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HomeMy WebLinkAbout0361 PARKER ROAD / 7G o oxfOD NO. 152 1/3 ORA ESSELTE 10% P r t -. ... .�-.r•._ �___ _ _ .w_+v+—_raw h.�y� w_!' -ems^`. ,�.� •.'^ - ^r.., �.�. Town of Barnstable *Permit# _I — b ! a Building Department Services Expires BARNSTABLM : Brian Florence,CBO 1 `0�' Building Commissioner''%, ��FD MAt 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us �. Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESflkN' fAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Dq/Residential Value of Work$ .r,� (�V�f ®� Minimum fee of 5.00 for work under$6000.00 Owner's Name&Address �4 X �P Contractor's Name Telephone Number TJb ����b �`` 6 g Home Improvement Contractor License#(if applicable)_�T� Email: / ZZY Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ,�am the Homeowner 'U 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) J'Re-roof (stripping old shingles) All construction debris will be taken to 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 a Home Improvement Contractors License&Construction Supervisors License is r /.Z SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc aJM 08/16/17 /_ i ti The C'omWarr»eakh afMaR.Yadrrrsetts D'eiaawhlfeat of ludacsitid Accidents Office offmWm6gadam 600'WasIdngtm Sheet Ba-stairs,AA 02111 tuyov.masmgarvfdia Waximrs' Campensal an Insurance davit BuiIder-s/Cantractars/Electdcians/Phombers caII#Infclrrmafi�n Please Psmf 3a g onllrt deal W Name - Address. • b1 Cifgfsta, l Are you an employer?Ch-eckthe appropriate ban ' Type of project(requiredy- I.❑ I ant a employer with 4. ❑I am a general contractor.and I 6. ❑New crostroction employees(Ball andfor part-ime,* have hired the sub-coatmCtors 2.❑I am a sole proprietor orpartm!r- IisfEd onthe•attached sheet~ 'F_ ❑Remodeling sbip and have ao employees These sub-co�ractors base 9-,El Demolition woddng forme in any sty: employees mdhave wormers' 9. ❑Building arMifion INo Wpdo5& comp.insu=ce comp_in=anoe-I required j 5- ❑ We are a corpozafica and its M El Eleodcal repairs or additions 3 ama bomeotimaer doing alf v�orlC officers have exercised omit 1L0 Fhmd)kgrepairs or add�otns. myo 't'emF- u of esempfrou per&fGL �❑Roofrepairs ir+cr a_[ re nir ed 1 Y C.f52,§l(4k and we have no employees-[No woikem' 13.❑Other cone_ins=nce required_l 'Airy apg&mot fat chedcsbox ffl Est also ffi o the sectioabeLvar�nssiag�eaao3ces'ca®p®satiaapc g inf mmag� tffame�araerswhosubmittthissi�daviri tbewycedoiivazUvra&Reed&m iremtsidecn�osamst.su�mitanm2Md�iadialir each ICa seiurs tche�cthisbox must stiedMd=addict—A shed sbavriag the nmneofthes:dVcatrcdos sad sfgfewhellmor not tboseeutideshwe emp403' M 1fthesub caatrsdashzce Maployeasi flLe7 FMM&t1Uir=dM&comP.J3QUU number lam art empFvyer fJeni is prauirliry n�nrkers'coarperrsmiarr iasura ca far mS*emgvTvy�ees $eioav is fF�e parity artd jv5 sda frrfbrmattam Insurance Company Dame: Policy 4111orSelf-iU&. ic_-4 �pirafiauDate: Job Tate Address: A& CitylStafetp: AC#ach a.copy of the workers'cornpensationpaUcydedaration page(showing the policy number and expiration date). Failnre to secure coverage as regniredunder Section 25A of MCA a 1572 can lead to the imposidioa of csimiaal penalties of a fine up to$1,SQQOU sudfor on,-yearimprisormient,as w611 as civil peaalties,in the form of a STOP WORK ORDERand a ftne, of up to$2fO-OG a day agatmt f e,violater. Be advised that a copy of this s-tatement.may,be Rwwarded to the Office of 1mvestigations of the DI&for=S=PCff coverage mdfica i= , Ida Frereby cadifF P��s�F rY fliatfFte