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'k} c''' ,[�@" �,�� a�Ly _ i�Rii P'�� M'•«k �'I.c.� " ' :. -, , u- o- �� ♦,. r°.. `ti. .!, .. a--, fi.`, I � ,. , �a .n�' �:." � ,� '�'' ��p��'zy� -....r�'4.� �, _,}'-- r , a . , m Q • " n G CAPECODT4' L INSULATION REIN2014 �: ; PI YYY YYASY 11AMYY33 MAVFQAM YYSPYNJYY YAKS JYRf YY IN34tAi10N G[ItIN03 ' 1-800-696-6611 ; DIi IS 1 `['own of Barnstable � Regulatory Services Building Division 200 Main St l-tyauutis, MA 02601 Date: yY13o�y Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation; Inc. perforntecM completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building pen-nit aplalication. All work has been inspected by a certified Building Performance Institiute (BP-1) inspector. All wort: preformed meets or exceeds Federal & State Requirements. Prc�z•t Owner Property Address ' . Village , / iPGA �ikwT3�e '71�- /ol CAP N !Ac/f Qom �e.✓l /li� ^4 Insulation Installed: Fiberglas's Cellulose R-Value Restricted Uiu•estricted Ceilings Slopes t'loors ( ) ( ) ( + ) ( ) ) Walls AaN3 - s. Sincerely He ry L Cas. y Jr, President l C" e Cod Ii, ulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ipplicatiolnH4 ' 1 Health Division Date Issued ZVAY*Z Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Stre Address Village yt Wy - - Owner ar Address Telephone :36 1_ "Permit Request V T ' �L�U j&/( v& , Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type r 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 n Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.f -� -TI Number of Baths: Full: existing new Half: existing ne Number of Bedrooms: y existing _new . Total Room Count (not including baths): existing new First Floor Roo Count c. s-r� 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 size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes LlAo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address `I License # / m g lJ Home Improvement Contractor# Email Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THI ROJECT WILL BE TAKEN TO �y SIGNATURE DATE /2 + FOR OFFICIAL USE ONLY 2 APPLICATION# DATE ISSUED- x MAP/PARCEL N0: i ADDRESS VILLAGE OWNER L Y ' 'M t- DATE OF INSPECTION: FOUNDATION FRAME $1 l r INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ji DATE>,CLOSED OUT ASSQ ION PLAN NO. Massachusetts -Departrn ant°of P�blic Safety' Roard of Building Regula#ons Anti Standards Constniction Supervisor License: CS-100988 HENRY E CASSED 8 SHED ROW WEST YARMOLF111 h�2' Expiration Commissioner,t. 11/11/2015 t . ail //Cr, :iac� � �J - Office of Consumer Aflalrz��-zc��zcc�ecz s and Business Re g111ation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvelnent CO r t tor-Registration Registration: 153567 Type: Private Corporation V Expiration: 12/15/2014 Tr# 233831 f CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE -- -- --.. SO. YARMOUTH, MA 02664 h,..., . Update Address and return curet. Marls reason for change. Address ❑ Renewal ❑ Ci n►ployment [ Lost Card ' '�PGr:ll(�f.7/GIIL[,,I6lGG'CI,CIiG c�(% JCcc!'(dGJFat Ulfive of Consumer Affairs& Business Iiegulatieu License or registration valid for individul use Duly ' !i{OME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: h egistration: 153567 Type: Office of Consumer Affairs and Business Regulation i xpiration: 12/15/20.14 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE 00 INSULATION r,IRJC . HENR CASSIDY 18 RE kRIDON CIRCLE SO. Y RMOU11-I, MA 02664 T� Undersecretary otvafi witho tWit ; • 1 it ° ' Th e'Common wealth of Alassachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 r` Boston,AIM 02114-2017 ►vww.mass.sov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/]Electricians/Plumbers A l llicant Information Please Print Legibly NIcllllc (Business/Organization/individual): City/State/Zip: �b _GUf VLI,O'G� �i Phone#: 0� ' �'" (21 A vlu an err►pI yer•? Check the appropriate box: i Type of project(required): I. I Lau a employer with 2�7 4• ❑ I am a general contractor and I . employees (1.'ulhand/or part-time).. have hired the sub-contractors 6. ❑ New construction 2.❑ I Hill a Sole proprietor or partner- listed on the attached sheet. . 7. 0 Re.niodeling shipand have no employees ees These sub-contractors have � P Y .$. ❑ Demolition` working; for mein any capacity, employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. [] We are a corporation and its 0.[] repairs or additions >.