Loading...
HomeMy WebLinkAbout0020 CANTERBURY CIRCLE o?O �,✓rn��gu�c, Ci�C f .� Town of BarnstableBuilding [Posted,Until ostThis Card So,That it is Visible from the Street-Approved Plans Must be'Retained on-Job-and'this Card Must%be Kept SrA i65� :Final Inspection Has Been Made: j °i Where a Certificate--ofOccupancIY is Required,such Buildings hall Not be Occupieduntil a Final Inspection has been made er i Permit No. B-20-1026 Applicant Name: ENRIQUE SANTIAGO Approvals Date Issued: 04/16/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/16/2020 Foundation: Location: 20 CANTERBURY CIRCLE, HYANNIS Map/Lot: 249-114 Zoning District: RB Sheathing: Owner on Record: CAMPO, PAUL M &LINDA A f Contractor Name -,ENRIQUE SANTIAGO Framing: 1 Address: 20 CANTERBURY CIR Contractor License: CS-106463 2 HYANNIS, MA 02601 i g Est Project Cost: $4,500.00 Chimney: Description: replace roof Permit Fee: $35.00 Insulation: Project Review.Req: 6 Fee Paid;#' $35:00 Final: �. . Date:. 4/16/2020 . - y Plumbing/Gas �> .. Rough Plumbing: „ ,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after"issuance. All work authorized by this permit shall conform to the approved application'and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws-and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public,inspection for the entire duration of the , Final Gas: work until the completion of the same. i l � Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are;provided on this permit. Minimum of five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing ^' Rough: 2.Sheathing Inspection g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final �rr1AT-�� I Town of Barnstable P�°Frr+� c Regulatory Services Thomas F.Geiler,Director swxivsznSTAsis. Building Division i639• ABED MA'S s Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE. $ �" SHED REGISTRATION 120 square feet or less 4v1-- C f vL I L Location of shed(address) Villag z1 Property owner's name Telephone number Size of Shed Map/Parcel# Zvv s Si ature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) U/ZG Jai- 9+�, PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 w MC) �t t a --.a � z� � I �V I�,� `�L �{�9at.� S� /�, �/ =_ �, �� ���s S�a� .,,. .n...... ._,F...... _.a .,,�,.., ..f .•.+-+n.'c. ....,.-.r.:,.,.,....,.,,,-.� .r. - _.r .,.. . ..,.., .. .. .. .. TOWN OF BARNSTABLE BAR_W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Paul. Caxapo Address of Offender 20 Canterbury Circle MV/MB Reg.# Village/State/Zip C:e iit8r''it e MA €2632 Business Name am/pm, on , " 6/1720 03 Business Address Signatu`re.o-f Enforcing Officer Village/State/Zip Location of Offense 20 Canterbury Circle Building Enforcing Dept/Division OffenseBuild deck without permit. Violation of zoninc�r law, Article XIII Facts Section 3 s You have; seven days to comply or a monatary fine will be assessed.. This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. .PINK-ENFORCING OFFICER GOLD-ENFORCING.DEPT. y yoFTNETo�° TOWN OF BARNSTABLE ii • i EARNSTAHLI, i ° "6 OUILDING INSPECTOR DM a , APPLICATION FOR PERMIT TO ...................... ':: •.,........::....... ................................................................ TYPE OF CONSTRUCTION ...................... .4.*' ... . . .................................................. ................. .. ... `.. .........1 9.. , TO THE INSPECTOR O BUILDINGS: The undersigned hereb applies for a permit according to the following information: Location ...... ....... ....... ..... ................ ............................. ProposedUse ....... ." 2: ..................................................................:.................................................... ZoningDistrict .....,,. ..................................................:..............Fire District ........ .......................:.......................................... Name of Owner ddress ..... .� . ..... ri Nameof Builder `. f . Address ..................................................................................... Nameof Architect ..................................................................Address ...........................................:........................................ ... .: ....................................Foundation ..... .a ............................... Number of Rooms .......... x .. Exterior '... . .... i• '� - Roofing Floors Interior<'". _ ............... ....... .................. f Heating `- . .. °� ,�,::� .....Plumbing ........... .. Fireplace .....Approximate Cost ....................... .... Definitive Plan Approved by Planning; Board __ ________4_________________19________. Diagram of Lot and. Building with Dimensions' SUBJECT TO APPROVAL OF BOARD OF HEALTHCL I�N � `4 `� e � Ica 00 in / ?J Ld N (1) l— R`� r �a \ CL. s� i� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... e, 6 —, , z Cedar Acres Realty Trust a , 1533 Permit for one story No ......... single family dwelling .............�.................................................................. Location`..........anterbury..circle................... Hyannis ............................................................................... Owner Cedar..Ac.res..Realty Trust ........... .... ...... ............................ frame Type of Construction .......................................... ................................................................................ Plot ......................... .. Lot ............. .............. Permit Granted ......Auoist..4................19 72 Date of Inspection ....................... ............19 Date Completed ...3 ... ... 3.......19 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... I ............................................................................... Approved ........................................ 19 ............................................................................... ............................................................................... Assessor's map: and lot number . ......... �^ ,Sewage Permit number Z B9SBSTL.BLE, i House number, ..... ... ............. .................... y MA66 O YPY TOWN OF BARNSTABLE _ BUI-LDING . INSPECTOR APPLICATION FOR PERMIT TO . . ...R.V).A.p.....$40...IZ�.!A...................................................... TYPE OF CONSTRUCTIO_N ... M: :........................................................................................................... ................................................ 9. 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location . .4.....� +t" ... .V�y.... �. �'•......�`'��/ N�1S................. ProposedUse .. N..LSOQ1'h...... ..................... ... ................ .................................................. ...................... ZoningDistrict ..............................................................................Fire District ............................................................................... Name of Owner ,.r� �} � /'/O.k.r I N4...Address CIVf�t2�U.. ...C :..l�"! . ........ Name of Builder 14�/VIv/�1� 14 �l!�;IMC /oa �3Gc/E �3�rcay...l' ����....1.1.( . F i �..... .r.... ddress ............ ............................... e... / Nameof Architect ..``.....��.. ...`.............................................Address .................................................................................... : Number of Rooms ....PNrF...............................................Foundation .. .IA. ./.-"�.*i# .....78LOG. Exieribr h/t ....r•. l.... Roofing ..................... w........0... 014T hd4E.5....... sOP 0....s�l �.s........... .... Floors .........................................................Interior .../?QG.p............................................................... HeatingAl ........................................................................Plumbing ...Al.................................................................. Fireplace ..104/0......................................................................Approximate Cost ..L//..� f.�....... Definitive Plan Approved by Planning Board ---------------____-----------19________. / Area f� .�r.....:............. 01 qC Diagram of Lot and. Building with. Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH N. `tip a 7r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ... Name . .. . .. ^............ Construction Supervisor's License Ql?.3.5.7'........... a ?'; MURPIiY, EDWARD J. � 26617 `No .:.............:. Permit for ...ADDITION...............41 ...........Single„Family..Dwelling................... _ K r -Location ... urx.. jr.QjQ................. E t E r y ' a Fj � Y• k F _OwnerJ-...M�?Th.Y..... _ t �i Type of Construction ...k'x3 ............................ , .. ....... ............................................. E • Plot ............................ Lot ...... '.................. .. Permit Granted June..25;_ .....: . ... .1:9 84 Date of. Inspection ........................... .....19 t ' Date Completed ...� .�G / .. ...............194fY Z ,.. Assessor's map and lot number .1..:"...`.......r..:.. THE Sewage .Permit number X10 ..... .. y sS Z 89fl39TADLE, i :., House number ..... .., .e�....s :`}a................ ..................... ro rasa r w oft p IPY.a\0� TOWN OF B,ARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... L D Su W R, iyi ..................? ............................................................................................ TYPEOF CONSTRUCTION ... �............................................................................................................ .....�..�.............................19 a€f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 0... s?fN r. ... "�. 2 ....�y~�..Z��. .=......f—(�/' Nt'°................. r. r ProposedUse ... t,a, a...��: : ?' :. .................................................................. ............................................. .......... ...... ZoningDistrict .............................................................r...�..........Fire District ...............................................................t. Name of Owner . .. . .! ......�.c..l..'.!.U!�.rH ...Address .��-. ,.> C;4 of 1=fC 30 le�...� ?...T ��f....... P _ r. Name of Builder j� RYA-�01V f `/f "f.S`Address . )1.� J�aLtf l 0K rc E�.. r' .... ............. .. .l. ... ...................... J ArYt Name of Architect ................Address .................................................. .................................................................................... Number of Rooms + IV/= Foundation .., . �..► " 'c r.` ...........`"�....� 3�1'JG... .................................................. ... Exterior . S...........Roofing .. e /l1� ..................................... / yY!:t� 1ira ..� ..I....... Floors Interior .......... ......................... l`� �t� Heating .............................................:.:...........................:......Plumbing .................................................................................. Fireplace As Approximate Cost :.r !..� 4................................ ............ i V Definitive Plan Approved by Planning Board -----------_-------------------19--------. Area .... ..t ry.................... Diagram of Lot and Building with Dimensions Fee `" ""' SUBJECT TO APPROVAL OF BOARD OF HEALTH `A 75 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. R_- Name k..... ............ ........... . .... .� .............. r Construction Supervisor's License A/ .. ...:! ............. MURPHY, EDVPM J. A=249-114 26617... Permit for Ad.dition'..To...........No .............. Addition .... SingleFamily Dwelling.............................................................................. • Location ...20..Cante?�Pury..!�irqle .... ........... . ............................ Hyannis . .............................................................................. Owner Edward J. Murph y y .............................. . ............................ Type of Construction ..Fram.e...................................... . ................................................................................ Plot ............................ Lot ................................ Permit Granted .251.................19 84 Date of Inspection ....................................19 Date Completed ......................................19 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. Z411 Parcel f M Permit# Health Division�: -��� �� 23 03 ����� � ' ,Y'_ B E k#: a A 3t�ate Issued Conservation Division ("I ZA u'€s 26 Phj, i Application Fee {` Tax Collector °l'/ Wo-3 Permit Fee Treasurer 4P 3 0-3 Planning Dept. ORPTIMSTEI!A MUST SE INaTALL21)IN COMPLIANC. Date Definitive Plan Approved by Planning Board WrTH TITLE 6 DMR041FAENTAL CODE ANL Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address Village Owner ;� J/d ZMZ>_ , Address 00 Telephone ° 7Z- Permit Request _Mlev 1 2 Z x 1`L' Square feet: 1 st floor: existing—1.9z proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation'll;;Iezu� Construction Type �>r;,h Lot Size 14,Od6 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Y Two Family ❑ Multi-Family(#units) Age of Existing Structure -So mac, Historic House: ❑Yes Clio On Old King's Highway: ❑Yes- WrNo Basement Type: 96rFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) -1�5 Number of Baths: Full: existing Z_ new Half:existing j ne.W_ Number of Bedrooms: existing new ; ry 4 rn Total Room Count(not including baths): existing new First Floor RooniTount 6.