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0175 HOLLY POINT ROAD
r; 1 y Town of Barnstable Permit Expires 6 nrontl rnnr isrr date Regulatory Services Fee _ ■ARNnML& v� MASS. Richard V.Scali,Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 2-5 Z ©l 7 /� n /� Property Address / 7 5 i4 x �c'l r n fi K d ( Pn�' �'✓� I le— [!(Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address / 7 5 -4--101 l f2 "4 �Cn—�erJl l�� /4 A D 3 Contractor's Name W11A oto Qot %�GFF S -,EFZ F_ Telephone Number 791— c3Z Y of axivij Home Improvement Contractor License#(if applicable.) Email: Construction Supervisor's License#(if applicable) 07 2-7 7 Z Ymorkman's Compensation Insurance V Check one: Mh ❑ I am a sole proprietor - m.. ❑ tam the Homeowner [ I have Workers Compensation Insurance Insurance Company Name Work-man's Comp. Policy# 2-2 W G-C_l--T 24 3,45' Copy of Insurance Compliance Certificate must accompany each permit. Pen-nit 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) ❑ Re-side 2 replacement Windows/doors/sliders.U-Value ' Z1 (maximum.32)#of windows #of doors: • v ❑ 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 department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: C:\Users\Deco)i •ita\ calhblicroso � mdo\vs\Temporary inicmet Files\Cbntent.Outl'ok\I-PIOI DHR\EXPRESS.doc Revised 040215 Window World of Boston, LLC MA MICRegistration Offices&Showrooms Number. w-`� 015A Cummings Park Ct 295 01d Oak StreeE 166025 iYLLf(�. Woburn;MA 01801 Pembroke;MA 02359' Federal ID rf "Simply the Hest Ill Less" (781)9324865 (781)826-6281` 27-148166s' 'nnvirr.WindowWoddofBostamcom- om—er Phona6) /7-7r�1J'T91 Instail Address: L r Phone(w) C�'��t"���� State:MAZipO�_LE•rnarl WINDOW WORLD GLASS OPTIONS` Y000 Series Singie•fiung AllalUefd Sf89. Z SatarZone Elite $119e' 2000 Series OH veciWelded Sash $ 15 � d 4000 Series DH All Neld p GlazeT(2* $195 y (*Seder g000 O1110. 6006Series DH Au•Weld $260 WINDOW OPTIONS. _21iteSllder $354 Glass Breakage Warranty $15 CLilOED 3 Llte Slider pa+a.tror nrK 4 14 $545 � 15 M U ED Z.Picture/Fixed Lite $954� #=Ldsatio6onjarribsa :nclHead $11111CLUDED Awning g $15INCLUDED r 5280 Double Strength Glass Casement' �0 _Double Locks(;j26") $5IICLUDED 2 Ute.Casement $595 �FuN Screens �3 Life Casement pR 0.A (,p;trz f,) $880 . �Cobnrel Grids(Contotjred/FIAt) $45 _,Prairie Grids_Basement Hopper $334 gay Window-Soffit Mount/INS Seat S266o Diamortd Grids. 489 Bow:Window_Soffit Mount/INS Seat$2785 Simulated Divided Life $182 Garden Window ?—Tempered DH Sash,(BSO)(TSO) U5T 1 S2Q40 Obscure Gtoss(BSC)(T$Oj B 535 eige NindovF. S —.Oriel Style(40/60 or60/40), $30 Beige/Almond $40 `Foam Enhanced Frame _Zwood Grain interior(Serii"Oooi BOooCory)S1oo $35 (Light Oak/Dark Oak/Cheiryl Fax PRE 1978 BUILT HOMES(EPA LEAD SAFE RENOVATION) Wood Z Load Sete Practices Required $30 O /ik:h Mapta): Cry% C ' _8ram Eutarior(Arch D/orue lAmedcan Terra)g1 MY HOME WAS BUILTIN THE YEAR/957 initial ^Designer.CobiCxteror 175 / MISCELLANEOUS �O do Custom`Exterior Aluminum Cladding Winw Cote /�' ' O Textured$75; Smoot $75 �TJtO Inside oatalde. Facing Color NON CUSTOM.DOORS _Morel+PlrndowRemoval $50. Ylnyl Railing Patio Door 5it:of 68. 51C95 Nl Construction+Jirrjl Rell $175 __Vinyl Roping Patio Door Hit. 31795 .,Specialty Window Exterior Trim _Addioba-,a*a for bd,sicmRopingpalb0acr$1250 _MuH:toForriliM iUnit. $30, FrertchRallSllding Patio Door SRor6ft. $13g5 _lnsta0lnterior/ExteriorSfopel $50. .,. Frenah l?eil Sliding Patio DoorBR. $1495; _install Intel CasingStarts At __ French Rail Sliding Palo&or90.. - $1595' - - Insul2te..WOlgtlt BOxaS: $20 - `Custom Exterior Cladd rig z $15U __Roof for.Bay/Bow..Windows. g500 _Sofa2arte Siteer ETC Gass $206 ^_Eieisting New GonSf.EM.Ratio Fit $150 ^Grids Pelry Inl ri $t49- ,_Removaeof Existing Bay[Bovi 1$250 _Noadgrain Interiors $295' _6fadar DesignecColors $396 ,_Repair Sal,Jamb'or repiaee Sin nosing $50 , _7pteriorCasing 2+n:3vz 3f75 _Full Sub-Sip(Single)'re.placoment $150 _Handlesat Options 4 Mullion Removal $30 $. _Bayl Conversion&t.Rell $350 (N-Siding Will Not,Match) Door dolor Inside ...OuGrdo.: r}r,} �'• J�"yr •T`y�"Ci�R� ustonl declines exterior'vrap and understands painling and/or repair maybe required initial - Customer declines grids on windows/doors initial �PJSMWAUft�, respctiWA lei the fogal in connealin via Btis comrect Paiming,Stafn rig;Alarmstem diseannec+jcet annect 8upd pg pmrptleesin r and of Conde AssoclaBon Approval rystorc 0isbiet Apprenral.City cl6oston pepang&sided fil lees in CO-sec§ll installation, Ni EXTRA WORK:IF NOT IN WRITING! Customeragrees to,the terms of payment.as follows: Extra Labor&Materials` Sito Set Up;;Permit,Disposal a Delivery Fees,$ $389,0.01 Total Amount S /0• Custom Order Deposit 50%1. Batance.Pald to installer upon Completion $ j Amount Flnanced $ Wmdo v Wadt1 of 8o tan anticipates srarurtg iMs wofx an �/ and being substial ccmillfil in/mays Security interesC Yes Ito Any,kl o rogwfed in advance of the Wn61 the w4 k 9FIALL urt owe 331/3%ef.the total comnm price or tire achral cost of any material or eGu pmenl of a special eideraccustommadenatura,;fiichmustbeorderedinadvancedithe start of the`v4xtoassure that the project'rn8proceedohschedideptofin payment rhea be Granaaded until U e contract is ccmp ikd to Ue fallen of baIbLee ties All home improve menr cant actors and sirbcmtbactars shall be registered and that any!itpelires atie,A a ionNaU or subcontractor relating to a regtsha_uolishaa(d fie: dlreU�ed to:Office at Consumer Atfahs and eusness Riigulatian,ibn Park 1Na:a,Suds 5170 Boston,hfn 02116.Pirane:(617)9)3�8700 , ~No work sball bagN prior to Ute signlmi dtNa comraet and trertmn(f19110 tiro ownerat a copy of sobh conlraei:: • `yindotr iVorld of 8tts�i under prevision of Chapter 142A of the ganerai tavts b iequired.to apply tatana obtain a9 ccnstruGron-reieted permAs.SNnAmv�Lodd ul: "Boston sttau rat oe deemed iesponstbta tar'dttays in the riork described in this agreerrem caused try reguiatcry,permit gianling ageni:ies,authariues of individuals:Notice:Il Ibe PURCHASEA(Sj ablator Ms elfin eopshuetian related peimlts for the work deurWed tinder this agreement ar deatswtth tmrepistereA aamractors, the PURCHASERS)is gereEy advised Ina1 in the event eta dispme,)udgentent and nanpaymentape PtfItCNASEiI(Sywlilnot heeNNled to maps a`datm or ` ca8eclleniromfhe guarahty iwd eslabifslied by chap1et142A,M.dL' - - - ,. You the buyer may,cancel this transaction aI any 'me prior to midnight of ell business aye er the date at this iransackon. Notice of cancellation must be in writing postmarked no later.Than midnight of the tNlowing third htrstn this dart; ` D This'Vmtbv'Notlda-kanchlse.isipd erd_ fill Oil a ra10dT441ndoiv7laldof3osfanUC.underiicrostilrorp-:15ndivtytad Inc. _Ovinal dAsIfinRniereareanyblankspacaa. .Date - ` Saesman oriots;gnif re anyb sttaoee., ate /! Otrner.Do not sign It there are any blank all Date �— ''Mhlte COoy-Ortgbraf Ye0aw Copy-Eve Fink Copy.-Customer - - r Y Massachusetts Department or Public Safety Board of Building Regulations and Standards License: CS-072772 cons.ruction Super'/isor JEFF C STEELE -- - 24 SHERWOOD AVE_�' - DANVERS MA 01923 Expiration: commissioner 04/07/2018 Office of Consumer Affairs&Business Regulation _}HOME IMPROVEMENT CONTRACTOR =^- Registration: 166025 Type: Expiration:. 