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HomeMy WebLinkAbout0118 GREENWOOD AVENUE ,�j$ ��eenwo� eve, _..d'"'-.. "f..y^Tti^^.t.tttr y'TY'ia"y�,,.�+,9Y �t�4iy;w�:i..-2'if-�/ �F-{"'T•jl�^'G i"�.:,^Tw:r'^*'rr-a'""i•""};� :ryF^ Zf '.s.�•,y��,Yr4,, ..7:54�iY.dK!'Yr'r1'•�0.7Mw'Ya�Jt�tl'^`�L't"ri-'a'Wi..s;� T CJ /W C Assessor's office(1st.Floor): r Assessor's map and`tot number Board of Health(3rd4loor)✓ i eW Sewage Permit number Engineering Department(3rd floor): 1i �sassrsnct � rua ' House number- /Vl, Definitive Plan-Approved by Planning Baird 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:60-2:00 P.M.only TOWN 01F BAR NSTABLE .� BUILDING INSPECTOR ' APPLICATION FOR PERMIT TO •;-� TYPE OF CONSTRUCTION 5'/J 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according.to the following information: Location ��� ���� w��� �9d� /`�`y-��u •� ��� S Proposed Use { Zoning District Fire District Name of Owner s ✓�=C + Address Z50k 7��� 1� � /U� C-77 Name of Builder l- �1.� Address Name of Architect Address Number of Rooms Foundation (?QA) S 5 J Roofing 9 Exterior i Floors �� Interior Heating Plumbing IVOIu�.` 1'hd"J��� .._. .-,•L.r� __ F � Fireplace �-+✓� Approximate Cost s Area Diagram of Lot and Building with Dimensions Fee r I J .. 1 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 cons ruction. Name , E Construction Supervisor's License BAKER, BARRY A=289-123 6� 001?-/6�3 No 34365 Permit For ADD TO & REMODEL Single Family Dwelling Location 118 Greenwood Avenue Hyannis Owner Barry Baker Type of Construction Frame Plot Lot Permit Granted May 31 , 19 91 Date of Inspection 19 Date Completed 19 _ a PIMMIT COMPLETED C oT # lv I i I � a s 6 � L -"NN� t TOWN ­OF BARNSTABLE r BUILDING' DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street address Section. of. town "HOMEOWNER' Ale �/ �l.0 a 3� o��7 Name Home phone Work phone PRESENT MAILING ADDRESS�� DST.L C'T 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 such homeowners to engage an .in-. dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sy who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family 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 buildin ermL 109 -p (Section 1) The undersigned "homeowner" assumes * ,responsibility for compliance with- the Stat Building Code and other applicable codes, by-laws, 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 pr cedures and requirements. ' HOMEOWNER'S SIGNATURE Z APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be re ui to comply with State Building Code Section 127. 0, Construction Control. red r- .r HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a-building permit is required shall be exempt from the provisions of this section (Section 105. 1. 1 - Licensing of Construction Supervisors) ; provided Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of' awareneE often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home ' Owner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home 'Owner 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 to amend and adopt such a form/certification for use in your community. Assessor's office(1st Floor): ' q Ti Assessor's map and lot number ®l /7 4.2& C�� ��ST�L���S7.EAqE t Board of Health(34,floor): flu Sewage Permit number r v Engineering Department(3rd floor): T {T � eaa9Tsntt House number ` JS Definitive Plan Approved by PlanninflITard 19 EGVw r APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN --- OF BARNSTABLF , BUILDING INSPECTOR • i 5'.° APPLICATION FOR PERMIT To TYPE OF CONSTRUCTION ' 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use. L-/ V 1 N 6- 100A1f "W �A Zoning District /�-� Fire District ���tiA&Y Name of Owner � � ���� Address EOY 7-.0 OeQT it1/� (fT. Name of Builder !� � Address Name of Architect Address Number of Rooms / Foundation (?d N C4 5-'7- C Exterior-- 2' Roofing TT Sl���1-r 9141 A) (1- ES Floors G/ o� Interior Heating � l'` ' '4- Plumbing �o� AVOW I d Fireplace ��� Approximate Cost Area Diagram of Lot and Building with Dimensions FeeD 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 ' BAKER, BARRY No 3 4 3 6 5 Permit For ADD TO & REMODEL Single Family Dwelling ` 118 Greenwood Avenue Location - " Hyannis Owner Barry Baker _ Type of Construction Frame Plot Lot g Permit Granted May 31 , f % 19 91 ` Date of Inspection l p "4 -119 a Date Completed �s' 19 x, x• CO ago o 7 r �Y *Permit# d �Q � �FTNE7pt, Town 0f B�lrnstable Expires 6 it onlfis front issue dale rintuvsrAs�E Regulatory ServicesF6 v�A b Thomas F. Geiler, Director a�. Building ]Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.LIS 0ffidD.\N 62-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY . Not Valid without Red X-Press Imprint Map/parcel Number ('1 Property Address 'r. I.JOd ). AU -Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �i r (� �i -�'" t L., ©/ C( I-) Contractor's Name Telephone Number Home Improvement Contractor License #(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor Tam 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 rood - ❑ Re-side ❑ Replacement Windows. U-Value (maximum .44)' *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.c.Historic,Conservation„etc. ***Note: Property Owner must sign Property Owner Letter of Permission. H me Imp oveme ontractors License& Construct Supervisors License is required. SIGNATURE: Q:\WPFIL:ES\FORMS\Express\EXPRESSPERM1T.DOC + Revisc06O4O9 r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ��•'� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): pa / fi: l%( CJ` 4L ti Address: 12 a tu. h J C4 City/State/Zip: P143f Phone.