�-2 , �r Heat Type and Fuel: d Gas ❑Oil ❑ Electric ❑Other co ry M Central Air: ❑Yes & o Fireplaces: Existing / New Existing wood/coal tove: ❑Yes RAo Detached garage:❑existing ❑new size Pool:Cl existing ❑new size Barn:❑existing ❑new size Attached garage:Qexisting ❑new size "3"w Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 2 No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone umber ( �) 7 7/ G ,<< `s Address License# 1 s. Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ✓SIGNATURE �f J? � -�-•��--�._ DAT�� � `� ��� , a FOR OFFICIAL USE ONLY PERMIT NO. ."'' 'y. f -DATE ISSUED `1 .� ` ) j MAP/PARCEL NO. ADDRESS ) 'l VILLAGE OWNER j-, A 1 , DATE OF INSPECTION: FOUNDATION s FRAME INSULATION `^ FIREPLACE _ ELECTRICAL: ROUGH FINAL- PLUMBING: ROUGH FINAL. GAS: # ROUGH FINAL''' FINAL BUILDING , rr `DATE CLOSED'OUT `.'ASSOCIATION PLAN NO., - 5 s . t • r t n • Town of Barnstable Regulatory Services Vl �' BAaxsrA=, ' Thomas F.Geiler,Director NAM 9q, 1639. .b� g Buildin Division ' plfp�,�A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no.� - Date AFFIDAVIT HOME ny2ROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type.of Work: Estimated Cost Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Doti Under$1,000 []Building not owner-occupied YOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME Z1PROVEMENT WORK DO NOT HAVE ACCESS TO TEE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. 10 r, +e wner's_NAme The CoMmonwea--lth of Massachusetts ....... — Department o f Industrial Accidents -_ -- Office oflasesaffloos _ 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affid avit � name: L G , location_ ci 1 hone# — — ©'I am homeowner performing all work myself. ❑ I am a sole rietor and have no one workiiin ca acitp ly rovidin workers' compensation for my employees working.on this job. NE" : }::i}}:: ::::: :::::<><;<:.:,.:},:: :: I am an anv:nam :. ?�'<;::#.i: to z'•> C::(}:{;:;:ytti};i:;:ii:�i:^:'�:$}i'}:iii:M1 r:j;.;•;:;`iC4::{%::•.::::�iiiiiiiii:vti::}:;:y},{ii,;};�}i:y!;ii:tiv~?,;:iL�} ..4.ti ;.,;.....:v0•:...{•::.:: •±:v:ri'C vr::i;{{•?:•}:;i}$•:r:;Y.;:;:;i;}:::::ii'i}:;:;i^:}:j.}}:•}:r.;3:{.;�w:'•i}}v'::•.:}v:.:1i{ 4 ,,j(j� '+:y}:}ar >'>•:: {h '••e+TF ' ?:j�::'':::'v:' i�:vi::.}i::?::L: i:S::;:;J:j:: ^';.'.;} ::.. tQ >.45>i ••;( :ij??�i�i�i�'::�i: :{;}?+;f;{::';?{{?.?•::+.?:{isjtM1t:}jY:is �:•,'!'..?:{:v:`':i�:i{: }�iii:}:;�;Y:;: •'`?'•:CA�.C�x;!.;ii:::::::':.ii::iti:::::::::::::i:;:yL::4:::?'i::::;:v:`::?:•'.:::[: ::.ii:•,:;:j:!Y::i:::i:�:�.:i;y'.i::.';:�.:;•':;.;:;':!:::;'�i tii�:: v: ; ? {{: ; 21UTaf1 ❑ I am WE a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have therktrs' co ensation olices; :...........:.................. :.... :;< > 's 'am :.:.....:........... istii•±:•:4:w::::.v :::.::::::•::::•..n..... r::::::.....:.:........:.................:....:::....:......n..::.....;::.}.�::::.::.::::::• .r.:v:{.; :.::.::.vn......::v:::.,,.;. •:•::•::.v. ,:.::::•.....:;{{.}-.:::::}::;{:Lw:::::::•:.v:::'-::?::::}::}'•i::i:::};?:.i}:L{::.... :..;ti v'v}.}:•f�::}vi.:'•r: .: ..... ......... ........... ......... .............. ...........,...............:v::.................v::;. ..........:::::..:.;....;,::::::.:v:::::•X{•}:•;{•:x::j;:;•±rri{tiiL�`}:..}}}} :}v.tn'?i�:ii$ ...... ...... ..... ... ............................... ....................:-.�:::::::.....v.....r.:::v::'•.{;^::::::?::.v::::::::.:::n..v::;::•.v:::.v:w:v:rr,.:w::n..... ...vf:\•}:•::::::: :........}...�........:::................:•:w.... ......:{.:.....................::•.:v::::::::.v:::::::::.v:::.v:-i+N}:{:::::::::.....:.::.::...................... :...,......n�.•:•::•: •:Ysv.{v.f.r........... ' jirC3§isv}::?;ii:;isi:'v;:{j{::• {f:;.v,:;i:::is�iiv'{•i:::::.?:{r•±::;.;:.v::;::;:r::•:.