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Home My WebLink About0067 HAMPSHIRE AVENUE 6jjjCA Town of Barnstable U11C1111 163 ,.ssr«tt T✓.h.f�.s,«C.=.a,�.r.�c.�d�.-...,S-'o�:.T..-�ha�tA isa�t�-, is.-�`�l"'h ws ib�«'l.e•,�..rcF✓u.raom.:.t��hase St'r-e e-t.°-.A.,a..p- p.r:-_oved--;e.'r,P;,"�i�.lans..wM.<_u,,.s,t=:ab.e.,x::R:'�e bP kt ei 1 t doP BnY41MA „WheereaC Permit No. B-18-2115 Applicant Name: ALVARADO, ISABEL F&YUDY Approvals Date Issued: 07/05/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/05/2019 Foundation: Location: 67 HAMPSHIRE AVENUE, HYANNIS Map/Lot: 291-140 Zoning District: RB Sheathing: Owner on Record: ALVARADO,ISABEL F&YUDY Contractor Name Framing: 1 Address: 67 HAMPSHIRE AVENUE Contractor License: 2 HYANNIS, MA 02601 Este Project Cost: $5,000.00 Chimney: Description: Siding ; Permit Fee: $35.00 Insulation: i Fee Paid:,. $35.00 Project Review Req: � { <' Date. 7/5/2018 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months after;issuance. Rough Gas: All work authorized by this permit shall conform to the approved appl catFon and th&approved construction documents for which=this permit has been granted. All construction,alterations and changes of use of an building and structures shall be in compliance with the local zoning by-laws'and codes. Final Gas: g Y g p g This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures bythe Building and-:Fire Officials are provided on this"permit. Service: Minimum of Five Call Inspections Required for All Construction Work:' • ` r4 '`' 1.Foundation or Footing .': Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: . 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT i t Application number...... ....... . ... �..L: ..... A K• Date Issued....... .:... ::... . ..................................... MA$3. J g • V14STAVA '�` �21 Building Inspectors Initials...................... ..... 163Sk 57. �@► ! Map/Parcel...........................I. . TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION 4 Address of Project: 4lI�9yJ NUMBER STREET VEL GE Owner's Name: ^,Cly� f/A.. F Phone Number J 2 Email Address: Cell Phone NumberT Project cost $ .S, o u Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: .S4BU A L VapAdd ` `� Date: TYPE OF WORK 11 Siding ❑ Windows (no header change) # 0 Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer of shingles) ^Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 7S YEARS OLD OR IF THE SUBJECT PROPERTY IS IN. A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER...........................................................', _ *For Tents Only* a Date Tent(s)will be erected Removed on +` . `number of tents total ,Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions,of each Tent X X J. X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours . of 8:00am,-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side .,� HOMEOWNER'S LICENSE=EXEMPTION'l Homeowner-s-Name:- 4 L �---Telephone Number "�f" �. o ��, C� Cell or Work number e � I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. CSigriature,,j,�',4�Qi2!/i C/ rDate APPLICANT'S SIGNATURE Signature �fo DateT_� All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts v 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 N eam Business/Organization/Individual): I,QQ.( 4t, 21`d V4 a Addr_ess:� / + �Sl �� . A V 4- Cify/_State/Zip:<"{�//9 exjS InA n a1 (0 Phone#: 2 p 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 b. 0 New construction employees(full and/or part-time).* have hired the sub-contractors , listed on the attached sheet. 7. ❑Remodeling 2:El I am a sole proprietor or partner- ship and have no employees These sub-contractors have employees �Demolition workingfor me in an capacity. employees and have workers' Y P h'• $ 9. �Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.F Electrical repairs or additions I am a homeowner doing all work officers have exercised their 11.❑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' 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. #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. 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct �S 9nature:.