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0034 SILVER LANE
�3V S� �se e.� �./�n� -- - �(�b'- I5� ����z � �l� �� � � Cape Save Inc. TOWN N 0;F 7-D Huntington Avenue South Yarmouth, MA 92 '4 2 I;: 7 - Tel: 508-398-0398 Fax: 508-398-0399 DID TT Z 6/27/12 3 .21 Town of Barnstable Thomas Perry CBO . Building Commissioner 200 Main St. Hyannis,MA 02601 k : Kr rW ' RE: Building Permits - p Dear Mr. Perry, This affidavit is to certify that all work completed for 34 Silver Lane,Hyannis has been inspected by a certified Building Performance Institute(BPI)Inspector. NO INSULATION WORK WAS DONE AT THIS JOB All work performed meets or exceeds Federal and State Requirements. ' Sincerely,` William McCluskey is , �. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _ Parcel Application ' U Health Division Date Issued ) Conservation Division 4 Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation / Hyannis cc . Project Street Address 34 J 1 'V L'r LoLo e- _ Village MA n 1S Owner CG`L n V +O Address 55 01�'I.OM�'�►Cf► . WAt(,Alleld G7 Telephone gLID Permit Request " I R ber 6 +0 -I've ('n 1D o x �re,n4i I w-�an 41 c Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation goo Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure l4 b Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other CD Basement Finished Area (sq.ft.) Basement Unfinished Area ROM — Number of Baths: Full: existing new Half: existing -Y new g) _n. Number of Bedrooms: existing —new - Total Room Count (not including baths): existing new First Floor Room Couri# Heat Type and Fuel: 0 Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: 0 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 (BUILDER OR HOMEOWNER) Name WimtkN �C Skvt�•Telephone Number 5�� - 3 % Address i�J� 'r�, v� License # G k 0 Home Improvement Contractor# I + 1 3 D O Worker's Compensation # t W G g 00 4- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Yna mb.,4 SIGNATURE DATE r ^ FOR OFFICIAL USE ONLY , APPLICATION# c DATE ISSUED _ MAP PARCEL NO. ' ADDRESS VILLAGE 4 OWNER. at DATE OF INSPECTION: a •'FOUNDATION; f FRAME ; INSULATION ' FIREPLACE ' ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL K R '—GAS: +^ ROUGH - - FINAL ,FINAL BUILDING ,., ; DATE CLOSED OUT l r ASSOCIATION PLAN NO. r I i The Commonwealth of Massachusetts Department of Industrial Accidents Office of lnvestigations 600 Washington Street. Boston?,MA 02111 wlvlv.nnass gov/dia r , Workers' Compensation Insurance Affidavit; Builders/Contractors/Electriciais/Plumbers . Applicant Information Please Print Legibly Name(Business/OrganizatiorAndividual): T n c. , Address: ' D Hofiiing+t7n Ptvenu�.e a • City/State/Zip:5eu�t�+ Yducrouth �A Oa(ob� Phone#;# ;5o'g_ 3 9 $ p 3 4 $ Are you an employer?Check the appropriate box: �. I. I am a employer with__ I �j_ . '4. Q I am a general contractor and I Type of project(required): T r r employees(:full and/or part-time).* have hired the sub-contractors 6 ❑New''constiuction 2.❑ I am a sole proprietor or partner listed on the attached sheet . .T. F-1 Remodeling ship and have no employees These sub-contractors have _ g. Demolition working for mein:any capacity, employees and have workers' [No workers'comp.insurance = comp.insurance.t 9. Building addition required.] 5. We are a'corporation and its 10.E Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers hive exercised their 11.❑Plumbing repairs or additions, - e myself. [No workers'comp. . right of exemption per MGL. insurance required.]t c. 152, §1(4),and we have no , -12. Roof repairs ` _ employees.[No workers' 13:5d Other �'n S u.1 QVj on 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 indicatingsuch. $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- 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 x information. - insurance Company Name: Teo n 0 0 it S w,'-an c.e CY, LAY � Policy#or Self-iris.Lic.#: C 3 31 g -4 Expiration Date: y Job Site Address:_ �_. O r',fe _ - ' City/State/Zip:. Attach a copy of the workers'compensation policy declaration page(showing the policy numbe�andpiration 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 impr . isonment,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 Investitrations of the DIA for insurance coverage verification. ' I do hereby certify under the pains andpenalties ofperjury that the information provided above is true crud correct Stsnature: ' z r Date: Phone•#: so Official use only.'Do not write in this area,to be completed by city or town official City or Town: Permit/License# ;r a Issuing Authority(cirde one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector .6. Other 6: , Contact Person: . Phone 4: AC<✓RO® p DATE(MMMDNYYY) , CERTIFICATE OF LIABILITY INSURANCE 5/10/2012 ;PHIS 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(ies)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 endorsement(s). PRODUCER CNAMEAC Risk Strategies Company. Risk Strategies Company PHONE (781)986-4400 FACNoc.(701)963-4420 15 Pacella Park Drive E-MAIL ADD E -- suite 240 INSURE S AFFORDING COVERAGE NAIC# Randolph MA 02368 NSURERA:Selective Insurance INSURED INSURERB:Safety Insurance Company 3618 Cape Save, Inc INSURERC:Technolo Insurance Company 7 D Huntington Ave A INSURER D - INSURER E South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBERCL125948081 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 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE D POLICY NUMBER MDLSUBR PIMIODf EFF MM/DDY/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $DAMAGETO RE 1,000,000 X COMMERCIAL GENERAL LIABILITY J PREMISES a occurrence $ 100,000 A CLAIMS-MADE ®OCCUR CPPS1994480' 0/16/2011 0/16/2012 MED EXP(Any oneperson) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2,000,000 GEN'LA GGREGATE LIMIT APPLIES PER: , PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO LOC r $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 ANY AUTO r Y9 "' BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 6208200 1/6/2011 1/6/2012 BODILY INJURY(Per accident) $ ' AUTOS AUTOS X HIRED AUTOS N NON-OWNED i .f PROPERTY DAMAGE $ AUTOS _ Peracddent X "• Underinsured motorist Bl spIC $ 100 000 X UMBRELLA LIAB ECOLAIMS CUR EACH OCCURRENCE $ 2,000,000 A EXCESSLIAB f4MDE ! tr• - < AGGREGATE $ 2,000,000 DED RETENTION$ CPPS1994480 0/16/2011 0/16/2012 $" ' C WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN Ll ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. ACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? Q NIE.L. (Mandatory in HH) C3318007 /9/2012 /9/2013 E-L DISEASE-EA EMPLOYE $ 500,000 If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $Y 500,000 6.. . DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Issued. as evidence of insurance. Issued as evidence of insurance. Thielsch Engineering, Inc. is listed as additional insured as respects General Liability as required'by written contract. M a i CERTIFICATE HOLDER CANCELLATION msong@ capelightcompact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED ,IN ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact u ; Attn: Margaret Song `' ' ' r ° AUTHORIZED REPRESENTATIVE g'.. PO Box 427/SCH ' k r 3195 Main Street Barnstable, MA 02630 # ` ` 4^ Michael Christian/BAM . ACORD 25(2010/05). ©1988-2010 ACORD CORPORATION."All rights reserved. INSA25 ronirmi ni , Tha Annon nzimo anel Inn^are roniatarod marke of AftnlN'1 — Niassachusetts Depailment of Public 'slit i:tN' . Board of Buildin.- Red and Srund.uAs Construction Supervisor Specialty License License: CS SL 102776 Restricted to: IC 4" WIL-LIAM MC CLUSKY 37 NAUSET ROAD WEST YARMOUTH, MA 02673 Y- Expiration: 6/28/2013 ('onunissioncr Tr=: 102776 Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation w Expiration: 3l14/2014 Tr# 222184 CAPE SAVE INC. - WILLIAM McCLUSKEY - 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 r Update Address and return card.Mark reason for change. Address Renewal ❑ Employment L7 Lost Card PS-CA1 is SOM-04104-G101216 Consumer Affairs Regulation License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g y • HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: r1 Registration::>>1,71380 Type: Office of Consumer Affairs and Business Regulation 'a fi Expiration: ,3?14l2014 Corporation 10 Park Plaza-Suite 5170 , =_ Boston,MA 02116 . CA SAVE INC.";:,--- WILLIAM McCLUSKEY _L: 7-D HUNTINGTON AVENUE: SOUTH YARMOUTH,MA 02664' Undersecretary 'Not valid will, it o signa 3m • Autho za tion'. i din as owner I ..v . f . F .. ive-m ermIssIon: t° F hereby g Y p EATHCAPE.'SAVEr '. 7-C Huntington Ave. South Yarmouth 02664 '(50 s}399-0398 to take all necessary steps to obtain a `building r ork,at m rty Y perm to perform tow Y prope located {T � � l - at a �P. Sogned . $ a Date �. . , n • _ " �. tl Via. yt'' `. " 'y� - r r 1 �oFVE r Town of Barnstable *Permit# Expires 6 month fro`i issue date Regulatory Services Feed BARNSTABLE, v MASS' $ Thomas F.Geiler,Director rFo A MIT PRESS PER ,►� Building Division APR - 2 2 01�om Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 . ®. N OF BARNS,TABLEvww.town.barnstable.ma.us n Office: 508-8 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work I � �C� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address e o J-.),�4' �� sL 1 l/j� V e UA' Contractor's Name kQ 11" Wit' f-Qc^ Telephone Number S Home Improvement Contractor License#(if applicable). / . Construction Supervisor's License#(if applicable) ❑Workman's Compensation.Insurance Check 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(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) 2-1 re-side #of doors Replacement Windows/doors/sliders.U-Value `'�� (maximum.44)#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. SIGNATURE: .Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 090809 License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 �� { Not valid without signature -1ze ` OtTCe of � Consumer HOME IAlp `hairs&g N . Registratio;,P M' NT CONTRACTOR gatation Ex1489 " Piration a iV15/ 99 RO TYPe}, EDB = 2011 Tr/� 1 BE r J1 A = 290092 ROSERT BROWNW STOII+1 BUILD 5611 OLD � / DING REMODELING CENTER VILLE, Undersec A retary P rd of Nktss tch Use tts_ p onst u(ctioU11dill Rcir7ment ot• n S 'Ulations .public sal ai. Licenser Upervisor anc/Stan SPecialt d;11 Restricted to: Cg SL 100878 Y License RF,WS 563O6ERT BROWN '�: OLD 3T f �ENTERVIL RAW BERRY NI � F E, MA 02632 L R M, . Col-Ile,. .. ExPiration: 1011012011 Tr#:.100878 Fig The Commonwealth of Massachusetts .. Department of Industrial Accidents Office of Investigations 600 Washington Street - ti Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,_� �^ Please Print Legibly Name (Business/Organization/Individual): �bt_6 1�� Pil, no C.✓/�1 Address: � v l c> City/State/Zip: Phone #: ���( ��1 2 —'4 7�> Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I erreyees(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. ❑ Remodelin9. 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 11.0 Plumbing repairs or additions myself ' right of exemption per MGL Y �o workers comp. 12.❑ Roof repairs insurance required.] t C. 152, §1(4),and we have no 1311 Other employees. [No workers' 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. tContractors 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 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is trite and correct. Signature: (2 Date: 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): 11 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - Contact Person: Phone#: Information and Instructions 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 including the legal representatives of a deceased employer, or the 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, constriction 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." 7 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permitilicense 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 4-24-07 www.mass.gov/dia Town of Barnstable . Regulatory Services 9$"R'' 'MAB& ` Thomas F. Geiler,Director o;o. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstabie.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, —JV'5�—ty V1 Vq 4-C , 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) Si a of Owner Date 10� t` V e Print Na If Property Owner is applying for permit please complete the Homeowners*License Exemption Form on the reverse side. Q:FO RM S:O W N E RP E RM IS S I ON F .;y Town of Barnstable of zHME rq4, o Regulatory Services BARNsz,AB Thomas F. Geiler,Director MASS. 9�A 1639• ��� Building Division Tfn�t1.'Is 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: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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 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 part of the permit application, that the homeowner certify that helshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC r. v O S�f � � K � w � �Q'`r� � I - i � P. 1 Communication Result Report ( Feb, 25.- 2009 10:49AM ) 2) Date/Time : Feb, 25, 2009 10:46AM File Page No, Mode Destination Pg (s.) Result Not Sent ---------------------------------------------------------------------------------------------------- 1840 Memory TX 918607217710 _ ' P. 7 OK ----------------------------------------------------------------------------------------------------- Reason for error E. 1) Hang up or line fail. E. 2) Busy E. 3) No answer E. 4) No facsimile connection E. 5) Ex c e e d e d max. E—ma i l s i z e �,xr roy� Town of Barnstable Regulatory Services Thomas P.GcIIer,Director Building Division Tom Perry,Building Commioicner 200 Main Strcct,Hyancir,MA 02601 .nv_(en•n.harnctable.ma.uc Office:508-862-4039 Fax:508-790-6230' PLEASE FORWARD THE ATTACHED PAGE(S)TO: TO: ATTN: SO-5E LY H if)9 LE P1'r i�: _ FAX NO: g•Lo 7 a 1 77 10. FROM! Pn,1— 20 64q DATE: .PA.GE(S): 7 (INCLUDINGCOVERSI19M, of THE r gown Of Barnstable Regulatory Services ` tu�+srAtILE 'Thomas F. Geiler, Director y . MASS. a°ArEo39 ,�a,� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 mm....tmvn,harnstahle.ma:iIS. Office: 508-862-4038 Fax: 508-790-6230 (PLEASE FORWARD THE ATTACHED PAOE.(S) TO.. TO: A rTN: -0 5- 4— N V t t—C—tI FAX N0: � 0 -7r� I -7 7 14 FROM: (DATE: PAGE(S): 7 (INCLUMNG COVER SHEET) 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHUSETTS STATE BUILDING CODE J (� people or uses other than normally expected for`this 51.00 through 99.00, specific information shall be purpose). given to establish such quality,and 780 CMR 51.00 6. Painting, papering, tiling, carpeting, through 99.00 shall not be cited,or the term"legal" countertops and similar finish work. or its equivalent used as a substitute for specific 7. Swings and other playground equipment_ information. accessory to a one-or two-family dwelling. When such application for permit includes fire 8. Window awnings nine square feet(0.8361 m') protection systems or portions thereof,the building or less in area supported by an exterior wall. official shall cause one set of construction 5110.4 Form of Application. Applicants shall documents filed pursuant to 780 CMR 5110.7 to be submit requests for building permits only on the transmitted simultaneously to the head of the local uniform building permit application form contained fire department for his file,review and approval of in Appendix 780 CMR 120.P or on a form that has the fire protection system items specified in 780 CMR 5313 and/or 780 CMR 93.00 as been approved by the BBRS for such purpose. The application for a permit shall be accompanied by the applicable. The head of the local fire department required fee as prescribed in 780 CMR 5114. shall within ten working days from the date of receipt by him, approve or disapprove such 5110.5 By Whom A lication- is Made. construction documents. If the head of the local fire ® la> N Applicatio for a permit shalpbe made by the owner department disapproves such construction - S or lessee of the detached one- or two-family documents, he or she shall notify the building C sP0 h(S 1 �L dwelling or agent of either. If application is made official (refer to M.G.L. c. 148, § 28A) in writing other than by the owner,the written authorization of citing the relevant sections of noncompliance with .,p fZ the owner shall accompany the application. Such 780 CMR or the sections of the referenced standards P written authorization shall be signed by the owner of Appendix A. Upon the request of the head of the G — and shall include a statement of ownership and shall local fire department,the building official may grant identify the owner's authorized agent,or shall grant one or more extensions of time for such review permission to the lessee to apply for the permit. The provided,however,that the total review by said head full names and addresses of the owner, lessee, of the local fire department shall not exceed 30 applicant and the responsible officers,if the owner calendar days (the same concurrent 30-day period l or lessee is a corporate body,shall be stated in the afforded building department review). .If such application. approval, disapproval or request for extension of Note: It shall be the responsibility of the registered time is not received by the building official within contractor to obtain all permits necessary for work said ten working days, the building official may covered by M.G.L. c. 142A, Regulation of Home deem the fire protection construction documents B U L L s Improvement Contractors. An owner who secures implicitly approved by the head of the local fire his or her own permits for such shall be excluded department. from the guaranty fund provisions as efined in Construction documents shall be drawn upon X C L U i)C M.G.L. c. 142A. Refer to Special Regulation suitable material. Electronic media documents are 780CMR 110.R6 and M.G.L.c. 142A for additional permitted to be submitted when approved by,the Q-D information regarding the Home Improvement building official. Construction documents shall be t,t � Contractor Registration Program. of sufficient clarity to indicate the location, nature and extent of the work proposed and show in detail 5110.6 Recognition of Laws, Rules and that the work will conform to the provisions of Regulations. The securing of a building permit by 780 CMR 51.00 through 99.00 and relevant laws, the owner, or the owner's authorized agent, to ordinances,riles and regulations,as determined by W N E construct, reconstruct, alter, repair, demolish, the building official. 1-5 remove, install equipment or change the use or At a minimum, construction documents shall PoK L& occupancy of a detached one- or two-family include the following: S dwelling shall not be construed to relieve or l D I. Site plan; � otherwise limit the duties and responsibilities of the jlZrct f 1, licensed, registered or certified individual or firm 2. Foundation plan and details(as necessary); under the rules and regulations governing the 3. Floor plans (including basement and attic. issuance of such license registration or certification. levels, if applicable); floor plans shall include location of all required fire protection systems and 5110.7 Construction Documents. The application heating systems storage areas. for a permit shall be accompanied by not less than 4. Exterior building elevations; three sets of construction documents. The building 5. Framing plans and/or building section(s) official is permitted to waive or modify the adequately depicting structural systems; requirements forfiling construction documents when 6. Schedules,legends and/or details adequately the building official determines that the scope of the depicting doors, windows and related material work is of a minor nature. When the quality of the installations; and materials is essential for conformity to 780 CMR 7. Energy conservation information. 50R pan rrr4n Q..-, 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHUSETTS STATE BUILDING CODE LATENT CONDITIONS. Deleterious conditions of work for any category of work proposed under which existed prior to alterations, additions or 780 CMR 93.00 except no permit shall be change in use but are not evident until after the start required for ordinary repairs. of construction,renovation or demolition. 9303.3 Certificate of Use and Occupancy. At the REPAIR/RENOVATION. The reconstruction or completion of work the permit applicant shall apply renewal of any part of an existing building for the for a certificate of use and occupancy in accordance purpose of its maintenance without altering the with 780 CMR 5120. physical layout of the space or spaces within the existing building. 9303.4 Unlined Chimneys. Where new HVAC appliances are connected to an unlined chimney,the REPAIR (Ordinary). Any maintenance which chimney lining requirements of 248 CMR or does not affect structure, egress, fire protection 527 CMR,as applicable,and those of the appliance systems,fire ratings,energy conservation provisions, manufacturer shall be satisfied. If the appliance is a plumbing,sanitary,gas,electrical or other utilities. solid fuel-burning appliance, the chimney shall be SERVICEABLE. A building feature,component relined to satisfy requirements both of the code for or system which,by virtue of its physical condition, new construction and those of the manufacturer,as is suitable to continue in service without having a applicable. deleterious effect on the normal or intended use of 9303.5 Power Venters. The requirements of the building or on the safety of the occupants or on 248 CMR or 527 CMR shall apply as applicable. If the public safety. the appliance is a solid fuel-burning appliance,any UNSERVICEABLE. A building feature, Power venter utilized shall be listed for the component or system which,by virtue of its physical application,as shall the solid fuel-burning appliance, condition is unsuitable to remain in service. sized for the appliance being exhausted, contain required pressure proving switching,and be installed Terms not Defined. Terms not defined in relative to combustible construction in accordance 780 CMR 9302 shall be as defined in 780.CMR with the power venter listing;likewise,power venter 52.00. requirements of the solid fuel-burning appliance manufacturer shall apply,as applicable and if power 780 CMR 9303 GENERAL REQUIREAJENTS venting is not allowed by the solid fuel-burning 9303.1 Classification of Work. Work on an appliance manufacturer,then power venting shall not existing building shall be classified in one or more be allowed. of the categories listed below and as and defined in 9303.E Flood-resistant Construction for Existing 780 CMR 9303. Buildings. When applicable, conformance to 1. Repair or renovation 780 CMR 5323 is required (also see 780 CMR 2. Alteration(s)" 9306). 3: Addition(s) 4. Demolition(partial or total) 780 CMR 9304 REPAIRS AND 9303.1.1 Repair or Renovation Shall Comply RENOVATIONS with 780 CMR 9304 and 9306 When 9304.1 Repairs and Renovations. Repairs or Applicable. renovations to existing buildings which maintain or 9303.1.2 Alterations Shall Comply with improve the performance of the building may be 780 CMR 9304 and 9305 and 9306 When made with the same or like materials, unless Applicable. required otherwise by 780 CMR 51.00 through 9303.1.3 Additions shall Comply with 99.00. Alterations or repairs which have the effect 780 CMR 9304 and 9306. of replacing a building system as a whole, or the repair or replacement, or installation of interior 9303.1.4 Energy Conservation Requirements finishes, or structural elements or systems shall Shall Comply with 780 CMR 9307. comply with 780 CMR 51.00 through 99.00 for new construction to the fullest extent practicable. 9303.2 Building permit Requirements. 9304.2 New Building Systems. Any new building_ 9303.2.1 Building Permit Re uirements. A system or portion thereof shall conform to 780 CMR building perrrut shall be required for al categories for new construction to the fullest extent practicable. of work in 780 CMR 93.00 except that a permit However, individual components of an existing bb C' shall not be required for ordinary repairs as building system may be repaired or replaced without " \_N defined in 780 CMR 9302: REPAIR(Ordinary). requiring that system to comply fully with the code 9303.2.2 Application. A building permit for new construction unless,specifically required by application shall be filed in accordance with 780 CMR 93.00. 