❑ I am a homeowner doing al.l work officers have exercised their l l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] .t c. 152, §1(4),and we have no Li employees. [No workers' 13. Other I y'�y '� _ comp. insurance re aired, P q ] *Any applicant that checks box#l must also till out the section below showing their workers'compensation policy information. t I h)IIICUwrler5 who submit this affidavit indicating they are doing all-work and then hire outside contractors must submit a new affidavit indicatingsuch: ll:onactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those_ entities have cniploycc.s. If the sub-contractors have employees,they must provide their workers'comp.policy number. j l am an employer that is providing workers'c•onpensation insurance for my employees. Below is the policy and job site iu�arrrutJiort. �'^ Insurance Company Name: Wv� GVII��U�PV twh�(i1wV'CA Policy# or Self-ins. Lic. #; C 00 2 Q ' Expiration Dater �n Job Site Address: lL � ' City/State/zip: V MT) Attach a copy of the workers' compensation policy declaration page(showing the policy'number and expiration date). Failure fir secure coverage as required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine 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 t of up to$250.00 a day against the violator. Be advised that a copy of this staternent,may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cAithe pains and penalties of perjury that the information provided lb ve is rue and correct. Si;rtaturc: Date: `� 1 [ - Phone il: Official use only. Uo not write in this area, to be completed by cite or town official. City or Town: Perrnit/License# { Issuing Authority (circle one): II 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector j 6. Other IContact Person: Phone# i; sj t CAPECOD-27 KLIGETT AC�Ra►" CERTIFICATE OF LIABILITY INSURANCE 7DATE,(MMIDDNYYY) 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 i 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 CONTACT NAME: Barbara DeLawrenCe. Rogers&Gray Insurance Agency,Inc. PHONE Rte 134 Ezt. Fa No: (877)816-2156 AIL South Dennis,MA 02660 ADDRESS:bdelawrence@rogersgray.com , INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company INSURED INSURER B:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER C:Evanston Insurance"COmpan 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,MA 02664.' INSURER E: INSURER F 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. INSR ADDL UBR 1 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER - MMIDD/YYYY MM/DD/YYYY ".LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE occUR CBP63063 04/01/2014 04/01/2015 DAMAGE T NT D ❑X 82 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 r PERSONAL&ADV INJURY. $ 1,000,00 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $= 2,000,00 X POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ' Ea accident $ 1,000,000 B ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person),' $ ALL OWNED X SCHEDULED BODILY INJURY(Per $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE - AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-MADE XONJ453514` 04/01/2014 04/01/2015 AGGREGATE $ . DED I X I RETENTION$ 10,000 Aggregate $ 11000,00 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D £ANY PROPRIETOR/PARTNER/EXECUTIVE WCA00525904 06/30/2014 06/30/2015 E.L.EACH ACCIDENT $` 1,000,000 OFFICER/MEMBER EXCLUDED? N/A Y/N (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If es,describe under DESCRIPTION OF OPERATIONS below t, E.L.DISEASE-POLICY LIMIT $ - 1,000,00 DESCCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors.` Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EVIDENCE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All-rights reserved.,, w AC RD 25(2014/01) The ACORD name and logo are registered marks of ACORD • OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at 1 UZ (Property Address) 14-7 01Z 63z (Property Address) hereby authorize 'e�o ze OL (Subc actor): an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Owne s Signature - y Date` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .Ma a Parcel Application # Health Divisionti,— No aa�oR�s Date Issued Conservation Dn ' Application Fe Planning Dept. -.Y Permit Fee f Date Definitive Plan Approved by Planning Board Historic OKH Preservation/ Hyannis . Project Strree t Address /Q•e say Village C�'•���iyr•`//� Address: / ;�ZC Telephone Permit Request � � ��/�� r. � Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new ' Zoning District Flood Plain Groundwater Overlay Project Valuation � Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. Two Family ❑ Multi-Family(# units) Age of Existing Structure �Sl��-s Historic House: ❑Yes 1<o On Old King's Highway: ❑Yes Q14 Basement Type: alull ❑ 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: sue-- existing _new Total Room Count (not including baths): existing new First Floor Room Couni Heat Type and Fuel: ZGas ❑Oil ❑ Electric ❑ Other Y Central Air: ZYes ❑ No Fireplaces: Existing New Existing woodlcoal stove: ❑:Yes ❑ No Detached garage: ❑ e fisting 0 new size_Pool: ❑ ex' ting ❑ new size _ Barn: ❑1xisting a© new size_ Attached garage: existing ❑ new size _Shed: Li, existing ❑ new size _ Other: cc Zoning Board of AppealsAuthorization ❑ Appeal # Recorded ❑ Commercial ❑Yes M/No If yes, site plan review# Current Use,��,7 /� Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)` Name � r �c `cr Telephone Number Address License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULT FROM THIS PROJECT WILL BE TAKEN TO i SIGNATURE P� DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP%PARCEL NO. ADDRESS VILLAGE OWNER f DATE OF INSPECTION: i "-FOUNDATION FRAME INSULATIO �Sv ��uAa l��:�i►.fe,^io�.Ov►ly , FIREPLACE f ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING mb '519-ICA DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ; Department of Industrial Accidents " Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly. Name(Business/Organization/Individual)::];��Ta-4 _ Address:Z&�� • City/State/Zip: e= Phone.