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Home My WebLink About0595 PITCHER'S WAYIrs-IS 'i ;4,(� IE � CAPE COD INSULATION 0 , 112_ 52 EMIRGLASS SEAMLESS S/RATF"IA SUSIIHASA MTn OUTp15 IMMXATON CTSINAS 1-800-696-6611 I.,nVISION Town of Regulatory Services Building Division Address - Address 2 - Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village Insulation Installed: Fiberglass Cellulose R-Value Restricted 'Unrestricted Ceilings ( ) ) ( 30 ( ) ) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) va-�s sl-e v�-� ��9 a '�u�e er n`g C'9 Oct SinceryCassidyk, Henry President Cape Cod Insulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel lXt �pp n'# Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee VIC Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Str4et;AddressVillageOwner ��51.d UJ Address Telephone Permit Request (a 10 v"--� (� rl a�j& ROY VO4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay l /w Project Valuation yJlo6y Construction Type • Lot Size Grandfathered: ElYes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family O'/ 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 . -. y Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood& al stove-L]Y , ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ ting U:6ew maize_ m Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: •_ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Ca1No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) G� Z Name �G Telephone Number / b Z ` �� Address License#5Z 1 &V-aer� Home Improvement Contractor# ��j�`�b 7 Email Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. rk ADDRESS VILLAGE OWNER 7 DATE OF INSPECTION: d• FOUNDATION FRAME c F INSULATION t FIREPLACE x .ti w ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t ` DATE CLOSED OUT ASSOCIATION PLAN NO. Massachusetts - Department of public Safety ..Board of Building Regulations and Standards Construction super\iscir License: CS-100988 . r.' '` HENRY E CASSHO 8 SHED ROW WEST YARMOU'rH r 6 \ ✓,�..� " "�\ Expiration Commissioner 11/11/2015 a Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cdnitractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE - SO. YARMOUTH, MA 02664 Update Address and return card. Mark reason for change. iCA 1 :5 20M•05/11 Address Renewal Employment Lost Card — _.. d Q�e I�wim,L042CUeaZ6*1t-/Q1&1jjccc/udelro, .C—\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistratlon: 1.53567 Type: Office of Consumer Affairs and Business Regulation xpiration:, ::1:2/:15/20:1.6 Private Corporation 10 Park Plaza-Suite 5170 :c, y Boston,MA 02116 CAPE COD INSULATCO*N;-:INC`% '-- HENRY CASSIDY 18 REARDON CIRCLE' .' g SO, YARMOUTH, MA 02664 Undersecretary ANVvalid tit sign •e The Commonwealth of Massachusetts Department of Industrial Accidents w W Office of Investigations W a a I Congress Street, Suite 100 W= Boston, MA 02114-2017 www mass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 41a (n / Please Print Le iblName (Business/Or zatton/Individual) —,9V1, �(, YV Address; City/State/Zi Phone #: 17N'_1� � -74 Are you an employer? Check he 4.appropriate box: general contractor and I Type of project(required); 1,$'I am a employer with ❑ I am a g 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, ❑ 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 3.❑ 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#l must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this'd'ffidavit indicating they are doing all work and then hire outside contractors must submit anew 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. j Insurance Company Name; �� Policy#or Self-ins, Lic. #: [P Moo 1;2 2,,r—A 0 Expiration Date: �v Job Site Address; ` City/State/Zip: i/[(�j Attach a copy of the workers' compensation poli y declaration page(showing the policy numbe 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 n r pains and penalties of perjury that the Information 4e: i true c r d correct. Si nature: D 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#; CAPECOD-27 KLIGETT CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6113/2014 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 confer rights to the certificate holder in lieu of such endorsements). RODUCER CONTACT ogees&Gray Insurance Agency,Inc. NAME: Barbara DeLawrence PHONE l Rte 134 A/c o FAX �g77) 816-2156 A/C No Guth Dennis,MA 02660 A�REss,bdelawrence@rogers_gray.com INSURERS AFFORDING COVERAGE NAIC N INSURER A:Peerless Insurance Company a SUREp INSURERB:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER C:Evanston Insurance Compan 18 Reardon Circle INSURERD,ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,MA 02664 INSURER E INSURER F; OVERAGES CERTIFICATE NUMBER: REVISION NUMBER: T IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN ICATED. NOTWITHSTANDING 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 TO ALL THE TERMS, EXG:.USIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R TYPE OF INSURANCE POLICY NUMBER MMI D/YYF Y MM/DDY E YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR CBP8263063 64/01/2014 04/01/2015 AM XGI�_�R ED PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATEPROT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POUCY.a JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ I.AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person) $ ALL OWNED F_V__1 SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ rX HIRED AUTOS X AUTOS NON-OWNED PROPERTY-DAMAGE AUTOS Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE XONJ453614 04/01/2014 04/01/2015 AGGREGATE $ DEO X RETENTION 10r000 Aggregate $ 1,000,000 ORKERSCOMPENSATION PER OTH- NO EMPLOYERS'LIABILITY STATUTE ER FFICER/MEMSEER/EXCLUDED?ECUTIVE Ya N/A WCA00525904 06/3012014 06/30/2015 E.L.EACH ACCIDENT $ 1,000,000 Mandatory in NH) f yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 3CRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Titers Compensation Includes Officers or Proprietors. iitional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, iR IFICATE HOLDER _ CANCELLATION HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. hereby consent to and agree that weatherization work may be done y the Weatherization Program of Housing Assistance Corporation on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic & basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. have read the provisions of this agreement and give my consent. l Home Owner(signature) Home Owner email: Date: . Agent:(signature) �� ............ Date: Weatherization Contractors: C _. Cv� r5 `t Adam T Inc Cape Save All Cape Energy Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement 13ui1 ding Sc+e onstruction Resolution Energy Cape Cod Insulation Tupper Construction Barnstable detectives arrest convicted sex offender in possession of a loaded gun Thursday Page 1 of 2 capecodtod, cape cod: 24/7 Home I Blois I Links I Weather Calendar Movies Loitery Horoscope Police and Fire News The latest local police and fire news. Become a business sponsor of CapeCodToday's Police/Fire News&Court Reports! Personal Injury Lawyers � T s i Barnstable detectives arrest convicted sex offender in possession of a loaded gun Thursday 05/05/11-7:04 pm::posted by editor ShareThis Barnstable detectives arrest convicted sex offender in possession of a loaded gun Thursday HYANNIS-As the result of a two-month heroin distribution investigation,a search warrant was issued for the home of Dennis Kelley,33,Of 595 Pitchers Way in Hyannis.During the investigation led by Detective Tom Chevalier,while under surveillance,undercover d`" heroin buys were made at Kelley's Pitchers Way residence,according to a Barnstable Police release. � Around 1 p.m.Thursday,detectives served the search warrant,seizing heroin distribution packaging materials and a digital scale.Also, according to police,detectives discovered a loaded.38 caliber handgun *a hidden in Kelley's bedroom closet. Kelley,a Level 3 Sex Offender,was arrested and charged with unlawfula possession of a firearm,unlawful possession of ammunition and as an armed,career criminal. s= Dennis Kelley,booking photo from the MA Sex Kelley's record includes convictions for rape of a child with force,rape Offender Registry Board. and abuse of a child and indecent assault and battery on a child under 14. According to the information provided by the Massachusetts Sex Offender Registry Board,Kelley was convicted in March of 2005. He was taken into custody and arraigned on gun charges in Barnstable District Court Thursday afternoon. Source:Barnstable Police Department. Content blocked by your organization http://www.capecodtoday.com/blogs/index.php/2011/05/05/bamstable-detectives-arrest-con... 5/6/2011 �oFtarr ti Town of Barnstable _ *Permit# Expires 6 monrtls from rs•sr Frr>f Regulatory Services Fee + BAR451LBLE, i ttnss. $ Thomas F. Geiler, Director Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-700-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Nril Valid Without RedX-Prests Imprint Map/parcel Nurnber�� p�JI Property Addressglic-� e yys 9 s �a6 0/. Residential Value of Worl< /✓�®�LOO Minimum fee of$35.00 for work under$6000.U0 Owner's Nam e & Address 3 a, S' Contractor's Narne_ Telephone Number 00'?6�i7 Home Improvement Contractor License#(if applicable) Construction Supervisor's License# (if applicable) ❑Workman's Compensation Insurance `"P.RESS PERMIT Check one: ❑ I am a sole proprietor OCT ._ 'j 2 10 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 accompany each permit. Permit Request (check box) _E�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 #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum ,35) #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. IGNATURE: AWPFILESIF0RMSlbuildingpermit fonnslEXPRESS.doc evised 072110 f i!i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 w4 s�•�°� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Naive(Business/Organization/Individual): 15CkL LAZ 1�� Address: �i 1�f�G�.✓.lf?c1`'1 . City/State/Zip: L Phone.