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Home My WebLink About0063 RIPPLE COVE ROAD to Town of Barnstable *Permit#n7� �' Expires months from issue dale ® h Regulatory, Services F� srnst.e, , 09 Thomas F.Geiler;Director 39. plFD(+AAr A TOWN 01 RNSTABLE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number � � V Property Address 63 0-0 11�_ t Ly IVA S Residential Value of Work,$ (5.000 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address e E T .JQ /L•E L I Contractor's Name. K j I✓/l K Telephone Number - 75`0 l ISA Home Improvement Contractor License#(if applicable) 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 be on file. Permit Request(check box) �/ Re-roof(stripping old shingles) All construction debris will.be taken to BI KNSTi16(-g OR, Im 460(VI 6NO2 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.44) *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 is required: SIGNATURE: C:\Users\decollikWppData\Local\Microsoft\Windows\Temporary Internet' iles\Content.Outlook\MY7NB41L\EXPRESS.doc Revised 100608 Town of Barnstable 11 Regulatory Services ;I Thomas F. Geiler,Director owes Building Division prFD Tom Perry,Building Commissioner v 200 Maiii Street,—Hyminis,Mil 02601 _._. . . _....... yr"Aown.b arnstable.ma.us Office: 509-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE I l ! y JOB LOCATION:(' number S j street �y ^7 /, e village HOMEOWNER": y� G L' Y �—06 7 C S 0 191 1 `7V 0 name home phone# work phone# CURRENT MAILING ADDRESS: 63 "el epl— d` <3 d G U city/" 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. DEFINrI10N OF HOMEON'PNER 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 an person who constructs more th 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 buildinir 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 B01n#ablq.Buildipg Department minimum inspection procedures and requirements and that he/she will comply with said procedures and require Signer omeown 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 homcowoer 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 cngages a pason(s)for hire to do such work,that such Homeowner shall ad as supervisor... Many homeowners who use this exemption are unaware that they are assuring the responsibilities of a supervisor(sce Appendix Q, Rules&Regulations en for Licensing Construction Supervisors,Section 2.15) This lack of awareness ofkn rcaults 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 liccnscd. Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the bomeowner is fully aware of his/her rrspoanbnlitirs,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilitirs of a Supervisor. On the last page of this issue is a form currently used by several towns. You may can.t amend and adopt such a fm lccrtification.for use in your community. / f t IME Town of Barnstable Regulatory Services 9xRARt � M Rig $; Thomas F. Geiler,Director E%6 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 509-790-6230 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 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' ' d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): c�T 1 l Address: eOJ City/State/Zip: 0AJ( Phone.#: y�� 7 7, 0 9 r Are you an employer? Check the appropriate box: Type of project(required): 1.El am a employer with 4. I am a general contractor and'I employees(full and/or part-tim.e).* have hired the sub-contractors 6. ❑New construction .2171 I am a sole proprietor or partner listed on the attached sheet. T. Q 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.❑ Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 1 L❑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. 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 certi nd a pai sand pe ties of perjury that the information provided above is//true and correct Signature: Date: U 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#: �I,E, Town-of Barnstable *Permit# . ~O� Expires 6 mon tit s firom issue ale } Regulatory Services Fee • BARN BM � 16.59. $ Thomas F.Geiler,Director �ED MA'I A Building Division Tom-Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 6 Property.Address 63 R J PLr 0U�j E 9 [Residential Value of Work 4aQ0 Q Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address_ � ([� L C CC .Contractor's Name 5 Z 1-- Telephone.Number Home Improvement Contractor License#(if applicable) Construetion Supervisor's License#(if applicable) 41, :• 'tom. ERN ❑Workman s Compensation Insurance - Check-one: /t.r I am a sole proprietor " I�{''` t I am the Homeowner , , w,r y i�, .��, ❑ I have Worker's Compensation Insurance a,�ltil ( .IW ��ARN S R 1'Lr 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 i ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ` #of doors Replacement Windows/doors/sliders.U-Value f (maximum.35)#of windows L *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.c.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'. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Filcs\Content.Outlook\DDV87AAZ\EXPRESS.doc ," Revised 072110 ' f y The Comynanwealth of Maisachusetts Departrneut of Industrial Accidents # Office of Investagadons r 600 Washington,Street Boston,MA 02111 xmu mas&govrdaa Worlmrs' Compensation Insurance Affidavit: Builders/Conti-actors/Electricians/Plumbers Applicant Information Please Print Legibly Name 03u&mewI0%anization&m ividual}_ Address: CitiylStateJZip. Phaae � Are you an employer?Check the appropriate bar':—Type of project(required): 1.❑ I am a employes with 4. ❑ I am a generail contractor and I employe—es(fulland/or yart-time). : have hire the sub-contractors 6. New constnrctioti 3.❑ I am.a sole proprietor or pier- listed on the attached sheet 7- . ILemodelOg ship and have no employees `ham stab-catttractors have g...Ej Demolition w or me n an capacity- employees and have veork�s' ` °�� f in � tY- --'9. Building additiaro. [No workers,comp-insurance comp.insurance.] required-] 5. We are a corporation and its lo.❑Electrical repairs or additions 3. officers have exercised their I am a homeowner doing all wok .11.❑Plumbing repairs or additions a workers' right of exemption per 1tirIGL m3' 12.❑Rnaf,.treparrs insurance r uired]I C. 152,§1(4),and we have no employees.[Noworltem' 13.❑Other. camp-insurance required.] *Any applicant that checks box#1 Est aLe fill out the section below showing their wtakere compensation policy nd—ttan., E Homeowners wbo subffit this affidavit indicating they are doing all wow and then hire antside contractors most submit a new aSYdaeit indicating such_ Contractors that check this box must attached as additional sheet showing the natne of the sub-ca mttmctoxs and state whether at not those entities have ' employees. Ifthe sub-contractors hate employees,they must pmv'ide thew workers'comp.policy number- ,I ant an employer that is prervMyng workers'comp'w' adon insurance for fitp elohea sBs policy mtd job site itTfQYfftatiQll. . . Insurance Compaq Name: Policy#or Sel€it s.Lie..# Expiration Date Job Site Address: CitylStateiZtp: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to sedge coverage as required under Section25A of MGL c. 152 can•lead to the imposition of criminal penalties of a fine up to$1,50G.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDEP and a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement may be fix warded to the Office of Investigations of DIA for insurance coverage verification. I do hereby certi a pain and p to es perjrst y that floe inforrna&n provided above is true and correct S Bate: / - J� /� Pho � Vne 7 7 'l I eiat use only. ?o not write in this area to be earn feted b ct or town � .1- � p y t3' City or Town: - Fermitllaicense ruing Authagky circle one}: 1.Board of Health 2.Buiildiag Department.3 Gtitg/1t of Clerk �!.Electrical Fnsgatctor:S.Fh'mbing Infector`i x 6.other Contact Fersow. Phone#• - 6 I �T Town of Barnstable Regulatory Services BAWMABM + 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: 3/1 JOB LOCATION: /, e�, I�L� �y�� V D �v! ��f/�(s, nu ber p �( \� street village "HOMEOWNER": M� T c 0 F 7 7s . o _:�O F yap G o v name ,q home phone# work phone# CURRENT MAILING ADDRESS: S 1 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 buildingzpermit (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 procedur d e e s nd that he/she will comply with said procedures and requirements. Si re 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 of this issue is a form currently used by several towns. You may caret amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110