HomeMy WebLinkAbout1855 MAIN ST./RTE 6A(W.BARN.) 0
uf� 5
UPC 13543
No�53LOORR ,In�,�``
NASTMO$. UN
Town of Barnstable *PermiiL
ryes 6 months from issue date
. �� Q� Regulatory Services fee
�� :s atvsrnst� '
Mass. �, Richard V.Scali,Director
Building Division
TOWN OF BARNSTABLE Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number' � _
Aeo
Property Address ` /
row
U�Residential Value of Work$ � fe 8 Minimum fee of$35.00 for work under$6000.00
Owner's Name&,Address 3T0-Aa-r C_01
�r-
8'S S M*I tit S 1 _Ce-?F W C S T- .BA2rSTH6 LG 1 M*75>S d2GGS
Contractor's Name If Z c. q I YY `6*A�t��'G4<1"V e/wl Telephone Number,Jl p 1 ,b 2 ;Ply/
Home Improvement Contractor License#(if applicable)/004>3r%R Email:
Construction Supervisor's License#(if applicable) 0 t1 [3 }
❑Workman's Compensation Insurance
Check one:
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. a
Permit Reques (check box)
®'Re-roof(hurricane nailed)(stripping old shingle Aconstruction 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 Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement-Contractors License&Construction Supervisors License is
required.
i
SIGNATURE:
QAWPFILES\FORMS\building permit fonns\EXPRESS.doc
06/20/16
A
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License:.CS-000998 `
Construction Supervisor ° C,eaa�aas�a a
p R 0£9Z0 WV'31GViSN8V9
yz .jFz= NI 000 3d`d0 89
VICTOR J WIINIKAINEN '. % -y — ,4 uauleNlunM Jo;ate
PO BOX 69
WEST BARNST4131- M' 266
' 1;3NI.` AINIIM'r2JMOIA
,�'�+% ` IenplMpul BGEIG/819: uollejldx3
pi :adA.L £900`OL i:uogej;s!BWd
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Commissioner 09pirati17 sO.LOVILLNOO1N3Wjj 0OudW13WOH
aoUslnSag ssaalsng 7y sjlejjV jamnsaoD jo 3argj0
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i
rbe
r registration valid for individual use only
e expiration date. If found return to:
Consumer Affairs and Business Regulation
Plaza-Suite 5170
MA 02116
No valid without signature
Department of Innis& Za1 Accidents
O ce of dons.
600 Washfivim meet
Bosun,HA 02111
impin waSSgovIdi a
QI'liie& Ct1iffipEIlS3 �I11IIS1IFhIICir {�BI S/ IIfI`aC�rSICISIIS �itleI S
App�#TII{wm=fiqn Please Print
Name
j Addres �8' C��� C0 0 � �
i Ci�gltatebA 'ttrsl�4 f/r`Q y 2 tO 3 o Phow �'
Are YGU an employer?Checkthe appropriate bom Type of project(req:uired):
I_❑ larnaemployerwith 4. ❑I art a general contractor and I ❑
employees andfor part�ime * have l:iredt&e sub-camtractors 6. New oonsfrrclion
2.RI am a sole pmpfietmr orpartuer- listed on the attached sheet: 7. ❑Remodeling
ship and have no employees • niese sub-cantm tars have g_ ❑Demolition
worl-Ing for me in any capacity. erhployees and have wo&ers' 9_.❑Butldmg addition
n'-orb5W camp-msurm e: comp-
5. ❑ We are a cospomfian and its 10-❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11-❑Pbnabing repairs ctr additions
[No work=' - right of egempfion per MGL L_w oofrepaiis
insurance require&]T c.M §1(4h and we have no
employees.[No was' 13_❑Other
cam-inmamnce required.]
6AayRW5c=fiLstcbedaboxinEstelseiiIIot the sectioabeIaa*she�ug�eirs9a�ces'compeasatinupn&egiaEncmaer�
t lameawne m Who submit ills af5d2<if i—Wrrtm submit a nem affidaejt mdirrhao such
-'i=mzc9=$iztchecir this box mno,attnedssadditimsalstreetshacesng&a--ofthe mmd stem vhmherarwtthase }n-a
eatplcpees.Ifthe tshavee@piopres,fty=5rPmVideduair wadm&CMUP•p0HFamabm
I am an eeiPloyer that is prouidirrg ura)*em caugm si an hmiran w for m
y errpiayw= $dote is tiTte prrNcy and job sds
informaiiom
Insum++ce,Company Name:
Policy,or Self-ins_Lin; Expiration Date:
Job Site Address: Ciwstafelz pl
Aftach acopy of the workers'compeusationpolicy declaration page(shoving the policy number and expiration date).