-r-JA/0-�,4 Date:"#1 (4 Phone`#'I fi �L Official use only. Do not write in this area,to be completed by city or town officiaG 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 ,l 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." >�' g PP 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-contractors)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 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 to give us a call. The Department's address,telephone and fax number: ` The Commonwealth of Massachusetts , , Department of Industrial Accidents Office of Investigations 600 Washington,Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gav/dia �p � � I�� I I _� ` � � �� uI ' Miscellaneous 898,E Transfers In Total Revenues $ 7,700, Expenditures Personnel $ 53 Contractual Services 8,207 Materials&Supplies Other 1,600 Capital Total Expenditures $ 9,86 Net Employee Health Insurance Fund $ (2,16 Resery Other P A Proj Proj '"Other Post Employment benefits accounts for t FAa Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 9/13/16 Thomas Perry CBO Town of Barnstable Building Division g 200 Main St. UIL�ING Hyannis,MA 02601 Sep-2 ZO 16 RE: Insulation Permit 16-2206 T owN of gAREV Dear Mr. Perry This affidavit is to certify that all work completed for 67 Hampshire Ave,Hyannis has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. r , Sincerely, ` William McCluskey .� Town of Barnstable Building Post'This Card So That i1/�s�ble From�,the Street Approved Plans Must be Retained on Job andah�s-Ca'rd Must;be�Kept � ,� ' 109- �` Posted UntFinal t�n`spection�HasBeen �� ,� �� Wh'ere a Cer>t�ficateof�Occui anc =is Re aired;such Bwldm sFialhNptbe.Occu �ed�untal a<Final lns ection'hasbeen:ma`de ei ijjlt Permit NO. B-18-3085 Applicant Name: Brien Langill Vivint Solar Developer LLC Approvals Date Issued: 10/19/2018 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 04/19/2019 Foundation: Location: 67 HAMPSHIRE AVENUE, HYANNIS Map/Lot: 291-140 Zoning District: RB Sheathing: Owner on Record: ALVARADO, ISABEL F&YUDY Coritractor Name :: _BRIEN LANGILL Framing: 1 Address: 67HAMPSHIRE AVENUE Contractor.Licerise: CS-1066752 HYANNIS, MA 02601 Est Project Cost: $20,460.00 Chimney: s Description: Instalation of roof mounted photovoltaic solar"stems,31:panels �$ Permit Fee: $_154.35 9.3kW „ Insulation: r Fee Paid. $154.35 Project Review Req: '` 10/19/2018 Final: Plumbing/Gas 0 Rough Plumbing: _. A:Building Official Final Plumbing: = Y° Rough Gas: This permit shall be deemed-abandoned and invalid unless the work authorizediby this permit is commenced within sx months after issuance. All work authorized by this permit shall conform to the approved application eaapproved construction documents forwhich this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structuresshall%6 in compliance with the local zoning by lav s ariij codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained openfor public inspection for the entire duration of the work until the completion of the same. Electrical ,' Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Buildmg and Fire Officials are prpvid,e. on tFiis permit. Minimum of Five Call Inspections Required for All Construction Work ` Rough: 1.Foundation or Footing ' 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons con with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department r` final: �z Building plans are to be available on site 'mac All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 4� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a TOWN OF B.ARNSTABLE Application#J" 9 � Parcel c �.� pp Health Division f �� r _ .� �: 55� Date Issued g—(' Q-� 6(p £a 1 P;16 Conservation Division Application Fee Planning Dept. Permit Fee •�/�/ F ,, y rq `Date Definitive Plan Approved by Planning Board (ec� �8 Historic - OKH _ Preservation/ Hyannis Project Street Address �KM eA 1`r?, LwG Village �- G��arL i� Owner i sib e Address S, f/ Telephone b` 3 0 r a 9.5 Permit Request All Z-k 9 cekk#A sb ko w 1C ))ease, nack W4S VIA 12-13 c&[ Air s - �� a EIY18A Via,,,��,�-�a�.• • Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Nq00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes •dNo If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name U%1AM n . Telephone Number S 6$3q8 0398 Address �� }�,��9f A 1�v�. License # C J - �� nn o q,� ��6(� Home Improvement Contractor# 3$a Email Worker's Compensation # (►JC_. U ' Y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Yir^ 41 I, SIGNATURE DATE ` b FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. s of l ti rrow1n of_ a>r>stab e Regu1�So> ces • aurt�sr�ars. BLAM. $ RiCuo W.Sc U' i Director s6}9. ♦0 Bgildin.g Piv szon. . 'Loan Perry,l3uildin�Cauarnissuhee 00 Mama S6eet,.Hyann s,.AA.02601 wwzvjtowm bar nstabie rik us Office: 50878.62-4038 �R4: 509 :90-6230 Propexty:Ovvner.Must ;Co� alld%S.ign This Section.;o Jf Uinor A Builder crof`tlie sulj .cT ro p Y. licreby audio a pC Sa to act on ruybebalf, in all masters relauvc:to; or ,authoa zed by:this b. g:permit apphcauc n for,- A1111�vL(;� (Address of.ff ob.) s .,.'Pool fenG s and alarms AM;the a spvnssblL T F t�e applicant: Poo1s: are not m be filled(,?rut.ili/-ed before fenx-e is izutal ed and all di al iosectoris are Perlcrrned and accegtl aOwner, Signature of[applicant: t ] z 0` . arise Paine Naax i:. +' p- fit . QfFOII;4S:O�NwF.F',RI.t3SSIONNWLs: ACCO& CERTIFICATE OF LIABILITY INSURANCE DAT `�D"'6 /i2/2:Dls THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS'CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,-AND THE CERTIFICATE HOLDER. IMPORTANT- If the certificate holder Is an ADDITIONAL INSURED,the,policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A Statement on this certificate:does not conferrights to the certificate holder In lieu of such endorsements.. PRODUCER _.. - ,., .! NAME CT Risk Strategies. Company. .. . Risk Strategies Company NOON E : ('76l)986-4400 FAC'No:(731)963-4420 WC,No.15 Pacella Park Drive AD�SS:randolphcld®risk-strategies.aom Suite 240 . . INSURER(S)AFFORDING COVERAGE NAICS . Randolph PTA 02368 INSURERA:Selective -Ins. of America INSURED i INSURERB:Allmerica Financial-Alliance Ins Co 10212 Cape Save, Inc r INSURERC-.St4r Insurance Co :7 D Huntington Ave INsuaERD ' INSURER E: .South Yarmouth PTA 0266A I INSURERF: COVERAGES CERTIFICATE NUMBER:CL1641211375 %:"REUISiON NUMBER: - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE.POLICY PERIOD INDICATED. NOwri-ISTANDiNG 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 T0'ALL THE.TERMS, EXCLUSIONS AND.CONDITIONS OF SUCH.POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DDL SUBR ICY EFF EXP LTR. TYPE OF INSURANCE POLICY.NUMBER_ MM POLICY LIMITS ..__... X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000;000 AGE TO RENTED A CLAIMS-MADE Fx_1 OCCUR ,, PREMISES Ea occurrence $ _-_.100,000. ' X 1 S1999480 *. i0/16:126i5 10/16/2016 MEDE)(P(Any one.person) $ 10,000. r - PERSONAL.&ADV.INJURY. $ 1,000,.000 'I GEN'L.AGGREGATE LIMIT APPLIES�PER:. GENERAL AGGREGATE $ 2,00.0y.000 POLICY LOG PRO- , t ' G'• ` - PRODUCTS-COMPlOP.AGG $ 2,000,ODOy OTHER:`.. AUTOMOBILE.LIABILITY r COMBINED IN LIMI $ ., 1,000,000 -(Ea accident) ANY AUTO r BODILY INJURY(Perperson) $ ' l3 ALL.OWNED SCHEDULED AUTOS X AUTOS .AtINA467966.00 .y 11/6/2015 11/6/2016 BODILY INJURY(per accident) $ NON-OWNED r PROPERTY:DAMAGE ED X HIRAllTOS X .AUTOS`� - Pere art $' X UMBRELLA LIAB ]{ OCCUR EACH OCCURRENCE $ �. •1,000,000 EXCESS LIAB CLAIMSMADE AGGREGATE $ 1 000 .QOO DED X RETENTION$ NIL' 3199'4480, ow 10/.16/2015 10/16/2016 $ WORKERS COMPENSATION. .. , - - PER :OTW ... l officers'Included for ! i` X STATUTE ER AND EMPLOYERV LIABILITY .'•;t}� YIN - _ • , 'r•. ; .. ANY PROPRIErORIPARTNERe)(ECUTIVE NIA Coverage. E.L.EACH ACCIDENT $ 5.00 000 OFFICER/MEMBER EXCLUDED? C {Mandatory in NH). 0«I )I '•' . ®COSS540.70.0 4L.97201.6 4/9/2017 J.E.L..DISEASE-EA EMPLOYE $ 500,000 Us t ye%describe Under '{..• .. . -^^r ,.. . . " - _. DESCRIPTION OF OPERATIONS:below +i E.L.DISEASE-POLICY LIMIT '$ 500,000 1..,, .I a.� .�'!� �' t .. _ .. c..a a., A. �l , d .L•.'� . 1 DESCRIPTION OF-OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remark I9 0chedule;may be attached If more.space.le required) - - National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial. Gas Company and NStar Electric are all included.'as Additional-•Insureds with respects to 'the General Liability coverage of named insured as required by written contract. CERTIFICATE HOLDER „ CANCELLATION a SHOULD ANY'60 THE ABOVE DESCRIBED POLICIES BE CANCELLED:,BEFORE Housing Assistance Corporation .