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Home My WebLink About0045 MARSTON AVENUE /fS�/azsiz.� �h'� _ — �. pig a6/3ds2� Town of Barnstable Permit# Expires 6 months from issue date Regulatory Services Fee _�3:BUNWARM , — ,AM Thomas F.Geiler,Director PRESS E ET Building Division Tom Perry,CBO, Building Commissioner AUG 19 2013 200 Main Street,Hyannis,MA 02601 www-town.barnstable.ma.US R.®�� ®� Office: 508-862-4038 t R7,� � EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �^ /, Property Address J /�/��r��✓� �/t�1 /7 K /,W,7 Py/Zr [q<esidential Value of Work Q$ 4Y 91_> 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 , 21010am 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 Requ t(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �-_n field D� ❑Re-roof(hurricane nailed)(not stripping. Going over' existing layers of roof) - ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value {maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 equired. SIGNATURE: O� C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Oudook\8R76BDVA\EXPRFSS.doc Revised 061313. lie Commonwealth of Massachusetts Depart rent of Industrial Accidents Office of Investigations, IF 600 Washington.Street Boston,MA 02111 ipwtv.mass gov/dia Workers' Compensation Insurance-Affidavit:Builders/Contractors/Electi-icians/Plumbers Applicant Information Please Print Le 'bl Name(BusinessiorganizationrIndividuai):/) UY Address:4 J� City/State/Zip: r P07Z7— Phone_ Are you an employer?Check the appropriate box: Tape,of project{eequu�edJ: 1.❑ I am a employer with 4- ❑ I am a general contractor and I 6_ ❑New eect(re uij employees(full and/or part-time).* have hired the sub-contractors 2-❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling 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. i 9. ❑Building addition. equired] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.FVI 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.]l c.152,§1(4),and we.have no employees.[No workers' 13_❑Other comp.insurance requured.]; *Any applicant that:checks box#1.mast also fill out the section belou,showing;tteir wo*ers'cempensetion policy info ion. Homeowners who submit this affid2irit indicating they are doing all work and then hate outside contractors must submit a new affidavit indicating such � Contractors than check this box mug attached an additianal,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 proiriding workers'conrpensation insurance for icy erlrplcyem Below is the policy and job site infortud on. Insurance Company Name: Policy#or Self-ins.Uc.* 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 2:5A 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 far insurance coverage verification. I do hereby certi r der the ' s and penalties ofpeduty that the irrforniationpro Tided aboue jis. true and correct Signature,re: Date: j Phone#: Official use only. Do not write in this area,to be completed by city or town o0`"iciai City or Town: PermitfUcense# Issuing Authority(cir de-one): 1.Board of Health ?.Building Department 3.City-/Tovim Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone it: I r Town of Barnstable Regulatory Services Z Thomas F.Geiler,Director 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 Please Print DATE:JOB LOCATION:45 r"yy►�y�1C 6iy/jz/Y Vff 9Y14/(WTSACAT number street village "HOMEOWNER": �/IIIZKWy J�,,/BUY, 5bB-iX7//2,1& name n- home phone# work phone# CURRENT MAILING ADDRESS:_ `P,6. &w C�7 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 pro c 70,and r ments and that he/she will comply with said procedures and requirements. �� Sign Lure 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. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Oudook\8R76BDVA\EXPRESS.doc Revised 061313