iitfareraiiau prtinirTcd abar�e is true ate correct SiMMAU - Bate: Phone iF O,ykicd use at y Da not at:rxte in tFds area,ter be camplretesd by city artai,va oJoIcifiL City or Town: PermiffI,icense;g Issuing Aufhorit3*(circle eat): L Board of Health Building Departmeat 3.fityl£own Clerk 4.Electrical Inspector S.Plumbing Infector 6.Other Contact Person: Phone 9: — -- 6 Information and Instructions ; Ma.,s etts Ge�c=al Laws rlaptrr ISz req=m all emplayeas'fo Fuvide ' fx-6ieir eaopIoyees- Pmsaaatto finis' ,an en pZV=is defined as`�:e�xy pe�scin m$ie service of anofcr ceder airy contxart ofhi, , exprcss or implied,'oral or 77itbzm." An nzpkye r is defined as"air mdividmLL partner,assoca�.on,Corp or other legal may,or any two or mare of The foregoing emgagCd m aJ�emeaPrise,and�b the legal FeZnese ves of a deceased employer,or 1he rrceivur or tvstse of an inuhvidnal,par[=hip,associafion or office Iegal entity,employing emPloy ' However the owner ofadwellinghaasebaomgnotmoretbantbree artmcntsaad�horrsides ,orfbeocrxofthe- dw Mug house of ano$ier who employs pecans to do ,=str u ❑n or repair won$om.such dwr- hie or on the grounds or brnl�appurrt=a� theretD sbZnntbecanse ofsurb.employmedbe detmedtn be an employer-" MGL abapfer 152,§ C(� a sty or local s"�agencY shall withhold•fie issuance ar 25 a]so sues that every reaew2i of a license or permit to operate a busskess or to contract buRdings in the comm anlwealth for any applicantw•Iro has not prodnced acceptable evidence of r-6mpHmce whir the ftG¢rance.coverage required.. Additionally,MCrL chapter 152,§25dM stairs fiTeither the canamgmweaML nor amy ofits political subETisims shaIL enter iota any coniiart for the prance ofpnblic won$miff acceptable evidence of campliancewh Ihe iosmanca._ reqErean off=ChaptEXhmmbe=pmseastedin the m fracting.aafhouty." Appiicant� . Please fill oiat faM�'compensation affidavit compyt4,by the boxes that apply in your sltnation and,if necassa:7,supply sub-co (s)name(s), ad&ess(es)andphone mmnber(s)alongwrthffi=cMtEE1cat (s)of ins->Zrance LimitedLiability Companies(LLC)or LnuitiedLiabflity-Partnesshrps(LI P)•w�no emplayees offim than the members or pazineas,are not Mquimd fo cauy wojdceYs'compeosatim insurance. If an LLC or LLP does have Ioyees,a policy is required. Be advised-that this aff dam maybe snbmitiz=d to th.Depadment of Indns :al emp AccideEds for conEmna]ion of fin=.�ce coverage. Also Be Yore to sign and darn the ai davif: The affdavit should bez etmmed to one city orTowntaintthe application for thepemait or license is beingrequesbA not the Department of l �t A_c:dd=,t_ Shouldyon have any gnestims regaoding the IaW or ifyou are regoaed to obtam a wor""s' compemsationpoficLpimsecaIItbmDepartmeofatthennmbealisied.below: Self-i`lred companies should'en�-rt$eir self-insa=ce license amber an the appropriaiE line. City or Town Oi$cials . �Iete and primed legibly. The Deparfncnthas provided a space at tine both= Please be sere that the a$idavif is of thin affidavit for you to fill out in the event the Office ofingest>a��irins has to co�actYou gibe '��� Pleas a be sure to f lI in the pen�it/license number which wM Be,used as a refix mce number. In addition,an applicant that must submit maniple peunitllicrose applbafl=in any gives yem,need only submit one affidavit mdicalmg c=en± policy information(if necessary)and under"lob S`Le A $e applicant should VM---all locations in (may or town)-"A copy of the.affidaviti3iathas been officially s'famped or maimed by the city Cr town may be provided to�e applicant as proof that a valid