#: , Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a' Y emP to er with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.F I am a sole proprietor or partner-' listed on the attached sheet. T. �Remodeling ship and have no employees These sub-contractors have g, '0 Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers'.comp. insurance comp. insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions Xmyself. [No workers' comp. right of exemption per MGL 12-kRoof repairs , insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.[] 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. XContractors 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: 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 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 tip 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification [do hereby certify er the.pauts and penalties of perjury that the information provided above is true and correct Signature: Date: ' Phone#: C� Offic cal use only. Do not write in this area, to be completed by city or town official 'City or Town: Permit/License# 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#: Information and Instructions 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 hire, 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 Iocal 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,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 compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-con6actor(s)namc(s),-address(es)and.phone number(s) along with their certificate(s)of d Liability Companies LLC or Limited Liability Partnerships(LLP)with no employees other than the insurance. Limited ty mp ( ) quired to carry workers' compensation insurance. If an LLC or LLP does have members or partners, are not re 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 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. 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 licenses. 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 burn 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 Commonwealth of Massachusetts Department of ludustri,al Accidents Office of luvestigatians. 600 Washington Street Boston, MA 02111 TeL #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727n7749 R-jvised 11-22-06 www.mass.gov/dia i z T ti 'I ow of Barnstable ` Regulatory Services �,swxrres � Thomas F. Geiler,Director QED a Building Division m 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 Mus { 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. Town of Barnstable Regulatory Services Thomas F. Geiler,Director E.A.xxscAar..e, Building Division PrFD a Tom Perry,Building Commissioner a -200 Maio:Street,—Hyannis;Mao 0260 www.town.barnst.able-rna.us Office: SOS-962-4039 Fax: S09-790-6230 HO'AI:EOWNER LICENSE EXEMPTfON Please Print DATE: I I JOB LOCATION: I I �Trt°(°�+ w O nuumber street village "HOMEOWNER": 1 Gl Gi !.t C( v 32d of y� �/ name --�. home phone# Way- re work phone# CURRENT MAILING ADDRESS: / � /[.` /; w44kt n city/town V state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or Iess 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$arnstable,Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and rc=i ements. Signature of�-,n a Approval of Bui)ding 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 boh=,%mer perfomring work for which a building perrrrit is required shall be exempt from the provisions of this section(Section 1om.1 -Liccnsing of construction Supervisors);provided that if the homeowner mgagcs 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(sec 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. ensure that the bomcowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, To that the homeowner certify thkt heshe understands the nrspo='bi)itics 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 fomr/eertification.for use in your community. �a YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL.,367 Main Street, Hyannis, MA 02601 (Town Hall) Saw DATE: ft 7 MUMMAx, Fill in please: APPLICANT'S YOUR NAME: S" BUSINESS YOUR HOME ADDRESS:. 4�:= too-(i" ( /W,9dNtt TELEPHONE # Home Telephone Number SZ 6e 6fU S`9 NAME OF NEW BUSINESS N "i YPE OF BUSINESS ltlel P- i'�le?S' IS THIS A HOME OCCUPATION? _YES. NO / Have you been given approval from the building division? 'YES NO'K ADDRESS OF BUSINESS 6 RjE� 1 tooc �' MAP/PARCEL NUMBER1 t�� When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. -.(corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to,legally operate your business in this town. 1. BUILDING COMMISSIO ER'S OFFICE n MUST COMPLY WITH HOME OCCUPATION This individual.ha b infor eld of permit requirements -pertain to this type of business. RULES AND REGULATIONS. FAILURE TO - COMPLY MAY RESULT IN FINES. Authoriz Si � e COMMENTS « �C._. i 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature**. COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature COMMENTS: Town of Barnstable ;r THE Regulatory Services F Tp� o Thomas F. Geiler,Director • •BARNSfABLE, Building Division � • y MASS. g Tom Perry,Building Commissioner r i639. 