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HomeMy WebLinkAbout0129 SPRING STREET /� � sp�-�� y ���� � i .� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 32� Parcel o Application # '�� Health Division Date Issued ��Z-7 I6 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Fr.�L Ste?' Project Street Address D � :5 Village �� Owner ��..�� -��� ���� Address Telephone 9-1-5I'-o 1•i1 Permit Request SAAi11r.z 411 I01.1%. , e Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation -I 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 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new siz,8 1 -rG YLspjting ❑ new size_ Attached garage: ❑ existing ❑ new . size _Shed: ❑ existing ❑ new size Other: XL 112016 Zoning Board of Appeals Authorization ❑ Appeal # _R QCb1d YARNSTABLE Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Mike McCairthy Construction Address PO Box 52 License# West Dennis, MA 02670 Cell (508) 250-6964 Home Improvement Contractor# CSL-58633 HIC-169393 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO J SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. it DO- Town of Barnstable 'Regulatory Services sNt.�'sr�et� 2 ' WAS& Richard V.Scali,Director i63A �0� Building Division Tom Perry,Building C:oirunissionei. 200 1. am Street,HPLa S,AN 02601 R'ww-totvn.ba rnst2bI e_ma.us afficc: 508-862-4038 par 508-790-6230 Property Owner Must Complete and Sign 'his Sectioi:l. If tTsina A$tli.Xde /�- = � as(,mnerof the-s ubject prOpezLy . hereby authorize i:o act on niybehalf, in all marts s relative to work authorized by this building permit application for. {'Ad SS of ff o Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled Or utilized before fence is imtalled and afl fiwJ inspections are perfc-rmed and accepted of er Signature of Applicant print Name - Piint'Nanne: Date Q:FORMS:016NF.RpF o l,tISSIO)yPOOLS RLB } � Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement tr ctor Registration y" ` — Registration: 169393 �''E�J Type: Individual�—~ Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 WEST DENNIS, MA 02670d — J, , date Address and return card.Mark reason for change. 1 .' y` p g SCA 1 is 20M-05/11 Address ❑ Renewal ' Employment E 'Lost Card ,sue �e�payrri»aoracvecr.CC�i a�C>/�icaaac�ar�eCC`s - --- -- �\ Office of Consumer Affairs&Business Regulation License or-registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ;Z_IB9393 Type: Office of Consumer Affairs and Business Regulation Expiration:: 6167261s7 Individual 10 Park Plaza-Suite 5170 F Boston,MA 02116 MICHAEL MCCARfF1Yi}' MICHAEL MCCART}'4Y 6 RANGLEY LN. SOUTH DENNIS,MA 02680 Undersecretary NotEOMid-with t signature . Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-058633 e Construction Supervisor MICHAEL J MCCARTHY. r P.O.BOX 52 $ WEST DENNIS MA 026T0AN Expiration: Commissioner 04/10/2018 i The Commonwealth of Massachusetts G Department offnrlustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-20I7 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. ;...,TO BE-FILED.WITH THE PERMITTING AUTHORITY:: A_ pplicant Information Please Print Le ibly Name (Business/OrganizatiorOndividual): Mille McCarthy Construction- po 52 Address: west Dennis, MA 02670 Cell 08) 280-6964 City/State/Zip: a#mC_169393 Are you an employer?Check the appropriate box: Type of project(required): l.[g�am a employer with employees(full and/or part-time).* 2. New construction 2. am a sole proprietor or partnership and have no employees working for me in ❑I l i S. 0 Remodeling any capacity.[No workers'comp.insurance required.] In I am a homeowner doing all work myself.[No workers'comp.insurance required.)t 9. El Demolition ' 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property.i will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.0 I am a general contractorand I havehirM the sub-contractors listed on the attached sheet.These sub-contactors have employees and have workers'comp.Insurance 13.❑Roof repairs paiiS 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other li✓d 152,§1(4),and we have no employees.(No workers'comp.insurance required.) *Any applicant that checks box#Imust also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. tContraclors that check this box must attached an additional sheet showing the name of the sub-conhractors•and slate whether or not those entities have employees. If the sub-contraclors have employees,They must provide their workers'comp:policy number. I ant.an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site fit rn►ation. Insurance Company Name: '/ I •��,� T►, _ co Policy#or Self-ins*Lic.#: y�I/L— ' -(�G 17(,'S� -ate f sA Expiration Date: l2 )►s- 1 l 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 MGL c:152,§25A is a criminal violation punishable by 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.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 t a' s enalties ofperjury that the.inforrnation provided above is true and correct Si ature: Dater Phone#: S-210 1'�, i r 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#: DATE(MM/DDIYYYY) ,�coJ a CERTIFICATE OF LIABILITY INSURANCE TE(MWDDN THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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). p PRODUCER 01962-001 NAM Cp�E:CT Bryden 8r Sullivan Ins Agcy of Dennis Inc o. • (508)398-6060 Ne,; (508)394-2267 PO Box 1497 So Dennis,MA 02660 INSURMS1 AFFQRDIN COVERAGE NAIC# _MURER A• A.I.M.Mutual Insurance Company -33758 INSURED INSURER 0: Michael McCarthy Construction Inc INSURER C: P 0 Box 52 N R West Dennis, MA 02670 I COVERAGES CERTIFICATE NUMBER: 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 i yp POLICY NUMBER MPN & LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED nce $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ OLICY ECO_ F-Joe A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ ci• ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ fDDEERDg CAM ERETENTION $ TU q� $ AND EMPLOYERP5 LIABILITY X gT TORY LAMITS It YIN E.L.EACH ACCIDENT $ 1,000,000.00 A or ffIPROpRIETORIPARTNSfj/�(ECUTIVE� N I n VyyC-100-6017666-2016A 12/15/2015 12/15/2016 (Mandatory In NH) EXCLU tug E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 �9W5CRIPTI8N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION Cape Light Compact PO Box 427 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Barnstable,MA 02630 THE EXPIRATION DATE THEREOF,' NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE •_ SIGN PERMIT. i I PARCEL ID 328 026 GEOBASE ID 24405 ADDRESS 129 SPRING STREET PHONE j HYANNIS ZIP - LOT P16&P17 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 62023 DESCRIPTION NEXTEL/VOICE. STREAM--5 SQ PERMIT TYPE BSIGN TITLE SIGN PERMIT I CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: \ $25.00 BOND `' $.00 O�THE CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE * BARNSTABL& MASS. 16,3 A�O� FD MI�►� i BUILDINC'DIVISIO�N BY ---�- DATE ISSUED 06/25/2002 EXPIRATION DATE 4 r 65- -1 0;4, Town of Ba rnstable a astable °F1MEr°,t, l g Reuatory Services y�P ti� . Thomas F.Geiler,Director • lARNFrABM 9� MASS. �e� Building Division Argo►��" Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 ' Fax: 508-790-6230 Tax Collector Treasurer Application for Sign Permit ApplicanthL ' V (�j '<4 Assessors No. (b Doing Business As. Telephone No. lS. Sign Location Street/Road: L1 e, ZE Zoning District: Old Kings Highway? Yes/No Hyannis Historic District? YesN, = Property Owner u� . Cn Name: `(�'�(_�� I `� '( �� Telephone: v>o4 —{ Address: o w Village: Sal— 6D t rn Sign Con ctor Name: (�O 4— Telephone: ^ jj__=,�. l`t 6S, Address: Village: �. Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes/No (Note:If yes, a wiring permit•is required) I hereby certify that.I am the owner or that I.have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. ` . Signature of Owner/Authorized Agent: Date: �SICDI Size: Permit.Fee: Sign Permit was approved: isapproved: Signature of Building Official: Date: GJ 2 Signl.doc rev.122801 tt 1 -� l C�� _� l l� ® �� ��� D� \ �- i �`��^ (;2c�- �� � ( _ �" r ��� � � �.. � i e ; • a . r � a ^ f � � a _ � f + ` J � � .. E X. A' t I n. 9 S f g: .n a g: a, E i in Sign g . 