affidavit is on tale for fcdm 'pamiits or licenses. A nepY.affidav>tmust be fIled out each year.'i heze a home owner or d97- a is obtaining a Iiceose or pem k not arl.f,d,i o any business or comm=ial v&rtUM e or permit to bum Ieav=etc.)said person is NOT to Mete this affidavit Cie.a dog licens The:Office of Investigzdinns wouUbam to thank you in advance for your cooperaiian and should you have any qaest=s> please do nothesitatr to give us a caM The Departua enf s address,tElePhone and;'ax number The COMMMwealithE Of Massachn_Re� $osf�o-nsll�E�11k -Ta 4.' 617-' -4,QW rot 406 W 1477 MA M4M Fax#61'7-727 7M Kevised424-07 �'WE Town of Barnstable Building Department Services ` Brian Florence,CBO w`� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must ;r , Complete and Sign This Section. If Usin-a 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 Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:0&/16/17 Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 0260.1 www.town.barnstable.ma.us I �. Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Q��� �lw� Please Print DATE: (/ JOB LOCATION: number Village "HOMEOWNER": / `/� �- 2��J��+3 !/ ���' / ` v name e phone# work phone# . CURRENT MAILING ADDRESS: city/town starve 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 unde eowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proced re nts and that he/she will comply with said procedures and requirements. Si owner App of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the 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:\WPFM ES\FORMS\building permit fors\EXPRESS.doc 08/16/17 FTME Town of Barnstable *Permit#F tres 6 months from issue date Regulatory Services fee aaWsrasLe, Mass. Richard V.Scali,Director v�A'F1639. � Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 AUG 12 2016 www.town.bamstable.ma.us Office: 508-862-4038 TOWN OF BARS TARL6-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number ,�� Not Valid without Red X-Press Imprint "/—/{(p Property Address Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 7. Owner's Name&Address zolli Oil A& Contractor's Name � .� '— Telephone Number", Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) . Ai I WV ❑Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor am the Homeowner I have Worker's Compensation Insurance Insurance Company Name !" Workman's Comp.Policy# Copy of Insurance Compliance Certificate must ccompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to r/►X/'lQld �W ❑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: ❑ 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 required. SIGNATURE: Q:\WPFILES\FORMM, ilding pe t fo s\EXPRESS.doc 06/20/16 t ?lie Comrtrornvealth of- assachusetfs Depa anent of 1ndTdsflYal AcciWe ids © Le elfinve-FfF.gafIti7fS. 600 Washington Street y Boston,MA 012111 ivFviiL dnl a-,mgov1dla Workers' Campensa an Insurance Affidavit:Bmlder-.lCuntractursMectricianslPhunbers Applicant Infarmatign Please Prnzt Le ib �I��Ie(Susmessf0'rganQationnal� � ��tJ� �Cf Patel - Phone ig: Are you an employer?Cit:eckthe appropriate box: Type of project(required): 1.❑ I am a employer with 4 ❑I am a general contractor and I 6- ❑New constructiba employees(full andfor part time).* Dave hired the sub-contractors 2.❑ I am a sale proprietor or partner- listed authe attached sheet I- ❑Remodeling. These sub-contractors have ship and have no employees 8_ ❑Demolifioiz w,,dzing, forme in a employees and hne workers' `�b � � C 8.# g..