Failure to setmm coverage as required under Section 25A of MGI.m L5 can lead to the imposition of crimistai penalties of a
fine up to$00D 00 andfor one-year imprisoumeak as we11 as rigid penalties n the fgrra of a STOP yi OFX ORDER and a fine
of up-to MOO a day abgaiasf the violator. Be adsdsed that a copy of this statement maybe forwarded tea the Office of
IrvesErgatiors of the DIA for+*+s=ance coverage yerifcagica
Ida Iteraby under the alterr afger rc ty thafthe informa6=proi-iiW abm a is true and carrmt
Date 9 —0,?
Phone i D- 3 - ?S�1!5 .
Octal am anly. Do xLet wriie in dds area,to be cmnpleted by dip artotvn ajoidaL
City or Town: Pexmkff eense;
LwaingAufl rarity(circle one):
L Board of Hmlth 12 Bwldm- g Department 3.Cdyl Toren Clerk 4.Electrical Euspeetor S.Pbumbiiugg Inspector
CL other
Contact Person Phone ff:
- - 6
i
formation and Instructions w
Massachusetts Gel:a Laws chapter M regoaes all CMPIoyes Eo provide work'campensalion file ffieg employees.
PmsaaJ-to this sty,an wpkyw is deed a&"_evecypersonm ffie sect vice of ano hm und=aay contract ofhar,
csprass or impliecl,Aral ar wnc�ne "
An wvk ym-is defined as-an fiewi ffi29 per,association;corporafion or other legal entity'.or nay two or maze
of the foregoing engaged is a joint a xbm. se,and inclndmg the legal=p=wtafives of a.deceased employes,or the
receiver or t ugtee of an indrvidual,p ip,assodafim or ofhmlegal entity,employing employees. However the
owner of a.dweIling house having not more thm three apmtmenis and who resides therein,or the octet of the -
dwe,Ilmg house of another who employs persons tD do maimscc,ca=tiuct on or repair wo&on such dwelling]rouse
or on the grounds or buadm- g gvor en�mtffieretn shallnotbecanse of such employmentbe d=nedto be an employes."
MGL chapter 152,§25C(6)also st3trs that"every state or local Piceush g agency shall withhold fhe isrm_anca or
renewal of a fice=e or permit to operate a business or to construct bufldings in the commonwealth for any
applic=f Who tins notproduced acceptable evidence of cumpfiance with the insurance.covearage requirecL"
Additionally.M(=L chapter I52,§25C(7)s dos;¢Neitharffie nor a'ny ofib poIiIical subdrvLsions shall
em ruin any con-tract forthe pm-Bmmmce ofpnbho wo:dcuuhl acceptable evidence of comphgace with the insurance,
regaii temts of this chapter have been pent rd in the Cciitr nag authozity."
A PPlicanfr
Please fill out the workers' compensation affidavit completely,by e boxes flIat apply fin your siin d and,if
necessary,supply s°b-contras s)name(s). address(es)and phone rr— m(s) along with their cerii icate(s) of
insolance. Litnibed LiabrMty Companies(LLC)or Limited Liabz7ity Partnerships(LLP)wi$rno employees other than the
members or partners,are not rbquard to corny workers' compensafion mstiranm If an LLC or LLP does have
employees,a policy isreq died. Be advised that this affidayk may besabmitiedto the Departmentof Industial
Accidents fur confmnaiion oft mm-an=coverage Also be sure to sign and date the a:ffidaFit The atd avitshould
be returned to ffie city or town that the application for the pewit or license is being reques A not the Department of ;
Indashial Arcidents Should you have any questions regard-mg tTie kw or if you ate regim-ed to obtain a workers'
campensaticmpolic�L please call the Departcaent at ffie nmmBer listed below. Self-mslz =33paniessbouIdmtrr$ieir
s elf inso mn=license number on the appropriate line
City or Town Officials
t _
Please be soar that the affidavit is complete and pry .legibly. The Department has provided a space of the bottom
of the affidavit for you to fill out in the event the Office of lnvestigatioas has to com±ELut you regarding the applicant
Please be sure tD fill in the pennrt crose mzmber which wM be used as a mfe=cc n=ber. In-addition,an applicant
that must submit nuzlfple pemtl?censo applitafions m Emy given year.need only submit one affidavit indicating current
policy infaonation Cif necessary)and under"Job Site Address"the applicant should wrhe"al[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-proo-fthat a valid affidavit is on file for future pemris or Iicenses Anew affidavit must be filled oiut each
year.Where a home owner or citizen is obtaining a license or putt not related to any business or commercial Tent=
Cie.a dog license or permit to bum leaves eta.)said person is NOT requited to complete f2is affidavit
The Office of Investigations wouldh7ce to ffL=k you m advance for your cooperation and should you have any questions,
please do not hesitate to&0 us a call.
