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HomeMy WebLinkAbout0051 DUNN'S POND ROAD 57 u.ti n's Pond �c�, �INKE Town of Barnstable *Permit Expires 6 months from issue date J1 Regulatory Services Fee 3, 0 anaxsrnsM M"S& Richard V.Scali,Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street:,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY y Not Valid without Red X-..Press Imprint Map/parcel Number Y ���� Property Address n at 14 in 5 n ^-,nd 1 Residential Value of Work$ �, 700-oo Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ; Qwj�CU t u N vt Y41 �j Contractor's Name Telephone Numb44 T I L' 136 -2W'Z— Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) aff waft Amr"1 , RAN ❑Workman's Compensation Insurance °i °S Check one: ❑ I am a sole proprietor NOV 14 2016 tjI am the Homeowner TOWN 1 have Worker's Compensation Insurance OF BA R N S-i"I1/rj B p®L E Insurance Company Name a Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to.__,�_ (, ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Wlicre 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 Nome Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Filcs\Content.Outlook\2PIOIDNR\ExPRESS.doc Revised 040215 Town of Barnstable Regulatory Services oF"E Richard V.Scali,Director Building Division 4 ' Baaxsr IRZ " Tom Perry,Building Commissioner , 1639.A�� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER:LICENSE EXEMPTION r - Please Print DATE: JOB LOCATION: Sr 1/LL4LN S �ytC�/�/1 �iVLLb1Yt/ S � �}36 number 11` street � n village ••HOMEOWNER":„,��/� �t?�>Ar ,Y 1 ,hi b Zoo—Z name ,home ph/one# / work phone# CURRENT MAILING ADDRESS: �I �uvb✓1 f (cJ+�1 /(['�I �yCt AV+ 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 worts 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 Tn�iy d that he/she will comply with said procedures and requirements. Siffhature 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. 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. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOID14RXEXPRESS.doc Revised 040215 77ae Comaaaonorealila of Massadjusews I.Deparnnetad of daadusPaaal Arcirlents Office ofInvesaigalions 600 Washington StreetBostan,M4 02111 ovot=ot:anass.goa©d'isa Workers' Cmmzpensafien Insmramce Affiaials'it:Builder-dCaiatracttDrsMezQaicians/1P umbers Applicant Informaafion Please,Print V Name(Busiwsslorrgauizationrtudieidual): nc� Ck,,,,rJ,C, Address: O�JG RJ LA VI VI 1Citylst�4e�zip: �>^Ki 0 (�a 1 , owe#: 1� �l 134 �C�®� Are Tom an employer?Check the ap r®priate boa: IID'pe of project(required): 1.❑ I am a employer with 4- ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. �]Neu*construction 2_❑ I am a sole proprietor or partner- lasted on the attached sheet. 7- ©Remodeling ship and havee no employees These sub-contractors have 8- 0 Demolition working forme in any capacity- employees and have workers' [No workers's'comp.insurance comp.insurance.z 9. �Building addition required.] 5. ❑ We are a corporation and its 10-[:1 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised thl eff I LE]Plumbing repairs or additions myself[No workers'comp_ right of exemption per MGI. 121M Roof repairs insurance required-]1 c.152,§1(4),and we have no emmployeas-[No workers' 13-' Oahe, comp.insurance.required.] *Any apphtsm that checks box#1 must also fill out the section balow showing their wotkeas'cou pearsation policy mfntmatiob T Homeowners who submit this affidat it indicating they are doing all work aid then Lire outside conincrors mast submit a new affidavit indicating such 1Contractors that check this bra must attached an additional sheet showing the name of dia sub-comiractors and state whether or am those entities borne employees. If the sub-conaaaors have employees,they rrmst pmvide their workers'comp.policy mbar. lam as e)App0p'er t➢tat is prmtvding lirorken'conipensaPion insurmice for nay en2p➢oyee& Be➢vary is idle pv➢icy mind job site informadOIL Insurance Company haute: 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 mate). Failure to secure coverage as required under Section 25A of MGI.c- 152 can lead to the imposition of ririmminal penalties of a fine up to S 1500-00 and/or one-year irmprisomnent,as well as civil penalties in the foim of a STOP WORK ORDER and a f ue of up to$250-00 a day against the violator- Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coti erage verification. Id oereb ce � �Ma, �afties o)pejap that the infora®to)prouder®brg is fte and correct i y Date: L LI Phone#: �® ®,ficia➢use on(. Do not virile in this area,to.be competed by ridk,or tout r)official City or Town: lPermit(License.9 Issuing Authority(circle one): 1.BoalrYl of l$eaIlth ?.Building Department 3.Cityfrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: