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Home My WebLink About0159 ARROWHEAD DRIVE �� J�� i P. b.1. [ i..ii=b ti4 w r ,hRU&iON C®o es� t�ai and Commeraal Buelder' ZNR 31 FVA +Fr1 IZ4iFAN SPECIALISE � r 10 •F �t 3S _ ,. March 15, 2014 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Street Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201309477;Status A; Parcel 270185 at 159 Arrowhead Drive, Hyannis, MA; Permit Type RADD and issued on 12:00:00 AM has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Fee 0 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address S5 /�. 'r 1Y.&L lon. Village AV�vw, Owner w c.s �cte�,o L Address , Telephone s-Ih - sCC- )':)7 1 Permit Request YZ- 3" 6,+,> '� , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tota new 4 Zoning District Flood Plain Groundwater Overlay 15 Project Valuation 1$W Construction Type ram' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: 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 ❑ No Fireplaces: Existing 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 (BUILDER OR HOMEOWNER) ;Name w,r..!'+...thy Cons+Vaetlon Telephone Number PO Box 52 Address _� �_��a.- AR A n��n License # NVeCell (508) 280-6964 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r FOR OFFICIAL USE ONLY 4 f' APPLICATION# `s DATE-ISSUED MAP PARCEL NO. ; ADDRESS VILLAGE a y OWNER � ..� •� ;.,r �,. DATE OF INSPECTION: FRAME .INSULATION FIREPLACE ELECTRICAL, . ROUGH FINAL PLUMBING: ROUGH FINAL t aL GAS: ROUGH FINAL 1 FINAL BUILDING -DATE CLOSED OUT ASSOCIATION PLAN NO. y 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 Mike McCarthy Constructiollk Name(Business/Organization/Individual): )PO Box 52 West Dennis, MA 02670 Address: Ce11(508) 7-80-6964 City/State/Zip: CSL-58f�oneIIC-169393 A;Zam an employer?Check the appropriate box: Type of project(required): 1. a with employer 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. 7. ❑Remodeling ship and have no employees These sub=contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P t3'• � 9. ❑Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 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 epau' s insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. er 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ,( Insurance Company Name: /�t Policy#or Self-ins.Lic.#: (/1, - - C017 6q � 3� Expiration Date: Job Site Address: /�ram. I�c:� �/.�- City/State/Zip: P/%,-,r,� 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 er the airs and penalties ofperjury that the information provided above is true and correct Si mature: Date: - S Phone#: s 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-,#qqe,aparhnents and who resides therein,or the occupant of the dwelling house of another who employs persons to do„mptenance,construction or repair work on such dwelling house or on the grounds or building appurtenant-thereto shallknox becaWe of such employment be deemed to bean employer." H 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 446 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia. 5�6-Cc,C- 1Y71 0 IL OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at S la4ao I/vk � ��-- f� (Property Address) 5 - co (Property Address) hereby authorize A— Qj (Subcontractor) ^ ' , an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. (Owner's Signature 8 % l3 Date 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 REPRESENTy4TIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject.to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to.the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER 01962-001 j NAME: Bryden&Sullivan Ins Agcy of Dennis Inc jA/C.No.Exc);-(508)39B-6060 _ i FA.No (508)394-2267 -_ PO Box 1497 EMAIL So Dennis,MA 02660 HDRESS .-_..__-_ _INSURER(S�AFFORDING_COVERAGE. NAIC# iNSURERA A.I.M.Mutual Insurance Company 33758 -- - - - -- -- - -- ---- - INSURED Michael McCarthy Construction Inc INSURER B INSURER C ---- - - - - _ - - - Ost Box SURER D Dennis,,MA 02670 i We _ ... II NSURER E I COVERAGES CERTIFICATE NUMBER: 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 CONDITICNS OF SUCH POLICIES.LIMITS,SHOWN MAY HAVE BEEN REDUCED C BY PAID CLAIMS. . ILTR! TYPE OF INSURANCE-- --IANSPIL WUB I -- POLICY NUMBER- - f_(MM DDY EE (POLICY M/DI - - LIMITS -- _ - - --- - i GENERAL LIABILITY ! I EACH OCCURRENCE - L$ - DAMAGE' RENTED -I$ COMMERCIAL GENERAL LIABILITY i _- _... .--; _-- PREMISES(Eaoccurrence1---�---- 1 CLAIMS-MADE I OCCUR Ii MED FRCP(Any one person) $ PERSONAL&ADV INJURY I$ 1 - j GENERAL AGGREGATE $ ,GEN'L AGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMP/OP AGG $ - - �- 'OLICY JE ..._i._-LOC L .+.-- .....- ---- -- --...- - _,_...- AUTOMOBILE LIABILITY $ ----- (Ea accidentl ANY AUTO BODILY INJURY(Per person) L$ - -ALL OWNED SCHEDULED i ~ BODILY INJURY(Per accident)I$ — - - AUTOS AUTOS - NON-OWNED II PROPERTY DAMAGE HIRED AUTOS 1 (AUTOS j(Per accident _ __-I$- $-- --- - - I ;UMBRELLA LIAB OCCURTAREGATE ACH OCCURRENCE $ EXCESS LIAB i CLAIMS MADE { I$ DED RETENTION $ I - _ WpRKERS CpMPFrNSATI N — - - ------ ----I-'-- -- - l X TORY LAt�ITSL ER -- AMID EMPLOYERS LIABILITY !ANyy PROPRI��TTppRlPARTNER/EXECUTIVE YIN )E.L.EACH ACCIDENT �$ 500,000.00 A oFFICER/MEMBER EXCLUDED? Fy. N/A I ! VWC-100-6017656 2013A 7/17/2013 7H7/2014 r- - - - - — -- (Mandatory,in NH) i---I I ;E.L.DISEASE-EA EMPLOYEEI$ 500,000.00 _-- If YY s ddes nbe un r I F.L.DISEASE-POLICY LIMIT $ 500 000.00 DE�CRIP�ION O 9PERATIONS below. _-i .. ..-.. - - I----- -- -- -- T_ -- -- DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) i CERTIFICATE HOLDER CANCELLATION TOWN OF SANDWICH Attention:BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN HALL ANNEX THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sandwich,MA 02563 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD d/IX-6 rn�aoauoe�rlC/o��la�aac/c�eCYi. License or registration valid for individul use only Office of Consumer Affairs&Busi ess Regulation g y OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: e istration: Type: Office of Consumer Affairs and Business Regulation 9 1'69393 YP xpiration::;:.,6/,1.6L201,5 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 , MICHAEL MCCARTHYt= ; "�--- i 1� \' A t MICHAEL MCCARTWY , 6 RANGLEY LN. SOUTH DENNIS,MA 02660 Undersecretary ANot valid without signature I c Massachusetts-Department of Public Safety. Board of Building Regulations and Standards Construction Supers isor > License: CS-058633 AHCHAEL J McCARTHY PO BOX 52 W DENNIS NSA 02670 r Expiration Commissioner 04/10/2014 tt ' The Town. of Barnstable Dun I'Services Department of Health Safety and Environmenta Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Grossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION ' Lo on of shed(address) ' S _ Property owner's name Telephone number � } � x Size of Shed Map/Parcel# t Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) - v THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg FILE/ A2010 CENSUS TRACT rr i 2 5 CLIENT:!,w.STEVEN J. PIZZUTI, ESQ DEED BOOK P1066G12 PAGE OI;:NER: MAX B. DALRYMPLE, GUARDIAN PLAN BOOK PAGE LOT APPLICANT: FRANCISCO A & MARIA A. REZENDE ASSESSORS PLAN 270 PLOT 185 MORTGAGE INSPECTION PLAN OF LAND LOCA.'' ED AT SCALE: 1" = 30' 159 ARROWI[MD DRIVE JANUARY 13, 1997 11YANNIS, MASSACt!i05E M 44 43 75' lof lob 185 0.25 ACRE 184 186 0 �n r Q L r- DECK X159 1 STORY �� Z--i► DRIVE WAY 75' ARR O VVHEAD I>RI VE ZONING DETERMINATION 'HE LOCATION OF THE ORIGINAL DWELLING S!IOWN HEREON EITHER WAS IN COMPLIANCE WITH LOCAL +PPLICABLE ZONING BYLAWS IN EFFECI' 'WHEN CONSTRUCTED WITH RESPECT TO HORIZONTAL DIMENSIONAL 1EQUIREMENTS ONLY OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS. G.L. TITLE VII, HAP. 40A, SEC. 7, UNLESS OTHERWISE NOTED OR SHOWN HEREON. A CONFIRMATORY INSTRUMENT SURVEY S ADVISED WHEN STRUCTURES ARE SHOWN TO BE ONE, FOOT OR LESS FROM PROPERTY OR REQUIR;.D ZONINC ETBACK LINES. NOTE: LOT REPRESENTATION WIT,LCONFIGURATION IS BASED ON ASSESSORS' MAP & OCCUPATION. . A MORE FLOOD DETERMINATION E DWELLING SHOWN HERE DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A P OF COMMUNITY .