`..:r. s:'; THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN r Cape Light Co�lpa. ACCORDANCE WITH THE POLICY PROVISIONS. -Barnstable County • 460 West -Main Street � AUTHORIZED REPRESENTATIVE- Hyannis, MA 096:01, [S Michael Christian/.CLC 01999=2014 ACORD CQUORAIION. All rights iesarvatf. ACORD 25(2014101) - The ACORD name and logo Are:registered marks of ACORD INS025'(n1401) The Commonwealth of Massachusetts . Department of Industrial Accidents 1 Congress Street;Suite 100 Boston,MA 02114-2017 www mass.gov/dia NN'arkers'Compensation.Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Busnessiorganization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508 398-0398 Are you:an employer?Check the.appropriate box: Type of project(required): LE lam a employerarith. 15 employees(full andlor.pact-time),• 7, r1eW COristfllcttOn In I am a sole proprietor or partnership and have no employees working forme in 8. Remodeling any capacity.[No workers'comp:insurance required.] . 03.01 am a homeowner doing all work.myself.[No workers comp..insurance required + 9. Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on mY property. I will 10.E Building addition ensure that all contractors either have workers'compensation insurance or are sole I L Electrical repairs or additions. proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I.have hired the sub-contractors listed on the attached sheet: 13:❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c 14.[]✓ Other Insulation 152,§1(4),and we have no.employees.[No workers'comp.insurance required:] *Any applicanrthat 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. .lam an employer(hat is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Star Insurance Co. Policy#or Self-ins.Lid.#i WC085540700 Expiration Date 4/9/2017 Job Site Address: 67 Hampshire Avenue City/State/Zip:Hyannis Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a.criminal violation punishable by 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:A,copy of this statement may be.forwarded to the Office of Investigations of the DIA for insurance coverage verification. I'do hereby certify under thg pains and penalties of perjury.that the information provided above is true and correct Si ature: Date: 8 2/16 Phone#:508-398-0398 Official 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 S.Plumbing Inspector 6.Other Contact Person: Phone:#: a, . Office of Consumer:Affairs and Business Regulation: 10 Park.Plaza Suite 5170 Boston,=Massachusetts 02116 Home Jmprovewof&C®ntractor Reglstratlor Registration 1'71380:. - rt Type Corporation �- _ Expiration 3/.1412018 Tr# 419291 CAPE SAVE I NG. WILLIAM McCLUSKEY ` .- 7-D HUNTINGTON AVENUE. . . SOUTH=YARMO'UTH, MA 02664. AZIV Update Address and return card Mark reason for change: . Add're§a Renewal (�.Employment Lost Card, SCA 1 0 20M-05/11 1c�anvcctn�acucull/z a,`��lluuu�tcc:,clt :v. Office of Consumer Affairs&Busi ss Regulation License or.registration valid for odrvidul use only HOME:IMP:ROVEMENT CONTRACTOR before the expiration date If found return to �]Registrat<on i71380. types Office of Consumer Affairsand BusineMW ss Regulation EzpUation 311- 618 Corporation, 10 Park Plaza Suite 5170 4' Boston,MA 01116 CAPE SAVE INC. Egg- =f , WILLIAM McCLUSKEY ' 7-D HUNTINGTON.AVENUE r �t._t S SOUTH`YARMOU.TH MA 02664 Undersecretary Not valid{ signature Massachusetts -Departrri'ent of Public Safety' Board of:Buiiding'Regulations and:Standards 4uuxiuCtiirie ou.7BtSirP�_�G�iiiipv ;•'`x+-c�-:.��, - License: CSSL 102776 �s. WILLIAMIMC OU 37 NAUSET ROAD West Yarmouth rdA Expiration: Commissioner 06/2812017 Page 1 of 1 , Anderson, Robin q From: . Tamash, Craig [tamashc@barnstablepolice.com] Sent Monday,.January 23,-2012 7:59 AM To: Anderson, Robin Cc: Walker, John Subject: FW: locations for BIRST .a._ Robin: FYI for future BIRST! Craig Tamash . Deputy Chief Barnstable Police Department PO Box B Hyannis,-MA 02601 r. 508-778-3801 508-790-6317 (Fax) From: Walker, John Sent:.Sunday, January 22, 2012 11:37 PM _ To: Tamash, Craig = Subject: locations for BIRST Deputy: On the 20th, ICE and members of the BPD went-to two addresses in Hyannis: Both addresses are candidates for examinations in regards to code violations. F 46 Fresh Holes Road: - 8 Adults an6one child living in.3 bedrooms: Of coursefour of the adults were , removed at that time by'BPD and ICE so the overcrowding issue may be resolved. 