#: FAre you an employer? Check the appropriate box: Type of project(required): ❑ I am a employer with 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors . . .211 l am a sole proprietor or partner listed on the attached sheet. 7...0 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.$ equired.] 5. We are a corporation and its 10.Q Electrical repairs or additions 3 am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions X 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. lContractors 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 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 may,be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of per' that the information provided above is true and correct. Signafore: Date: oZ 7 Phone#: .— �l>' d 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#: - Informatro structions - ------- -- 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 includin the le- acre iesentafives of a fieceased-em-Io er-or, a - g gJ rP g g P P Y 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-contractor(s)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 permitflicense 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 11-22-06 www.mass.gov/dia r 0 KWE Town of Barnstable Regulatory Services $4I;isrnst lass. Thomas F. Geiler, Director $ a �, Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 518-862-4038 Fax: 508-790-6230 --------------------- HOMEOWNER LICENSE EXEMPTION 0Please Print DATE: L711 c JOB LOCATION: ��S L b �fiy/ L14 number / // street village ,.HOMEOWNER" B mr 6c", &1utA 5oe Fwld 7 d 2 pal — 77JL name home phone# work phone# CURRENT MAILNG ADDRESS: �j��— liU r (,L� Ici,tyltotvh 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 proce �res and equirements and that h s will comply with said procedures and requirements. Signature of Homeowner Approval of BuildingOfficial 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 ofconstruction'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 i amend and adopt such a form/certification for use in your community. Q:1WPFILESIFORMSIbuilding permit formslEXPRESS.doc Revised 072110 OF IHE # i � BARNSI'ABLE, MASS. Town of Barnstable t6gq. �0 ' ATFp MP,Y A Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO . Building Commissioner 200 Main Street, Hyannis, MA 02601 wivw.town,barnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder h , 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, QIWHILESTORMSIbuilding permit formslEXPRESS.doc Revised 072110 �Assessor,s map and lot number .t..l..t.�.l��l�.`...�:�a-5�� /y / C �_ : Q— ,�r ` 77 i K SEPTIC SYSTEM MUST- BE �� INSTALLED IN COMPLIANCE _ py Sewa a Permit number ................... n-r ............... ;a g 1 WITH ARTICLE !! STATE SANITARY LOGE �Nd 'TOWN b�Py�FTNET��O TOWN: OF BARNISTIA.BLE n M 0 M �;,C1639- n BUILDING INSPECTOR ry c�639•'g� 0 ). ;ts ;fi W: x• APPLICATION FO'.R PERMIT TO ..:. O� .C! ......5.� 1c.(C .... :........................ CA TYPEOF CONSTRUCTION ........ ........................................................................................... .............:.......... ' ............./.. ......`.. ................19.71 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....... ., IU'..!..��1.��e4d, � ..........��Y.�.�,��.f.......................................................... ProposedUse .......... 111y-.Z3.��l.,tl/.. ...................................................................................................................................... n Zoning District ............I.``>......r................................................Fire District ... iJ..: .`P... ............... Name of Owner ....... IP. li�� ...�11!..............Address .... ! ✓ ............ Nameof Builder ........................................:...........................Address ....................................:............................................... - df 11 Nameof Architect ..................................................................Address .......:............................................................................ Number of. Rooms ..7.............................Foundation .......... ..................................... Exterior ............... ......... ...1:.....1.... /.................Roofing ................ r1 ................................................. Floors ................ ...........................................Interior ................... ................ ............. .......... .........Plumbin Heating ........ .....:....... ...r.!!I.LI��....fJ�...o.�../ g .................... �—. ....................................... Fireplace ..............:.d,�......................................................Approximate Cost ..........�' S %........................................... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ....1..��.0v............ Z Diagram of Lot and Building with Dimensions Fee .13................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardin the above construction. No ................ e � Capewide Development z 4 -19608 1 1/2 story _ N ............... Permit for �....8ingle:fam ly dwelling :W ............................... y.....i..................... - - • Location.........................•.......................... ............. Hyannis ` Cap ewide. . ...Develop. ment Owner .................. ........ . ...... ........................... Type of Construction ............frame... .: ......... , -.......................+ :. •• ...................... .. ... .......... f• ♦ - . I Plot ...............`.......... .. Lot ........... 14............. i September•16 77 ► - Permit Granted `.........:.................:.::.......19 Date of Inspection ....................................19 Date eCompleted Y..../Z/�..........................19 r I *PERMIT REFUSED ......................................... '...............:.... 19 1 ....................................... •• ...� • •.................. ............ 9...........I...................... . �♦ ...................... ` ...........................r. ................. ; /L• - :) -. ............................................................ ................. Approved , ................... • •.......................................... ......... fr I� - Assessor's map and lot number + a '— y /7 ' 5•� �/ Sewage Permit number ....................................... yoF111E?p�1 TOWN OF BARNSTABLE BJHHSTOIILE, i 9� 6 9 +�•� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........,a m .:................................................................................................................... (TYPE OF CONSTRUCTION .............................................................................j..................................................... t ................................ ............19.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..........__.�n / ../-................................................Z� ' . W�.................. .......... //./../.r................... ProposedUse ............ ............ ... .... .... ......... .......................................................... Zoning District ............� :... ..................................Fire District ... iCd/3.', . .... ... 7........ ....... Name of Owner ...... ;', ,i/ .�!'. .. G:!t..............Address .................. ''`s-..�.�..:. ��`.L....:........................... Nameof Builder ....................................................................Address .................................................................................... ' / Nameof Architect ..................................................................Address .................................................................................... v Numberof Rooms ...............................................................Foundation ........... ...........................................................�cC; Exterior ....................='.....................r f.%'. ......................Roofing ...............f1.//........................................ .... ...... r Floors Interior �........�............ f .................................................................................... Heating ........... .. .. y.............:.'f............ ...,......................Plumbing ........................... ................................................ Fireplace ................'...::.. .........................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -----------_______-----------19________, Area .................................. -- Diagram of Lot and Building with Dimensions Fee �` 1............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. C'�r✓/ &:jwP S-' Name-......�/. .f:r rLl .? `:...��.�............ Capewide Development A=270,-251 J/ 19608 1 1/2 ?toryA Y No ................. Permit ford"`........: ................ ...... single family dwelling ...............• ..........................................i........... itchers Way Location .............................pay Hyannis ............................................................................... Capewide D4velopment -11 Owner .............................11................................... X frame Type of Construction. .......................................... .. ..............................(............................. .... **A* Plot .................. ...... !I Lot #14A ................... .Sep�telmber 16 77 Permit Granted ..................... .................19 Date of Inspection ............... .................19 Date Completed .... 19 .................... PERMIT REFUSED ...................................... . . ...... .. 19 j. . ... . ............................. ............................. ............... ................................. .................................. ............................................ ............................................................................... N. 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