The Depart mfs ad&ms,telephone and fax xsmbe:
T Cam *of Massachn&eM
D rent cif li&Estdal Aocide±nta
Bwtou,MA E 11f
Ted#617 -49Q4 cut 406 Qr 1-977 MASS
Fax#617 727 7M
Revised 424-Q7 �g
S
Town of Barnstable
Regulatory Services
` Richard V. Scab,Director
s639. '
5 Building Division.
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.maxs
Office: 508-862-4038 Fax: 50&790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, S"rl)f�Q� C $ v t-rt-1NC— —, as Owner of the subject property
• y �CTo2 Wi. w+ � K A I N�
hereby authoriz act on my behalfy
in all matters relative to work authorized by this building permit application for.
r4 Sty w*,s-r ,-prA&Le Ma v zb 6
(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 Signatur-'of Applicant
Print Name Print Name
Date
Q:FORMS:OWNERPERMISSIONPOOLS
Town of Barnstable '
Regulatory Services
Richard V.Scali,Director
Building Division
t RAVRNUMBL& Paul Roma,Building Commissioner
9. A�� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
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 structures.''A person who constrticts 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: der 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.
._, ti '4 n ..'T .. E ,. A•
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.
. a
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 S.upef*isor.'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
f1 `�
•
ofIKErp� Town of Barnstable *Permit#
Expires 6 mo—rs, issue dale
Regulatory Services Fee
t - PERMIT
9 Huss' Thomas F. Geiler, Director
i6 �
AlfD1MR to_'+ � 2011.
Building Division
TOWN OF BARNSTABLE Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601 _
www.town.barns tab 16.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 24 �� f
Property Address/
eResidential Value of Work, }
� �.�� Minimum fee of$35.00 for work under$6000.00
Owner's Name& Addressi
Contractor's Name Telephone NumberAC-, N,-2 jV/c
Home Improvement Contractor License#(if applicable) /Lc es ;:�
Construction Supervisor's License#(if applicable)
❑Workman's Compensatiori Insurance
Check one:
Plam 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(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not stripping. Going over existing layers of roof)
2"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
requ'reJd�.n 4
SIGNATURE c�CJ A
Q:IWPFILESIFORMSIbuilding permit formAEXPRESS.doc
Revised 070110
+�•. Nlassachusctts - Dcpa�Kmcnt of Nut�lic�at'ch
� Board of B.uildin�� Rc!�ulutions uiul Stnntlards
I
Construction Supervisor License
License: CS 998
Restricted to: 00 }
VICTOR J-WIINIKAINEN }
PO BOX 69
W BARNSTABLE, MA 02668
Expiration: 9/29/2011
Tr#: 2294
('unuuisi„ncr
1
Office o on umer A airs ene� egn a�Ong y
HOME IMPROVEMENT CONTRACTOR Type:
Registration: �*100053
Expiration: <6Z$12012 Individual
V, R J.WIINIKAI E:N
Victor Wiinikainen,"''�
58 CAPE COD
BARNSTABLE,MA 02630�: Undersecretary i
i
I
License or registration-Valid for-individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
C r
No lid without signature
t
f�
The Commonwealth of Massachusetts
E Department of Industrial Accidents
Office of Investigations
`!"�;; 600 Washington Street
a j Boston, NM 02111
r www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
��jo
Address:
City/State/Zip:13AJ?,VS2'I�l3.G� (0 3e Phone #: rc3 Tr
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-time).* have hired the sub-contractors
2. I am a sole proprietor or partner- listed on the attached sheet. t ?. ❑ 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 ]0.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I. Plumbing repairs or additions
myself. [No workers' comp. c. 152, §](4), and we have no 12.❑ Roof repairs .
insurance required.] t employees. [No workers' 1.3OtherR t1114C.Z I
comp. insurance required.] g
*Any applicant that checks box#l 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.
tContractors 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.
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 cer i enderjthpainsand penalties of perjury that the information provided above is true and correct
Si ature: LJ �� �^�—�� Date: 0
Phone#• 3>b 7
I
Official use only. Do not write in this area;to be completed by city or town official
I
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person: Phone#:
t
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 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
Revised 5-26-05 Fax # 617-727-7749
www.mass.gov/dia
A
:y
THgE Town of Barnstable
` Regulatory Services
• uxxsrAs[.� .
MARL g Thomas F. Geiler,Director
g'�ED }gym Building Division
Tom Perry, Building Commissioner
200 Main Street,Hyannis,NIA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Ovine rMust
Complete and Sign This Section
If Using A Builder
2
I, 'R'�T C &y f7 , as Owner of the subject.property
hereby authorize GTniZ W � � A 2/U t AJ to act on my behalf,
in all matters relative to work authorized by this building permit application for.
(Address of Job)
1kcr
�igna'Lm of Owner Date
i
STU eu C
Print Name
If Property Owner is applying forperrimitplease co ' lete. the
Homeowners License Exemption Form on :the reverse side.
Town of Barnstable
��of V►E rQisy
o Regulatory Services
�;��� Thomas F. Geiler,Director
Muss
Building Division
PIED µF,{►
Tom Perry, Building Commissioner
200 Maili.Street,_Hyannis,MA 02601
,K ww.town_barn..ttable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
HOiS OV NER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state rip code
The current exemption for"homeowners"was extended,to tuclude owner-occupied dwellings of six um—ts or less and
to allow homeowners to engage an individual for hire*Wbo�dbe!s nbt possess a license,prodded tlLfthe owner acts as
supervisor.
a r D $`RgMG OF.�OT>y11:0 YNER.
Person(s)who owns a parcel of an of which hdlshc residcs`o intends to:reside, on which.thrre 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 constrgcts more than one home in a two-year period shall not be considered a bomeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be
responsMe:for all such work performed tinder the building?permit (Section 109:'1.1)
� r a '
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 complywith said procedures and
requirements. * `'
Signature of Homeowner
Approval of Build ing.Official }* g (1
Notc: 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 span be exempt from the provisions
of this section.(Scctian 1 o9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a peraon(s)for bin:to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they arc assurring the responsibilities of a supervisor(sec Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack ofawarcness bftm 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 helshe 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.
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NAM
�2639- BUILDING
INSPECTOR
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APPLICATION ��� ��� � �� .��������—'—�:^---.. ...... ...........................................................
� TYPE OF CONSTRUCTION ..... ...................................................`___________________.
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TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for ponnh according to the following information:
Location —.��� ~---- —.R�yR�� --------_.;--------------------
ProposedUse ---------------------------------------------------------'
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Zoning District ------------------------Fi,e District — —��zn�����-��.�2 -------'
Name of Owner .4k ....AumVV$J4.....Address ...A.4.4 __.W 6-vr_.09 19A,%]s7-A.q,.«~�� _� |
Name of Builder ----------------------.�A66,e� ----------------------------
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Nome of Architect ----------------------A66res ----------------------------
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Nonn6e, of Rooms ----------------------Foun6otion -------------------'
Exterior ...WP.P.-P.—':�/*^N^q �- ------------Roofing —..�/�.���--���,z»w��.o&�------------
Floors —4/ ----------------------]nterior -----------.----------------.
Heating ....................
......................... ....................................Plumbing . �
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Fireplace ............. ..............— ...................................................App,oximo^eCost ..................................... _________.. |
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Definitive Plan Approved 6v' F1onning Board lg-__'. Area ......... � ...............DiagramandBuildingDimensions
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/ SUBJECT TO APPROVAL OF BOARD OF HEALTH
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| hereby agree to conform to all the Rules and Regulations of the Town of 8ornuhz6|e regarding the above
construction.
� Nome .1eea4—..���������n� ...................................
��_ J
Bunting, Keith 4 Enid
No ....... Pe.r it for ..Demolish Barn....... .......... . .. ...... ..
.... .............. R.......
Location ....Rte...6A....W....B.a.rnsta.ble..............
...... .... .... .. . .......... ......
...................... .................................;..................
Owner ....Keith ...Bunting....................
...... .... ... ........ ........ ......
Type of Construction ..Wb.....o..d....Shin
......... .............
a.
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Plot AP..z16............ Lot ...............
Permit Granted ........Mariah.....I..............1974
Date of Inspection ..................................19
Date Completed' 611�9
PERMIT REFUSED
.................................................................. 19
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Approved .................................................. 19
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