�:n:'::.;..::;::.y v:.;:•�. {{:::.v:L:^is�}'+ti}}?:j::{:iT:ii:-'i}}}}i1.4:;:•}:•ii±i:{: ..... ....................:::.:...................::..::...................:�::::::.......................r.:x:.::..................^::.±................::::. .,.........J...nr.::.v:x:w:::::i::n.....ti•... .4:v:n;,}+`.tAtL>�.C'�;iY -;.vv)(,:;;.v ............................::::v::::::::::.v::.}}:{{•}}:;J:3::::.v:::i'ii:i':}±?:i}•:vr:::::::.:::.:v:::::+v;.}}::•}}}.v::i.:v{:;+•.,v w.;{•::... e. .. ............. ..{..:........ .. ................ ...............:....�rr...vr....:vi::L•}:•}::•:v,ry.v:.:±:•}}i}}:;4:;' ...:•}.... :::..v...:...v.:,r.' v:+:x::: ... .. .:.:::::,•::.:vv-.r:::...........n.,.:v:.::::..�:.v::.::{•:{;{n'{{:.v•.v;:::::{{::::.;<{{:::4;i{•}i:•i.}:::i;v5v:.�::•:;::.:. tf�nraitee:so:{:.;?:{:-{,.::::;;::.:,,;.:::.:.:::.:::............ .......:,............:...::.....,...... :;:}�yi:�:;i:;:$;:$i$;:;i!{:?•:i-+.iii.'•i:i�i;:;:'i;i:is�iii:ti::is.:;:;:':•.:;:;:}:-F�{}::.�{: :i;tii:;iiiir;;:i:?�i}}J:•:�}:4}i:::�:L!;::?:::.:}•+.:::¢}>:i:vi}}:{4}}}:L{•�::::i•i:3}ii}:nv::w...;...... ::.::•::vY<^}}:i{•:•�:;•:{.???:!•%;•}:'!{-:;v�:-ii}::•.;,?':.:;;...: ... ..,�,.\ri'vviitiJiviv,�:Cti:i:i(:ii:?:�i astIIe:......... is .....::... ....:.::.:..:... i:.}•}: t7II .,�l " :{......... ■t �1 :ar. rYy •}}:•}?:•}:}:•}::•:::ii::�:22�iri>i}:�;:;:;:::�}?;:�::�:`�::::i;•;;:<�Sig,:•::•� ::�:a��:�i::':�:%�:: :� `::;:%::r::S:�:�{:}:•:oi5:,:•::..,:•:.::•::•:.•,:•::•.:::•.:•:::•::::.::-::::::.;..�:::::.;•.;:±.•::;�::{r;,.:;,.:;Yy:..;.;........:. FaOme to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,S00.00 and/or one years,immptisomnent as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify wqe1he pains a aand�penalties of perjury that the information p►ovided above is trup.and correct If/L Date - Signature' Print name ✓�,�•� L. t Phone# 2 ^ 7 rlG� oftldal use only do not write in this area to be completed by city or town official city or town peradt/iicense# ❑Building Department ❑Licensing Board ❑Selectmen's Office ❑checkif immediate response is required ❑Health Department contact person: phone#; ❑Other (Umvised 9/95 PJt� Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", 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' wo 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 ttie'owner:of a hovuse ha ' not more than three apartments and who resides therein, or the occupant of the dwelling house of dwelling dwelling house or on the grounds or work on such dwe ' construction or repair o persons to do maintenance, another who employs to s p Y building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 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,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until ce of compliance with the insurance requirements of this chapter have been presented to the contracting ac c table evidence P eP . authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your siftmdon and N.'' supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may e V, submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and �i_ 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit yo u ou to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please-be sure to fill in the permrtllicense number.. which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a calla 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 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409. or 375 f 1, The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 \ Fax: 508-790-6230 1 • HOMEOWNER LICENSE EXEIYIPTION Please Print DATE: 70B IACAMON: - / number Q street village "HOMEOWNER": -1��,/yi/l[� S0�• �T�'^C3�/� name home phone# -work phone# CURRENTUkWGADDRESS: ic city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellines 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. DEFINTITON OF HOMEOWNER who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is Person(s) 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 B arnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures requirements. Si tare 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 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. Iu 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. T�a i„ tha r the hmeowner is fully aware of his/her responsibilities,many communities require,as part of the permit IN i A"a \ 1