❑Building addition [NaS4ot�e[3. Gump.ia�ranr� comp-fIL°llCa]I �--� etlnired 5. ❑ We are a corporation and its 1 ❑Electrical repairs or adcla1ions r� 3- ama bomeoumer doing all work officers have esrscised their 1L❑Plumbsngrepairs or additions -L/ self o woikers, right of exemption per MGL_ c.152, §1(4h and we have no 12� ❑Roofrepatrs innzance re=;*pd i employees.[Nowozlcers' 13-0Other camp-insraanae-required.] ;Any applic=tffiut cbeds box#1 most also fiIIoulthe sectioabdowshamag fliamwoxicene campensesnapeTiyimbungdom Eamwwne m who sabot this affidavit ing&xt g they axe dGmg all vrcA and dim hire outside ca=ctars amst submit a new affidx6t mdirmtsm sorb_ . TCauuattas text deck ills boot must attached as additiazid dmet shovdng the nsme of the sub-ccnMwtoa.and stale whether ar not those entities bay employees.Ifthesub-=tactumbave mnpIoyees,theyumstpM-.i&their•work'tamp.policy number- I am au eniplopr that ispraszriurg workers'compensrrtiolr insuraRcefor my ampfoyees Below is fita po cy road job site inf ormathm Insurance Company iFame- Policy,or Self-ins-I.ie.* Expiration Bate: Job Sif�Address= CitylStatel2sp: Attach a-eapy of the workers'compensationpolicy declaration page(showing the policy,number and respiration(late). Failure to secure coverage as required under Se-cfion 25A of M_CL c.152 can lead to the imposition.of csimistal penalties of a fine up to$1,50O:OU andfor 6ne--y6ir impaisoumeut,as well as civil penalties in ihe fozm of a STOP WORK ORDER and a fine of up to$250-00 a day against the tizolator. Be ad-,ised that a copy of this statement raay be forwarded t o the Office of 1mvestigations of the DIA for imsurancStovenge tesffica3ion.. Ida hereby csrtiif ratdsr 'i iafties afperjury tJratflte irafbrma€mj-proii&d above Z9 trots mid correct Sit3tature: Date: P�h:.: afi7ciaL tree Qrrtj: Da not antra in dds area,to be campTeted by city artown gfj`iciat City or Town: Perri itffikense# Issuing A uthvrity(drcIe one): L Board of Health 21.Builffiag Department 3.CitytTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person Phone#: - ------ --- - - - 6 to • �. Et' b H, n w a ro o .Q• ° � � • �' � �`C � i p Fr. cry p rib �y � R O �' 5 n o , R �� � +� , ON, w H ° Gl `C w c1 g w ton O'YO qqACP f$ c� � m N P' � b� p ° p, ooi 'rttclfh �tri �i o c7 O �• y i 'LI 'CI p �•. P. th G Et ' EV � H p � R o 1 (�7 I M• ►�5- '�' " (➢ bj H' �] (y Q• Fj• r,y g -Cp Er � ' a � Ct F7Cl p co Ph 04I^R Er rf (13 S➢. p ryR 'tl a, pp' �. 17 �y p I�➢ p hy� o P AR 1 hR. y `� o o . �^ . PI+, 0 0, p � p A A A ,�._ � y W CP I Town of Barnstable Regulatory Services AS& Richard V. Scali,Director 6; ►�� Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 . Fax: 508-790-6230 t Property Owner Must Complete and Sign This Section If Using A Builder t 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 Print Name Print Name I Date QTORMS:OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services Ott tq� Richard V.Scali,Director Building Division MIMSTasts. Paul Roma,Building Commissioner � Mass. $ 1639. 200 Main Street, Hyannis,MA 02601 ArEn '� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print JOB LOCATION• , / _ � ` A number street village J J� name Jj (� home phone# work phone# CLIRRENT'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 undersi a owner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proced e ' e is d that he/she will comply with said procedures and requirements. Si lure o . wrier A roval Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing.Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application,that the 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Town of Barnstable *Permit# ' Regulatory Services o� (��ee 6 months from issue date y KAsa. Richard V.Scali,Director I�1� s639 �� [� �E„► . Building Division T� AIN 23 Paul Roma,Building Commission r ��'I it. 200 Main Street,Hyannis,MA 02601 VI' �U/I'� www.town.barnstable.ma.us '] V r4 1 1� Office: 508-862-4038 Fax: 508=790-6230 EXPRESS PE MT APPLICATION - RESIDENTIAL ONLY I Map/parcel Number Not Valid without Red X-Press Imprint 0071 Property Address '46 �� U v49P I U ❑ Residential Value of Work$ 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �l Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: yXj w( P �YA04(!Ao . A* _ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ,�am the`Homeowner nL� 1 have Worker's Compensation Insurance Insurance Company Name P Y 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 ❑ 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: ❑ 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 Own'pr must sign Property Owner Letter of Permission. A cop o t Home Improvement Contractors License&Construction Supervisors License is r r SIGNATURE: Q:\WPFILES\FORMS\bu ding p t forms\EXPRESS.doe 06/20/16 r , y The COTt mo2rweaht of A&wad ruseff5 Department cif smd Accidenft Oirwe of Fm afims. 600 Waslav NOM Street Boston,CIA 02111 tvrvtumass govIdIa Warkere Campensatcan Insurmce davit:Bmiders/CuntractarslEIec dcianslPhm3Lbers Rican#Information Please Prat -Nw=4B � We!!�/ citylsta Z� Phonon 10,F 06 Are YOU an employer?Clseckthe appropriate bam Type of project(required): I.❑ I am a employer with 4. ❑I am a general contractor and I 6. ❑New oot aMCtioa employees(fall audfor part-hme s bave hired the sab�-conbactors 2.El I am a sale prqpzietor orgartaer- lisfs=don,the attached Sheet` I ElRetswdeling. ship and have ao employees , These sub-contractors have g_ ❑Demol6oa wodting for me in any capacity. employees and have wogs' 9..Q Bui1 sddifioa [No��°O�"ias�ce camp- # 1�Q Electrical or ad�ioas reclnined-I 5. ❑ We axe a corporation and its ❑ repairs 3. ama homeowner doing all work officers have exercised their 1L0 Phntabingrepairs or adcEtions npsel€[No worlmrs'oamap_ Tim of emmpfion per 14fGL 12A oofrepai:s inqum=e regmjre&]y C.M §1(4} and we have no I`" employees`[NO workers' 13-El camp-'"surtm a required-] •Any apyBcKukdmtcbeftbasinEscdlsnMmtthesecd=beiowshuvw�,tbeawv&exs'amp—sat; permyinffi-2= t Ekmmmaem vdw submit dris affidME is nca>iag they axe lain.-mu wa l and tbea bar outside cantmc=— suhmc a new off duet mdicatina sud IC=w&a x I=cher'k sb=muaansds maddi-21sheersbaaingtbeaameofthesnb•co sadstefewhedmarwflhnseefffitiesba e employees. wades' PaJky nt en I am air suipIriper flaw is prvui workers'corcrperesrdian irrszirarres for my empooyee Below is f$e policy ar�d job site informat&iL Insurance Company Name: Policy.4 or Self-ins-Lic Forpisation Date: Job Site tlddre= Citylstatet2np Attach a•copf of the warkers'compensationpolicp decLumtion page(shaving the poficy,number and expiration date}. Failure to secure coverage as nequimd under Section 25A of MO-r—1572 can lead to the imposition,of trim nal penalties of a fine up to$L500 OD and for oni yearimprisonmenk as we 1R as rivil penalties n the farm of a STOP WORK ORDER and a fine of up-to$25fl-oo a dap against the violator. Be a&ised that a copy of this s entent snap be f warded to tine office of Investigations ofthe DIA for insramnce coverage terifrcatiom. I do[ter,*csrlsfy' "der nah�s afgedrtry flratfhs irrfarwrationprmided abay�s is bus arrdfaa/erect Sire: Date- Phone ik- `' a Offidab am a:dy. Do not