200 Main Street, Hyannis,MA 02601 �A fD MA A www.town.barnstable.ma.us Office: 508-862-4038 Vax�,* 8-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: ('r/ - E!Xwf AJ S r�y Phone#: TOP 3Co J=r . Address: Village: A/ Name of Business: f� S �FsoA9s 6�2� 6,t;r, 20UrnGlnm </vCs Type of Business: 6�0 b Z PiF,4 uU Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit, located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat, glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Hcme Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No QVrson shall be employed in the Customary Home Occupation who is not a permanent resident of the Jdw ]l ng u I,the undersig , have d and agree with the above restrictions for my home occupation I am registering. Applicant: Date: Homeoc.doc Rev.5/30/ 3 Town of Barnstable *Permit# OVA 6 Expires 6 mop the front date Regulatory Services Fee Thomas F.Geiler,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 PE MT APPLICATION - RESIDENTUL ONLY rNot Valid without Red X-Press Imprint Map/parcel Number Property Address G 4 Gs oo0 0 15 Residential Value of Work Fri Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address WC4r= A��rniAJ S I`r Contractor's Name < <- Telephone Number }__Z1, 360 I0el Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: -PRESS PERMIT ❑ I am a sole proprietor I am the Homeowner J U L 2 2 7 ❑ I have Worker's Compensation Insurance Insurance Company Name '<''t'3" s::. = STAB LE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Fl.Re-roof(stripping old shingles) All construction debris will be taken to Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side 1,N 2AaZ S�2ei?S . Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance s permit does not exempt compliance with other town department regulations,i.e.Hi mac;Cdtrservation etc. 9 p ernp mp ep gu ***Note: Pr perry Owner must sign Property Owner Letter of Permissions , v t, copy the Home Improvement Contractors License is required' z -,for SIGNATURE: Q:Forms:expmtrg Revise061306 R ,per The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 .UV www.mass.gov/dia Workers'Compensation InsuranceAffidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): -1Z4-P,010US< Address: I( y agf'R'N-t,JA=�o City/State/Zip: &tvNis oZ 6o Phone.#: mil'®V 36�' Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. I am a general contractor and I 6. 0 New construction . employees(full and/or part-time).* have hired the stab-contractors 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. a.Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P t3'• $. , 9. Q Building addition [No workers' comp.insurance comp.insurance. required.] 5. F71 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbin '3.NI am a homeowner doing all work ❑ . g repairs or additions myself [No workers'camp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' . 13.0 Other comp.insurance required.] . *Any applicant ihat 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 him outside contractors must submit a new affidavit indicating such. xCoutractors 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'camp.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: 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 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 of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investi.eations of the DIA for insurance coverage verification. I do hereby certify' der the pains•and penalties ofperjury that the information provided above is true and correct: Si Date: afore: 2.3 7 • Phone-k S Official use only. Do not write in this area,to be completed by city or town offciaL City or Town: Permit/License# 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#: 4 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pursuant to this statute,:an employee i§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 two.or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or truste6-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 bean 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 or to 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 compliance with the inscurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,it necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s) along with their certificates)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 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. 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 licenses. 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 burn 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Inv.estigatims 600 Washington Street Boston, MA 02111 Tel. 4 617-727-49QG ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax 4 617-727-7749 www.rnass.gov/dia OF1HE r Town of Barnstable Regulatory Services anaxsres , : Thomas F.Geiler,Director %I Age 039. p.