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Home My WebLink About0013 BIRCH STREET C- 7- Town of Barnstable Zermoit4t�a �� S Expires 6 mon fr m issue_ } Regulatory Services Fee • snaxsTasrEMAM + 9� 1 Thomas F.Geiler,Director Building Division 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 r Not Valid without Red X-Press Imprint Map/parcel Number L 6 d a t Property Address 6z�i 0 Residential Value of +J ��' M. I, fee of$35.0 fo ork under$6000.00 Owner's Name&Address J0A l�- Contractor's Name ` Telephone Number � lJ �1� Home Improvement Contractor License#(if applicable). Construction Supervisor's License#(if applicable) PEP A's All ❑Workman's Compensation InsuranceAY MChe eS 2��2 m a sole proprietor ', I am the Homeowner oVVN O�B El have Worker's ompensation In sur c ' AR/VSTAB`E Insurance Company Name i �r �. �Y V Workman's Comp.Policy# Copy of Insurance Compliance Certificate must Accompany"each permit. Permit Request check box) ` , <� lie kf (CAftjAQ Re-roof(hurricane nailed)(stripping old shingles) All construction-debris will be taken to 0 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations'i.e.Historic,Conservation,etc. ***Note: Prop Owner must sign Property Owner Letter of Permission. A c py of the Home ImproveyCo tractors License&Construction Supervisors License is re uired. SIGNATURE: Q:\WPFILES\FORMS\bui mg permit forms\EXPRESS.doC Revised 051811 The Commann ealth of Massachusetts DepaphnentofIndusivialAcciden& 09we of Insw gadoxrs 600 Washington Stmet Boston,MA 92111 wwn,.mamgav1din Workers' Compensation Ins ce Affidavit Bvdlders/C;ontrActor&Tlectric ans/Phmbers Applicant Information I I Please Print 1,mbly V pp Name l):: �-C S Are you an employer? eck the appropriate boa: Type of project(regaired):. am a contractor an 1.❑ I am a employer with 4_ � I d I 6. ❑l�iew construction' employees(fail anfor part-time).* have fired 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-contract ors have 8_ ❑Demolition working for me in any capacity. employees and havre worms' o workers'comp,insurance comp.insurance-1 9_ ❑Budding addition d] 5. ❑ 1JVe are corporation and its 14.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their11.❑Plumbing repairs or additions myself.[No workers' right of rsemption per MGL 12_0 Roof repairs insurance required-]t C.152, §1(4),andtive have no employees.[No wmkers' 13..❑Other camp.msurance required_] •�l ay applic flat checks boa#1 mast also fill ow the section below showing thou vtmkers'compensation policy infnrmx&m Homeaa�ners Who submit this affidavit indicating they are doing all vat and then}tire outside canacntrs amst MA=anew afdmit indicating such 10witmctars that check this boar must attached an additional sheet showing the name of the sub. -cu muacam and.stste schemer armt these entities Dave empioyees.Ifthe hub-cnntactotsIm empT"s,theyxmrst:pmvide their eke s'comp.policy,number_. I aM an employer that isp works `'coarperts n i for any j�e Below is the policy an d job siloinformation. InsurancepanyName: Tolwwem* n.tt Policy#or Self-ins.Lic.#: I Expiration Date: Job Site Address: City/StatelZip` Attache a copy of the workers'compensation policy declaration page(showing the policy mimber 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 ofup to S250M a day against the violator. Be.advised that'a copy of this statement maybe forwarded to the Office of Investigations of the D for insurance coverage verification-, I do Hereby csrfefjr a theparns aMos of q that the inform ' :prm!"&d hove* and correct 2-614 Phone;9- f off mid U"nutty. Do not toile in this area,to be completed by racy or town o daI City or Town: PermitfLicense# Issuing Authority(circle one):: 1.Board of Health 2.Building Department 3.cityfrown Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• 6 -- - - I t To wn of Barnstable Regulatory Services • aaxtvsz�rs, + Thomas F.Geiler,Director �A 39. "�� Building Division Tom Perry,Building Commissioner f 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION t Please Print DATE: JOB LOCATION: 1' V Vl_6 0 ye street village / l "HOMEOWNER" i V 1 e " R/� �✓ />� , �Z J - ` _home p/hone# ✓ . work phone# CURRENT MAILING ADDRESS: Q(/ 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 buildingpermit (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 ed"homeowner"certifies that he/she understands the Town of Barnstable Building Departnent minimum' ection procedures and requirements and that he/she will compy with said procedures and require e - - ,. Signa of Homeown / r 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.' " r r HOMEOWNER'S EXEMPTION The Code states that Any homeowner performing work for which a building permit is required shall be exempt"ftom 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 full aware of his/her y 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. i Q:forrmhomeexempt HE t , Town of Barnstable Regulatory Services • �uvsrnsra. • "A Thomas F.Geiler,Director �Fp Buff0ing Di iS1U11... . Tom Perry,Building-Commissioner 200 Main Street,HYannis,MA 02601 www-town.barnstable-ma.us Office: 508-862-4038 F 508-790-6230 Property Owner Must Complete and Sign This Se on If Using A Builde as Owner of the ro subject J P .PAY hereby authorize to act on my behalf, in all•matters relative to work"authotiz b this building permit ddress of job) Pool fences an alarms are the responsi ' ' of the applicant.pplicant. Pools. are not to be fille before fence is installed an ools are not to be Utilized until ' final inspections are performed • d accepted. tore of er S' e of Applic VIVI - P t Name Print Name Z Date Q:F0RW:oVRgWERMISSI0NP00LS ''Coyle, Brenda From: Niemi, Maureen Sent: Tuesday, May 15, 2012 10:53 AM To: Coyle, Brenda Cc: Niemi, Maureen Subject: Donna Quinn Hedges Parcel 309-103 13 Birch Street Dear Brenda, Please be advised that I am in a payment agreement with Donna Quinn Hedges for the delinquent taxes owed on 13 Birch Street, Hyannis, MA Parcel 309-103 authorize a permit for a new roof to be issued. If you have any questions, please fee free to contact me. Very truly yours, Maureen Maureen E. Niemi Town Collector Town of Barnstable P.O. Box 40 Hyannis, MA 02601-0040 Tel: 508-862-4055 Fax: 508-790-6310 Email: maureen.niemi@town.barnstable.ma.us 1 Coyle, Brenda From: Niemi, Maureen Sent: Tuesday, May 15, 2012 10:53 AM To: Coyle, Brenda Cc: Niemi, Maureen Subject: Donna Quinn Hedges Parcel 309-103 13 Birch Street Dear Brenda, Please be advised that I am in a payment agreement with Donna Quinn Hedges for the delinquent taxes owed on 13 Birch Street, Hyannis, MA Parcel 309-103 authorize a permit for a new roof to be issued. If you have any questions, please fee free to contact me. Very truly yours, Maureen Maureen E. Niemi Town Collector Town of Barnstable P.O. Box 40 Hyannis, MA 02601-0040 Tel: 508-862-4055 Fax: 508-790-6310 Email: maureen.niemi@town.barnstable.ma.us 1