required); I am a employer with 4. [] I am a general contractor and Iemployees(full and/or part-tense),# eve hued tie sub-contractors 6 ❑New construction I sin a sole proprietor or partner- Listed on the attached sheet 7. ❑Remodeling shipand have no employees• These subcontractors have 8, ❑Demolition working for me in any capacity. employes and have workers' [No workers'comp.-insini,nCe comp.insurance.$ 9. []Building addition required.] 5. We area corporation and its 10.0 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 ins,r,once required-]t c. 152, §1(4),and we.have no employees. [No workers' 13.0 Other A) 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 art doing all work and then hire outside contractors must submit a new affidavit indicating such• tConb-dctnrs that cbeck.this box must am hed an additional shxt showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employe=,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 I do hereby certify u the pa Jand penalties of perjury tkat the information provided above is true and correct Si atom: Date: Q 13 Phone F f cgial use only. Do not write in this area,to be completed by city or town official ty or Town: Permit/L,icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3, City/Town Clerk 4.Electrical Inspector. 5.'Plambing Inspector 6. Other Qont#ct Person: Phone#: J . ' .• .. � .. � .. •�' . � \ / . . � � - . _ � � � .. i i � ". ... .� .. - - �. �. Reodator_y_S&-vices ----- -------- —.___ —.__. r MASS Thomas F. Geiler,Director . Building Division . Tom Perry,,Bail-ding Commissioner - 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us' . . Office: 508-862-403 8 Fax: 508-790-623 0 Property. Owner Must " Complete and Sign This Section If Using A Builder I, (/J-' 1,as Owner of the subject property hereby authorize !t//L L/A'1M ��sf�'.e 7�y to act on my,beha] in ail matters relative to work authorized by this building permit (Address of Job) ' 'kPorol fences:a-tid 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. 4W4 a1�1re of ex Signer e of A plicant dya _ :� . a . .-� Fo,:s�A ��oLt lath ..� : Print Name Print Name Date Q:FORMS:OWNERPERNMSIONP00IS 6/1012 SHE 1p�� Regulatory Services - - f —� " -- ---- Thomas F.Geiler,Director E R�RNCTARr.R t ,\ Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 wyyW.town:barnstable.ma.us . Offioe: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMF.O WATER": name home phone# work phone# 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 strictures. 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) for compliance with the State Building Code and other The undersigned"homeowner"assumes responsibility 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 1.27.0 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 cazmot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner.aciing 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 formlcertificaionfor use in your community. Q:forn•rs:homeexempt -_�_ -- :Office of Consumer Affairs&•Business Regulaht HOMEIMPROVEM�NTCONTRq License or registration valid for individul use ont Registration:{,15 CTOR. 1 t before the expiration date:: �807." Type: ? If found return to; Y Expiration �F3�201 Office of Consumer Affairs and Business Re "• Individual 10 Park Plaza_ WILLIAM J..F gulation a t OGARTYlI.r ==. `jj a Bosto Suite 5170 IY; .... n,MA 02116 a s WILLIAM FOG ARfiTr{Y,� 1l�_a46 /ERMEER 'CMAOSTERVILL E, , z 02655 �� - Uudersecretaty + of valid witho ut srgnature'f ublic Safety. ment of P Standards h usetts -Re9u ations and il�:#- .Massac d of auildin9 t 2 F an' Boar erisor AS uction Sul' -0642 Contitr`iceose•. CSFA_�.�'� 46II� ECG 0165, L VE�EE cJr, mmissioner