4/12/2018 LLC WINDOW WORLD OF BOSTON,.U-C. JEFF STEELE 24 CUMMINGS PARK SUITE 15-A WOBURN,MA 01801 Undersecretary License or registration valid for individual use only before the expiration date. If found return to; / } pffice of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 it .. l ' E1Vot valid Without signature The Commonwealth of Massachusetts Department of Industrial Accidents e 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia «orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PEPMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Azh,341 ) l�rl /01C / _�Sk L` Address: / 5-fl C ,/h zn,-Y1 15 S r K City/State/Zip: 1()Obuf A O o i Phone 4: -78 I —-i 3 2- - y8 o S Are you an employer?Check the appropriate box: Type of project(required): 1.Cgl`am a employer with 5 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp insurance required.] 9. El Demolition In I am a homeowner doing all work myself.[No workers'comp.insurance required.]t • 10 E]Building addition . 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.F90/ther tN In c(O 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. �J 152,§1(4),and we have no employees.[No workers'comp.insurance required.] I I A ree-►',•,,f-rS *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $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. rr Insurance Company Name: ('�C�/'t�o J'd FA fe T!1 S J RA)V C f. Cep . Policy#or Self-ins.Lic.#: Z Z W C C L— „)2 Expiration Date: I" Z 7— IS Job Site Address: 17 S 44-I tY !"&^4 1?A• City/State/Zip: l�Pn��/✓%/% M A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expira ion 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 s tement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verifi tion. I do hereby cer ' under a pain erjury that the information provided above is true and correct. Si ature: Date: 0' 1'r Phone#: a 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 laspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: WINDO-2 OP ID: HI l DATE(MN11DD1YYYY; ACORD CERTIFICATE OF LIABILITY INSURANCE 0510412017 L� 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 1 certificate holder in lieu of such endorsement(s). PRODUCER Carli Witcher CISR,CBIA,CIC Marsh 8i McLennan Agency-GSO PHNo ONE 336-272 7161 Fiuc,No' 336-346-1397 3625 N.Elm St Arc Ext Greensboro.NC 27465 M Ess:Carli.Witcher marsfimma.com C.Timothy Ward,CPCU,CIC INSURERS AFFORDING COVERAGE I NAIC S INSURER A:Hanover Massachusetts Bay J22306 INSURED Window World of Boston, LLC INSURER B:Allmerica Financial Benefit 118 Shaver Street INSURER C:Hartford Fire Insurance Co. 119682 North Wilkesboro,NC 28659 INSURER D i INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TC THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TC WHICH THIS I CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TC ALL THE TERMS." EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. OLiSIJBRI ' POLICY EFF POLICY EXP LJMrrS ! INSR' POLICY NUMBER MMIDDIWYY MMIDD/YYYY LTR TYPE OF INSURANCE INSD'N1VD 1,000,I)OO' A X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE S OD6790252708 0410112017 04101/2D18 DAMAG RE 5p0,000 C1.AIMS-NIADE X QCCUF. PREMISES(Ea occurrence) MED EXF(Anv one person) S,000 PERSONAL&ADV INJURY �,DOC.00CI GENERAL AGGREGATE 2,OOG.DOC GEI.1'L AGGREGATE LIMIT APPLIES PER: ' z.0D0.o0D PRO- PRODUCTS-COMPIOF AGG ` ' _- POLIC`' JECT LOC • ) QTHER: COMBINED SINGLE LIMIT S 1,0003.UUOi AUTOMOBILE LIABILITY • (Ea accident) - B X AN"AUTO AW68767615 061161209E 06.!16 2017 BODILY INJURY(Per Person; _ j ALL OWNED SCHEDULED BODILY INJURY(Per accident) S i AUTO°. _AUTOS - PROPERT'DAMAGE I NON-O)AJNEG (Per accident) HIREL:AUTOS AUTOS S Z.000,000 X UMBRELLA LIAR X OCCUR - - EACH OCCURRENCE i "7 A IXCEss uAB ' ;OD6790252708 04101/2017 D410112016 AGGREGATE CLAIMS-MADE j DEL) RETENTION S :WORKERS COMPENSATION - X STL'TE ER c ' AND EMPLOYERS'LABILITY YIN T S 50C,000� C ANY PROPRIETORIPARTNERIEXECUTIVE 'NIA,Y. ZWECLJ2635 01127/2D17 01/2�/2D1S E.L.EACH ACCIDENT 1 OFFICERIMEMBER EXCLUDED? ,�= EL.DISEASE-Ek EMPLOYEE S SOGAOO; (Mandatory In NH) _ - - li Yes.describe under EL.DISEASE-POLICY LIMIT S SUC,000! DESCRIPTION OF OPERATIONS below ! I I 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1D1,Additional Remarks Schedule.maybe attached Y more space Is required) - I _ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4 ACCORDANCE WITH THE POLICY PROVISIONS. - AUTHORIZED REPRESENTATIVE i 1 ©1988-2014 ACORD CORPORATION- All rights reserved. ACORD 25 (2014101) The ACORD name and loge are registered marks of ACORD ��, r Town of Barnstable *Permit#��lq(_ 0 �. �. Expires 6 months from issue date Regulatory Services Fee NSTA BARBLE, ThomasF. Geiler, Director 7 MAs& �1l 1659. Building Division PrEo MAC a V 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 hI Not Valid without Red.\-Press Imprint Map/parcel Number �/ 1 Property Address '� 7 .l (v llL9 1001 nt CJ• C -eta -J:�� M. �oZ�o .�.a Residential Value of Work /�o�� Minimum fee of$25.00 for work under $6000.00 Owner's Name &Address Contract' ame Telephone Number Home Improverrient Contractor License#.(if applicable) ❑Workman's Compensation Insurance -PRESS X-PRESS PERMIT Check one: I am a sole proprietor SEP 5 2008 I am the Homeowner I have Worker's Compensation Insurance --OWN OF BARNSTABL E Insurance Com ny Name Workman's Comp, P cy# Copy of Insurance Comp iance Certificate must be on file. Permit Request(.check.box). / Re-roof(stripping old shingles) All construction debris will be taken to t� ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Gn ❑ Replacement Windows/doors/sliders. U-Value (maximum..44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e..Hist ric,Conseg3tion, . ***Note:. Property'Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required.' SIGNATURE: Q:\WPFILES\FORMS\buildingpermit forms\EXPRESS.doc Rtvise020108 The Commonwealth of Massachusetts Department of Itrdustrial Accidents Office of frivestigations 600 Washington Street Boston, MA 01111 www.mass.govldia. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers &Pplicant Information Please Print Le 'bl N=I e (Businesslorgauizatsonfffi6 iduan: �� ( C� 13°��r'n llcQ • �e,�;tcr:�;iJG, Mai Q�.�3a ity/ tatelZip: , ��� Kl� Oallal Phone.#:1oi-l- t1�13 -a"15a Are you an employer? Check the appropriate bow r7. pe of project(required): 1.❑ I am a employer with 4. I am a general contractor and I ❑New construction employees (full and/or part-timz).* havo hired the s'ob-contractors 2.❑ I am a"sole proprietor or partner- listed on the attached sheet ❑Remodeling ship and have no employees These salt-contractors have g, 0 Demolition employees and have workers' wpLTcing for mein any capacity. 4. ❑ Building addition • camp.insuiranmi � [No workers'.comp.insnce 10. Electrical repairs or additions .required.] 5. [] We arc a corporation and its P 3. I am a homeowner doing all work officers have exercised their I1.[]Plumbing repairs or additions X myself[No workers' comp. incnrancc r right df exemption per MGL 12 Roof repairs 1 in. 152, §1(4), and we have no �� ctnployees. [No workers' 13. Other comp.insurance required.] *Any applirant that chmc s box#1 must also fill out the section blow abowing their work='compaisat?on poficy information. t Horrxowncrc who submit this affidavit indicating fbvy arc doing all work and then hire outside eontractars must submit anew affidavit indicating such XContzactors that check this box must attached an additional sheet showing.the name of the mbtontrarwa and state whctha or not thosd M66Cs have employers. If the sub-eonTrrehsrs have ecnployecs,.they must providt their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees: Below is the poliry and job site ormation. Company Name: Policy#or Se - ie.#: Expiration Date: fob Site Address: City/Statraip: ` Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to sccurc coverage as required under Section 25A of MGL c. 152 can le iropositiou of cr ap to the iminal penalics of a firm,tip to S 1,500.00 and/or ant-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a 5nc of up to S250.00 a day against the violator. Be advised that a copy of this stater crit may be forwarded to the Office of vesti tions of the DIA for insurance coves e vcrificat iom I do hereby certify under the pains"andpenalties ofperjury that the information provided above is true and correct S' c: CVaVI O fu1 use only. Do not write in this area, to be completed by city or fawn official City or Town: Permit/License# Isguing Authority(circle one); 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Phone#: Town of Barnstable. �0f 7HE Tp y Regulatory Services Thomas F. Geller,Director BARMsrABLE, .• s, MAS& �* Building Division Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 WM'Y.tovm.barnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 -- HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: num/b^er street --1 village ..HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: i n U 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 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 "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 per rnit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of meowner g ,i Approval of Building OfficialOf 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,I-Licensing of construction Supervisors);provided that if the homeowner engages a persons)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 responsfbilitics 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 forrn/certification for use in your community. oF1HEt, 'Town of Barnstable J Regulatory Services lARNSTABLE, MASS, Thomas P. Geiler,Director rfoµAta Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A.Builder as Owner of the subject property hereby au rite to act on my behalf, in all.matters relativ o work authorized by this building permit application for: (Ad ss offob) Signature of Owner Da Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel _ Permit# - J Health Division � � �h o.<nt 1232! <-x 0 �/ C Date Issued " 4 Conservation Division �� ���l�Z j Fee g� Tax Collector Treasurer 31, Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH — Preservation/Hyannis Project Street Addresso � t1U 1( at Village f 8 Owner tom'" Address I�5 (�� Pa�n�' Telephone Permit Request Cen S- r-U r laNuP� Cfft� 3 �' 7'1 5 F+- 7 Fes- (�" hi�ti (f201- r zA 7RYW+Y Awl+v r—goM L-Ak e, >!ao',s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new `S Valuation Iwo Zoning District Flood Plain Groundwater Overlay 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 y 4a t Historic House: ❑Yes )V'k 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 �a' 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: XG"as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes �00 Fireplaces: Existing C1(.F New Existing wood/coal stove: ❑Yes Xd 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 ❑ No If yes,site plan review# Current Use Proposed Use /r►✓,�t, C�G✓ rr �� ,y BUILDER INFORMATION n - `Name ' - � i'Y3 .-.'��, � Telephone Number nos Address N C fir' License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO .SIGNATURE `�� &1V_&r V DATE FOR OFFICIAL USE ONLY t PERMIT NO. .' DATE IISSUED _ MAP/PARCEL NO. r ; ADDRESS VILLAGE , } OWNER DATE OF INSPECTION: s FOUNDATION FRAME i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL - t GAS: ROUGH FINAL FINAL BUILDING t . � t . 7 DATE CLOSED OUT _ y ASSOCIATION PLAN NO. a - a3z PAaf of 1He roy, � � Purcel a'11 Th , BARMAB The' Town of Barnstable y MASS. �a �AT1 6g9. Regulatory Services Thomas F. Geiler, Director. Building Division Peter F. DiMatteo, Building Commissioner 200 Main.street,Hyannis MA 02601 . ce: 508462-4038 Pax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION j Please Print DATE: JOB LOCATION: PIS`S -tip -Pst"1 f �/'' tl�`-(t/i tc number street village "HOIvIEowNER": C,:lyonw 0 name ho phone# work phone# . CURRENT MAILING ADDRESS: t 1 -'G 41i� � olyl t ��Ls J ~lr v i D at" 3�. city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dweldws 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"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall_be responsible for all such work performed under the building permit (Section 109.1..1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said . procedurend requirements. 4 (� , Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that suchHomeowner 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:FORMS:EXENUTN L-01 o f �o E RW rwAV N O E A _ TE STANDARD LEGEND NOTE nat a0 symbols ERR a ppoar on a map p[ ' � DGE GOV COURSE FAIRWAY o v � E OF DECIDUOUS TREES % J EDGE OF BRUSH ORCHARD OR NURSERY V-V-7-V EDGE OF CONIFEROUS TREES MARSH AREA — EDGE OF WATER MAP 232 f - DRIVEWAY � �--PARgH6LOT PAVED ROAD DRAINAGE ORTCH ' PATH/TRAIL MAPPARCEL ONE** MAP# 1—PARCEL NUMBER ,•�/� `` CNN—HOUSE NUMBER MAP 2 F=CONTOUR LINE Is-- 10 FOOT CONTOUR LINE ElwroNan bold on NGY029 1 �\ 4.9 SPOT ELEVATION 1 i "" STONE WALL •X--X- FENCE RETAINING WALL j I I RAIL ROAD TRACK �- -.--� STONEIETTY f SWIMMING POOL PORCH/DECI( 1 tP+CF BUIU)W/STRUQURE • OM/PIER Q HYDRANT e VALVE ® MANHOLE O POST Ow FLAGPOLE T O W N O r 0 A R N S T A R t R O r O O R A p N I t I N F O R M A T I O N S Y S T R M S U N I T p SIR ® 3TORLLDiWN r POMSIMIFEET j*ROmIlbomphanlnlopeuadof* s*NOIETh/por®I@msmeNly�pAkfMW.Smd�n DATASOUR�511anNimda(nmrmodehalumU�eAtlrpeMAac1995arlol abOrlooms 1"=t00'smbmap®dmoyNOTmer dpmpodyhmWaftThW'menrtnrWp�ony.TWDFghhy�mld�;wpbflonrral %ml9PmWpbo4mphsby= 0 MITIYPOLE .aTOYIER 0 20 - 40 N�Mo wAwSbodl�dsolHds mAare�odudnickaftsID*0at l'=ta Pmodltmswre�p komFY1 T A a LdDITFOIE o EIECIR�B01f f:\dgntconservation.dgn 03/13/0210:55:44 AM ��ee 1�15 {p6 6�te,_V4, n1A_ aa�3a I �- Q I I I I • I I I i /l(/sG%!//�������//cGG!//�% .%!'%%%.%:%%y.> i I I I Fill MUM ,, 11 1•IU-•••1� w.nl•ui 1 • ••IU. 11 Nam ■ 11 1 .Inl• • a • nu • ..�-. •nn✓tit .:n ul 1.1 u • - n•.�n n : , ■ I - nl - 1 r•nur.� •1•. - 1• ;111 II ••1•.11•I ' JI 1111• 1.11 •1 1 1 -1 ' 1 . 11 • ••' 11 •'•.••`� r•1111•tit vl• •11 •• 1•. 1. 1 1 11 :., y,'1• `?`.,".Oc. 'ti a4•»'a�s ���c r<��.x,C r Yi:r'l4•lc J <<•c �"Fn^c �,.,oxR.``\J.v..OR:�ae`>•g. r Jf K,9^ccc•C ro . :iJ'i: � •�' r� � >:2•�a�K�i' f� o ii.p,:iAi3ow �2��:^'': ` '; ro <,a::xt', e 5 0�suc `a�s orb xrxe :srcekc. y,, 'R,�:O�. ,•oc, w�., r.�..:S;Y;�;4?:i`ai?:,::�cr;t's:l'!:�tjS .7777r, • it �toi wr. H 1 • 11 _ 1 .1 111 �•111 • bycMycrWmO9WA cilyor ■ ■ mPonas is requbmd ■ / ■ Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th2�r emplovees. As quoted from the "law", an employee is defined as every person in the service of another under anY ca= of hire, e.,cpress 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 Iegal representatives of a deceased employer, or the rcc—ver 0, trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three aparaneats and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, ca stractiaa err repair wmuic an such dwelling house or on the grounds c, building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL cbapter 152 section 25 also states that every state or local licensing agmep sbaII 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,neiathe commonwealth nor any of its political subdivisions shall ceder into any contract for the performance of public work until acceptable evidence of compliance with the insurance requiremm_ts Of this chapter have been presented to the - authority. VAN INAMM Applicants please fill in the workers' compensation affidavit completely,by checkin the.boxthat applies to your sit Fd m and P supplying cAmpaury names,address and hone numbers along with a certificate of iasmaace as all affidavits may be : r submitted to the Department of Industrial Accidents for c�mfirmaziam afiasttraace8e• Also be sure to sign and date the affidavit The affidavit should be,retumed to the cry ortowathat the application for the pemut or lice is being rcquested,not the Department of Industrial Accidents• ShCM1d 7QU have any Qaesdans regarding the"law"or if S ou are required to obtain a workers'compensation policy,please call the Department atthe mmber listed below. i51111011 City or Towns _ as h Please be sure that the off davit is cAmplete and printed legibly- The Department provided a space at the bottom of the � lip._I'Imse affidavit for you to fill out in the event the Office of Invcstigat. has to contact you regarding app be sure to fill is the peumitRicease member which wu7l be used as a reference nrimlier. The affidavits maybe rid t0 the Department by main or FAX unless other arrangcmmft 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 caEL tDeMp==McesadMdress,tc=icpho=Mand5Mx=mb=cr. The Commonwealth Of Massachusetts Department of Industrial Accidents amce Of Investigations 600 Washington Street Boston,Ma. 02111 fax*: (617) 77.7-7749 phone #: (617) 7274900 exL 406, 409 or 375 The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. G G 4_9 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. T e.of Work: (,Qt�S U G P�� �Li,3, h� < yp Estimated Cost Address of Work:. l�5 lip,, Pri►fn-i' Owner's Name: C �' ba 6 c.i Date of Application: 3/f 3/i a I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 []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: Date Contractor Name Registration No. OR q:forms:Affidav :rev-122001 - A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION P Map 3c� Parcel fSq.p Permit# Health Division Date Issued Conservation Division Fee 06 Tax CollectorMAI Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Addresso+-L�/ Pa o w► ��e�l �-c�i 1 a8 � Village Owner Cali-Jncr Address l l l FUJJ-ct- S'�', DOCA 7/ ,dylc,. Telephone �b� �-1�- `1(a o r l o i-1— W3S—(.a w-t- Permit Request Re-Sh nel-e e., . l_ o ho Ce-do,- SY�;�y1us Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new 11 4 oa Estimated Project Cost ✓Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes Cl No If yes, attach supporting documentation. ' Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure a iAr's Historic House: ❑Yes �No On Old King's Highway: ❑Yes No Basement Type: WFull ❑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 A 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: Existing M-e- New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:A existing ❑new size )CL r Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use 6f,�-brqr BUILDER INFORMATION Name l Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _ &4 ' jr FOR OFFICIAL USE ONLY PERMIT NO. _ T DATE ISSUED MAP/PARCEL NO. 2 ADDRESS VILLAGE T OWNER ' DATE OF INSPECTIO _ l FOUNDATION _ - t y FRAME INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL t FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. E ' a • 1 _ S t g, °F THE ,� h•t Pam. ti The Town of Barnstable * BARNSTABLE, " • , 9 MAC De artment of Health Safety and Environmental Services 0 P Y Building Division r, 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date 3 ".I ).000 AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION i 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: 96k.N�, d(- -00wst Estimated Cost n Address of Work: ��s k(LA Owner's Name: x>/J� Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law XfJob Under$1,000 ❑Building not owner-occupied ROwner 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: Date Contractor Name Registration No. p, �+ OR 4 'Date Owner's Name q:forms:Affidav ' The Commonwealth of Massachusetts ._. ..., Department of•Industrial Accidents :-- -- oxceo/lasesUgatioos _ 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name location �- �11(,(e, hone# Sol-11"I - gel tQ� city I am a homeowner performing all work myself. ❑ I am a sole Proprietor and have no one worki>1 m aav ca acity ---------- co an 1 workers' mpensation for my employees working on this job..:;;.;;:.;:.:.;.:?.:; ; >;::«<::<:<::: ::<» >:<:::>:;; I am employer P 'r .......................:.::.:::::.::.. ::::.::::::.::::::..:.:.:::. ::.::.:.:....::::::.::::::::::::::: ::::::::::::::: . an name:.. "ildre ss~ X. e. of icv itisu net ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have winworkers' co ensation polices: :?::;::.::.::.:;; ;:.;:.;:.:::;.;:.;;:?