1011 QeKnpton311* pY ^- LtrlCo Dimensions:. nit, _ fascWGabinet;Dimensrons;_ PY` C), H above grade ' »._. Iliuminated: n dbubteface. yes a _ Face Material: pleas Wall Material nfa �. . ,r 411 Sign Text: NextellVoaaStr�m e .e r o: p: _ :o s e d o p' t 1 0 n 4 � v . Sign TypeftJumbe � celztau�a etitng.Yolsae3tr+�rr�, rgetac tith Tlobil±a 16n Alex escnption: Dim.ensiorj s" "_. R..eplacernent Pace: : , , x , 'Ilium ton:w):�{ x no' ',.Cc rn MbMs _. ._.,. r y ✓< h LE ApprovaIA mare sheet .,-u.,. # PR;QPQ$ED $1GNAQE 1'of? ®, B TEt cf td,:m I 6107 LCs'SELL AVE • U,R��M ..--reel0/m,numbers. .. ,Rea,larer�k; _.... Doer Z. . __...._ _ _._.. b ALTO'OA PA-16601 RadD aQui f¢OA 2$8: R t. ;2 8 rroice:;i.800 f8101M9 fox W7 Ik5/2110.2 H. nn n 1 s, M A 0 2 B 0 1 rnfo►matfon allwr/n on'this drawing is proprietary and the sofa property of Blair Sign Co.and Is not to be ioproduce!y dfactosed,or;tran"amitted to others for any purpose not authorized by Blair Sign Co. or) Map cX-- Parcel Permit# ,3o?4 House# Date Issued - g J a rn' Board of Health( oor)(8:15 -9:30/1:00- Fee ;, i aZ1 w d Conservation Office (4th floor)(8:30-9:30/1:00-2:00) CiEnIC SYS`YEM.MUST BE Planning Dept. (1st floor/School Admin. Bldg.) INSTALLED LIANCE Definitiv an 1proved by Planning Board 19 W1 ` ENVIRON DE AND TOWN OF-BARNSTABLE. TOWN , ®NS Building.P 't Application i Project Street Address f { Village al. .a Owner ddress -` '�„ c- ;/? Telephone D J % Permit Request e c' rid a 'First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ da . J� Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ;h�qo n Old King's Highway ❑Yes Z�a(No Basement Type: El ❑Crawl ElWalkout AOther ,- _ 2J Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing _ New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas Oil ❑Electric ❑Other Central Air ❑Yes ArNo Fireplaces: Existing _ New Existing wood/coal stove ❑Yes *0 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) None �Shed(size) e. 0 ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes &kNo If yes, site plan review# Current Use Proposed Use Builder Information Name Lrx Telephone Number �/� ) �'/ `%,1%-�] �•� Address License# Home Improvement Contractor. Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIgE,SULTING FROM IS PROJECT WILL BE TAKEN TO a/ * - rp-f� r�'C fix'°-1✓ ,✓ /0X41 SIGNATUR DATE BUILDING PERMIT DENIED F THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY ^•'f, r'••- ` _. . -. • _ 'ram 1 ' n • _ �'r -- •* •! PERMIT NO. it ••DATE ISSUED. '. . ' w t _ ' t _ _ _ r � 1 _ _ r. •_ �� , MAP/.PARCEL NO. .. , ADDRESS , VILLAGE # r OWNER DATE OF•,INSPECTION: `. . _y 1 • ''` # . -. p, .:{ F .,, - 1 # Y �° ' • s FOUNDATION FRAME-.. 4 INSULATION , FIREPLACE --• �' , 4 � •r FINAL ELECTRICAL: ROUGH - t PLUMBING: p `ROUGH FINAL t GAS: ' !SaOUEil t; FINAL i r rab f ,FINAL BUILDING --- DATE CLOSED O C) t r ASSOCIATION'PL%N - ivex M t The Town of Barnstable KAMM tee$ Department of Health Safety and Environmental Services 1"9. BuiIding Division 367 Main Street,Hyannis MA 02601 Ra lph Crosson Building Office: 508-790-6227 B Fax: 508-790-6230 ing Commission: For office use only Permit no. Date AFFIDAVIT HOME IMP ROVEMENT'CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 147A 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 than 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. Type of Work: O ►^ ��i*' Est.Cost Z/ J r7 Yl Address of Work: � Zier's Name /9 z-// Dace of Permit Application: `2 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,000. Oilding not owner-occupied wner 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 PROGZAM OR GUARANTY FUND UNDER MGL c. 142A SIGYED UNDER PENALTIES OF PERJURY I hereby apply for a.permit as the agent of the owner. Date Contractor Name Lion No. OR Dar oik6es Name _�_�-4 The Commonwealth of Massachusetts r._zit —— Department of Industrial Accidents Office ofinaestigadeffs 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name (/ location: city ✓7r�J Q. �—Co�j hone# 4 -7 5-Z am a homeo er performing all work myself. ❑ lamas I d have no one working in anv ca acity ❑ I am an employer providing tivorkers' compensation for my employees working on this job. com anv name: _. address: cites phone#. insurance co. Vo1icV# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: com anv name: address: dty phone#: insurance co. olicv# com anv name. address: city' phone#• olicv# insurance co / Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of DIA for coverage verification. 1 do hereby certify r t e sins and penalties of pea ry th " e ormation provided above is true ' d correct Date Signature --T—�-- Print name "'�' "� Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑checkifimmediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other otcria 9/95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any con=c-, 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 c trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew. of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha, not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Ofilce of investigations 600 Washington Street Boston, Ma. 02111 - fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 :t TOWN OF BARNSTABLE `w BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Phase print. . ,...- • . . . t DATE a JOB. LOCATIONJZ23 Number UStreet addr s Section of town "HOMEOWNER" CQ _ Name Home phone Work phone - - PRESENT MAILING ADDRESS / 3/94-4.07c, City to . State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual 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 re- side, 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 Officia on a form acceptable to the Building Official, that he/she shall be resDonsibl for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the Sta Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she under t ds the Town of Barnstable Building Depart3men minimum inspection proc s and requirements and that he/she will com y wi h s 'd procedures and r� ments. HOMEOWNER'S SIGNATURE - APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The: code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home Owne shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing Construction' Supervisors, Section 2. 15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home " wner act_: as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/Eer responsibilities, ma: communities require, as part of the permit application, that the Home Owner 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. er.a f I ' - ASSESSORS ASSESSORS LOT 27 LOT 28 (o o � 11c ` PATIO — _ — — _ IN / l tJ \` LOT 25 NOTE'.' PRE—EXSTIArG N0N00NF0R lII_NG 3 RES. This R F�larc is For AE. RB MORTGAGE IINSPECTIOIN Bank �lse_2niv FL ZONE. G s Y�� �n �� _ _ _ _ __. .._ — _ _ REGISTRY O�YNER• E�"�B�T�Y_C-.�rlfli-! _I DEED REF: _ZQ� 9�- .. _ - - -BUYER: -.4LTaVE _;IL _e:_&CHaED_JY._ &9�t10,tTT_ - -_ _ I DArE: 3/2 '�` - - - - - - - PLAN REF: _37/_?! _ _SCALE: i"- gory FT. I HEREBY CERRTIFY TO ,;Qti _ 8N — FIR. T aAr1E�1�IC.�Iti'' TIT S., G'(�. THAT 'THE BUILDING �t�iOF `�'ANKEE SURVEY SHOU-N ON THIS PLAN IS LOCATED ON THE GROUND AS ��� ��� CONSULTANTS 4 SHOWN AND THAT ITS POSITION DOES _ CONFORM TO THE ZONING LAW SETBACK REQUIREIAENTS OF THE A. 40B (SUITE x) TOWN OF ,R_4& Z!EfZ--_---_— —AND THAT � N � c INDUSTRY ROAD IT DOES_ 1VDI' LIE WITHIN THE SPECIAL FLOOD HAZARD d p MARSTONS MILLS, MAI 0264E i AREA AS SHOWN ON '1'Hi H.U.U- MAF DATED��11���.__ �s �r�STEA`� Q�� TEL: 428-005 omrrit�ni'v— -ne] # 50001 000,5 C °'+�_t At+nS FAX- 4?U-5553 1. THIS PLAN NOT MADE FROM AN M ' DPG , RI. E IsGS SURVEY, N01' TO BE U51=D FOR. FENCES. ETC. 1650,E x =VZ usz, rm=,, XCM= An .. r �= � .1 -- 7 ' d/_ �, Now o.c-AL- _ -b v o � _ r 4 � l y �