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HomeMy WebLinkAbout0023 MAPLE ROAD em.' -� �, ¢� ,� ., t: i r • - �, . a.': f - a :- -. . ,. ,. � _ q � _ - n � n .. � �' - I�� .� - ... �. a .: .. :. � '� u :. ' ,�. � � P. Town of Barnstable *Permit# I r Expires 6 mon[hs froi»issue date Regulatory Servile Fee BARNSrABLE, " �N v a �' Richard V.Scali,Director w :. FD Building Divisi AIAY 2 RINI l Toro Perry,,CBO,Building Comm , �20�'200 Main Street,Hyannis,MA 02601 �® www.townbarnstable.ma.us t7LE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION -. RESIDENTIAL ONLY Nut Valid without Red X-Pre s Imprint Map/parcel Number Property Address 25 Mppy f PD eFu_Pr_VRV 1L!-F�M4 [dResidentiai Value of Work$ 4 g� 8k> Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Jof. CTRLLlt'ZZD A 4"PTY OR ZO.VDO.e DEP-9e ' .C�J�f, C>305 2 Contractor's Name Telephone Number ad � Home.Improvement Contractor License#(if applicable) Email: C1r9Q1" 1 1C(P172aY 1 W,-n Construction Supervisor's License#(if applicable) 208- ❑Workman's Compensation Insurance Ch k-one: U 1 am a sole proprietor ❑ I am the Homeowner ❑ 1 have Worker's Compensation.Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check boa) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to e-roof(hurricane nailed)(not stripping. Going over existing layers of roof) JZ Re-side ❑ Replacement Windows/doorsJsliders.U-Value (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 department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property OwnerLetter of Permission. A copy of the me provement Contractors License&Construction Supervisors License is requi d. SIGNATURE: C:1UsersiDecolliklAppllatalL.ocalllMicrosoftt WindowsVremporary Internet FileslContent.0u11ook12P101 DHRNEXPRESS.doe Revised 040215 f cN 0 Install new Harvey 6 over 6 double hung window to side of garage and trim exterior with Azeks and interior Total cost of job $18,586.00 Deposit $6,262.00 Due upon start and on customer's receipt of 2"d invoice $6,262.00 Due upon completion, customer's final inspection and receipt of 3rd invoke $6,162.00 Make All Checks payable to " Dream Home Improvement LLC Compliance with Laws: Contractor agrees that it is properly licensed and insured under Massachusetts General Laws Chapter 142A and that it will perform the services contracted for herein in compliance with applicable building codes, laws, statutes and ordinances. Parties' Understanding of This Agreement: by signing this agreement, the undersigned Parties acknowledge they have had the opportunity to ask any questions concerning its terms; have read, understand and agree that its terms are fair and reasonable; and agree to be bound by the terms in their entirety. This agreement is effective as of the date it is executed by all the undersigned. Contractor '� Custom e�Qjut7,0 Joseph Galluz o Date signed 51 OP-1 All labor,materials,disposal and permit fees are included in a price.All additional extra work will be charged 60$/h plus materials f The Commonwealth of Massachusetts z Department of Industrial Accidents d 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 (Business/Organization/Individual):Alexey Lebedev/Dream Home Improvement LLC Address:60 Franklin ave City/State/Zip: Hyannis, MA, 02601 phone 4:774-208-3589 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I in employer with employees(full and/or part-time).* 7. ❑New construction 2.1yI am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doingall work myself p required.]t 9. ❑Demolition y [No workers'comp. re uired. 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 1.1.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5❑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? p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 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. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 the ains a d pe alties of perjury that the information provided above is true and correct. Si nature: Date: 'D le2 Phone#:774-208-3589 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 1 ® DATE(MM/DD/YYYY)AC� AC� CERTIFICATE OF LIABILITY INSURANCE 3/1/2017 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 certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Ashley Paiva NAME: Y Southeastern Insurance Agency, Inc. A N E (508)997-6061 FAX No:(508)990-2731 439 State Rd. E-MAIL ADDRESS: P a aiva@southeasternins.com P.O. BOX 79398 INSURERS AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURERAArbella Mutual IIIc Co 17000 INSURED INSURER B AEIC Dream Home Improvements LLC INSURER C: 22 Horse Pond Road INSURER D: INSURER E: West Yarmouth MA 02673 INSURERF: COVERAGES CERTIFICATE NUMBER:2017-18 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 TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MWDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE a PREMISESS OCCUR DAMAGE ( RENTED 100,000 Ea occurrence $ 9520053178 3/8/2017 3/8/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1-1JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (CEO, SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $$ EXCESS LtAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/NANY STATUTE ER OFFICER/MEIMBER/EXCLUDED?ECUTIVE ❑ N/A E.L.EACH ACCIDENT $ 1,000,000 B (Mandatory in NH) WCC50050156792017A 3/8/2017 3/8/2018 E.L.DISEASE-EA EMPLOYEE $ 1 000 0o0 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Display Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ashley Paiva/AMP #' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014011 f :U i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen isor License: CS-108208 ALEXEY LEBEDEV 60 FRANKLIN AVENUE Hyannis MA 02661 " O Expiration Commissioner 11/27/2018 c/2/�i l(Jt4�7i %t Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration � . � < Registration: 176777 s� Type: LLC �I ¢ Expiration: 9l25/2017 Tr# 270447 DREAM HOME IMPROVEMENT LLCM ALEXEY LEBEDEV 60 FRANKLIN AVE. : -- HYANNIS, MA 02601 ,7o� .'~Update Address and return card.Mark reason for change. SCA i 0 2OM-05111 Address Renewal ❑ Employment Lost Card ��c���nay�arreuea�f�o ��l�r�scrc•�usc�C/r � Office of Consumer Affairs&Business Regulation License or registration valid for individul use only p HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:. Registration 176777 Type: Office of Consumer Affairs and Business Regulation Expiration 9/25/20,1-7 LLC 10 Park Plaza-Suite 5170 Boston;MA 02116 DREAM HOME IMPROVEMENTLLC. ALEXEY LEBEDEV 60 FRANKLIN AVE. HYANNIS,MA 02601 Undersecretary Not valid without signature r ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ Parcel 01 c57� ff L TA LE Permit# if W Mt Health Division �'R -3 Date Issued �. Conservation Division 3 p'. r (' ) � ' 5 Application2Fe _^` do Tax Collector . Permit Fee 9 `� Treasurer �� ' �''� SEPTIC SYSTEM MUST DE INSTALLED IN COMPLIANC i�lk Planning Dept. VATH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANC Historic-OKH Preservation/Hyannis • TOWN REGULATIONS Project Street Address3 Village yja6 A+ Owner aiwm Address 1 HOUP Telephone 'rTS-68Zub59s g7e)p-5) 3`Oq Permit Request Ate " 9W&W4' Y-P VqWd ' an- Ai ,g, �?I17�'6CV o—sm 0*awl f — f Square feet: 1st floor:existing I©fO proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation_ u Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family L/ Two Family ❑ Multi-Family(#units) Age of Existing Structure ❑ ®' Historic House: Yes No On Old King's Highway: ❑Yes �No Basement Type: CdFull. ❑Crawl ❑Walkout .❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1D21 Number of Baths: Full: existing new Half: existing 8 new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing new First Floor Room Count 6 Heat Type and Fuel: ❑Gas O Oil ❑--Electric ❑Other Central Air: ❑Yes o Fireplaces: Existing New Existing wood/coal stove: ❑Yes Cf No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing Cl new size Attached garage:(2f existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 5N0 If yes,site plan review# Current Use Proposed Use.40 f BUILDER INFORMATION Name rowwwO Telephone Number 3 -3 Address 1 4 -, V1N License# �iy►?� 2 ��4 elg/,b. Home Improvement Contractor#' Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE S - - FOR OFFICIAL USE ONLY � PERMIT NO. DATE ISSUED _ - r__ MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION OK o Y ? S-• U FRAME c� INSULATION ���\ 12 j FIREPLACE w � a ELECTRICAL: ROUGH FINAL. / 1 PLUMBING: ROUGH . FINAL_ GAS: ROUGH i 7 £ - FINAL y FINAL BUILDING f DATE CLOSED OUT ASSOCIATION PLAN NO. •r ` The Coriimonweadth of Massachusetts Department of Industrial Accidents gfffce 0f1#ye5tfyatioas 600 Washington Street Boston,Mass- 02111 { 'Workers' Com ensation 7nstu once idavit / / iocation B q??-�8z T hone# &Ta�ma � erfasming work myself. Q.2omeown p am a sole rietor and have no one worl�s in ca aci Yrl ////i//%%%%//////%%%%/%%//%%// %%/%%%/%%//%//i/%/%/%/S/%// gni b%�////%%�/%%%%%/%%�/%/�/%%%are//%//�/��M1� %/ ensation for my employ . 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';`::tE�:•:..:Y:'b::+;;,•rrb..+,;is��:F:Y`.:::{ry}:•:}'tro;•r:r,•.a.;.:;;i•::.�r:'r,.;:•:!•}F..;,. ,.x�,:.. ..-?•r::t:;!::.. 4�•E�'}�:i+:'... ':?rir?vf?;•}:.:'rY:::{}:4i4%''i.:.. ...,<?;r9?, .:?t•{:{, i•}"•: f}.f}}Y'v';ia':Y:.r ••:.+•�,,'f:'s::}i: :{-•F..w $Ys5'£::�}•..:•::ix,v �.J'�:zE:a-r7:;S:?s•r..#: :{:.r;j ur a�{:..:w.;rJfiv:.,;L<`}t' E.Y}::i.:....,..:}..... 3 :..R?