#- 3�41 c/���/ 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 employees(full and/or part-tim.e).* have hired the sub-contractors 2:❑ I am a sole proprietor or partner- listed on the attached sheet. 1..❑Remodeling. ship and have no.employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• ` $ 9. ❑Building addition , [No workers' comp.insurance comp. insurance. quired.] 5.. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their I LEJ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] "Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: '. Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage,as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the violator. pl dvised that a copy of this statement may be forwarded to the Office of Investi ations of DIA for insurance co raj a verification. I do hereby cent' er t pains p, altt s of erjury tha formation provided above is true and correct I - IV/ Si ature:. Date: 2 E9' — I Phone#: G 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#: Information and Instructions -Y 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 3eceased"employer;"o"r 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,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer:" MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence,of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the,contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)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 permit(license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town)."..A copy of the,affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is.on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. . . The Office of Investigations would like to thank you in advance for your cooperation and should you have.any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts - Department of.Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TeL #617-727-4900 ext 406 or 1-977-MASSAFE' - Fax.#617-727-7744 Revised 11-22-06 www.mass.go�rfdia ,.ram Town of Barnstable ' Regulatory Services BARNSMABLE, Thomas F.Geiler,Director ` suss 1659� `•�, Building Division PjFo s Tom Perry,Building Commissioner _.. 200 Main-Street, Hy__annis.MA 026.01_. _. www.to wn.b arnstabl e.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ' Please Print DATE JOB LOCATION;/ S numb er er street a vtll ge "HOMEOWNERS name home phone# work phone# CURRENT MAILING ADDRESS: ci /town ' ty 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 Persons)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 "hortieowner"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 rsigned"homed r�'certifies that.he/she understands the Town of Barnstable Building Department . ._4 inspection pr ce s and requirements and that he/she will,comply with said procedures and r m u S a 're of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner,performing work for which a building permit is required shall be exempt from the provisions of this soction.(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 supervisorl' Many homeowners who use this exemption art 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 responstbilities,many communities mquire,as part of the permit application, that the homeowner certify that Wshe 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 formleertification for use in your Community. Q:formZs:homeexempt 1 Town of Barnstable Regulatory Services Thomas F.Geiler,Director AM Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property hereby authorize. to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner . Date Print Name If Property Owner is applying for permit please complete.the Homeowners License.Exemption Form,on the reverse side. Q:FORMS:O WNERPERMISSION • , g t G�C F�A M I I_Y - :'S B E U P-0 OM �,�•� G 4 . ! '.� 1 Q' ! i WO .GA¢BAGE- CDwND62 n/a►L.� Flow e110X 47, 5EPT1G TAtiK U5� Ioo_o GAL• ' . / � 1��� oiSPoSAL P.IT v5E I0o0 GAL.. 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I� j, u u i �n E / Town of Barnstable Approved r/ Regulatory Services PP Fee C Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230. *rill Home Occupation Registration Date:Name. . -�1`+CSZ-�= � Phone#: 1,50�� e.�i�. Village: Address: ff Name of Business: ,C) Rk Type of Business:49 / I Map/Lot: _ INTENT: It is the intent of this section to allow t e esidents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors, electrical disturbance,heat, glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containg the Customary Home Occupation. No sign shall be displayed indicating the Customary Home Occupation. If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwell' g unit. I,the undersigne ave re d an ee the above restrictions for my home occupation I am registe ' g. Applicant: Date: Homeoc.doc