780 CMR 5110 and 780 CMR 93.00 and a building permit shall be obtained prior to the start 866 780 CMR-Seventh Edition 3/23/07 (Effective 4/1/07) f . 780 CMR: 'STATE BOARD OF BUILDING REGULATIONS AND STANDARDS REPAIR,RENOVATION,ALTERATION,ADDITION,DEMOLITION AND CHANGE OF USE OF EXISTING ONE-AND TWO-FAMILY DWELLINGS 9304.3 Existing Nonconforming Buildings, roofing. Spaces, Rooms, Building Systems or Building 2. When the existing roof covering is wood Components. Features of existing construction shake,slate,clay or cement tile;except when including but not limited to stairs, guardrails or the new roof covering , is installed in ceiling heights which do not meet the requirements accordance with approved industry standards. of 780 CMR 51.00 through 99.00 for new 3. When the existing roof has two or more construction shall, be presumed to have met the layers of any type of roofing. regulations, codes or laws in effect at the time of Exception. The removal of existing roof construction or alteration and,if so,shall be deemed coverings shall not be required where . to be existing nonconforming. Unless stated complete and separate roofing systems are otherwise,nothing in 780 CMR 9304 shall require provided which transmit all roof loads the upgrading or replacement of any existing . directly to the structural system of the nonconforming features orcomponent of an existing building and which do not.bear upon the building,provided the feature(s)or components or existing roof. systems are in a serviceable condition unless the building official determines that an unsafe or .9304.4.4 Reinstallation of Roofing Materials. dangerous condition would exist,in which case he The reinstallation of existing roof covering. shall order the remediation of such condition. Nor materials which have been removed is not shall 780 CMR 9304 be deemed to require the permitted. replacement or upgrading of serviceable components 9304.4.5 Flashings. Flashings shall be which are not included in the scope of work for reconstructed in accordance with approved which a permit is applied unless expressly required manufacturer's instructions and 780 CMR 51.00 by other sections of 780 CMR 51.00 through 99.00, through 99.00. or unless the building official determines that an 9304.4.E Structural and Construction Loads. unsafe or dangerous condition would result. The existing roof system shall be capable of Exception: Existing''components or features of supporting all equipment loads encountered an existing building which,in the opinion of the during installation as well as the loads resulting building official, are dangerous, unsafe, un- -from the new roofing materials. serviceable or demonstrate damage or significant 9304.5 Replacement Windows. deterioration or which otherwise present a threat to the occupants or to the public safety shall be 9304.5.1 Structural Requirements. Where re mediated in accordance with the applicable windows are replaced which require enlargement sections of 780 CMR 51.00 through 99.00. of the existing opening, an adequately sized structural header,jack studs and other necessary 9304.4 Roofing,Reroofing and Flashing. framing shall be installed. 9304.4.1 General. Materials and methods used 9304.5.2 Emergency Egress Windows. All for repair,replacement or recovering an existing emergency escape windows from sleeping rooms roof shall comply with 780 CMR 59.00 and shall have a net clear opening of 3.3 square feet applicable sections of 780 CMR 93.00. When the (0.307 m'). The minimum net clear opening shall p repair,replacement or recovering within any 12- be 20 inches by 24 inches(508 min by'610 mm) l 6_k" t T month period exceeds 25%of the roof covering of in either direction except that windows in sleeping Lam-C� the building,the entire roof covering shall comply rooms of existing dwellings which do not with the requirements for new roofing. conform to these requirements may be replaced 9304.4.2 Roof Covering Installation. Roof without conforming to these dimensional covering installation methods, materials and requirements,provided that the windows do not flashings shall comply with 780 CMR 59.00,as significantly reduce the existing opening size. applicable,and in accordance with manufacturer's Exception:Replacement windows utilized as written installation instructions. Where emergency egress windows, other than manufacturer's installation instructions differ double-hung windows,shall generally conform 'from the requirements of 780 CMR 51.00 through to the requirements of 780 CMR 5310.1.1 ' 99.00, printed manufacturer's instructions shall without conforming to the cited dimensional govern warranties relative to roof covering. requirements,provided that such replacement 9304.4.3 Recovering Versus Replacement.New windows do not significantly reduce the roof coverings shall not be installed without first existing opening size. removing existing roof coverings when any of the 9304.5.3 Safety Glazing. Safety glazing shall be following conditions occur: used in specific hazardous locations where l.. When the existing roof or roof covering is identified in 780 CMR 5308.4. water soaked or deteriorated to the point of being unacceptable as a base for additional 12/28/07 (Effective 1/l/08) 780 CMR Seventh Edition 867 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS SPECIAL REGULATIONS �. mortgage on a residential property, or as subcontractors for the performance of any part of otherwise defined by M.G.L.c. 255E. the home improvement contractor's or OWNER. Any homeowner of a building which subcontractor's contract. is an existing building at the time of a contract SUBCONTRACTOR. Any person,other than a that is owner occupied,containing at least one but supplier of only materials, who enters into a not more than four dwelling units, or a tenant contract, written or verbal, with a home authorized by the homeowner thereof,who orders, improvement contractor for the performance of contracts for, or purchases the services of a any part of a home improvement contractor's contractor or subcontractor. An owner occupying contract with an owner for residential contracting, a condominium unit in a building containing no or who enters into a contract with any other more than four dwelling units qualifies as an subcontractor for the performance of any part of owner under this definition,provided the owner the subcontractor's contract. owns a total of not more than four condominium units. A condominium association does not 110.R6.1.3 Scope. qualify as an owner. 110.R6.1.3.1 M.G.L. c. 142A and 780 CMR OWNER-OCCUPIED. The residential building 110.R6 require the registration of persons who of at least one but not more than four dwelling engage in residential contracting work as defined units and occupied by the owner as a primary in 780 CMR 110.R6 and M.G.L. c. 142A after residence. July I, 1992, and define the requirements of PERMIT. For the purposes of 780 CMR 110.R6, M.G.L. c. 142A and enforcement of these any construction-related permit, excluding any requirements, as they pertain to home tmprovement contractors and subcontractors. permits required by the owner which are: not considered construction-related, such as zoning, 110.116.1.3.2 Except for those persons who are environmental, historical commission, and the specifically exempt from the provisions of like. 780 CMR 110.R6 and M.G.L. c. 142A, all PERSON. Any individual, partnership, contractors and subcontractors who engage in residential contracting as defined in 780 CMR \ corporation, society, trust, association, or any 110.R6 and M.G.L. c. 142A shall be subject to other legal entity. and shall comply with 780 CMR 110.R6 and REGISTRANT. Any duly registered home M.G.L.c. 142A. improvement contractor or subcontractor. REGISTRATION NUMBER. The number 110.R6.1.4 Administration and Enforcement. assigned to the applicant after he has been 110.R6.1.4.1 Director Responsibility. . The approved for registration by the director and the director shall promulgate and -enforce the Board of Building Regulations and Standards. provisions of 780 CMR 110.R6 and M.G.L. - c. 142A as to all home improvement contractors RESIDENTIAL CONTRACTING. The - and subcontractors who are registered or required. reconstruction, alteration, renovation, repair, modernization, conversion, improvement, to register. H , C, removal or demolition or the construction of an 110.R6.1.5 Persons Who Must Register. addition to any pre-existing owner-occupied 110.R6.1.5.1 General. All home improvement building containing at least one but not more than contractors and subcontractors, as defined in four dwelling units, which building or portion 780 CMR 110.R6, except those exempt in thereof is used or designed to be used as a 780 CMR 110.R6.1.6, shall register with the S I N C L� residence or dwelling unit,or to structures which director by filing an application prescribed by the Fj are adjacent and accessory to such residence or director. ���lE�( — building,including but not necessarily limited to. —n o W garages,sheds,cabanas,poolhouses,gazebos. 110.116.1.5.2 Designated Individual. In the case 0 t!i-XPTC4 SALESPERSON. any person, other than a of registration by a corporation or partnership,an supplier of materials or a laborer, who solicits, individual shall be designated to be responsible offers, negotiates, executes, or otherwise for the corporation's or partnership's residential endeavors to procure by any means whatsoever, contracting work. 'directly or indirectly, a contract for residential 110.R6.1.5.3 Liability. The corporation or contracting services from an owner on behalf of a partnership and its designee shall be jointly and home improvement contractor or subcontractor, severally liable for the payment of the registration SECRETARY. The secretary of the Office of fee, the payment to the guaranty fund, and for Consumer Affairs and Business Regulations.- viol ations of y provisions of 780 CMR 110.R6, SUBCONTRACT. A contract,written or verbal, including actions by the registrant's employees, in any amount, between a home improvement subcontractors or salespersons. contractor and a subcontractor or between two 12/28/07 (Effective I/1/08) 780 CMR-Seventh Edition 957 .A New Look for Department of Public Safety License Cards Page 1 of 2 The Official Website of the Executive Office of Public Safety and Security(EOPSS) r� } Mass.Gov ` Public. Safety Home>Public Safety Agencies>Massachusetts Department of Public Safety> NEWS&UPDATES ......... A New Look for Department of Public Safety License Cards Building Code The Seventh Edition of the Building Code establishes four new,Specialty Construction Supervisor Changes for March 1 U, 2009 BE3RS Public License categories. The new license categories,which go into effect o October 6,2008,include: Hearing • Residential Roof Covering . AAB Posts Call for • Residential Window and Siding N 0 'r �( (� E� Entries for 2009 • Residential Demolition Only and i Accessible Design • Residential Solid Fuel Burning Appliance Installation l " Awards g With the introduction of these new categories,the Department has redesigned the look of its license . Board of Building cards. Previously,Department licenses were laminated in plastic.(See picture of an old license below). ' Regulations and Standards(BBRS) The redesigned licenses look similar to a motor vehicle operator's license(See picture of a i News h -- anew license below). The new license design , Update to The MA IksrtlnfBe1191rt�1latltl+a{ii0i�adarili r, "will allow the Department to generate license ; Energy Code darofruGNen$uPNV. eufLlCeotae .,_ ✓ w ( !cards more efficiently. Therefore, it i 1313RS News . I�sra�5e CS; �959. i g) da a t122ft951. d rs anticipated that the timeframe for receiving More... �, .