•.a:•.::{•.:'•:j:;.,>;iY;.J:lrt :?k4{35�{{f:Y{v:;i}x?::.b:ii.ast#:'r..,Yz't:.g;:. x:•. .... :.... E QrsaCe?e0,r::Y}w:•}::.??r:,::a . enalties of a lineup to S1,500.00 md/ar osiiion of erinsinal p Faihrre to secm a covera(e as rogatxd mmder Section 25A of MGL 152 can lend to the imp a tine oL$100.00'day against me. Iundesatand$at a imprisonment e 1 xeII as t g penalties in the form of a STOP WOl�0 Z R and one yam,imp be forward to the 0Mce of Investigations of the DIA for coverage veziiication. copy of iMs Statement may the p ' and penalties of perjury that the information provided above is irur anti carted I do hereby certify . Date ' AO signature _�f o Plint name oiHdal use only do notwritt in this area to be completed by city or town official perndt111eense# ❑Building D epartznent ❑Licensing Board dty or town: c3Sdectmea°s Office byte response is maulred C]$ealth Depart Mrnt ❑ chPckif immediate phone if; contact person• (�svised 9/95 PJA� information and Instructions Massachusetts General Laws chapter 152 section 25 rewires 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 egntract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or'renewal of a license or permit to operate a business or to construct.buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe commonw ealth 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 co authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your shuationand supplying company names,*address and phone numbers along with a certificate-of fimnance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation ofinsurarCe 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 pernutllic s number which will be used as a reference number. The affidavits may be retnmedln_ 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. The Department s address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents gfflce of lnvesdgaUuns 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 nhone#: (617) 727-4900 ext. 406, 409 or 375 oftHE, y Town of Barnstable Regulatory Services mxresr.+n , % Thomas F.Geiler,Director - aUss. 9� i6Jr9• A Building Division MA '�jFD GI Tom Perry,Building Commissioner . 200 Main Street, Hyannis,MA 02601 Office: 508462-4038 Fax: 508-790-6230 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. ,f Type.of Work: �r Estimated Cost Address of Work: oZ3 Owner's Name: � « Date of Application I hereby certify that: Registration is not required for the following reason(s): MWork excluded by law ❑Job Under$1,000 []Building not owner-occupied 25'wner 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 v 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 I , RESIDENTIAL BLTII,DING PERMIT FEES ' APPLICATION FEE _ _, �', _ $50.00 New Buildings,Additions $25.00 Alterations/Renovations ' Building Permit Amendment S25.00 U 3 I,-EE VALUE WORKSFIEET NEW LIMG'SPACE QC� square feet xS96/sq.foot= 1#50yo- x.0031- . plus from below(if applicable) h AL RATIONS/RENOVATIONS OF FMS'TING SPACE -- a(,o square feet x$64/sq•foot= �6� ® x.0031= plus'gm below(if applicable) ACCESSORY STRUCTURE>120 sq.ft.� >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 100.00 >1000 sf-1500 sf >1500 sf-Same as new buiTding.permit: x,0031= ' square feet x$96/sq.foot STAND ALONE PERMIT'S xS30.00 _ Open Porch (number) x$30.00= Deck (number) x$25.00 Fireplace/ChimneY (number) Inground Swimming Pool S60.00 r, Pool $25.00 Above Ground Swimming $150.00 /M Relocationovino, ,�. . permit Fee (plus above if applicable) ` i tME Town of Barnstable �DF ip�� o„ Regulatory Services snxxsTnstE, •` Thomas F.Geiler,Director 9 MASS' $' 1639• Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: b !7 JOB LOCATION:. �3 IVAC;_ P.P. number �T street c� `gyp village "HOMEOWNER �l tl `",�'1�l C9/Iw�t E7 //��I Z'G�7/S name 'r home phone# work phone# CURRENT MAILING ADDRESS: 1 1 xo yy/}V ft/YDOr, Aff 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 resvonsible 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 require nts. Sign r eowner 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 camriot 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:homeexempt 4 k, - ,7►�,� : 8'�� 3.0`: ll��" Z4~ gam. ��.��� 2�" G S EQ, �0 6Wny �ii{ � B"#I &tT►f� z w -P<N►NG LIU 1 AR 04 ,�u D►�l�Nsl 6F Frr1, - �x�s7r�c 641 SNnwCY? 30"x30" :rv. RR €WA tab A 2'� nco�lcRF'I� SCAB. fLctx ul 44 ,cs q °� ,B ,VlLu 1NG rLfl� f . 5MLE y �� 1 S133HS 001 Vil ZZ v v 51331IS OOL ZDL-ZZ � S123HS OS LVL-ZZ or,/ 6"7Jkc FaaT!/lG. i5C7i70wt Cott S 1�htL of rcawt' -e15 Tyf *io r- — t1 II FE e _ w 1 „8�21 LLJ 9 ' • • s - - Sri , •. a w . .{ V S L= Lbt „ r• . a,..,.....s,. a::+:.t ,,..� --.,:k.•. �a.•..e.., ,,e ...;.�...,. .r:;�� '�°[{ .',,..+,+ :«,.�,:.... ,.{...�+,. 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