�� Building Division ED fMA't 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: JOB LOCATI N: ✓'L �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 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 and rsigned"homeowner"certifies that he/she understands the Town of Barnstable.BuiWing Department minirrighl inspection procedures and requirements and that he/she will comply with said procedures and req it ments m Signature o 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 f Town of Barnstable *Permit# -76q(a? Expires 6 months from issue date Regulatory Services Fee R Thomas F.Geiler,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 Not Valid without Red X-Press Imprint Map/parcel Number " P rop erty A d dr e zZ�cqW` co `U 4 r' r YANK S ( [residential Value of Work ��� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Telephone Numb Contractors Name Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) l''�� ❑Workman's Compensation Insurance X-PRESS— PERMIT Check one: 20�7 ❑ I am a sole proprietor JUL 3 0 �.I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to & Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side '.9 A ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department re jula"ti6&,1�!I i$ ,C ppsen+ op,etc. ***Note: P o erty wner must sign Property Owner Letter of Permissir± �,4,�;.;i;, t.I copy the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a ' d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers" Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep_ibly Name (Business/Organization/Individual):. M!LZE ,7 Address: tie City/State/Zip: Phone.#: Are you an employer? dheck the appropriate bog: -Type 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. []New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ELRemodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity, employees and have workers' $• 9. []Building addition [No workers'comp.insurance comp, insurance. 10. Electrical repairs or additions required.] 5. We are a corporation and its ❑ P 3.�I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' camp. right of exemption per MGL 12.Q Roof repairs insurance,required.]t c. 152, §1(4),and we have no 13. Other employees. [No orkers w 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: Policy#or Self-ins,Lie.M / Expiration Date: Job Site Address: UP (��c ;fWcoc>—¢ City/State/Zip: 0— 6611 Attach a copy of the workers' compensation policy declaration 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 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 InvestiRations of the DIA for insurance coverage verification. Ido hereby certi :rude the pains•andpenalties ofperjuQ,that the information provided above is true and correct signafore: • Date: 3.® O Phone#: .z; ��J -- Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense# 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#: Information and Instructions 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 hire, 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 or to 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 compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill 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 certificates)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. De 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 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. 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 licenses. 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 tc give us a call. The Department's address,telephone-and fax number: lze Commonwealth of Massachusetts Department of Industdal Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.4 617-727-4900 ext 4406 or 1-877-MASSAFE Fax## 617-727-7749 Revised 11-22-06 www.mass.gov/dia oFTHE, Town of Barnstable Regulatory Services . aAMszasLE, . Thomas F. Geiler,Director tHAS& Ar i639• A,m� Building Division Foy 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: ` 3 o JOB LOCAT ON: / number street village "HOMEOWNER": ?YO�C�i= �P/NS1G1 I�ctP �vco 4 name �> home phone# work phone# CURRENT MAILING ADDRESS: t C P 2!�, 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 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 minimu inspection procedures and requirements and that he/she will comply with said procedures and req ' e ents. Signature of omeowner 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." h 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 ofawareness 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 Mattos, David From: Dillen,.Elizabeth Sent: Monday, November 22, 2004 9:57 AM To: Mattos, David - Cc: Edson, Linda Subject: update on-referrals to amnesty program Hi Dave- I spoke with Jeff last week,who thought it would be helpful for me to periodically update you both on the status of the properties referred to the Affordable Accessory Apartment (Amnesty) Program Here is the latest info I have for the properties referred in Hyannis,Barnstable,West Barnstable and Marston Mills: • 125 Southgate Drive,Hyannis - Michelle Tucker YES- scheduled for ZBA comp permit hearing on Jan 5,2005 / • 952 Old Falmouth Road, Centerville - Pam Bordman YES- scheduled for ZBA comp permit hearing on Feb 16,2005 • 118 Greenwood Drive,Hyannis -Jan&Barry Baker NO- not eligible for program because they live in Florida (property must be owner-occupied);I am working with them to try to relocate the tenant of the apartment into one of our vacant amnesty units Ii