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Home My WebLink About0656 CRAIGVILLE BEACH ROAD d Assessor's map and lot number .....�,�.. .... ..J.....�� r,1 SEPTIC SYSTEM MUST BE .# IN C MPLIA INSTALLED 0 NCB, y Se.age` 'ermit number .::... !-� 1r V�lITN ARTICLE II STATE . . . .. .... . „ SANITARY CODE AND TO cl: j o *THE Th y } ®01 ♦i �..: OF B A 1 R a.1 \N S W OH F L L s Z BASBSTALL o pYp�e� n B U 11-0 1 +N G INSPECTOR AOLICATION FOR;PERMIT TO .........R .P. .:...::`..`..............................R................ ......................... TYPE OF CONSTRUCTION .........I�.iP.Lit.... �? .... 1`ucTy,'` ............... c; TO THE INSPECTOR OF BUILDINGS: _ The undersigned hereby applies for a permit according to the following information: Location ............ .........rl. ...........ed..................................................................................................... ' Proposed Use .............Ssem.meuz.......! .... ZoningDistrict ........................................................................Fire District .............................................................................. 31 oc✓0 rJ ACZ Name of Owner .... 9. s aP. ..........5PIMC.A.....................Address Ant ,hs. ..,........oa®G �. Name of Builder ... .u1...... .......... .........R................].....Address ) .�,r r2 o C w...�c � I ...�z.v.�.�!:....1�:....rn.�?:!:.5�'�+z�;s...m:.�.4..�......... Nameof Architect ..................................................................Address ................................................................................... .... �: g.ti......P .v.f—'R............................. Number of Rooms ..................................:...............................Foundation ....... Exterior ...1r+.a.a.t d...................................................................Roofing ..............U.(.K!,"d.i..................................................... c1 ..................................................Interior ........P.. s............................................................... Floors �Ar...i.. ............... v..Y• !1 Heating 7D.....;IA.c......�r�$......lTe"� �'.ra�Crz-.................Plumbing ....5'�.�f 1i2cFaV t Gt7k'i9e!�............ ... .......... ............ ........................ ......, ...,.::..:.... ................................. ............ Fireplace — ► f`"v ..................Approximate Cost �;...1o..Q..a.................................... Definitive Plan Approved by Planning Board ____________________ ____19________. t�/ Area ....1.k '. .................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH tD 3`1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... t ........... , Joseph '�� ' No ...200-45 Perm for — � fire -- — .�� ._----' - . . damage ----.��-----------------. ` - Location —..658. . .Rpsd_ Centerville ��'��_��'��'' � �w 0azca � Owner ---��__._______.__.___. fram�� ' . Typo of .......................................... ^ ' . . '�'—..—.��.�--.-..---..,.—.---.-----.. _ ~ ' Plot ....... .................... Lot ................................ - ^ ^ / . . �7 7@ ' parmh Granted — —.—lQ ibate of | ./� - ~ / --]g ° � . . . ^��- Date Completed —.~��.��—`�" —_—]� � ~ PERMIT REFUSED � ..... 19 ~---,..—~..,^.....—.-~----.--.--. � . . .......................... ' ��^^^~^—'^—~r~~^---'-,,`—~^^'^—.—^—''' � 'r�'------`—'--^—'~^~~'--^—'—^'"^^^'^' ---------------.. Yq ,ApprovedF ^ ` --.----.-------~.~--.-----.~.--. ' . ' -------.--------.—.--.....,-... . . . ^ ~ Assessor's map and lot number ........................................... Sewage Permit number ......,.:.:.........,. _..... 'trot P�O*TNETo�y TOWN OF BAR.NSTABLE 88HB9TADLE, "6 9 BUILDING INSPECTOR ' APPLICATION FOR PERMIT TO .........:f�P.!" ! . ' (. Q 4..v. !� G e........................................ TYPE OF CONSTRUCTION - ✓ . G'7�`.' ......./I?.!92G ......Z.7.........192.? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location !� 5 (-' r O,a , G +_-$ , ).t. ., s.( .................................;......... . ..r............_..,.. ...................................................................................................... Proposed Use SA,,,-0 ,mr?" .. 5��.. ��c,C_. .................................................................................................. .............................. ........:...............:................. ZoningDistrict ........................................................................Fire District .............................................................................. ,31 Qo•�o tis 12�1 Name of Owner ..... ........ rz .' ......................Address Z rl, /1dr{ !7- n ,.. i.�.�....Address ,.�c.r....Q rh !� c Name of Builder ..........tea.:..................... ............. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .......�F .......................................................Foundation .......3.... ....... Exierior ..+. c.* ,. ...................................................................Roofin &CA Floors llpr a�.rgoC .............................Interior .........Q�..!!:. .. ?. . ....................................................... ...........................:.............................. Heating .�!n.....f3 c 4< I-« . c, n It�2 Plumbing ....C oa f." 1,2...n........ ............................................... ......... ................................................ Fireplace .......j x. 4, . c ........... ............. Approximate Cost ...........I...? .n............................................ -c. ._ Definitive Plan Approved by Planning Board _____________________r_______19________. Area ...... -^�:8."..:.................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH A I i I { iD 3y I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. , Name ..... ( .f.. : ........(..:i'.......^^ -:.S.JC"................ Bart" Jmaeo� �= ~7 \ �� ` �� 4� ^ . ` ' 20045 repair'� fire ' No ................. Permit for ..................................... � ' ' ~.~~*^ ............................................................. ^ 658 Craigville Beach Road Location ---..--.'....-.--^--------. / Centerville . —......--.---.---.~.---.,—.-----.. Jwmemb Barca Owner -----.----------.------. / > frame � ` Type of ' ' `. / rn, � . , . Permit Gran, � ' Date of |" ` ` / ' Date Completed / ^ '? PBRAA:I�T | � ' ' . — lV ^ ' . ' . —. ��v ... .. —.---.. .............. ........ -e--.—.--.----....................................................... � " qk ` —.------.—~--~—..~....—..�W................ ' ( ----'---'---'---^~'+----'^---^^'' ' ^ / Approved ................................................ lQ - ` ----------.---.---.--.--.—~..- � ----.---------------~....—.,. v ` f 11172�G �IKE, Town of Barnstable *Permit# 6IF0 L3 l9 Expires 6 mon '� �•`ro*ssuedate> Regulatory Services Fee 5S // anxxsTnB�a Thomas F.Geiler,Director 039. a,.0� Building Division X-PRESS PERMIT Tom Perry,CBO, Building Commissioner MAR 17 2008 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 TOWN OFBARNFSTA08- 90-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number��f� Property Address 0 0 Residential Value of Work ��j Minimum fee of$25.00 for work under$6000.00 Owner's Name&Addresses- Contractor's Name _Telephone Number Home Improvement Contractor License#(if applicable) 6 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor , r I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name/?AZ. SC��i3i��C_ ��/��ws %l/✓��C� d/!S�' Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) �D [O/Re-roof(stripping old shingles) All construction debris will be taken to m r/iLc: (Z1/`�-3 / /// . ❑Re-roof(not stripping. Going over -_ existing layers of roof) [KRe-side [["Replacement Windows/doors/sliders.U-Value (maximum.44) a *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. a SIGNATURE: Q:Fonns:buildingpermits/express Revised 123107 r THE 1p Town-of Barnstable OF � Regulatory Services aaxxsreete, : Thomas F.Geiler,Director MASS i6.19 A.• Building Division JFO � 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 �y Please Print DATE: JOB LOCATION: number >� street village ,HOMEOWNER": _0Cl�/�/` name home phone# work phone# CURRENT MAILING ADDRESS: 06Cs'C_� E=«�G�lT zz city/town state zip code 1 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 Ins ection procedures and r quirements and that he/she will comply with said procedures and require nts. Signature o wner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such' work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness.often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fom✓certification for use in your community. Q:fomrs:homeexempt THETA Town of Barnstable Regulatory Services r a MMSTASM y NAM $ Thomas F. Geiler,Director i639. 0. 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 , ti If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION 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): �/S Address: Ent/ ' o2ZOA City/State/Zip: lei ��a7j Phone.# 0'1� 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-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet 7. [. temodeling ship and have no employees These sub-contractors have g, ,E]Demolition " workingfor me in an capacity. employees and have workers' Y P tY• # 9. ❑Building addition [No workers' comp.insurance comp•insurance. required.] 5. We are a corporation and its 10.0 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 ed employees. [No workers' 11F] Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infomnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins-Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb fy under the- Signature: a�ins- d/pee ' s of perjury that the information provided above is true and correct i' � �/ � - Date: Phone# Official use only. Do not write in this area,to be completed by city or town offtcidL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M 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,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-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 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 hike 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 C6mmanwealth of Massachusetts Deparlment of Industrial Accidents Office of Investigations ; 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia $ngineering Dept. (3rd floor) Map .2 414 Pircel - 41JJ Permit# ;_n _ House# i�,5 f Date Issued a� 0 _ Fee ce oor 9—9:30/1:00-.2:00)- Planning ) ? tME Defin ffifffift.r, Ed19 ; BARNSTABLE. TOWN OF,BARNSTABLE 'F°"�+'� E Buildingg Permit Application Project Street Addr ss_ I% 1;lei(' \ 1 6 UJ. t,jCknY)t5 Village ' Owner JLAI e, r. I e6 V r : Address F Qf. F Telephone Ll i Permit Request .�:.. _..... Al 1 First Floor ® ® S` square feet Second Floor square feet \ Construction Type xEstimated Project Cost $ (Tv \Zoning District y Flood Plain 0 Water Protection Lot Size ' Grandfathered ❑Yes ❑No 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 ravel ❑Walkout ❑Other f 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 o Fireplaces: i/sting t New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Y`' Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes )No If yes, site plan review# - Current Use / \ Proposed Use Builder Information Name ®C1�21- C'// Telephone Number 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 DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO •�IGNATURE DATE <6 _a tl•rr_I Bi&ING PER AT DE IFD.FO> SHE FOL WI G REASON(S) - .FOR OFFICIAL USE ONLY �. PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGEf OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION k _ i -FIREPLACE f -' ELECTRICAL: ROUGH ! FINAL P`C.UMBING: ROUGH FINAL _ GAS: ROUGH ` t FINAL FINAL BUILDING - - DATE CLOSED OUT ASSOCIATION PLAN NO. : + J L'. 1 1 t , The 'Town of Barnstable ' �0�' Department of Health Safety and Environmental Services 019. '' Building Division I 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any 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: f[X�t'- Est.Cost Address of Work: -750 a r t-) X to Owner's Name ( eve-( Date of Permit Application: 27 q 1 hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Amnodf, MIA Date 19fdrEtractor Name I Registration No. OR _ n..... flwnerc IVamp w ' Tile CO111111U11 N'ea1111 (J l tassac•Ituseffs Av - _ -•-. 1:_�- Dcpartnunt of lndustrial.4ccirlelrts • A 1 y / • � I 3 \- Office of1/lvestfgat/ons " =i `'` 600 if'uslullr tu�1 Street ': Bnstulr. A1uss. 0 111 ` Workers' Compensation Insurance Affidavit li �intintormation• Plc•t5e PRINT leb' �lv location' 0- l t 1/11 V 1 1 �� fi��G(k) -Rnt � hon.# I am a homeowner performing all wok myself. I am a sole proprietor and have no one workinL, in any capacity Cj 1 am an employer providing workers' compensation for my employees working on this job. company name: atitlress: city: phone#• insurance cn. policy# [•I I am a sole proprietor. general contractor, or homeo� (circle one) and have hired the contractors listed below who have the followin_ workers compensation polices:— cmm :im• mine: i adtiresr. cir• phone#• I insurance rn. noiiry# cmmnany nntnc: addresc: rip phone#• insurance co nolicv# Attach addition .:..— al sheet if nece -.ssary- ... `'---•.';:=,.,,:•..: y Z,.a ,..,_---�..r.,...._.�'�...r.._`._.;�� :... =:�i`e�r•`~•.w.;:...a. Failure to securr coverai:c:'is required under Section 25A of 111GL 15Z can lead to the imposition of criminal penalties of a line up to S1.500.00 andiur unc%cars' imprisonment ax it-ell as civil penalties in the form of a STOP u•ORK ORDER and a fine ofS100.00 a day against me. 1 understand that a copy of this statement mas, be furwarded to the Oltice of investigations of the DIA for coverage verification. 1 do herein•cerrift•under t c pants and penalties of perjun•that the information provided above is true and correct. 'O� 4 (� Q /S,nature Date 1 1 Print name Phone>* :.'rnf(iciai Ilse only do not write in this area to be completed by cin or town official city or town: permittliccnse# r'tl3uilding Department Licensing hoard [: trM check if immediate response is required C3Scicctmen's OMce 1 C111ealth Department .. contact person: phone#; nUthcr S. Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers* ctmi.Pctlsation for ;i employees. As quoted from the -law-. an e'nrpinree is defined as every person in the service of :1110t le under any contract of hire, express or implied. oral or written. An c•mphorer is defined as an individual• partnership, association, corporation or other legal emit}, or any two or r-:c the foregoing en�-aued in a joint enterprise, and including the le al representatives of a deceased empiover. or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the dwel lin- house of another who employs persons to do maintenance , construction or repair work on such dwelling_ or on the _rounds or huiiding appurtenant thereto shall not because of such employment be deemed to be an empio-, ` Id the issuance o r MGL chapter 152 section 25 also states that M-cry state or local licensing agency shall withhold rene++al of a license or hermit to operate a business or to construct buildings in the commonwealth for an}- applicant who has not Produced acceptable evidence of compliance+vith 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 chanter been presented to the contractin-azuthority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation sac suppi�'in`= company names. address and phone numbers 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 uested. affidavit should be returned to the cit-• or town that the application for the permit or license is being req not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are reauir: to obtain a workers* compensation poiic-'. please call the Department at the number listed below. City or •I•owns Please be sure that tiie affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P be sure to fill in the perm it/license number which will be used as a reference number. The affidavits may be returnel unless other arrangements have been made. the Department by mail or FAX The Office of Investigations would like to thank ou in advance for you cooperation and should you have any quest', please do not hesitate to �unve us a =11. Tile Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Y office of investigations 600 «'ashington Street Boston,Ma. 02111 fax R: (617) 727-7749 • a ~u TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE �Z JOB LOCATION �� lam( -,/ 1� Number St eet address Section of town "HOMEOWNER" r 4f - 3 Z Name Home phone Work phone - PRESENt MAILING ADDRESS 106 ? diDL6 C a'_ty7 town State Zip code The current exemption for "homeowners" was extended to include owner-occupies 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(sj 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 Offic'_ on a form acceptable to the Building Official, that he/she shall be responsih for all such work performed under the building permit. (Section 109.1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the St Building Code and other applicable codes, by-laws, 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. HOMEOWNER'S SIGNATURE k02244 P 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. 01 Construction Control. Y i 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 awarenes 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 - Rome "dwner-' act'_n as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man 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 licare to amend and adopt such a form/certification for use in your community.