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HomeMy WebLinkAbout0047 FIDDLERS CIRCLE fl fa�cE.es Gor1E_' X.--PRESS PERMIT Town of Barnstable *Permit# -DEC 12 2007 F pues6monl/isjrom issue date Regulatory Services Fee TOWN OF BAANSTAKE Thomas F. Geiler,Director Building-Division T� FC Tate Perry,CBO, Building Commissioner 26 1. itreet,Hyannis,MA 02601 ww.t wown.barnstable.ma.us Office: 508-862-4038 '�/�/, Fax: 508-790-6230 EXPRESS PE T APPLICATION - RESIDENTIAL ONLY i{valid without Red X-Press Imprint Map/parcel Number CJ C1 yv Property Address IN) Z S C be,I // yJ A0KI s �]Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �" e l t iU G u C a c LC V— V a uW Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: LRI am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 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 (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 c9py of the Home Imp vement Conlractors License is required. iIGNATURE: S �:Forms:expmtrg Zevise061306 Town of Barnstable ��SHe rOkt, Regulatory Services sArsxsrAsLE Thomas F.Geiler,Director 9 MASS. 1639. Building Division QED ° Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 vrww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ny /�� Please Print DATE: fL�CP �!, _ 0t/ 2 JOB LOCATION: -� T �D�L�K�)S G�/�- Awls s number street v -7 7 village "HOMEOWNER': & lI �• G f11i �V �©/ / 70p- y 2O name h^home phone# work phone# CURRENT MAILING ADDRESS: �l//�/LZ/C�r� ex, ,�V"f-/v/V/s OZIoO/ - ity/town state fzip code The current exemption for"homeowners"was eNtended 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 requirement 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 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. Q:forms:homeexempt �1HEA Town of Barnstable ` ~� Regulatory Services BARMABM MO& $, Thomas F.Geiler,Director 'AjFDMA'IA Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date , Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&O WNERPERMISSION ILS ' The Commonwealth of Massachusetts Department of Industriat Accidents Office of Investigations 600 Washington Street Boston,MA 02111' www.mass.gov/dia ' Workers'Compensation Insurance Affidavit: Builders/Contractors/Eleetridans/Plumbers Applicant Information Please Print Lepibly Name(Business/Organization/fndividud): 40 lR-�_ C City/State/Zip: 4 n aS o Phone.# SL Are you an employer?Check the appropriate box: :Type of project(required):, 1.❑ I am a employer with 4. E] I am a general contractor and I emP Y 6. ❑New construction . employees(full and/or part-time).*• have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- an the'attached sheet 7. ❑Remodeling ship and have no employees . These sub-contractors have g, Demolition' Y capacity.for me in an c aci employee$and have workers' avorldng tY 9. ❑Building addition [No workers' cpmp,insurancecomp.hisuranco.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumb' repairs or additions '3.�,I am a homeowner doing ill-work . ❑ � P myselt[No workers' comp. right bf exemption per MGL 12.❑Roof repairs insurance.required.]t c. 152, §1(4),and we have no • 13.❑Other employees.[No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing Buffrkers wo 'compensation policy infamnation. t Hmneowocra who submit this affidavit indicating they are doing all work and Bien hire outside contractors must submit a new affidavit indicating'such. tconbactms that check ties box must attached ea additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, if the sub-contraetms have employees,6uymust provide their workers'comp.polio 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.Lic,#: Expiration Job Site Address- City/State/Zip: Attach a copy of the workers'compensation policy declarafion 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 lip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the foml of a STOP WORK.ORDER and a fine $ Y .get of nP to 250.00 a day a the violator. Be advised that a copy of this statement maybe forwarded to the.Office of Investigations of the IDIA for insurance coyerate verification. ' I do hereby certify under the pains•ahil p i a des of perjury that the information provided above is true and cc�orrea Si store: / -�'l Date: 2) d` aD Phone#k S7(� b — 77 Official use only. Do not wrtte in this area, tb be completed by city or town:officiaL City or Town: ' Permit/License# Issuing Authority(circle one J.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other ' Contact Person: Phone#: