Loading...
HomeMy WebLinkAbout0078 HOMEPORT DRIVE t I i I i I i Town of Barnstable *Permit# 6-i ?- j `( Building Department S o� h`' es �iles6mon�e from issuedtue�� snxxszAsrs, : Brian Florence,CBO �C �'0t ► � Building Commissioneraa Fp Mp`l 200 Main Street,Hyannis,MA 02601 www.town.barnstable.n SFp 16 4 t F Office: 508-862-4038 VV �o ?O�� Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTI%—away Not Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work$,-2650 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor - I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. - SIGNATURE: QAWPFILESTORMS\building permit forms\EXPRESS.doc 08/16/17 f 4 The Commoymealth ajf assadiuseffs Deparhaerxt afludas-frid Acddentr Offike a. sfigafio= 600 Washusgton y�ireet Baastan,AM 02111 mvtumam%govldia - WurrIcers' CampensafienInsaranceAffidavit B.m"ldex-lCnntractursMectdcian hmihers AypHcantInfw=iihn Please Fx iint f e ffi Nye IaRSmkaa3�lm,JfmarTRaS. %!��D�/l�$S /� / liL�i^' /( Address City/State," __Z ' ia? ©16002 Phanc 4 Are you an employer?Checkthe appropriate bow ' Type of project(required)- L❑ lama 1 ufth 4. ❑I am a general contractor and I ❑ employees(fialffilf andfor pmt4ime,)* haveluredthe soar-contmctorss 6. New consfr�r tog 2.Ell am a sole propFietar orpartuer- Usfed on.the.attached sheet.. 2- ❑RemodeHng ship and bare as employees These smb con4ractars have 9-,❑Demolition woddx g fornm in any city. employees mdhave wod=s' 9. ❑Building addition LNq ty-d$' camp,iasu. =e comp-k=CdIIV— � Trequired j 5. ❑ re We a a corporafion and its M❑Ex.0*cal repairs or adcEEwm 3.;6j am bomeov nw doing all;wo& officers have e=dsed thEk LL❑Plumbingrepaim ar addifians. myselt[No 'comp. riot of esemgfion per MGL 1Y DRoofrepairs +nsm-mce re Eirea j T c.152,g 1(4).and we have no employees-[No wo&ers' a❑Other consp-ituiance required_) r�¢yapg��t�acchedsbos#l�talsoMcutthesw6aabeIowshmmiagdieawale�camp—sat; apn&cgin5msaan. ffameowaersvrho sabngt this affida�u indicating they are3ain�s1EePa¢ic and t6mhiiz autsidQcontrnctatsnmct.s�bmita newOmdavf indieatiag saeIt rCauttacCors�a2 d�eck*h box nut t a=dmd sa addi6aaal sired showl=g dim namecf the sn3►camas mzad stotp whether.arnotftsa eaff tinhne ®playas.IfthaMIb-CCMbEdtsbXVt MURIoyee%9hey= stpmwidtt3 W tt•o&E&camp.PGhcy atm+bM lain art employer dint;ispm ding workers'camperesrdian inmirmicefor my*enWhUe". ffetoav is Aepaficy imd jala sate information „ hismanre Conipmy Name: Policy 4 or pelf-ins.Iic.-Ilk EkpirationDate: Job%teAddres-s_ City/Statetzap. Att2ch a copy of the workers'compensationpolicy-declarafi m Me(shoving the policy,number and•e=ph-ation(Tate). Fai-Inre,to secure coverage as requirednuder Se6on 25A of MCL c.15-7 can lead to the imposition of criminal penaNes of a fine up to$1,50D.OU an&or one-year impriso—t,as.cell as civil pe talties,in the form of a STOP WORK ORDEgand a fine, of up to$2510(l a dap against the violator. Be addsed drat a copy of this statement.maybe forwarded to the Office of Irr�;esEigatirifrs o€8re DIA far iflaurance coverage yedfitatinn.. I rfo kenaby eed#'under tics pains and pan ffiu r fFerjurl'that the info areta#zmx prmztTed a5ate is Barg arrd arrrect ^t;arxairer� Date - Phone ik o �v t)•,feicd uss wily. Do not wrRe in t ;urea, be cmnpfeted by car artDwu o oiciral City or Town: Permiff cerrse 4 Issuing Authority(ca le-erne): L Board of$•eaIiir I Ru:T�Depmtnent I Citg]£own Clerk 4.Electrical hmpector S.Phxmbing Inspector 6.Other Contact Person: Phone it: --- 6. ormation au' d Instructions Ms3ccarh�G=M-g Laws chaps IV requires an employers to Fes&wakes'=EP do for$les employees- Pta�ttn this•st&ft-,an=17layee is&Rmod as.":eveaYPetson in f6ie sMavice of another V.dW-MY CCMtra t ofhfi eXgress 6r implied,oral or V=n=7 �4a errplvyer is defined as`�aa ind�fdaal,par[n ,assolon,cc¢parafton or Offs=log CM ,or any two or mope the forego>IIg is a3omt •and i mhiding the legal repsesenfafes of a deceased employer,or the of recefyer or trustee of an indrvidnal,P��tP,assocsafton or of erIegal entity,emploY�mnPIoy�- Hoveves fhe owner of a dwelling hD se having not me a i�tbr= arhnenfs and�ho modes thereni,or flit occopa�ofthe- dw,Ilmg house of anoffiw who employs pe�sans to doap ,constru dcm or repair wok on such dwelling house or on.•(he grounds or bui7dimg appmtnad therein shannotbecaase of snch employmedbe deemed to be an empployea" MGL chapter 152,§25C(6)also states that¢every state or local licence agency shall �Vaold -ffie im c or renewal of a license or permit to operate a business or to construct bwldaigs iu the commonwealth for any aPFlic=twho bus notprod'¢ced acceptable evidence of complianeewith the mesurance.coverageraguirDclf Addidona br,MGM diapt cr 152,§25CM states aldeitioer iiie c=m=wmM nor lay of its political subdivisions shall enter uito any c oat urd for the performance ofpublio•work matI acceptable evidence of compIiancowM i-Ld insurance. r eefs oftisis chapterhavelieen preserhedin the mnf�.authoizify.7 A-pplican-is Please flI oirt the wofl='compmsaiinn aff idavit completDly,by cbec&>ng the boxes that apply'to your soon and,if necessary,supply sub-contractor(s)name(s). address fthth es)and er(s)along cer�c�(s)of insurance Limited LiabiIiCy Companies(LLC)or Lmnted Liabfiitp Par�hips(LL P tb)w� no�loY other than the members or partneas,are not mqua-ed to c=Y workers' compensation insurance. If an LLC or LLP does have employees,apolicyisreiared. BeadyisedthdthisaffdayitmaybesnbmittDdtatheDeparfinentof Indus•trial Aeeideds for confirm ation of msurmoe coverage Also be sure to sign and daft ice of davit The affidavit should b e•retimned to the city or town tIat the application for the permit or license is being iDquestA not the D eparfinent of B2 �aI A ram;dmts_ ShonIdyou have a ayy ques ins regarding the law or ifyon are rcq=ed in obtain a workers' compensation policy,please call the Deparimea3t at tb.e mmb=Hstl d below- Self-ins =33panfes sh onIci enter their self-msara7 ce license number an.the appropriate line. City or Town Offidals - r Please be sure that the aibdavit is complete andpriutedlq;al y. The Deparfinenthas provided a space at the bottom of the affidavit for you to fin opt in the event the Office oflnvest79atims has to confactyonregarding the,applicant Pleas a be sure to fill in the peamzHlicense mnnber which wM be used as a=5rence=Mber. in addition,an applicant that mast submit multiple peffiitllicens0 applications in.any g:mM yea r,neej only submit one affidavit indicating cvT mnt p olicy i of =aatioa(if necess Ha ary)and der`lob Site-Q ass"the applicant should �"sII locations ii (my or town)--A copy of the affidavit that has boa officially s upped or marked by ALL city air torn maybe provided to tbz applicant as proofthd a valid affidavit is on file for fotare'pelmits or licenses A new affida�must be wed Dirt each Year.'Wh=a home owner or ciii=is obfia ing a license or Permit not related JtD any bukin=or cmmmercW vet - (ie.a dnglicense or pen»it Coburn Ieaves etc-)said pmsm is NOT reed to coac2Iete this affidavit Thaofficeoflnvestig inncwovl lib--totimnkyoukabmcefuryo-orcoopm-aflmandshovldyonhavomyq=stms. please do not hesif$teto&u,us a call 'Ihe Departm mfs address,telephone and fix n=ber: . CG j*of Massachmatts ` �r}f Inds Arcz3ent� . • �Q4�� f Bo Rill MAMAUM Rai#CI'-727'749 Kevised¢24-07 WW Ma 9TfdhL I t Town of Barnstable Building Department Services ` 4 Brian Florence,CBO ►`� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section." If Using A Builder I, ,as Owner of the subject property hereby authorize to act on my beh4 in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools " are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. ' I Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:09/16/17 Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 uiAP24srAIs, KAM � www.town.barnstable.ma.us �%639. & Fp�Cl Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: _ �/ I��®�T number !� ,� [sDtr�eet/ t J /mil village b "HOMEOWNER": 71`1yMAJ5 �'/� �G T /`- 7 J �/�— name home phone# work phone# CURRENT MAILING ADDRESS: 1 /v�L�`� 77 D Z 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.. DEFIMMON 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 requirement that he/she will comply with said procedures and requirements. Joe ignature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page 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. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doe 08/16/17