HomeMy WebLinkAbout0068 CARLA ROAD �8 C�-A �o,9t�
L = Town of Barnstable Ulllil
g-,
. . � .
�qi
sthis..CafPed UntilFinal lnspect on HasnBeen,Made �,Wreas Cert�ficate`of O�ccu an�c ,IsxRe aired such Bwldirr'•shall'Not'be.Occu ied"until a Fina�lns ection.hasH,been made Permit
11 it
Permit No. 13719-912 Applicant Name: Kaitlin Harrington Approvals
Date Issued: 04/12/2019 Current Use: Structure
Permit Type:. Building-Solar Panel-Residential Expiration Date: 10/12/2019 Foundation:
Location: 68 CARLA ROAD, HYANNIS Map/Lot:' 248 163 Zoning District: RB Sheathing:
Owner on Record: WOJTOWICZ, ROBERTT&FERGUSON, ( Contractor Named Richard J.Tobin,Jr. Framing: 1
Address: 68 CARLA ROAD `= Coritracto�r License:4-CS074317 2
ff
HYANNIS, MA 02601 r Y Est Project Cost: $15,000.00 Chimney:
Description: . Installation of a safe and code compliant grid' pusystem; t Permit Fee: $126.50
roof mounted 15 panels 4.875 KW ) Insulation:
Fee Paid• $126.50
Project Review Req: r£ Date 4/12/2019 Final: ;.
Plumbing/Gas
cg Rough Plumbing:
,
. �.h ui in iaa
hon -
This permit shall be deemed abandoned and invalid unless the work autzed`by4this permit is commenced within six mo-'hs�after issuan Final Plumbing:
All work authorized by this permit shall conform to the approved application and the,approved construction docu is permit has been granted.
All construction,alterations and changes of use of any building and structures'sh"all be incompliance with the local zoning by 1'ws;and codes. Rough Gas:
This permit shall be displayed in a location clearly visible from access street o"r ad d shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. Final Gas:
The Certificate of Occupancy will not be issued until all applicable signatures ,y the Building and,Fire Officials are,provided on this permit. Electrical
Minimum of Five Call Inspections Required for All Construction
1.Foundation or Footing _ Service:
2.Sheathing InspectionTV
..
3.All Fireplaces must be inspected at the throat level before firest flue I rLI g".1 installed . Rough:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Priorto Covering Structural Members(Frame Inspection) Final:
6.Insulation Low Voltage Rough:
7.Final Inspection before Occupancy
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. "
Low Voltage Final:
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons c tractin with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final:
�
Buildingplans are to be available on site p Fire Department
$ All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
'Town of Barnstable Pen nit: l l
Regulatory Services ate: /al/t�
oF�"E Toir. Richard V. Scali, Director
Building Division ee: S
9 MASS. Tom Perry, Building Commissioner
p i639. A�0 200 Main Street, Hyannis,MA 02601
rF0 MAC
www.town.barnstable.ma.us
Office: 508-8624038 Fax: 508-790-6230
TOWN OF BARNSTABLE
SOLID FUEL STOVE PERMIT
Owner: R o�eA Wo�towC G- Phone:
Install at: oa p Village:
.__-_- ----Map/Parcel:_. a.�t�_. ! ��� Date:
Stove
A i�l Used
B. Type: Radiant/ irculati t
C. Manufacturer: Lab. No. I or 14 Idbe
D. Model No.:
Chimney
A. New/ xisti (If existing,please note date of last cleaning)
B. Flue Size "
C. Are other appliances attached to Flue? AJO
D. Pre-fab Type and Manufacturer VPNPi 1 i t--Lo .
E. Masonry: ine - nlined
Hearth
A. Materials: C,cf� 4lrc�� rd� `
B. Sub Floor Construc ion:
Installer
Name: g� ��i`f-l9tdlG-� Address: 6 �kAI
Phone: �l �- .
Location of Installation: lw+Q A00W, hey
H.I.0 Registration#
Construction Supervisor#
OR check V11"Homeowner Installing, no license required
LICENSED INSTALLERS SIGNAT
APPLICANTS SIGNATURE:
APPROVED BY: / /► — /
Please make checks payable to the Town of Barnstable
*This constitutes an official stove permit after inspection,photographed, and approved by the
Building Inspector
Q:forms:stove
Rev 11/4/13` ;
�I, Town of Barnstable _
t
Regulatory Services
>awsuvsresLs, : Thomas F.Geiler,Director
MARG
ram ,, 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
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: Dec_ Il�fi'�!Y
JOB LOCATION: b �u s- O0.[Q Qhh S
number street 9 village
"HOMEOWNER": No6e L 10 Iti6f.,tc- . y Y'3.4 36—6?6 Z)
name home phone# work phone#
CURRENT MAILING ADDRESS: 1; Cez('Lk
Mty/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"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 Ho owner
Approval of Building Official
dwellings containing 35,000 cubic feet or larger will be required to comply with the
Note: Three-family
State Building Code Section 127.0 Construction Control. .
