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Home My WebLink About0015 EDGEWOOD ROAD /s Edyywoe l I �] NO. 1521/36GFi Town of Barnstable *Permit Expires 6 month from i� e � Regulatory Services Fee P • snxxsrASM • MABS'1639. Richard V.Scali,Director 1� Building Division Tom Perry,CBO,Building Commissioner _.._— —200 Main Street,Hyannis,MA 02601 _www:town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number " � P Property Address_ P'C� I jc) ,KResidential Value of Work$ ®0 Minimum fee of$35.00 for work under$6000.00 Owners Name&Address Ls 1 1 Q Contractor's Name —S CC)LS2. �t S: Telephone Number Home Improvement Contractor License#(if applicable) l,�6 CrJ2� Email: Construction Supervisor's License#(if applicable) 0�]�� ,, ❑Workman's Compensation Insurance S+�P Check one: ., I'o1�,� INV am a sole proprietor of ❑ I am the Homeowner 84 ❑ I have Worker's Compensation Insurancergp Insurance Company Name ` Workman's Comp.Policy# Copy of Insurance Compliance'Certificate must accompany each permit. - Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) DS,Re-side Replacement Windows/doors/sliders.U-Value X7 (maximum.32)#of windows - #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. ' Separate Electrical&Fire Permits required.' *Where required: Issuance of this permit does not exempt compliance with other town departrnent 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: , QAWPHILESTORMS\building permit formsUTRESS.doc Revised 040215 i ei Tlie Comm.omvei2 hh of-Mossadlrusetts Repay ntent efIndrrstrial Acdderdds - Or of int,eftations 600 Wasbutgton street Boston,MA 02111 ` - sopm Wass govIdia "Workers CGmpensatrrfn hisu ce avit-BuiI �CantracfarslEl�cbricianslP hers —Piease-Prinf-Le_U. -- 1'"151178ncirrP�f tgsn�a�iaDfhidEVidu3j 1 / 1 ��, {�re5s �� -- F-L='-��P �' 9 t c » �1, ®o Are you an employer?Checkthe appropriate box: Type of project(required): 1.❑ I am a employes mith 4. E]I am a general contractor and I 6: ❑New construction employees(full amVor part-ime).* have lured the sub-contra s 2. 'I am a sole propriettotr orpartuer- listed on the attached sheet: Rrsnodeling ;bip and have no employees These sib-contactors have g..❑Demalifiou wcA-ing for me in any capacity. employees aad have wadoess' [No insim a Comp_%nererarxp 1 9. ❑'Buil3tng additiaa rezpure d 5_ ❑..We are a norporafiaa and its 10-❑Elect ical repairs or a,d�tions 3111 am a homeowner€�o work=doing All--work officers have exercise 1 L❑Plumbing repairs or additiems rim of e$empfion per d their MGI. 12 ❑~ Roof repairs insurance requited.]i ;$ c.152,§1(4).and we have uo employees-[No workers' 13-❑Other ,A) : WtbDiu�!S cow-mmxarrtce required-] *Any appB=t&at checks box'Kum also M cut the sectianbelows gdmirworkezecampensa5aaparmyiU5rMMUML ISameawners who submitdaiseffidavit-&—tng&eyaz dGkgall wax au4tfiea hire outidecontmctorsxmlctsubmit anew affidavit mdicatiogmch fCaatzact=that lids baamast attached amadditiamsl sheet sbaumg the mmneof the sub-camtrzcbm.aad stmeWhethes or not those eatitiesham emp3oyees.Ifthesu resat EsbaveempTagersEfiey�stpmrzdethes workess'cmp.politynumber_ I arA!ar!eArlplo r flerrt is pratzdin,,workers'sou rlsaftcrA!iulszirarlce joy m}elrrpir gees Ectorp is ALrpaUcy and job site irlformrrtfals ' , , l si=ce Colupaay Name: -Policy-.-or Sel€-ins.Luc_ k FxpiaationDafe: Job Site Addre= CO/Statetzap: Afi.2ch a cop} of the wort-ere compensation:policy declaration page(shaving the policy number and expiration date), Faihue to secure coverage as requuedunder Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,50D:OD andror orne year imprisor%meuf�as well as eisl penalties in Ih.e fora of a STOP WORD flRDER and a tine of up to MO-00 a day against the violator_ Be adtised that a copy of this statement may.be forwarded to the Office of IQvestrgadons of the DIA for insurance coverage I,�cati= I t0 IlEt'Rby Gly ldA1dBP tttR pc&ls mid pen of per that Me iriformotiurlprmEZd ahrrry is huR mid correct _ Siffiafure: U �\ Date e 02kial um enl. Do itat,write in this area,to be campletced by cdy artoirn o,j r`ifiL City or Town: PermitUcense# ` IssuingAuthority(c rde noel: I.Board of Health 2.BmTs&Qg Department I CitylTown,Clerk d:Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone it: formation and lastrue ons •4. MRCc-ar-huse#fs Gm=al Laws chapter 152 regoaes all employers in provide wars'compensation far their employees. Pa suantto this stye,an.e7nP&5 ee is defined as."_.e•yery personin lhe service of aac thcr under say contract ofhire, express or implied,oral or wry." An mTT.vyer is reined as"an mdiyidnaI,par[nesshhip,associafi cm,OMPorafion or other legal eniiiy,or any two or more of the foregoing migaged ina Joint a tmprise,and including the legal repress&=of a deceased employes,or the receiver or t ustee of an individual,pajtnblp,association or other Iegal entity,employing employees. However the owner of a dweIImg horse having not more than three apEdme.±s and who resides therein,or the occupant of the dwdjiag house of another who employs persons to do maintmance,cf*^stract'on or repair W013C on such dwalling house or on the grounds or building appMt mm tth=to shall not because of such employment be deemed to be an employer" -M(3L chapter I52,§25C(S)also st'afns 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 buiildings in the comimomwealt3i for any applicantwho has mot produced acceptable-evidence of eumpm-mce with the insurance.coverage regIIn ed..." Additi.onaDy,MCxL chapter 152, §25C(7)sfa:rs"Neither the commaaweahhnor a'ny ofits political subdivisions shall eut-r fnto aPy contiaet for theperl=onnance ofpnbho wmkUaff aou?tab la evidence of comp Han eewith the fizm-ance._ reqairements of this chapt=have Been piesented to the contacting authouty_" - AppIicasis Please fill ovt the woi3cers'compensation affidavit completely,by chug the boxes that apply to your sitoaiion and,if n=c:ssary,Supply sub-contractor(S)name(s), address(es)and phone mmmber(s)along with their certfficate(s)of mcr =cj--. Limited Liability Compames(I.LC)or Linter LiabilityPartneasbips(LI P)withno employees other than the members or parinex-�,are not reqaied to cagy workers'compensation msarance. If an LLC or LLP does have employees, a policy is required. B e advised that this affidaTit maybe submitted to the Department of Industrial Accidents for conformation of msarance coverage. Also be sure to sign and date the affidavit: The affidavit should be retuned to the city or town that the application for the permit or license is being regaested,not the Department of Inu�i I Aca o&nts Should you have any gnestians regarding the law or if you are regoaed to obtain a workers' compensation police,please can the Department at thermmberlisind below` Self-insnaed companies should enter their s elf-ins'ar-an ce license limner an.the appropriate line. City or Town Officials . r _ Please be sae fhat the affidavit is complete and pri�.d legibly. The Department has provided a space at the botbom of the affidavit for you to fM out in the event the Office of InefLg�has to comet you regarding the applicant P Ie:as a be sure to f 11 in the,p=�iUlicense number which will be used as a mference number. In.addition,an.applicant that most sabmmt multiple pexmWticense applilmdons m any given year,need only sobmit one affidavit indicating dent. policy mn[bznation.(if necessary)and under'gob Site Ad firms tie apphcam+should write"aII locations in ( Y or town)-"A copy of the-affidavit that has been officially stamped or marked bythe city or town may be provided to the - applicant as proof that a valid affidavit is on file for fuira pe=.its 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 fQ any business or commercial vie (Le a dog license orpennit to bum Ieaves etc.)said person is NOT ralaired to complefe this affidavit The Office of Invesfigafions would like to thank you in advance for your cooperation and should you have any ques•fions, please do not he hLt!,to givens a call The Df--15 nent's address,telephone and fax number. ; fhe,Carman lt1[of if asrc ust t ' Department cif usual Acciclent% �te�of Xuve�fig�fio� 64,was�Gn t T(-,I,0 617 -490-0 Cxt 4-06 W 1477 MA.SSAFF, Fax 617-727 7M Kevised 4-24-07 m3ss-gQgldia. 41 MASS. Jown 6f Barnstable,, ATED�A ' ; . Regulatory Services Richard V.Scab,Director Building Division--- - --- _ - - - -- ---- Thomas,Perry,.CBO 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 ' ' " 1 1 .y to act on my beh4• b in all matters relative to work authorized by this building permit"application for:_"Q (Address Job) Signature of " er Date Print Name b . I If Property Owner is applying for.permit,,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services t �oFS r�yr Richard V.Scali,Director Building Division . g Tom Perry,Building Commissioner MASS. 1639. `0� 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 -IOMEOWNER": 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) v 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. r� 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(Sect on.109:-1X:_'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 form/certification for use in your community. Q:\WPFILES\FORMS\bui1ding permit forms\EXPRFSS.doc i Revised 040215 ��e�o�nr�r�wauaeal/�a C�ccaatc�cu�eC� Office of Consumer Affairs 6i Bu mess Regulation HOME IMPROVEMENT CONTRACTOR Registration;;°`1,36003 Type Expiration i3Q/2018. Individual BRUCE P.MILLS BRUCE MILLS 16 CROOKED POND' HYANNIS,MA 02601 Undersecretary s' Massachusetts Department of Public Safety_ fBoard of Building Regulations and Standards ' License: CS-078687 Construction Supervisor BRUCE P MILLS 16 CROOKED POND-RgAD 'HYANNIS MA 02601" Expiration: Commissioner 06/29/2018 -• Town_ of Barnstable *Permit# ��. p Expires 6 mon�t) from fss�e da .a T� Regulatory Services FeeNAM v 3 se39 Thomas F.Gellert Director �b • ��0 Building Division X-PRESS-PERMIT Tom Perry, Building Commissioner. 200 Main Street, Hyannis,MA 02601 MAY 3 0 2005 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERWr APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint lap/parcel Number / roP erty Address �� ✓ Residential Value of Work Minimum fee of•$J25.00 for �wiork under.$6000.00 hvner's Name&Address -��y 1 �t 1 �C�.�S4L t ;ontractor's-Name . v ! Telephone Number Some Improvement Contractor License#(if applicable) Q�� construction Supervisor's License#(if applicable) , ]Workman's Compensation Insurance Check one: . I am a sole proprietor 0-1 em the Homeowner ❑ I have Worker's Compensation Insurance U=rance Company Name CJ� Worktnan's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) old shin es Re- All construction debris will be taken to roof (s�PPmg ) ❑Re-roof(not striping: Going over existing layers of roof) ❑ Pw side ❑ Replacement Windows. U-Value (maximum.44) *Where regturedaissuance of this permit does not ea;empt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement q9Wractors Li is required. Signature Q:Farms:expmtrg ,- Revise063.004 u 617 Tppy�yiyto�uuea�di a�/ ¢c�i� tb Board of Building Regulations and Standards s HOME IMPROVEMENT CONTRACTOR Registration: 136003 ' •.Expiration: 5/30/2006 Type Individual BRUCE P.MILLS.- .. t BRUCE MILLS 16 CROOKED POND RD: HYANNIS,MA 02601 Administrator j Town of Barnstable Regulatory Services sntWAS&tE � Thomas F.Geller,Director 16 A 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 ABuilder as Owner of the subject property Z. hereby authorize: (J to act on my behalf, in all matters relative to work authorized by this building permit application for: dress of Job) Signature of Date Print Name' n•vn-0WAC•f VJNPRPRRMTgSTON