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HomeMy WebLinkAbout0073 RIDGEWOOD AVENUE '73 �*�+bad�' l�,u �-- - — i n 04/24/2011 16:53 5087785010 TUPPERCO PAGE 01/01 r,06,* � TUPPER- CONSTRUCTION CO.LLc, 79B MID-TECH DRIVE,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 IVILTUPPERCO.CQM Date: -/®• J3 Town of Barnstable Thomas Perry CBO 200 Main Street , Hyannis,' Ma 02601 Re: Insulation Permits .Dear Mr. Perry This affidavit is to certify that all work completed for permit application # 02 Issued on 6 167 has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. •chard Tupper TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health'Division Date Issued )\*3 Conservation Division Application Fee U: Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Addresses i2cur�DG� Village Owner Address �3 O0d G,-c Telephone ' 'I Zo3 7' I7 'Permit Request 1,L�>c�S� ��✓� �ti 9 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) --- CT .., c-:2 O Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kinc `s ighway 0 Y ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq. Number of Baths: Full: existing new Half: existing nim Number of Bedrooms: existing _new rn Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: XGas ❑ 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 _ _ - r _ (BUILDER-OR HOMEOWNER) Name i "d Telephone Number 10 B r'7`7 '011 1 Address 7q 6 M. `e - �.cc c License # c v — 0(a 9 al 'Y16 0216v73 Home Improvement Contractor# I0_? Worker's Compensation # W M 5005590012012- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L 9� ' L) 026 73 SIGNATURE DATE //___5 FOR OFFICIAL USE ONLY E 'APPLICATION# i DATE ISSUED r ' MAP/PARCEL NO. r� ADDRESS VILLAGE y OWNER DATE OF INSPECTION: *--,,FOUNDATION, - E ' E FRAME INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH • FINAL GAS: ROUGH = FINAL , FINAL BUILDING DATE CLOSED OUT r ASSOCIATION PLAN NO. :tI 6 The Commonwealth of Massachusetts Department of Industrial:Accidents- Office of Investigations ftth Washington Street Roston.-MA 021.11 www.massgvv/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/EI'ectriciansiPlumbers Applicant information Please Print:Leeibly Nt.ame:(Btisiness/Orgahiz.atit)ri/*Itidividi(al): Tupper COnStruCtiC) l Co. , LLC Address: 79B Mid Tech Drive City/State0p: West Yarmouth, MA 02673 Phone#: 508-778- 0111 Are you an employer?Check the appropriate box: Type of:project'(requred): 1.21 1 am a employer with 4. ❑ I am:a general contractor and.I o (�New construction employees(full and/or part-time);* have hired the subcontractors- 2.❑ tam a sole proprietor or partner- listed,on the attached sheet.t 7. ❑Remodeling ship and have no employees These sub- ontractors have 8. ❑Demolitiotn working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [N'o workers'comp.insurance 5. ❑ We are a corporation and.its req&ed.] officers have exercised their 10.❑.Electrical repairs or additions 3.❑ I..am.a homeowner doing all work right of:exemption per MGL I I.❑Plumbing repairs'or additions myself[No workers'comp. a 152,§J(4),and we have no 1.2.❑Roof repairs insurance required.]t employees.[No workers' l3.❑ether 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 ail 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'their workers'comp.policy information. I am an employer that:is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AEI C Policy#or Self-ins.Cic.#:. WCC 5_00559n3012012 _ Expiration Date: 10.1 0 3/2 013 Job Site Address: city/,state/Zip:. 01-601 Attach a copy of the workers'compensation:policy decla tion page.