HOMEOWNER'S EXEMPTION
The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such.
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas 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:homeexempt
oFTME Town of Barnstable
Regulatory Services
MASS. Thomas F.Geiler,Director
i63a
r�,�►�" Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnsiable.ma.ns
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subjectpropetty
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit
(Address of Job)
Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signature of Owner Signature of Applicant
� � rr t
Print Name . Print Name
Date
QTORM&OWNERPERMISSIONPOOLS 62012
09 Won Street
ffaskuz,.MA 62M
Warke& Campeusaficuhaa ance� frdavrL�aildersfC�anb7actgrs/Efec£ric=snmmbers
Applicant I-a rmatian Please Print Le�ihl
I�Tar�e( ndt �al�: k4u
Adchres
Are yan ah eurplayer'? eckthe appropriate bG= - Z of a'ect r
1_❑ I am a to With 4-.❑ I am geact-al ccufmcfor and I 3 p� e 3 {d��=
�P * have;hir>�tbe sorb-raatmctars ❑Ideur�z
erugloyees{fuI1 aztdfocgaLt-#ime). -
2-❑ I am a sole prap�tor orpa-taer fisted on th-e attached shy 7- ❑Rradeling
ship and have no employees These snb--aogiractms have g- ❑DeMCiifina
la anti have workers'
� �� � Q_ ❑Building addifian
• [N6wadan:s- covpp_in=ante CaTZtp_mcltrwrrt
- aTaireL] j_ ❑ We:are a carparatfanand its IO..❑Electrical regsics ar add�ians
I�I am a hom. doing aII wail= a$u-.ers bay earn-;and their 1 f❑Plumbing repairs ar addstion5
mvc Sf [No"workers'conpp- :6�.ofe=mpfian per MGL 12-0 RDofrepaus
i e� uL n re nxp ire-3_I-F c 152,§I(#),anti we lrs�Te no
employees_[No workers' -❑Other
comp_in-ce
ikny mph fhxr checkshastI list also ffi out tie:secdonbcSaxshrxing the rwD&E s'mmneassfioapaw=TM' '
j Sametrwnes crht,�l;�i i�.ts soda;;,i:,rn r<rr+•g�z�e ctaing.II r.�•*�-_TMi�h;,-e tii*lside contracture n:mst snl�t a uezz<a�dscst m"'�snrh
r( +r=ors thst rh�rk this bur mast attfirhgi sn an t;t rn t sheet shnxmg then�me of sub comas andstate u}rEther ncnatfise fi
_ es�Iuyees. Ifthe sah-car�drnsh.'ce empTo�s,thegrmist provide the tvaib�rs'camp.paIicpu�bez
I ivri atr 6r-rvinyer thrrtisgrtn tvarkers'c-orrg7en rvian insrtr=c8 for rrzy angAEGyLcca. Bezow is tFte pp&cy raid job situ
Po Huy 4 oSSeFf-ins_Lic f IxpEmfiau.Date:
Job! rt dress CrfgfStatdZtp:
Attach a COPY of the M:-kers'Wnlpeusatian palicT declarstiou page-(showing the polio number arrd cKpi ation date):
Failure to sea xm cov-eras a-&stain d.nuder Sectio€-25A of MGL c 152 c$n lead to 6e imposition.of c6mmal pmalkiEs of a
Rue-up to 5 L5OG-GD andlor one yearimprisor ,as wf--U as civil pesatties in the foTin.of a STOP WORK OID:EF-and a free
of up to$250-Do a day against the violator_ Be advised that a cbpy of thin statement may be Ex-warded to tht Office of
Liviesfigatiom of ffpe DIA for ins:=C;coverage ved5catia r
���.fy
.p too Fatzr-e u tlra s rri srpa.�ftss tfratfhe�vnrzatrnn rax�r£rrbAt e is Irua rrnd cArrect
Signatures: ]date
phone i ,
r cisrI Eras ari£y. Dar rrat wri&io flits area,iri be caRzpieted by d3`ar tawff rrfzcia£
C`itg or tow Psr�s;tlT ceztse#
Issuing Authority(drde dney. '
L Baard Qf$eaItfp 2.Burffang Depzcbn--tat I Gti fFuwn O=rk 4_EIecirical Fnslrector 5.Phun -big Elzpmtor
G.G�
Cor�ctgerson: g1>:on��
- G
Massar General Laws chapter 152 requires all employ err to provide workers'compensatioa for fheiT~`e> p?t%iee
PMST] to this srai e,an mpFayyee is defined as`--every person is the seaviGe of aaother under any contract ofhim,
exiPress or implied, oral or written.." .