-._, E� tlbn bfT�f2Il79. Trtii 9�894 tteslfitiari rj l s the new licenses from the Department will Subscribe Learn more Lkenzae a.Tbe shortened. Finally,the new license card is - - - ' � s ONLINE SERVICES 1 Y9.$GetB$`•fret .s i, �T". Sodom tan az1�06 �„�mt-- 6��--- $more durable and its design will significantly �Watch DPS Video ..b.. �'_ �`�'+e•- ^ , •- - t reduce the chance,of fraudulent reproduction. Apply for a job at The new,Specialty Licenses will be the first to be issued with the new look. Shortly thereafter,existing DPS construction supervisor license categories will be printed in the new format.Over time,all Department { File a Complaint licenses will bear the new look. ; DPS Licenses and f!1(: �ttil " f1J 'f� fa.Atf<iittli td rs�t'� fife# I Permits � Existing Construction Supervisor Wit ttkiflt11 6-1— FTudtf�a '.trttt ' ito�#�ted Inspection License categories include: � ? t? t �f i Applications • Unrestricted ` t • Restricted and • Masonry Only 1l,Q• LIc'7IR@ e r xb . ✓ � ; PUBLICATIONS It is important to check license 2'4 Atty4rh "t� Sx 111 �f , Pwl�?R14S t ; Powerl'oint restrictions that appear on the front a "` ;; z Presentations of the card in the upper left corner. Restriction codes are defined on - �= -E*g�tr Linn V142 tLl Elevators Infi�rmation t»nitay� u��asz T4. : � 9. Report on Acushnet the reverse side of the card. A ; Modular Structure Fire restriction code indicates the type of work allowed by the license. For instance,a license with an RF 13 January 08 restriction code allows the licensee to perform and supervise the installation of roofing materials A click here to download Public Request P complete list of Construction Supervisor License categories(including new license categories)with the the restriction codes appears below. CALENDAR • Unrestricted-00 • Restricted—1G http://www.mass.gov/?pageID=eopsterminal&L=3&LO=Home&L 1=Public+Safety+Agen... 2/25/2009 � .r Town of Barnstable *Permit _ i�ro� F3 of Expire 6 months from issue date 1,egulatory Services Feet + Y Thomas F. Geiler, Director + IARNSrABLE, - 7 MASS' $' 4�p 1619. � Building Division lEb hlA� Tom Perry, CBO, Building Commissioner D 200 Main Street,Hyannis, MA 02601 ^ . www.tow-n.barnstable.ma.us I! Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address S3 q ck Lck- !q a N 0 W 1 — Residential Value of Work .1 SOU `3 6 00 Minimum fee of S25.00 for work under$6000.00 Owner's Name&Address n"Q �1 V) Ceti s Name Telephone Number cd�� Home Improvement Contractor License# (if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor Xw PERMIT ' I am the Homeowner ° ❑ have Worker's Compensation Insurance SEP 3 2008 Insurance Company Name TIMN OF ARNSTAB LE Workman's Comp.Policy# - Copy of Insurance Compliance Certificate must be on file. Permit Request(check.box) 'V �" -� / ❑ Re-roof(stripping old shingles) All constt ion debris will be taken to__ ❑ R -roof(not stripping. Going over__existing layers of roof) �17I J Re-side JJ ❑ Replacement Windows/doors/sliders. U-Value (maximum..44) *Where required:'Issuance of this permit does not exempt compliance.with other.town department reguaations,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: Q:\WPFILESTOWS\building permit forms\EXPRESS.doc Revise020108 Town of Barnstable *Permit 000E r Fxpire 6 montfes from issue date Regulatory Services Fee uxrtsTnsU, Thomas F. Geiler,Director v MAsa g 1639.. Building Divisions%50 prEb �° Tom Perry, CBO, Building Commissioner D 200 Main Street, Hyannis, MA 02601 0 www,town.barnstable.ma.us Office: 508-862-4038 Fax: 508-7.90-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 4 Residential Value of Work 0 dO Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Q&CA yl r s Name L ' Telephone Number i( c,3i Home Improvement Contractor License# (if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietorX-PRESS PERMIT I am the Homeowner El have Worker's Compensation Insurance 3 200� SEP Insurance Company Name TOW ARNSTABL 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__ V-roof(not stripping. Going over, existing layers of roof) e-side %�jM �©�q i!�- one. 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: QORFILESTORMS\building permit forms\EXPRESS.doc Revise020108 �-s The Comrnortwealth of Massrxchusetts 1. Department of Industrial Accidents Qj.�;,7ce of 1 n veStig•atio ns 60.0 Washington Street Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumberg A licant Wormation Please Print Le 'bi e (B ess/organization/Indiviauan: Se • A� _dcl'ress,� �`{ �� JUG `►.cam - .. ^ty� tatelZ p: 0-WkA�� �rnjA 44 Q.A& ( Phone.#: Are you an employer? Check the appropriate bwc Type of project(required): 1.0 I am a cmploycr with 4 ( ] I am a general contractor and 1 6. ❑New construction employees(full andlorperrt-time).* have hired the shb-contractors 2.❑ I am a'sole proprietor or parincr- listed.on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition cmploy=r. and have workers' working for me in any capacity. 9. ❑ Building addition • comp.inrtTrance.� ' [No workers cop.-msusancc 10.0-Elr,l cal re airs or additions rfmTired ] S. [] Wo are a corporation and its p 3.❑ I am a homcowncr doing all work officers have exercised their 11.❑Plumbing repairs or additions myself: [No workers' comp. rigbt 6f exemption per MGL 12 ❑goof repairs in c�„ance r t c. 152, §1(4), and we have no em workers' employees. [No 13.❑ Other comp,insTrancC require] 'Any applicant that almlz box#1 rnust also fill out the soction blow showing their workers'coroprnsaiian policy infatuation. t Ho T=VAYers who submit this a$davit indieafing fey az-e doing all work and then hire outside contractors must submit anew affidavit indirafrng such tContmctnrs that chmk this box waist attathed an additional sheet showing the name of the rub-caofiactars and gbdn whether or not those entities have cmplaycrs. If the sub-conractoon have employers,tbcy must provi&their workers'comp.policy number. I am an employer drat is providing workers'compensation irrsurarzce for my employees Below is the policy and job site ' informaiian. Inmi-anca Company Name: Policy#or Self-ins.Lie.