# 250001 0005 C AS 'ZONE C DATED 8/19/A5 BY THE NATIONAL FLOOD T.NSUR.ANCE ROGRAM. CERTIFICATION CERTIFY TO STEVEN J. PIZ7,UT.I, I,SQ. , 0[be fitone Raub 6urbep CO. o�iNQ��r DRWEST MORTGAGE, AND ITS TITLE � ROD 4r� VSURANCE CO. THAT THERE ARE NO Me11 Vdbp 3ft0ab D ISIBLE ENCROACHMENTS OR EASEMENTS s CARTE M XCIPT AS SHOWN AND THAT THIS PLANe� ebfOCb, 02745 O I AS PREPARED UNDER MY IMMEDIATE 1 -800-993-3302 - ° a D � "PERVISION. -lax 1 -800-993-3304 GENERAL NOTES:This mortgage Inspection plan was prepared for the above mentioned client only us of this dote and Is not Int ended or represented to be a land or property line survey. No corners were set. It cannot be used for preparing deed ddescrlptlons,construction or establishing fence,hedge or bullding i!nes. The land as shown heron Is based on client furnished Information and may be subject to further out-sales,takings,easements and rights of way. No responsibility Is extended to the land owner or occupant. It Is not Intended to be recorded. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel pp r I Application �� l a Health Division Date Issued 4 �U Conservation Division ,mod Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board (3 Historic - OKH _Preservation/ Hyannis P o c S etet Addr se s Village A ,✓,AX S /AA -"__._._- r NCB Co % /t/G' , k'Owner- �. S �.� ZC_ Address -P,ermit Request:`" " ~v?o l Nl�' r2-C CLA-CCS t'� �. �J�'Gk.. ..-S'�_4 L G © y J y L.Gr o 10 &r� i o 0 C-G(( e r?--f AA7Vf t:r/''✓a �E. o"CC S to �—G �}"''��'�r/(.� a rcC 6*;(C{f Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay rPr_ojectValuation �00Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: .0 Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other ® w g Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood I stove: Yes* No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ ex ting ❑n w ei e_ Attached garage: ❑ existing , ❑ new size _Shed: ❑ existing ❑ new size _ Other: ::R set cm Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ rn Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION C.(BUILDER OR HOMEOWNER) , 2'P ee T61e hbne.Number p Address License # A114_ 0 2 (Of' Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION,DEBRIS.RESULTING FROM THIS-PROJECT WILL BE TAKEN'TO SIGNATURE DATE 4 l t FOR OFFICIAL USE ONLY � t - APPLICATION# f DATE ISSUED t s MAP/PARCEL NO. q ADDRESS VILLAGE i OWNER DATE OF INSPECTION: 3 ' FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING I� DATE CLOSED OUT ASSOCIATION PLAN NO. Wiigj UI ( r DePaTtment ofindustrial Accidents IQ Office of Investigations 100 Washington street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insuraxice Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Tnforlaiation PIease Prmt Le 'bI Nam-_e.(B'usmess(Og izadon/Individud): A s 4.'o ' ,/19 GAddress City/st-ate/zip: S A44._0260. Phone.#: /d Are you an employer? Check the appropriate bog: Type of project(required): I.❑ I am a employer with 4• E] I am a general contractor and I * have hired the stab-contractors 6 .0 New construction.. . employees (full and/or part time).. . 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet': 7. ❑Remodeling. s and have no employers These sub-contrac�rs have ' "8. 0 Demolition • . working for me in any capacity. employees and have workers' o workers' co co insurance.t 9. 0 Building addition [N comp.insurance'. comp. . . •�frequirled.] 5. ❑ We.are a corporation-and its 10.0 Elec�cal repairs or additions �3.