An e TTzyer is defined as aaa individual,partam--14,association,corporation or othe r legal.entity, or any t\vo or more
of the.,foregoing engaged is a joint enirEprisn,and iaclading the legal representatives of a deceased employer,-or the
receiver or trastee of an iadivid A partneaship,association or other legal entity,employing employees. However the
owner of a dwelling lzause having not more than three apartments and who resides therein 'Or the occupant of the
dwelling house of another who employs persona to do mamteamm,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 stag or local limnsiag agency shall withhold the issuance or
renewal of a license or permit to operate a business or to constrrct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the basvrance.coverage required.''
Additionally, MGL chapter 152, §25C(7)states'Ne-ithea the commonwealth nor any of its.poliiical subdivisions shall
enter into nay contract for the performance of public work until acceptable evidence of compliance with the in¢UI ce
requirements of this chapter have been presented to the contracting authority.'
APplicarrts
Please fil.I out the woricers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary, supply sub-contractDr(s)nam(--(s), addresses)and phone numbers)along with their cer�ncaic�s) of
insurance. Limited Liability Companies(LLC) or Lun tedLiability Parfneisbips(I I.P)wzthno 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 reqused Be.advised that this affidavit may be submitted to the Department of Industrial
Accidents for confrmation ofinsm- nce 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 Deponent of
Industrial'Accidents. Should you have any questions r aardhig-the law or if you are required to obtain a workers'
compeusafion policy,please call the Depar iacat at the number listed.below. Self-insured compani es should enter their
sell in�nce license number on the appropriate IiDe.
City or Town Officials .
Please be sure that t ie affidavit.is completes and print d.Iegrbly. The Deparbmeat has provided a space at the bo rn
o f 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 flI in the permitlliaense number which-vU be used as a reference number. In addition-an applicant
that must submit multiple pcDm Ylicense applications in any given year,need only submif one affidavit indicating current
policy iaformation(if n(--cessary) 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. Anew 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 Yentjre
(i_e, a dog license or permit to b=leaves etc.)said person is NOT regained to complete this aff davit
The Office of Investigations would h ke 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 nimber-
aI Commaawt-,Ka of Massachu-%#,
Depaitiuffat Qf Jjid al AQaideat
�4C� �shzu�an �
R la�MAG21II
T�L_f 617 727-49 0(�)±4-€6 ar I-U7-h SAFE
F�x 4 617-727-7149
Revised 4-24-07 y a _go�r�clia
., Q
A 76�
OfTHE r `� Town of Barnstable *Permit#
Expires 6 months issue dote
OR ?0 ®� Reglulatory Services
v� 6�9 08 Thomas F. Geiler, Director f[L
AT�o��a RNdS . . .
T,qB`E Building Division
Tom Perry,CBO, Building Commissioner
' 200 Main Street,Hyannis, MA 02601
www.town.barnstab le.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press hnpri.nt
Map/parcel Number _-_Z1 $16 �-
i
Property Addressbx --
�sidential Value of Work �(`�6J M.inimum/ee of$25.00 for work.under $6000.00
Owner's Name & Address-- �,_AV_a " �d `L in
Contractor's Names Telephone Number
I Ionic Improvement Contractor License ff(if applicable)
Construction Supervisor's l.,icense 0(if applicable) / .S �?_F r _
orlanan's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am.the Homeowner
lave Worker's Compensation Insurance
Insurance Company Name. y vt
Workman's Comp. Policy# �la IN e 4 Z
Copy of Insurance Compliance Certificate must be-on.file.
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)
❑ Re-side
[Replacement Windows/doors/sliders.U-Value 31(maximum .44)
*Where required: Issuance of this pennit 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 II a Improvement Contractors License is required.