(showing the policy.number and expiration date). Failure.to secure coverage as required under Section 25A of MOO 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 und! r h airs andpena/lies ofperjury that the information provided above is time and correct. Si nature: Date: 69/r3 P..ltone#: __ _ 77S -0// Official use only. Do not write in this area,to be completed by cite 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 M _ . . Dec 1� 2012 4:37PM No. 8524 P =!2 t,Q G UKt oATEaMmroom Yr) CERTIFICATE OF LIA 31LITYTINSURANCE 112i19/2o12 THIS CER`CIFIGATE.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:IN the certificate holder Is an ADDITIONAL INSURED,the pollcoes)must be endorsed. If SUBROGATION IS WAIVED;subject:to the terms and conditions of the policy,certalo policies may require an endorsement. A.statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCECONTACT R NAMEi Lora Lowe Southeastern Insurance Agency, Inc: nJC No.E , (.508)997-6061 Ne (508)'990-2731 439 State Rd. E-MAIL _ ADDRESS: ... .. P.O. Box 79399 PRODUCER c ST M DN: .. ..... ... . . N. Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIC9 INSURED - - _.. ..... wsuRERA: Arbella Protection Insurance Tupper Construction Co LLC INSURER a AEIC W INSURERC.: CNA Surety. ....................................._...._.._..-......._......................................... ....... ---- 27 Roberta Drive INSURER D West Yarmouth, MA 026T3 INSURERE: INSURER F: COVERAGES. CERTIFICATE:NUMBER: 12 j13-.2 REVISION 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. NOTWITHSTANDING.ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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, EXCLUSIONS AND CONDITIONS OF SUCH.POLICIES.:LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER I WDD MM€DD LIMITS GENERAL LIAsimy 8540008743.f 11101/2012 111611100 EACH 0 11 RneNCeRP a 1;BOO,aO0. X COMMERCIAL GENERAL LIABI fI Y . la0 PrtEM s S.� s ac�ire) $ _.... ao Cif iMS MADE i. UL CUF2 ;AEC EXP(Any one piano<) $ _ 5,000 A I ?ERSONtS a ADv a 4my ,, .1,600,000 _ I.GENERAL AGGREGATE. $ y 2,000.,.00. GENL AGGREGATE LIYRT APPLIES PER: COMP CP�AGG $. 2,000,000 POLICYPR` JE CT LGC $ AUTOMOBILE LIABILITY 1 56662400002 1210112012 12/01/2013 f ^ONSNED.SINGLE LIMIT $ 11000,00 0 ANY AUTO I (Ea accltla-t) _._ 130D LY NJUr?Y iP!r person) $ ALI OWNECAUTOS I I ,SOU L i P JI RY(Pe eccidwe I$ A X I xI+.E0ULE4 AAJ O5 I PROPERTY DA'i6i" ---�� X HIRED AUTOS (Par acc Den') III f X 3 NQ'J ONlNEG>ALMOS UMBRELLALIAB 0rx.'JJR EACFiOCCUP.RENCE EXCESS.LIAB :CLAIM&MADE j 1 aGGREGgTE. $ DEDUCTIBLE. i $ . RETENTION $.. I $ WORKERS COMPENSATION WCC50OSS9301200 10/0312012 /0103/2013 AND EMPLOYERS LIAmmy Y I N YOR�PulErcu ,�t FIECIJTiuc i RICNARD 7llPPER I r: En +AcCI s 6Nr. $ 500,00 B CFFICERIMEMSEREXCLUgEU% NlAI IMandatoryInNH) INCLUDED UDED FOR C COVE RAG E L U SEASE•Ei EMPLOYEE'$ SOO,00. It ye s, I OFF OPEkATONSGei e E:L DISEASE-POLICY LIMIT $ 500 00 uCIi PTI PTiON cn4 , on or theft of money & or 71069913 021281..2513 0212812013 Limit of $10,000 C property. .RI�o OF OPERAnONS l LOCATIONS I VEHICLES(Attach ACORD 101;AddMonai Remarks SchedWa,if more space Is required) T.1I'.it iCI&sgrp.-com. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE:CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Conservation Services Group Attn: Bill. Julio AUTHORIZED REPRESENTATIVE 50 Washington Street 4 We thorough, MA 01581 Lora Lowe O 1988-2009.ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD BUfLD1f eta PtiR Uft U l C1`3 U tt INC � � J(as A.Cl U s.- 1ep ttrnent o Po sUc Sate 107 E3 rrtt 5 Road,5uite<11p ja a€c!of ui�dii e ui a on and St rsdarr#s. M,aIW.NY12020. constmail S�'i�e Q8771274 127 L.fcl thsel'CS469058 www.bpi.com. a, 'RICHARD �l WEST ID �17 1 -. s I (SHWOM;st FOR D04MMAfpiEatfiAt«AMO*TtV) w nr aintssi taer 12131I2414 - � •.