@-I'am a homeowner doingall•work officers have exercised their 11: ❑Plumbing re paus 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' Cj'13-&other comp:insurance required] *Any applicant that checks box#1 must also fiU.out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hum 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-contractois and state whether or not those entities have employees. If the subcontractors have employees,they must providb their workers'comp.policy number. w 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 e. 152 can lead to the ir�osition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as-well as civilpenalties 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 Investi lions of the DIA for' ce coverage verification Ida hereby certify under th and penalties of perjury that the information provided above is true and correct. S-i�nattrre�., . . � • .. ��D ater"'""_,�,,.. �; .�..q :_i �._ : 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): _ .•X.Board of Health 2.Building Department 3.City(Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#• . 1 Town of Barnstable THE ro �H•' RegulatoryServices • BARN BM Thomas F.Geiler,Director . a�sa 1639 Building Division prEo �a . Y: Tom Perry,Building Commissioner k 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma:us. Office: 508-862-4038 Fax: 508 790-6230 HOMEOWNER LICENSE EXEMPTION Please Print JOBLOCATION•" number street villa n- /"HOMEOWNER;:: /' A/�'LCS �Ci��C� � ��OJ `6 • � 1 name home phone# work phone# CURRENT MAILING ADDRESS:'{t d� 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"home r"certifies that he/she understands the-To wn of Barnstable Building Department minimum inspection o dures and requirements and that he/she will comply with said procedures and requirements. Signature of Hom .-eowner - Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction.Supervisors);provided,that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor. Many homeowners wlio.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 of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexernpt. F. Town of Barnstable Regulatory Services f 1 Thomas F.Geiler,Director 9�AlEv►ar��`� 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 I, a Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by thi uilding p t (Address 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 QTORM&OWNERPERMISSIONPOOLS 62012 _ Remove and replace exterior back door z_ Install double mullion window=Anderson 24310. 3 _ Enlarge 10'x10'area to existing deck Remove and replace decking and handrail on existing deck Remove and replace siding on the gable ends of the house Replace trim on gable ends of house v a Q Q 00 N 0 9U1 x I I I i I 0 I i ! I •I ,I i I � � -- I I ! I I I I! I i I I I V �1 ; (► I I I I G _. �. w � �� z�. ,..� � C'7 '� i _. � C7 �.�� —rt � � ., ,,, :� W (� �7 �� _. f x"' :t ' � .;+j� i. ,l a, :! MOON - -m-m m am MEN ME MOMME e No M ENOEMOMME M MEN ON MEN OMEN ME 0 Elommomm MEMNON IN ME on m MEMNON MEN Emmummi No= ON MEE No INN MEMMOMME ION MMEN No MIWImmm ME ME mom MOON ME mom ON 0 MEMO lMMM' ---- MMMMMff ME M mom MOM 0 No ME 'NEE- No M No •,o � is= mom e■n � No @SOME 0 � ■ u�ii � ■ �iIN mom b I f I ; f I ' I a I 1 1 I L t I y. i � BommerC6erd Rezende Francisco P DFrIYAddress 159 Arrowhead Dr_ Cay Hyannis----_-- _CRT Bamstable -----.------.......ate MA Zip Code 02801.-- Lender IoanDe Lcom LLC AAIP 19, ------------- - ' {'�/r /s�h Cy 1 / .. 95: f �� i�^� . Deck I�- Bath(hat „ � . m Bath Dining AXOP 10 00 Bedroom Living .^ ,eft 2- W.3 �0 V 40' Laundr y Utility Rec Room N bo W N Utfllty Utility 40' xorx.am�snirmmsec i. Ma Olarlxiomsammary . � ,. .... 112050$. 28 x 46.1L20 ToW U!"A—(RouMIed)s .. L120 sa ft 8namot" 312o lq$ Form SKT.BLDSKI-'TOTAL 2011'appraisal soIlware by a la mode,ine.-1.80D•ALAMODE o n o co � cn cv :: 0 ll... BomerCfierd Rezende Francisco �- --_----__.---. —.--.— -----.--.—._.-- —. p MAY Address 169 Ammhead Dr_ — ` Cky Hyannis Coonty,Barnstable Slate Mq—.....LpCade Lender IoanDe ot.com LLC KA r 9 10 ' r ' a ------1------- ,; , lee16 �. f. aas1-� 4arQ l �40 1 E Bath (half) 4' ,- 1 V f T- t; ,o 4' m Bath Dining n06i Bedroom Living , A 40• oq • -; /� r�� ,�t_ tart' c¢%a� �� 4W Laundry Utility Rec Room . N t0 W N _ Utility Utility 40. �my.S..s..Dr��efaoc K-- 4. Mee Olarladew Summary • ......_-... .. :.. .:... ... .:.... 11205gk_ .. .. 28r 40=1R0 Tod Uvio{r Nea.(tpoundedk L120 Sq ft - t .. .. .. _... .. _. ze,40 a 11io Form SKT.BLDSKI-'TOTAL 2011'appraisal software by a la mode,inc.-1-800-ALAMODE L , { co . \ TEVEN J. PIZZUTI ESQ DEED BOOK P1066G12 PAGE B. DALRYMPLE , GUARDIAN PLAN BOOK PAGE LOT ;ANT-. FRANCISCO A & MARIA A. REZENDE ASSESSORS PLAN 270 PLOT 185 MORTGAGE INSPECTION PLAN OF LAND L 0 C Aj. ED AT SCALE: 1" = 30' JANUARY 13, 1997 159 ARROWHEAD DRIVE )ft mi[s, mASSACHU5EP1'S 44 43 75' lof l0 ( 185 0.25 ACRE 184 186 0 �n 0 �n DECK �159 1 STORY �� Z_BMW_ DRIVE WAY 75' ARR U 4VHEAL� DRIVE ZONING DETERMINATION E LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON EITHER WAS IN COMPLIANCE•' WITH LOCAL PLICABLF. ZONING BYLAWS IN EFFECT WHEN CONSTRUCTED WITH RESPECT TO HORIZONTAL DIMENSIONAL QUIREMENTS ONLY OR IS EXEMPT FROM VIOLATION ENFORCEMENT AC'CION UNDER MASS. G.L. TITLE VTI, AP. AOA, SEC. 7, UNLESS OTHERWISE NOTED OR SHOWN HEREON. A CONFIRMATORY INSTRUMENT SURVEY ADVISED WHEN STRUCTURES ARE SHOWN TO BE ONE .FOO'17 OR LESS FROM PROPERTY OR REQUIRr:D ZONING TBACK LINES. NOTE: LOT CONFIGURATION IS BASED ON ASSESSORS' MAP & OCCUPATION. A MORE FLOOD DETERMINATION E DWELLING.-SHOWN-HERE DOES.NOT FALL, WITHIN A SPECIALrFLOOD -HAZARD ZONE AS DELINEATED ON A P OF COMMUNITY # 250001 0005 C AS 'LONE C DATED 8/19/85 BY THE NATIONAL FLOOD INSURANCE DGRAM. CERTIFICATION CERTIFY TO STEVEN J. PIZ7.,UTI, ESQ. , Otbe fitone lanb &ttrbep Co.. . �,o�"`��+�► RWEST MORTGAGE, AND ITS TITLE ROD e[[tp Moab ROD SURANCE CO. THAT THERE ARE NO CARTE SIBLE ENCROACHMENTS OR EASEMENTS -QeW 380forb, IM 02745 0 01 " CEPT AS SHOWN AND THAT THIS PLAN 1 -800-993-3302 S PREPARED UNDER MY IMMEDIATE O PERVISION. jfAX 1 -800-993-3304 GENERAL NOTES:This mortgage Inspection plan was prepared for the above mentioned client only as of this date and Is not Intended or represented to be a land or property'llne.survey. No corners were set. It cannot be used for preparing deed descriptions,construction or establishing fence,hedge or bullding I!nes. The land as shown heron is based on client furnished Information and nicy be subject to further out-sales,takings,easements and rights of way. No responsibility Is extended to the land owner or occupant. It Is not Intended to be recorded. TOWN OF BARNST BL 2013 MAIR 28 Pl 112: 07 Town of Barnstable Regulatory-Serviceg.70V I OF BANS W E of THE rp� ti Thomas F. Geiler,Director P o�, Building Division i Ill : Uf €'t1 1 5 BARNSTABLE, I - v MASS. Tom Perry,.Building Commissioner , 200 Main Street, Hyannis, MA 02601 www.town.barnstable-ma .us d MION Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Dater Name: 6 ram('Us\/06' Phone ff: Address: Pr/2//977 VV4'elY/l p� r Village: Name of 13usiiless:_V /✓__!C�_ __C "j tiff--- �?/ — c'w------ ------ - - Type of 131.1siness. C,4 _C, ^/ I Map/Lot. 2 I'O INTENT: It is the intent 6f this section to allow tl)e residents of the'roivn of[:ail stable:to operate'a liome occupation ewitliin single family dwellings,subject to the 1) V) iixis of Section l 1.l of Zoning 01"(llllall(c,p«ivided that the actin ty shall not be discernible from outside the dwelling: there shall.be no increase in noise or odor;uo�risuaCalter(tion to the premises which would suggest aiOung other than a residential use;no increase in trafl c above.normal residential volumes; and no increase in air'oi'ground",ater pollution: .. After registration with the 13uikliug Inspector,aCLIStOillal y home occupation shall be permitted as of right subject to the following conditions; . • The actiVity_is carried on,by tll'e pelmaiielit resident of a single f'im(ly residciltial(hwelluig unit,located�i ithIn that dwelling unit. Such use occupies no more than 400 squire Feet of space. There are no external alterations to the dwelling;lwliuh are not customary in residential buildings, and there is no outside 6rldence of such use. • No traffic�%rill be.geneiated in excess.0 no-n)al residential.volunies • 'file use does not:involve the production of offensive noise,vibration,smoke, (lust cir other particular inatter, odors,eleetncll disturbance,heat,glue, humidity or outer objectionable effects.' a `I'lie.re is no storage or use of toxic of hazard.S Illatenals,of flammable or exl�losive materials, in excess of nornml household quantities. • • Any'need for parking generated by such use shall be'niet on the same lot containing the Customary Home Occupation,uid not mithin the required front yarcl: • There is no exterior Storage or display of materials or equipnielit.' • "Iliere ue t)o cominereiatveliicles relatecl to the Customary Houle 0ccupatioil,other than'oue vari or otic pick-up truck not to exceed one ton capacity,and one Mailer riot to exceed 20 Feet in length and not to . ' exceed it.tiIIes'-parked on the same lot coutaining.the Customal•y Holiie Occupation. ' No sigh shall be displayed indicatini,the Cusforna y Holiie Occupatiou. ' • If the Customary Home Occupation is listed or advei used as a Business,the street address shall nor be I included. • No person shall be employed ill the Customary Houle Occ•upatiou«:ho is'not a permanent resident of the dwelling tAllit. l; the Liildersig led, hav ad and agree mth the above restrictions for lily honie occupation 1 am re�gisterim. Ahplical)f: Dater ) 1� 0 ti YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.,-it does not give you permission to opera e. ness Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, NIA 02601 (Town Hall) DATE: �• j Fill.in please: a APPLICANT'S YOUR NAME/S: 1 A//,:�'E BUSINESS YOUR OME ADDRESS: I S9 �1��'-,� w��A�' /,yL C ®Z / fin TELEPHONE # Home Telephone Number `? 1 NAME OF CORPORATION: I5 NAME OF NEW BUSINESS i 'i �CX-STYPE OF BUSINESS " - �' '7 IS THIS A HOME OCCUPATION? Y NO ADDRESS OF BUSINESS ; i t MAP/PARCEL NUMBER ,O (Assessing) When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need.- You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.' 1 BUILDING COMQa�sb R'S O ICE = This individu d f ny nermit requirements that pertain to this type of business.. Auth e Sig re** MUST LY WITH HOME OCCUPATION M ENTs �Y� RULE REGULATIONS. FAILURE TO COMPLY MAY HESUE1 IN FINES. 2. BOARD OF HEALTH - ' MUST COMPLY WITH ALL This individual has be informed of t permit r irements that pertain to this type of business. HAZARDOUS MATERIALS REGULATIONS .. � - JAuthorized Signature* COMMENTS: 9 3. CONSUMER AFFAIRS (LICENSING AUTHORITY)- This individual has b e info med of the licensing requirements that pertain to this type of business. Authori Signat re* COMMENTS: I ( {� ��,b%1 . o � Town of Barnstable *Permit#,) /j' Regulatory Services e s on coln.lsske date sw tSr�h 2009 Thomas F. Geiler,Director QE-F ell 7� 9� Building Division t RNSTABL�S Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint f (S Map/parcel Number ��V Property Address /�s .)'1^4r A-0 � 1, fl" A AlResidential Value of Work 21 - G� =�� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ror2_-ern r Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ®-I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name �t,7;3✓' � r �� -�^' !'