SIGNATURE;:
Q:`WPFIf.ES\- )RMS'�building permit ronns\EXPR dos
Revised 100608
i
p -✓ P� �u
Board of Building Regulations and Standards
a
*' Construction Supervisor License
License',CS 95228. 1,j
Birthda e�3/2211982TO 8
952
z 1
�i Exp�ratwn 3i22��L010
Restnction00i`
i 1 x I�
.� .DANA PICKUP
, c✓ { I
J .19 HAMLET STREET_'`„ I
•
MA 027.19 Commissioner
FAIRHAVEN, �
_p ac`uc6el
` v ndards License or registration atet if foundd for s return to idul use only
Board of Building.RegulatWs and S before the expiration d
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR ; one Ashburton Place Rm 1301
Re9istra on ,10Q503 Boston;Ma.02108
Expiration 6b:19/2010
t`luge Supplement Card
yp
CARE FREE HOMES INC Y tJG
DANA PICKUP,JR � 1 I Not valid without nature
239 Huttleston ave. `4 is
719, Administrator.
Fairhaven,MA 02
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
d 600 Washington Street
Boston,MA 02111•
°,k ,.•�' wWw.mass.gov/dia
Workers}Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A licant Information- dn Please Print Le ibl
Name(Business/Organizationffndividual): . d
Address•?���
City/State/Zip: ��n�/t .-�-►-M--
Phone.#: ?�r'l
Are.yo n employer? Check the appropriate bog: .'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
odeling
2.� I am a'sole proprietor or partner-
listed on the-attachedsheet. 7. m
sub-.
ship-and have no employees These sub-contractors have g, []Demolition
-;working for me in any capacity. employees and have workers' 9• Q Building addition
Ce comp, insurance,$
t es co
mp.inEuran
0 workers., � ,
w p 5. [] We are a corporation and its 10. Electncal repairs or additions
required.] '
3.❑ r qu a homeowner doing all wotk . officers have exercised their 11.0 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' Un 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.
$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: g
Policy#or Self-ins.Lic.#:��.0_ 9/? 9 Expiration Date:
Job Site Address: &1 F l� � � City/State/Zip: �
Attach a copy of the workers' compensation policy declaration page'(showing the policy numb rand expiration date).
Failure•to secure coverage as.required under Section 25A of MGL G. 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
Inve,sti ations of the DIA for insurance coverage verification.
Zdo hereby ert' under the pains-and enalti fperjury that the information provided abovg is true and correct.
Si afore: Date: 7 U _
Phone#:
Official use only. Do not write in this area, to be completed by,city or town official
City or Town: Permit(Lic ens e#
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#:
JUILU1XAAdb8,&Vlil 64.A.9.M �t;g�tsys� am ®.emco�a,�
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 hiie,
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 onto 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 cornplarree with the insurance
requirements of this chapter have been presented'to the contracting authority:
Applicants
Please BE out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contiactor(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
t or license is being requested,not the De artment of
be returned to the city or town-that the application for the perms . g P
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 li."'enses. 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 cowmwwwth of Massachusetts
Dtpartrafmt of end tt' al Aecidmts
Office of fn�estgaoz�s
600 Washington Street
�oston,_1�1A Q2111 .
Tel. 617-72.7-45N ext 406 or 11977-MASSAFE
Fax#G17-727-7749
Revised 11-22-06
www.mass.gov/dia
'4
tHerOwti Town of Barnstable
Regulatory. Services
9 Huss. �, Thomas F. Geiler,Director
men �a 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 Us ing 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
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FO RMS:O WNERPERM ISSION
Town of Barnstable
�oFz�T°�ti
Regulatory Services
BARNSTABL.E, ; Thomas F.Geiler,Director
� MASS. Building Division
'`rEn►M't"
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
vrww.town.barnstable.ma.us
Office: 508-862-4038 Fax: S08-790-6230
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 190MEONVNER
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 homewAmer. 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 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.
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 who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as.part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a,form/certifi cation.for use in your community.
Q:forms:homeexempt
i
Client#:33723 CAREF
ACORD,M CERTIFICATE OF LIABILITY INSURANCE D9104/0roDm v,
09/04/08 -
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Herlihy Insurance Agency,Inc. A ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
54 Pullman Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POL
ICIES Worcester,MA 01606
• _ . S BELOW.
508 756-5159 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER& Acadia Insurance Company
Care Free Homes Inc INSURER B: Interguard Insurance Company
239 Huttleston Avenue
INSURER C:
Fairhaven,MA 02719
INSURER D:
INSURER E
COVERAGES
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 CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
- POLICY EFFECTIVE POLICY EXPIRATION
LTR NSR TYPE OF INSURANCE POLICY NUMBER - DATE MMIDDIYY DATE(MWDDIYYI LIMITS
A GENERALLIABILITY CPA0265674 0910 108 09/01109., EACH OCCURRENCE $1 000000
X COMMERCIAL GENERAL LIABILITY - PREMGES Ea occur ante $300 000
CLAIMS MADE I X1 OCCUR MED EXP(Any one person) $1 0000
PERSONAL'&ADV INJURY $1 000 000
GENERAL AGGREGATE s2.000.000
GEN'L AGGREGATE LIMIT APPLIES PER: - C:•_ PRODUCTS-COMP/OPAGG $2000000
POLICY[71 JET LOC
AUTOMOBILE LIABILITY
COMBINED SING
LE LIMIT-
$.. .
ANY AUTO (Ea accident
ALL
OWNED AUTOS
s.
y $ODILY INJURY
SCHEDULEDAUTOS (Per person) $ '
HIRED AUTOS BODILY INJURY ,
NON-OWNED AUTOS - ," (Per accident) $
PROPERTY DAMAGE $ -
(Per accident)
GARAGE LIABILITY - - - AUTO ONLY-EAACCIDENT $ -
ANY AUTO - -
OTHER THAN, . EA ACC $
• AUTOONLY: AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE. $
OCCUR CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE
RETENTION $
B WORKERS COMPENSATION AND CAWC917429 09/01/08 09101/09 WC STATU OTH-
EMPLOYERS'LIABILITY - - .
ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000
O /MEMBER EXCLUDED?
yes,de
If yes,describe under E.L.DISEASE-EA EMPLOYEE $1+000+000
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS -
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION r Town of of Barnstable •„. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL• -..1 n. DAYS WRITTEN
Buildinga
Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILUR
E TO.00 SO SHAH
367 Main Street - - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR -"
Barnstable,MA 0260T REPRESENTATIVES-
` AUTHORIZED REPRESENTATIVE
}
ACORD 25(2001/08)1 of 2 #M35563 MSS 0ACORD CORPORATION 1988
OFFICE: (508) 997-1111 ®® MA. Builder's Lic. #021330
FAX: (508) 997-1297 CARE F fR E E Home Improvement
TOLL FREE: 1-800-407-1111 Contractor's License
WEBSITE: s inc. #100503.MA.
www.carefreehomescompany.com .239 HUTTLESTON AVE. (RT 6) FAIRHAVEN, MA 02719 #15179 R.I.
NAME �� f�f�)27'(0 DATE
ADDRESS ZIP CODE C):iZ��/�
ADDRESS OF JOB �` / TEL
JOB DESCRIPTION
go
l
74X�t ?/�l �-; S' Cr�
y "
77Z-0 S 1z)6&
G
C r1C �
Scheduled Start G `[ = Scheduled Completion 0 S%
A. Replacement of missing or rotted lumber is not included unless specified.
B.Ali start&completion dates are approximate and could change due to weather conditions.
C. Stripping of roof includes removal of up to two (2) layers of shing e ach additional layer to be charged @ ftz"
D. Replacement of rotted roof boards/plywood to be charged @ ft2.
E. Existing chimney flashings will-be reused; replacement, if necessary, is not included.
F. Care Free Homes, Inc. is not responsible for mold/mildew conditions that are pre-existing or result from leaks not brought to the
attention of C.F.H., Inc. promptly.
The Company hereby proposes to,furnish labor and material to complete the above work for the amount herein. Fulfillment of this
order is contingent, however, upon the want of strikes, fires and any natural disasters, the ability to obtain materials, or any other
conditions beyond th`e)control)of..thCompany. I
Cost of projects PAYMENT TERMS
Date i
1. You,the Owner,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.
2. You,the Owners,agree to pay any and all expenses incurred by Care Free Homes, Inc.in collecting money due under this contract
and enforcing the terms of this contract, including but not limited to, reasonable attorney's fees, interest and court costs.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
CA E HOMES, r.C. AC PTED:
( 'T�
By: � � � Buyer acknowledges Owner
CARE FREE HOMES,INC. receipt of fully completed —":— ---
copy of this Agreement Owner
All contractors and subcontractors shall be registered by the director and any inquiries about a contractor or subcontractor relating
to a registration should be directed to:
Director, Home Improvement Contractor Registration
One Ashburton Place, Room 1301
Boston, MA 02108
Tel. (617) 727-8598