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HomeMy WebLinkAbout0010 LIAM LANE f . App'Iication number l 1... �.t l . s pan I Date Issued. Bu�idin iris ectors �Cr 5 2019 g . p initials J �"?, l � �Map�Parcel. �� D I nn h!� TA .; ��. i EXPEDITE APPLICATION =_ ROOF/SIDING[WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION . _ w PROFERTY 1�NFy+`ORMAfiION w Address:,of ProJeet /Q �/ NUMBER STREET �" '.VII IAGE Owner's Name: ,17 .r Email Address:-e,(Ct, na 5 ' ocbm Cell Phone Number Pro ect cost$ y��� Check one Residential 4/ Commercial ,n. ......: .�._.. ;.,._ ,.-,•. OWNER'S AUTHORIZATION , w , As owner of the.above.property L hereby authorize ��L o7v to make application for a buildulg permtt in accordance with 78 MR 3 Owner Signature: Date: ' ..... r t,,... ,...: ..+.. vim) YPE OF. IM 4 = Sid g W udows"°(no header change):#y r Insulation/ eathenzahon Doors (no header change)# Commercial Doors requirean anspector'sreview r ` ❑ Roof(not applying more than 1 layer of shingles) Construe.tionDebns;will be going to CONTRACT ORMATION Contractor's namehC., /1N M� CT"' 6 Home Improvement Contractors Registration(if applicable)# 1 (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor1 e/'r1 C1,�1G I�1" ZEc�97J7ti Phone number ,. i'U v���`1�1°a: ALL'PROPERTIES THAT A*4#8 STRUCTURES Ot/ER 75.YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A-HISTORIC,DISTRICT,-YOU MUST OBTAIN HISTORIC,APPROVAL BEFORE PERMIT CAN BE.ISSUED. APPLICATION NUMBER *For Tents Only* Date Tent(s)will be erected Removed on number of tents total . Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each-Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APP IC T'S SIGNATURE 4 V Signature (/ Date All permit applications are subject to a building official's approval prior to issuance. DocuSrgn Envelope ID:OE49C2A7-B434-4F39-8480-6D9BD47EE4BF Permit authorization imss save Form Site ID: 3825634 " Customer: Steven Psiakis I, E Clln� CC f` owner of the property located at: (Owner's Flame,printed) 10 Liam Lane T Centerville, MA 02632 (Property Street Address) ' (City) hereby authorize the Mass Save Name Energy,Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property, DocuSigned by: - p Owner's Signature: Ste- q f-WAc- PSiks 9/4/2019 1 4:42 PM EDT Date: Ora-V/GAS 00/e/i3OG4 IS 0 604 //G;0ON// 1000110 POP 6 601f/1AD0 a OR 10 0GO0 0a010 V/00/1r G QV/0 G%io/gOFV/9F/POP 019 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the -above referenced project: -Iytr^_T�i C_' �//_Z/9 Participating Contractor- Date Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 'For-Office Us Only 1Y4:fx%//%ia;;/.MKY.Y,A>�ii�/.H.O/.YBN�dfL/d//////HLYIbXU//i0/n/M H.O.'MGa/v/F //h 4MiMG/',Y_'ii'u.NHi�W Ui%�Po' d✓.5✓ii//�d/nm".MiYMgtlX9///,...i///i�%//MSFtlYW/i/25,.:Y6."/�'N////'.p,'-rl. iMYk ' Rev.102015 ,p a The Commonwealth of Massachusetts = Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Bu siness/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC.' Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction 2.M I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.EJ I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition 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.M 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.E]Roof repairs 6.r-1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[D Other INSULATION 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *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:LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lie..#:X/W0�58867158 Expiration Date:06/07/2020 / Job Site Address: �U C®/ City/State/Zip:6 ,01 Ji j; /�[� �,4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration ate). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under e s and alti s of e ury that the information provided above is true and correct. Signature: Date: Phone#:508-567-4240 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i Commonwealth of Massachusetts: ' Division of Professional Licensure. Board of Building Regulations and Standards Constrq tiba So, p'ervisor CS-105454 plres �i ; 05/08/2021 TIMOTHY CABRAL' f' 58.DICKINSOfV STREET,,, - y ° FALL:RIVER MA 62721 } 4 r `�J. commissioner •> -- �l Ctf�2f�2G�fzCCtP.CIfG z G�. ./�'�CG1r: GG`?LC�66/y Office of Consumer Affairs and Business Regulation 1.000 Washington Street.- Suite 710 Boston, Massachusetts 02118. Home]mprovement ontractor eaistreI ion Type: Corporation ALTERNATIVE WEAT��ERIZATION ING: R FX t G Icn; i7�683 .. _ l a.lo u�,'28t2021 2 LARK ST ALL:RIVER, MA 02721::.:::: :Update Address and RetuHi Card. scA 1 0 NNI.OV17 _. . V. Office of Consumer Aftairs 8 Business Regulation HOME IMPROVEMENT CONTRACTOR: Registration valid for individual.use only _.p. g Registration Expiration Office of Consumer Affairs and business'Re ulation Corooration before the expiration date. If found return to: 175683 05(28/202t.,_ 1000 WashingtonSere2,t:-Suite 710 eLTEPNATIVE WEATHERIZATION.'ING. Boston;MA 02'i18 f � n i/ i TIMOTHY CASRAL )? ! E w. i i/. , 2(ARK c,. if _� _. � •� r' FALL RIVED.!AAA 0272; / . l f :l of vaid'withoui signature Undersecretary. f r - DATE tMMIDDIYYYY) -AC"R CERTIFICATE OF LIABILITY INSURANCEE615/24/19 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Anthony F.Cordeiro Insurance Agency PAic°NN Ext: 508-677-0407 ac No): 508-677-0409 171 Pleasant Street I-MAIIADDREss:_HSouza@Cordeiroinsurance.com Fall River,MA 02721 INSURER(S)AFFORDING COVERAGE -NAIC# INSURER A: Liberty Mutual INSURED INSURER B: Ohio Security Alternative WeatheriZation INSURER C: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT;TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN SD WVD POLICY NUMBER MMIDDIYYYY MMIDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR E�TE PREMISES Ea occurrences S 300,000 MED EXP(Any oneperson) $ 15,000 A Y Y BKS58867158 06/07/19 06/07/20 LPERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY PRO- ❑ JECT LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accidents $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED Y BAS58867158 06/07/19 06/07/20 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/07/19 06/07120 AGGREGATE $ 1,000,000 DED I I RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STA PERT ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICERIMEMBER EXCLUDED? a N I A XW058867158 06107/19 06107/20 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA,its direct and indirect parents,subsidiaries and affiliatesshall be named as Additional Insured on commercial General Liability and Automobile Liability polcies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road AUTHORIZED REPRESENT Waltham,MA 02451 �. !�y I ©198#=2015 ACORD CORPORATION. All rights reserved.j ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD A�T•ER 'AT-.IV . . '• WE.AHER:IZ.AT:I:Q.N .Date hq, Town of Batiks-table 200•Mal .St. �.":K;:�'^}wXe^,lx:yi''•'c',`Sq, :.S..i°::'r'�� Hyannis,MA, 02601 , sg, / �//(y Py,�`Jp �1'N\...y�r F.wy.ti�.`r�/<. r :.%4/rn:' w�.{�.�' ,': '^•A` g V I V e Re:Permit# �f / ` XL4P, ;S,.i?Li4',:`Villag'`ea:�' r 4' !r�r�R..l:,r 4 :F•yl:, aUN 7,: .:".. 6�, r`"tiny's y�. ^r } .u_r.�.y.t rS. c: �'�•''%%,. :.>a'y�:C.,w' `>+'�.."y:: '+Y'ili;� .''�'�„',:!S:;J7'j:��;%:'.:.. ,Ad. x,`.!!G-'�!a:a p M r`.• y _�Y'," v: w. t"s;:.:.v}i:?;.. :,d%�R * pY x,yrr: insulation/weatk „ irk at .., u•. .;e,^,u`:%, ..„.-v.r,,:Ca .., t;^Mi.>,.,2.5y.�..,yw'7r•I:rsar.. v.. r.,..r. _ '' n 'pen corn fete" - a'iice�rvi`�[�[� ` ze s<;:a:;::+'•::: :; ; rY>,:'ti, c }p r ?.q.'Vr�.:•e7r.`r ?. .. 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'President 'CSL-105454 58 DICIGINSON STREET'..'( :FALL R1V,ER:^MA 02721 'I '(508}567-4240 ALTERtNATIVEWEATk{ERIIATIOI*L�GN1,AlL:Cblw' ' TOWN OF BARNSTABLE BUILDING`PERMITAPP'ICATION e - - Map 1 _7 Parcel 16•0 Z 2•- v Permit# ��yY Health Division Date Issued Conservation vision - r Fees Tax Collec Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board ; a Historic-OKH Preservation/Hyannis Project Street Address �� Village Owner y�¢��e-i J I ZzC7 Address _7 Telephone Permit Request f U G5 o er e�_ .:�,v", �� Square feet: 1st floor: existing proposed -- 2nd floor:existing proposed -Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay rConstruction Type F_ - Lot-Size Grandfathered: ❑Yes ❑No ,.If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure i Z Historic House: ❑Yes No On Old King's Highway: ❑Yes �No Basement Type: 1 Full- ❑Crawl ` ❑Walkout ❑Other Basement Finished Area(sq.ft.) No Basement Unfinished Area(sq.ft) SVC' Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing ? new Total Room Count(not including baths):existing -new' First floor Room Count Heat Type and Fuel: VtGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes )&o Fireplaces: Existing S New Existing wood/coal stove: ❑Yes )o Detached garage:❑existing ❑new size Pool:❑existing- ❑new size •Barn:❑existing ❑new size Attached garage.Kexisting D new size Shed:❑existing O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION [ Name— `yip Q-s'St a, —� Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TO dU / SIGNATURE L DATE _ 0(� ' 4 FOR OFFICIAL USE ONLY PfRMIT.NO. Y, DATE ISSUED k} MAP/PARCEL NO. ADDRESS ' ` VILLAGE } Y OWNER !I DATE OF INSPECTION: FOUNDATION ' FRAME ..- ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING,` DATE CLOSED OUT ASSOCIATION`PLAN NO. , The Town of Barnstable UL Department of Health Safety and Environmental Services rEo �" Building Division 367 Main Street,Hyannis MA 02601 i Office: 508-862-403 8 ` Ralph Crossen Fax: 508-790-6230 Building Commissioner 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: 9.0 9 Estimated Cost A° 50 ' Address of Work: 1 Owner's Name: 5-rC-Q4F,, Date of Application: 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. Da e O e 's ame q:forms:AMdav r -- The Commonwealth of Massachusetts Department of Industrial Accidents 4:9✓ Ar - �V� 600 Washington Street Boston,Mass. 02111 Workers' Com,pensation Insurance davit name: location: i hone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity ' /%//%/��//%%///////%%%%%%O�%%/%%%%%%%��%%%%%%%%//%%%/%/%%//%%��%%//O�%%/.5;;;� ; ❑ I am an employer providing workers' com ensation for my employees working on this job. com nnv name: address: city: ! / hone#: insurance co. policV# ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have � the folloning workers' compen on polices: company name: address: : :•:;:;>,.:.::. city phone#- ... insurnnce cn. camnany name: address. cite ... phone#' .:.:.:..:. ..:.. :. ;;.:;;• ... ::...;::;:.; ,::.::>:,.;:<:.;.. :: icy# hunrance co. o i Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tlne up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP♦VORK ORDER and a tine of S100.00 a day against me. I understand that a -- copy of this statement may be forwarded to the OlUce of Investigations of the DIA for coverage verification. 1 do hereby certify under the p penalties of perjury that the information provided above is tru,and orreet Signature -- Date Print name :l - Y I Z 2 0 �'1 Phone# Lmntsct oniv do not write in this area to be completed by city or town official n: permit/llcense# ❑Building Department dUcensing Board f immediate response is required ❑Selectmen's OMce❑Health Departmentrson: phone#; ❑Other (men 9,95 P1A) Information and Instructions } Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any con -"Z—. 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 receive: trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews: 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,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 coatracdne authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company, names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and . date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the`law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimit/license number which will be used as a refinance number. The affidavits may be returned fo the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. //%/ /1���ii,!�i,!%i,! i.! i%ji,! �i.!i,%i,�i,! � The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of imles gatfoas . 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext 406, 409 or 375 The Town of Barnstable �FTME Department of Health Safety,and Environmental Services Building Division 9� $` 367 Main Street,Hyannis MA 02601 i639. ♦� ArED MAC A Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION _ Please Print DATE: JOB LOCATION: G' � CCA)77Ekv number street village '/r "HOMEOWNER": 7l 'Yy""�F (�I' � l`��f^�I�lm"0 name home /phone# work phone# CURRENT MAILING ADDRESS: * C7 I�` P"4 ram. )"&: -, NA- city/town f 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) 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 requi ements Azv( -1 ff?�* Signature offHometperf 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. QTORMSIXEMPT TOWN OF BARNSTABLE Permit No. __ Building Inspector cash OCCUPANCY PERMIT Bond __---------__ _9 0 No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to urge 1br.Ler Wrp• Address iiLile j1:1 Wiring Inspector Inspection date Plumbing Inspector a_� / Inspection date r Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. j ...................................................... 19......_ ............................................................ _. . Building Inspector P- A Assessor's map and lot'humber ...... ......................... THE Sewage !Permit number ... . .. .. ....... ................................ . ... BA"STAIL House numbe'r .............. NAB& O 039.Ar TOWN OF. BARNSTABLE BUILDING INSPECTOR ........... ....... APPLICATION FOR PERMIT TO .... .......... ........................... TYPE OF CONSTRUCTION. ............................. ......1 .................................................... % ..... ...........19...................... .......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies forit according to the following information: / —T permit 6 , - Location ..................................... ...................6,................................1.. ........ ......?1�..... ... ........... /.....ef Proposed Use ............................ . .. ...... . ........... . ...............................................................................f . Zoning District ................. ...................................Fire Fire District ...................C...—..o........................ ...... ..... .... ..... .............Name of Owner ............ ........... ®:`Address .................................................. S,11,17 < Nameof Builder* .............:......................................................Address ... ........................................................................... Nameof Architect .......6.............6,-�=...............................Address ...........................................6........................................ Number of Rooms .....................6.......................................Foundation ....... ....ca Exterior ................. 014A..........................6..........Roofing ................./51 .....................!�..... ....... ........... Floors .................. . !� / Z!�.Interior ..................... :> .................................. . .... .. ... .. .. .. Heating ...................r .....y ...................Plumbing ............. .......... ........................ Fireplace ..................................................................................Approximate Cott ........ .......... Definitive Plan Approved by Planning Board --- ---19--------- Area ............Y.............................. Diagram of Lot and Building with Dimensions Fee .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH a-_ 57 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstoblq�regarcling the above--,-,' construction. Name ............ . .................................................... GREENBRIER CORP. A=82-280 No .:�A.11.5.. Permit or ..One StorX ,,,,,,,,.Single„FamilX Dwelling,,,,,,,,,,,,, Location ,Lot #6 10 Liam Lane ............................................... Centerville ............................................................................... Owner Gr.eenb. rier. ....Co.rp. .. ......................... ....... ....... .... .... .. .. . Type of Construction F.rame... .... ............................ . ................................................................................ Plot ............................ Lot ................................ Permit Granted ...June...........................19 82 Date of Inspection ....................................19 Date Completed ......................................19 'V0 t� o ssor's map and lot number ?......... *TNE Qyo wag Permit number l SEPTIC SYSTEM MU STABLE, House number ................................................................. INSTALLED IN COMPLI `332-NAG& Jwrc1 Op '639 WITH TITLE 5 PlVAL COD AF. "R TOWN 0 F -B A- - N 6n, lvq'ju n'-1 BUILDIRG ,.- I' SPECTOR W............ 6 7. ..... APPLICATION FOR PERMIT TO ....................C. ..... TYPEOF CONSTRUCTION ..�.............................. .......Ft..... ....................................................... ..................5 .......................190 C, 2 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: . , Location ......... ...... ......... ,../ . ........ .. ....... t Proposed Use ............... ..................... ........... .................................................... ......................... 0 Zoning District ................ ...................................Fire District...........................C........—............................ qPdress ......... ..5�0.............................C ...........< Name of Owner .............C_a 0 Name of Builder- .. 5/.1/ ...................... ..7. ......................Address ....... ............................................................................ Nameof Architect ............... ...................................................Address .................................................................................... Number of Rooms .......................(4�............I.........................Foundation ...... W..vsn�f/....co ............. Exterior ..................Ce... ....................................Roofing .................. C, nferior ......... ................................ .................... Floors ............... .. .. .... .. ..................... ........ -Heating" .::................. ............. .....Plum'bing ...............;r............... ................ . ...... ......... Fireplace ............... e ............ .......................................................... ... ....Approximat Cost ........../ t Definitive Plan Approved by Planning Board --- 19--------- Area ..... ................ 7S Diagram-of Lot and Building with Dimensions odlt_ Fee ..... ...................... le C��� SUBJECT TO APPROVAL OF BOARD OF HEALTH e -3 .1 43 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable egardin the above construction. Name. ....................... ......................................................... - BRIER CORP. � 4115... Permit forO...n..e......S..t...o...r..y..............Single Family Dwelling ............................................................................... Location Lot #6 10 Liam Lane ................................................................ Centerville ...................... Greenbrier Corp Owner .. 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