67'Hampshire Road: in the basement there are`three bedrooms and one bathroom built in. Each -bedroom was occupied when we were there. - A Respectfully Lt. Walker , 1/23/2012 t 6 THE T Town of Barnstable Perm l D �D it F � p p Expires 6 months from issue date Regulatory Services FeeMAW * sAxrtsreBi.E, * s , ; Thomas F. Geiler,Director prEDMA't� S —Era` IT Building Division Tom Perry, CBO, Building Commissioner OCT 0 7 2011 200 Main Street,Hyannis,MA 02601 AN RNSTAB .E 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 G� Map/parcel Number a 9 l ! Y O Property Address Residential Value of Work =3 _2 G— Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /-) 44 44 . J Contractor's Name Telephone Number Home.Improvement Contractor License#(if applicable) Construction Supervisor's' sense#(if applicable) ❑Workman's Compensarlo "insurance Check one: 1 ❑ I am a sole proprietor gI am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken too �Ut�lrO 57'L� ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *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 copy of the Home Improvement Contractors License & Construction Supervisors License is required. 1 SIGNATURE:_4421c, e Q:1WPFILESIFORMS\building permit forms\EXPRESS.doc ' Revised 070110 .ti 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): - CA Address: C1a50 �re !� y =r City/State/Zip: el?G Ozpfone Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with T%7.,4. I am a general contractor ar.d I employees(full and/or part-time).'* i have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or a listed on the attac p p partner- hed sheet. 7• Remodelin ❑ g ship and have no employees These sub-contractors have g; ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp. insurance comp,insurance.# 1 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions -3.CR'I am a homeowner doing all work officers have exercised their 1 I.[]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4),and we have no 12.❑Roof repairs 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. $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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sienatur= �( Ill�A IZAA P /� ( Date � � l Phone#: V Official 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#: i �1HE r, Town of Barnstable Regulatory Services B"NUABLE, ► Thomas F. Geller,Director 9 1HASS. �pt16 39. 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 HOMEOWNER LICENSE EXEMPTION J Please Print t DATE:_ JOB LOCATION:_ (� l�l �i (�/�,i �a number street ='--�{ C,, village ,.HOMEOWNER": Zb / r/C/ /Y/U uI,/6 djl name home ph ne# wort-phone# y CURRENT MAILING ADDRESS: v,. �0 A h i rr 4 zllp Mu 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 minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. i�gnature orRomeowner L V 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 �r �I"Ey Town of Barnstable Regulatory Services BARNSTABLE, + MASS Thomas F. Geiler,Director i639. Fo►�►�" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 vvww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623 0 Property Owner Must Complte and Sign This Section I \Sing A Builder as Owner of e subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this bull p t (Address of Job) **Pool fences and alarms are the re ponsibility of the licant. Pools P are not to be filled before fence is ' stalled and pools are n t to be utilized until all final inspections re performed and accepte . Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 Parcel '` "� 'Application #d v ` Health Division Date Issued Z' Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation% Hyannis Project Street Address Village '� �'�� c� � y Owner Address(a1t �V� Telephone Cn f"� — Z3C� 0 1-3 %S7 Permit Request To'u) 1 R_4k-r4' kq4 T\,,f1J WLT, 'A T b Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 4v Project'Valuation Construction Type Lot Size • 2 '1 � Grandfathered: ❑Yes ❑ No If yes, attach supporting dgcume�ntation. Dwelling Type: Single Family >' Two Family ❑ Multi-Family (# units) 122 Age of Existing Structure Historic House: ❑Yes d No On Old King's4 Highway'O Yew ❑ No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other ) Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) ZIA Number of Baths: Full: existing new Half: existing new. w Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size . Barn: ❑ existing ❑ new size_ Attached garage:'(existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name "LJ (S Telephone Number (�1 r 2s C) Address �O C �S��C License# Home Improvement Contractor# Worker's Compensation # I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE�! Q.L / DATE /r l — FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED j. MAP/PARCEL NO. s ADDRESS VILLAGE OWNER �t € DATE OF INSPECTION: FOUNDATION P FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING x DATE CLOSED OUT ASSOCIATION PLAN NO. 4 , } s 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 rApplicant Information aa Please Print Legibly Name (Business/Organization/Individual): Address: ��l V6 ,e,.City/State/Zip_"- Phone #: Z"So . -Are y'yo a-employer?`Check the appropriaatte,boxxr Type of project(required): 1.❑ I am a employer with 40 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. T ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 37-1 am a homeowner doing all work 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' 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. tContractors 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 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is tr a and correct. °nu a r � � .. Phone#: ' Official 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#: s Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. P P 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-contractors names address es and hone numbers along O O� address(es) P O o g 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. Als o be sure to sign date the affidavit. g g d vet. 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 are you required to obtain a workers' Y 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 tha t 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 t 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 Investigations 600 Washington Street, Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax #. 617-727-7749 www.mass.gov/dia I Town of.Barnstable ��'(FtE Tpiy Regulatory Services • Thomas F. Geiler,Director BARMGrABLE, 0Kf Building Division oTfo a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 T HOMEOWNER LICENSE EXEMPTION r-/� ' Please Print DATE: 1 ` 0 JOB LOCATION: village number street ` l "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,bylaw§,rules and regulations, y 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 fonn/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC THE Town of Barnstable Regulatory Services ]AMEMABLE; Thomas F. Geiler,Director 039.'rfv 39,.E 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 bythis building permit application for, (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit pl se comprete-- e Homeowners License Exemption Form o the reverse side. Q:FORMS:OWN ERPERMIS SION Town of Barnstable Geographic Information System December 8, 2009 291138 + �� + 291137 #52 72 CM- 291136 #74 1 291136 y11R 84291139 #55 ' s 291140 309016 967 #48 . eta;. ^/".'��`�� - •� Gi 291 41 t . #75 I'1291146 #58 291142 ` 985 291145 #68 lkl v,. ,,�""�• 291144 ��~Mrr � #78 } 0 18�Fee391143 e"�y� 309012- DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal p Selected Parcel I boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:ALVARADO,ISABEL F&YUDY Total Assessed Value:$235000 7-100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.21 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:67 HAMPSHIRE AVENUE r I such as building locations. Buffer r ; ........... --- ------- jlj- J Ogg i I �_ � I < 1 , � J , wi Vj- 07 I I I ; ) I I � o �, I I i �� I _ �, I � ---- b-4 -A 77- hi `�-- ,�__ I -� I �- I I mo_-� i J � I I � � I j CO. ---------------- I 4573 T-j ----------- I F