� W12,t'1-i..r6, j4 Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) 99 .Re-roof(stripping old shingles) All construction debris will be to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.44) *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 Impro ent Contractors License is required. SIGNATURE: v Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 t t 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/Eleetricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): bC�� ✓C"f {�& �✓�� Address: �a lA/ fJ'� i 2 � .✓�t� /' - City/State/Zip: ��. � Phone.#: Are you an employer?Check the appropriate box: Type of project(required): 1.El I am a e to er with 4. I am a general contractor and I Y 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors .2:0 I am a sole proprietor or partner-' listed on the attached sheet 7: .Q Remodeling ship and have no employees These sub-contractors have 8. Q Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑ Building addition [No workers'-comp.-insurance comp. insurance. required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3JR 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.®-Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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. xContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub contractors have�employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 tip 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 th a' sand penalties of perjury that the information provided above is true and correct Signature: Date: Phone# d 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#: - S Infor mation 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 jomt-enferprise �neldding=the legal-represent Wvt a-k ofy--du ased-empioyer,-or. - 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-conti actor(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 permittlicense 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 maybe 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 fo 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 1-977-MASSAFE Fax# 617-727-7749 Revised 1 i-22-06 www.mass_gov/dia f Town of Barn-stable ° Regulatory Services yMASS. $ Thomas F.Geiler,Director 163;g616 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 to act on my behalf, in all matters relative to work authorized by this building permit application for. '(Address of Job) Signature of Owner Date Print Name r , If Property Owner is applying for pernn please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION ry r . r ' Town. of Barnstable t KME � s. Regulatory Services • uxxsres�, : Thomas F.Geller,Director Building Division PIED � t4tP'1 Tom Perry,Building Commissioner _.. _ _ . ..._ ....__..._ _......200 Mairi.Street;Hyannis,NIA 02601 _ ....... . . .... . ._. .__ . :. __. www.town.barnstable.ma.us Office: 509-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Fj , Please Print DATE C : I JOB LOCATION: 1 " M/ number street village "HOMEOWNER": iyli�S� tvl'!�l!/�L� ) ",f7° � '✓0 // ��O 6 12, name home phone# work phone# CURRENT MAILING ADDRESS: S city/town state zip code The current exemption far"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned."homeowner"certifies that.he/she understands the.Town of BarnstableBuildi Department minimum inspection pro c ores and requirements and that he/she will comply with said procedures and requirements. ,,✓� Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building perrnit 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 ad 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 Doerr results in serious problems,particularly . when the homeowner hires unlicensed persons. In this cast,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 responnbilities,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 seven)towns. You may cant amend and adopt such a for n/certification.for use in your community. Q:forms:homccxempt