#: Expiration Datc. fob Site Address: City/Statc/Zip: Attach a copy of thewarkers' compensation policy declaration page(showing;the policy number and expiratiou date). Failure to sccurc coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine rip to 31,500.00 and/or one-year imprisonment, as well as civil Penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statc=I t maybe forwarded to the Office of Invcstigntiqns of thr DlA for incrTrancc coverer c.vcrification I do hereby certify under the i ms•and enaLdzs ofperjury that the information provideedd Iabovle is true anal'correct Phonc#fi O facial use only. Do not write in this area tb be eotrrpftled by city or town offcclaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other r 4.--f'P ... Phone#: Town of Barnstable ap THe rp�y Regulatory Services N f Thomas F.Geiler,Director t aARNSI'A13LY, . v M 0. Building Division � ,sz4. �� g pr�D �a Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 vc'ww.town.b arnst:abI e.ma:us Office: 508-862-4038 Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION fPlease Print DATE: 13�e0 1�n JOB LOCATION: l `'' I�Qx number street ^V village HOMEOWNER": /S V A��lIL� OAP D name �\ home phone# work phone# CURRENT MAILING ADDRESS: S S u \Cif CN-Vwy—\W O t- to ^1 city/town state zip code The current.exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and I 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 procedures,and requirements and that he/she will comply with said procedures and :rr-,quireme Signer�rc�Honn.e����� owner 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 parson(s)for hire to do such Jr work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption aie unaware that they are assuming the respons�bilities of a supervisor(see Appendix Q. Rulcs&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 liccnscd 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 hc1she understands the rrsponsrbilitics 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'usc in your community..° 77..a �r �oFYHEr�, Town of Barnstable � do t Regulatory Services ELAIINSTeaLF- ' Thomas F. Geiler, Director Mess. Y$ i634. � Building Division Tom Ferry, Building Commissioner 200 Main Street, Hyannis, MA 02601 wfvw.town.barnstable.ma.us Office: 508-862-4038 Pax: 508-790-6230 Property Owner Must Complete and Sign This Section Zf Using .A,. Builder X , 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 Own6r is applying for permit please complete the Homeowners License Exemption Form on the reverse side. The Commonwealth of Massachusetts .fo Department Industrial Accidents P W 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 LefJbly. �Na111e-(Business/Organi`zation/Individual): � � � �� ��Ad`dress: ��3 c7 �e,R, t--4 4 ��. je� _Ci_-/State/ZiP C,�J✓�`' - i • Phone.#: SBA _ Are.you an employer? Check the appropriate box: :Type of project(required):. 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction .. e yees (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 employees and have workers' -working for me in any capacity. 9, El Building addition [No workers' comp.insurance comp. insurance, required.] 5. F ] We are a corporation and its 10.❑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 13.❑ Other employees. [No workers' 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 anew affidavit indicating such. tContractors 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: lob 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify.under the pains and penalties of perjury that the information provided above is true and correct. Si _at e -7-,- Date Phone#: Official use only. Do not write in this area, to be completed by.city or town official City or Town: TermitI/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#: Richard L. Boy 50 Sterling Rd. . Hyannis,MA 02601-3655 C 7� _ Il g/ti - ry s e� "' .MooseCharities.org s ' o2l Ise Barnstable Assessing Search Results Page 1 of 2 a x» Home: Departments:Assessors Division: Property Assessment Search Results New Search New Interactive Maps >> 3RJ 1 )U Owner: 2006 Assessed a Values: LOFSTEDT, MARTHA E 34 SILVER LANE Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $ 108,000 $ 108,000 268 /154/ Extra Features: $2,500 $2,500 Outbuildings: $0 $0 Mailing Address Land Value: $ 142,600 $ 142,600 LOFSTEDT, MARTHA E Totals $253,100 $253,100 34 SILVER LANE HYANNIS, MA.02601 2006 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $28.96 Fire District Rates Town - Barnstable-Residential $1.90 $6.31 Barnstable-Commercial $2.51 Commei Hyannis FD Tax(Residential) $407.49 C.O.M.M.-All Classes $1.06 $6.54 Cotuit FD-All Classes $1.33 Persona Town Tax(Residential) $965.43 Hyannis-Residential $1.61 $6.49 Hyannis-Commercial $2.50 Other R: W Barnstable-Residential $1.60 Commur W Barnstable-Commercial $2.46 Total: $ 1,401.88 Construction Details Building Property Sketch Legend Building value $ 108,000 Interior Floors Hardwood Style Ranch Interior Walls Drywall Model Residential Heat Fuel Gas Grade Average Heat Type Hot Air Stories 1 Story AC Type None Exterior Walls Wood Shingle Bedrooms 2 Bedrooms Roof Structure Gable/Hip Bathrooms 1 Full http://www.town.bamstable.ma.us/assessing/assess06/displayparcelO6map.asp?mapparback... 8/7/2006 r Barnstable Assessing Search Results Page 2 of 2 4 Roof Cover Asph/F GIs/Cmp living area 986 Replacement Cost $128615 Year Built 1968 Depreciation 16 Total Rooms 4 Rooms Land 3 CODE 1010 Lot Size(Acres) 0.23 � a Appraised Value $ 142,6003 kr E Assessed Value $ 142,600 View Interactive Maps > Sales History: Owner: Sale Date Book/Page: Sale Price: LOFSTEDT, MARTHA E Sep 15 1992 12:OOAM 8229/149 $87,000 MALONE, ESTATE OF MARY A Feb 15 1992 12:OOAM P0054-E1 $ 1 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,500 $2,500 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area UST Utility Area(Unfinished) (Finished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story (Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/assessing/assess06/displayparcelO6map.asp?mapparback... 8/7/2006