twi a in ff ss area,to be wmpfeted by city artoirn of t My or Trion: PerudtUrense i€ Leg Aaflarity(carle one): L Board of Ife dth I Builirin DepmtmLent I CAYfrawR Clerk 4.Electrical Inspector 5.Plmbing Inspector 6..other Contact Person: MOW#: 6 :Information and Instractions ! �e#ts Coal Laws chapter M rsqMes all esDPIUCES to grM&worTM&=Mpuos5ion fur fbea eECIPlayees. pmsu=±-tn ffiis stye,an mpkyw'is of anotherunder any contract ofhire, r express or finpliett oral or wriff mf Air mmpFaym,is defmcd as-air fiuEvicing pamineaship,association;corporation or ofber legal enctity,or any two or more of the fioregfling=gaged is a Joint=ter s ,and incbadmg the legal FeX=x±a Ives of a.deceased employer,or the receiver or trustee of an individnal,per,association Cr other legal entity,employing M3ployee9- However the owner of a.dwelling horse havmgnot more than three apartmes and who r emckz ffierein,or the occupant of the - dweMag house of an a8�er who employs pessan �cc s to do rca>r ,caostm_r_t;on or repair work.on such dwelling bouse or on the grounds or bm7dng appuriEn ffiereto shallnotbecanse ofsach exoploymealtbe dcemedto be an employer." MQ,chapter I52,§25C(6)also states that"every stale or local licensing agency shall wi-thhoId fhe iss aance or renewal of a license or permit to operate a business or in constrict bwidings in the commonwealth for ray applicant who has not produced acceptable evidence of compTlanrl'with the insurance.coverage requn ed." Additionally,MCrL chapter L52,§25C(7)states fileifhm the n=rn mwealth nor jay ofi spolifical snbdivi_sions shall ester mfe any contract for the perfarmanee ofpubho woric until acceptable evidence of compliAamwith ffie fi=ance.- mTnrements of this chapter have been preseoled fn the curXII�anthoaty." A pp4cant s Please fn o-c± the worl=, compensation affidavit completely,by d=Jd33g&e,bo7ces ffiffiat apply to your d riation and,if necessary,supply sub-cuu�s)name(s), address(es) one s(es)and ph -r— m(s) along with{heir=tif te(s) of insurance. LmmifedLiability Campames(LLC)or LimitedLiabilityTartaerships(L P)wilhno ezopIoyees other fhanfile mertibe2s or parb=s,are not req=ed to carry worice& compensation insurance- If an LLC or LLP does have employees,apolicyisregni:i d Be advised that this affidayk maybe snbmitied to,the Department ofludnsft-W Accidents fur confirmaiim of msorance coverage. Also be see to sign and date the affidavit The affidavit should be retnned to the city or town thatthe application for the permit or license is being requested,not the Department of Tndristrial A c cidcats_ Shouldyou have any questions regarding the law or ifyou xis required to obtam a woria'rs' cazopensation policy,please call the:Department at the number listed below. Self-in=ed companies should ear their s elf-fi sormce license number as the approgr late line. City or Town Of FiriaTa c _ Please be sme,that the of misvit is complete and prhIIz d legil:Iy. The Departmeothas provided a space at the botfoin. of the.affidavit for you to fill out i a the event the Office oflnvestig has to coact you-regarding the applicant_ Please be,sure tD f M in file pemh/licrose,number which will be used as arefere nce number: In addition,an applicant ffiat must submit multiple pew bU=MSe applibatium in any given year;need only submit one affidavit indicating con-ent policv inf=ation(if neccssaxy)and under`rJob Sitm A.ddress9 the applicant should write"aIl locations in (cry or- t own)"A copy of the-affidavit chat has been officially stamped or ma 3md by the city or town may be provided to the - applicant as proof that a valid affidavit is on f le,for fizinre permits or licenses_ Anew affidavitmztst be filled oirt esach year. Whes•e a home owner or ccitizen is obtaining a license or permit not related�D any business or commercial veers (hie_ a dog license or pemnit t o bum leaves ei�.)said person is 1�IOT req�red to complete this affidavit The Office of Investigatinms would-1:5m to thank yDu m advance for your coopweion and should you have any questions, please do not heshafm to give us a call- The,Dc-Parfine nt s add=ss,telephone and faxmnnbea: j 'Iha cowmoawwn of Massachustm . DepadMMtofTT;&x-qfn-EdAWi -ts face of� tio� . Os MA 0411 Tel.*617- -49W QExt 4€6 W 1-977 MA Sfi,4FF Fax #617'27 7M Revised 424--07 �g Town of Barnstable Regulatory Services Richard V.Scab,Director Building Division. Paul Roma,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 Z I 7, er of the subject property hereby authorize to act on my behalf in all matters relative to work authorized by b 'ding permit application for. ( ss of Job) **Pool fences and are the responsibility of the apph t Pools are not to be filled r utilized before fence is installed and all final inspections are p ormed and accepted. Signature-of Owner Signature of Applicant Print Name Print Name Date Q:F0RMS:0V NERP$RMISSIONPOOIS Town of Barnstable Regulatory Services ; dF Richard V.Scali,Director Y Building Division r . t Paul Roma,Building Commissioner 6s9. 200 Main Street, Hyannis,MA 02601 a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION _ Please Print DATE: 6 `� `/% " 1 � 1— JOB LOCATION: MVA i&J number h street ! village "HOMEOWNER": home phone# work ph ne CURRENT MAILING ADDRESS: 06�� 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'V owner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures a nts and that he/she will comply with said procedures and requirements. Signt7aAmer 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 i 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:\WPFILES\FORMS\building permit fonns\EXPRESSADC 06/20/16 QUERY PROPERTY: QUERY END QUERY PROPERTY PENTAMATION----------------------------------------------------------- 05/06/98 PARCEL ID 176 021 GEO ID 10444 LOT/BLOCK DBA PROPERTY ADDRESS OWNER JENKINS 361 PARKER ROAD PETER .P JR JENKINS EDWIN B &,JOHN P W BARNSTABLE 453 CHURCH ST W BARNSTABLE MA 02668 PHONE DISTRICT WB DEVELOPMENT STATUS C ASSESSOR'S CODE CAPACITY (NOTES) ZONING DIST/ZOC RF SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? Y # BEDROOMS ZBA DECISION FAMILY APT LOT SIZE 679536 OPER/MGR NAME WET LANDS MULT ADDRESS USE 101 PROTECT DIST (N) EXT / (P) REVIOUS / NO(T) ES / PER(M) ITS / (V) IOLATIONS / (G) EOBASE / (E) XIT This value is not among the valid possibilities ��_�_-i F_ ///� � a Y� /�/ /II�1� W � ��� ��',�%� �?Cf � � `� `�° ,� • ��� ', ��o /� e ���� 1 � � 1 . * GZ%�. � �r�s _� . , _ , , I :.. I r I / I 1 1 rFrOMWE / ROOM MW �. • // /� , / WIN `� I J • A 1 , i / .�.� TOWN OF BARNSTABLE BUILDING DEPARTMENT COMPLAINT/INQUIRY REPORT Date -y�/6��8 Rec'd By,/, s Assessor's No. Last Name �/,P.c-e� First Name a ORIGINATOR Street Village State Zip Telephoner Home Work Description: &a, it= COMPLAINT dt INQUIRY Requestor's Signature COMPLAINT Street Address ��✓2�1[�t� �:� �.cj LOCATION A= OFFICE USE ONLY t INSPECTOR'S Date Inspector ACTION/ COMMENTS FOLLOW-UP ACTION ADDITIONAL INFO. ATTACHED COPY DISTRIBUTION: WHITE - DEPARTMENT FILE YELLOW - INSPECTOR PINK - INSPECTOR (RETURN TO OFFICE MGR. ) j � yD 9 Oz � 0a va��c.�uo Go;m� . ��'c.c��2�� ✓t�� �;��Z—cam `���