�;,." C3f'�icr of Gnasut�n� lfifntra Bc'8aia4ata��c�alxtiaXr p; { "Ii� R�Y 6 S i Y id l(Ft�C�OR �Rogistrston a.1 5 Type. y - 4 individual 3i - py/w�g�pp t, PFf\ii5J4RD TV 1/ifis k� :�Zs'�s°ah'r' less xYra� �S�' •- f!:' �h? I\IV�T RID d'.P"Giti., 29 RCberta D€i �+t�dw:�`6''--'-'• w YARMt7 1 N.MA tY2 Uaderarrrrta � fill�� W -'OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at .�(Pf6perty Address) h 4 Property Address) thereby authorize; l \� f (Subcontr f ) ` an authorized subcontractor for RISE Engineering;to,act on my behalf to obtain a building permit aridao performvo'rk on my property. Owner's Signature { Date �Ccy\-'sl�c� t �a Town of BarnstablePermit: *THE A Regulatory Services ate: / S� Thomas F.Geiler,Director BMMSrABl.r'w ' Building Division ee:a dU y MASS. �Ar 1639. p1m� Tom Perry, Building Commissioner Foy 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: ST��en &r 60 Phone: 7 7q- 3 _a 9 7 � � 3 Install at:' 7 S 6 1'4ei✓oo j lgyy Village: Map/Parcel: 3� 8'0�{ o� �� �- �� Date: I ) Sto A Ne /Used . B. Type: adian Circulating C. Manufacturer: jLetan Wrs f Lab. No. D. Model No.: .�LG,-) ayG q Chimney _ ` A. New/Existin If existing,please note date of last cleaning) in/1 o 00 yi B. Flue Size r' Ln C. Are other appliances attached to Flue? D. Pre-fab Type and Manufacturer E. Masonry: Lined/Unlined Hearth A. Materials: B. Sub Floor Construction: Installer Name: o &46YhC17iML'.I �� 'UI' �e - � Address: 13 7-7 B Phone: 5'n-39y-- 7q6 Location of Installation: I� ��, ({ ,m APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 122801 Town of Barnstable ernit: °F1ME Regulatory Services ate: / s=o Thomas F.Geiler,Director BARNSTABLE. : Building Division ee:� dv MASS. 1639. � Tom Perry, Building Commissioner ArEDr a 200 Main Street, Hyannis,MA 02601 www-town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: v '0-L,ell &r6o Phone: '7�Ll- 3(a `a ?7 � 3 Installat:"_73 4K'A,ei✓ooj 4ye Village: 11r,0/) Map/Parcel: 3Q g©9 Date: Jslo-v StnNeA /Used B. Type: adian Circulating C. Manufacturer: Dvkh Wes f Lab.No. D. Model No.: �q(,2 /Qqr cf ,S ^,6 Chimney A. Ne /Existin f existing,please note date of last cleaning_ Joy of 00�{. B. Flue Size g�` tyr.t Y C. Are other appliances attached to Flue? D. Pre-fab Type and Manufacturer E. Masonry: Lined/Unlined r- Hearth A. Materials: B. Sub Floor Construction: Installer Name: fb 40 &116r►, &47^'0 e "O' y -T,7 _Address: 1-7 Phone: c -39y- 701 Location of.Installation: �j�5'Pec•1.,�i' 6t,�ckk.ct l3 v�� APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 122801 Town of Barnstable pIME tpy Regulatory Services . Thomas F.Geller,Director 03 Building Division �Eo Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 FERAHT# 0 0 -7 I FEE: $ SHED REGISTRATION 120 square feet or less 7 S 9` �W W oo � Ave- �l��nn►`S Location of shed(address) Village Property owner's name Telephone number Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) 6 y �— PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN . Q4b=-she&eg REV:121901 T N n 3 n sT oo \ O > 0 pp r> �0 4s � m 2 a 2�9 2e � a � � aom p •N T v C A > W 0o I T ago _ Z i lg OR x a \ Ii 3 0 3<' 0 3 ME Z 9-794 3 �mo� , lVi \ n on N now O O T A T O vO—i /v p q ® O OO v p to v in p o o n a o a v a n f CD CDO A n T O o� ~ r� m� n_ z <�� A m A O c m v C A _=� y o \ Vf \ Z �_ o Z �^ < a z vzm x c �+ Ci7 m v T n ti 3� m v aoa o n �° O c c O n T �' T � JO a '� or � � � � Z � � A A A ,M• � = v� A n N � = vi A � Z TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel •O Permit# -Al/ -3 l 3 Health Division Date Issued �f Conservation Division Fee Tax Collector ,�+ " ► � �� Treasurer '� E Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis d Protect Street Address ? 