{?{.:}:<?;>:::{{:};;:«:::><::;:;:<::;}:.,:;:;}»> the following ...................P ...::::::::.: :.::.:::::::::.::::::......;:.::.::::..:::::{.::.::.}::.;>:<.:.;>;:.;.;; .. :.:: :;;......:...:.... ......::::.... .........:::........:....:.:.::address: .... ... ......::.�::................... hone. .:.:...::.....::::.................................::..:.......:::::::::::..:..::::.�:.. ............................:::::::::::w::::n}i'•i":T4'vi'vi'L}}::4:i+}i}}}:_}Y.ii:}:i•:}:vii:^:i;:};:i:J:•i}}:?iS}::•:}:::+?y •i:•i}J•i}}}i:{hi:^X}y�;%::: .................... SIIV lla address. e ...:.::-:::::•:•: :. ............. .................................................................................. ......................................:.... ............................ Fafiure to seems coverage as tegoired ceder Sectlon 25A of MGL I52 can lead to the imposidon of criminal penalties of a fine up to S1,M.00 and/or one yeaia'imprisomneat as weB at dvfi penalfla 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 atatemmt may be forwarded to the Office of Investlgatioas of the DIA for coverage verification. I do hereby certify under the pains and penalties of pejwy that the information provided above is true and correct Signature Date 3/alf,-,,Oo Print name � 1 �-tt Phone# ��$" n� ✓g �°g 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 ❑ ❑Sel checkif lamtediate response is required echne❑Health a Office_ Department contact person: phone#; ❑Other (revered 9195 PUS FIME r, Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 buss. 11659• �0 f �ArED N1Pj Js, Office: 508-862-4038 - Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: 3/o11't�UC�(7 JOB LOCATION: number street village "HOMEOWNER": ��'�� ��r�>•. SU$ — -1"lS'��1a� name home phone# work phone# CURRENT MAILING ADDRESS: l k 1 S�" city/town state d up code t r The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. , The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and req uirements. Signature o Homeo er s 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 to amend and adopt such a form/certification for use in your community.,_ Q;FORMS:EXEMPTN " I I I I r. iFi I / I. - --- _.._ .- Existing house no work to be . - _ - -- - - -- - - "I I performed. Solid shading denotes new Nevv;Entry 1 construction. 4'8 x T8 ;1 Windows to be , Double Pressure Treated 2"x4" sill I I\ ` 21/6" 470" Vinyl bolted to existing brick platform L.. -) Double Hung \ with,tempered. Walls 2,.x4 studs with 2 x10" _ safty glass I - __. -. -- -. .— - =J header, 1/2 OSB sheating, R13 . FiberGlas insulation. 2"yc6" Ceiling joist with R30 r "White Cedar shingle siding LIVING AREA insulation. Rafters to be 2"x8" with to match existing. 1108 sq ft 1/2" OSB sheating, Asphalt shingles with Ice and Water underlayment. I SCALE: _ APPROVED BY DRAWN BY DATE: Y g d 2 D f RAWING NUMBER s• - -c CNARRETTE PRO-FORM 920PF PRINTED ON 920NICNARPRINT VELLUM I — - I , I . . I I . I . � . " �,"l,�..' . 1.� . I I . I I . . l . , , I. .14" 1 ,� ��, , , ,4 f , i ,� I I . I - I 1, . . , � - � . I .:" I - ��,,,, " 1 . i i, ,,,,, . . I I I . P'. � f ., � .,,w';�,, . I . _� . ,�',A I � Y, - ,l�,� -_ , 41 1 . . - - � . . ....-. . i�4.11 I'll , "I `vwi- I I . 1. I � ,�, ,� ;'� . 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