9/ceo&tjac d A Village 61-,1r v lk7#-r /t/s rT L/f— ' Owner �96 va� C l�2- Address �� �rT��k A V & Telephone r '�k Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type lloa N Lot Size ( /_5 Grandfathered: ❑Yes ❑Tlo If yes, attach supporting documentation. Dwelling Type: Single Family G Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: 0 Yes &KNo On Old King's Highway: ❑Yes &Ao Basement Type: [9 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) esyoq"d Number of Baths: Full:existing I new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count —1 Heat Type and Fuel: ErGas 0 Oil ❑Electric 0 Other Central Air: ❑Yes Slo Fireplaces: Existing CIk ,%f New Existing wood/coal stove: a-les ❑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 O Yes EMo If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name. 141111'3 Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED 3 MAP/PARCEL NO. ADDRESS -,. .: VILLAGE A OWNER ,Y� • E ;� a' r DATE OF INSPECTION: _ FOUNDATION FRAME INSULATION FIREPLACE ' - ELECTRICAL: ROUGH FINAL ' w PLUMBING: ROUGH - FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT y a- ASSOCIATION PLAN NO. r } r The Town of Barns a e 9 Department of Health Safety and Environmental Services Fo Mo.►'' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT ` HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to nay pre-existing owner-occupied building containing at least one but not more thaA four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. D Type of Work: Estimated Cost Address of Work: �- Owner's Name: X- Date of Application: I hereby certify that: Registration is not required for the following reason(s): [3Work excluded by law 1 [3Job Under$1,000 '-- E]Building not owner-occupied h-fowner.pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. R Date Owner's Name g1or ms:Affidav :1 T j� 1 1 1 1 1 I I 1 1 1 �s//t)f• i����t rs V. sis's %/ / �Li�/ % :�Si.!✓ly �s����������������� �������� / rpr 1. 1 . . . , _ 1 1 ..: .. ■ 11 1 1 . 1 . . / 1 ' 1 . 11 . 1 . 1 11 111 • ' ••1 ,� 1_ . 1 1 1/ 1 n 1 /// /// / / M����/////////////%///%//////////%///%///////////////////////////////////%/////%/////%//// . 11 . . 1. 1 1 1 1 1 FO 1 1 9i ��� Y I 1 1 1 1 it 1 . 1 1 . �/ 1 1 • 1 OEM 1 . 1 1 1 1 1 � • � • 1 J)• � 1 1 1 1 � i 1 111 1:11 .... ...,.:::::...,,:..:..a.w:i,:J,:a:,�u,..�u«:.:'../,iw:o:.w>xai✓,r-,x..w»x.�:......�.�.:J:.•.c:�: ::. .:�-.:-;.:' .:`.�.:�L: ...::.::�':x.:.\'x.:.oa:oowc:..ln000aaJ• ;:: . . 1 -->:2-.y„o�+pw�la x�.�a .•.. .,.:,�av�•)cta\v..�»Y�tixi000?xDi�C.ra'0000?oDOoo�:J>rc.,cap;.nJ.,...r..�......./.<\tea.M+�ce!^.tra:. ... ... 'nN000wr<c:Cc�Y�Pwr.�hx:vvaa�cMMA..b'o yJY wa _ - • . �O�\n�'T __ • --'tee_-__ ��f 9 A o rt ilelw .�:._ : ,�-_O.th Safety afety and En svironmental :�� Depa • Building Division ' %RNm'"BM ' 367 Main Street,Hyannis MA 02601 NAM ED bAA'I� Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Q Please Print DATE: ( �Y JOB LOCATION: 12. �_YY kiG�o� ✓�- �7Y ��/°S' number street 2 village "HOMEOWNER": A26 1,� y4`✓04f�% /` (-� name home phone# work phone# CURRENT MAILING ADDRESS: Z51 �Cc��cQ bi J oG c{ /� ✓2 c /town state zip code The current exemption for"homeowners"was extended to include gwner-occupied dwellitrt?s of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,=ided 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. 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' 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 pan: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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN