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Home My WebLink About0037 MAUREEN ROAD :� i-, r..,Y,{,:,,. ,.,r,7 �.. „h5 ?-..: .,.;,: ..r fit:.. .f:C: .q n. •�°r.. r l..n C, t ,:>'x '>t• :nY''w ..,x. . A, 35' x pi,rt r4 'q " it 4, xy � f v �. x +.'fit n�f �r R.• � J r � .� 4a,.Ys � '� u kk `;e(�ti ��::, s 4 , TAT, illy a R L � fi e e 4 1 � + � r _ , 'ck - 4 c tt,+� & MA - ---- IN n I NO Lege d • a Parcels l "Town Boundary i j a� �4 228d67 - Railroad Tracks I r # Buildings AMR 228107 � ��: �i i 84bb Q Approx.Building #-325 k #9 Buildings Painted Lines a P` arking Lots ~� 228076 Paved I f 5 -- l `:Unpaved r= �,' 228 tt4 f Driveways Not228499 4 „fi # 7 it. J Paved 2art h ttt Unpaved Chia, #33 Roads pgg M Paved Roa d ^ VUuJ VvV Unpaved Road ,� ` ., � 228477 �Bridge r 2284b5 `� r' -- —�� # 2 E Paved Median �. Streams ffl 1228b8�ls ?� r t' 228469 ,t�' Marsh � # 5,5 #6F ax �' Water Bodies ` - �� 22849it�42Z r aC a' 22846 22478 �fi #62�µy y v F rr'`r 228476 � [ 17/Vyw, ®(e,, 228`188 , z aatt 228479 ; #69 #293£ T h s{ #70 - �� 3 228463Ota 1, 228471 ' r f � 1� 22 8492 . �� a ',r 9 � � w.. #51Ito `• I #99 22$ �.4 ��- S.2-2846t #67 +rit #� ♦ �22848I0 22807#23 3 d 4" ❑� .❑� #129 s i Map printed on: 3/29/2019 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi 0 83 167 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: 1 inch= 83 feet cartographic errors or omissions. gis@town.barnstable.ma.us Town of Barnstable � �� .�. � ,. _ Building !' ` PPost This Card SoaThat itis Visible Fromahe Street ApprovedPlans Must be Retained on Job and this Card Must be Kept osted Until Firial``Inspection Has Been Made • 1Where a„Certificate.of Occupancy is'Required,such Building shall Not be Occupied until a'Final Inspection has been made 63 Permit Permit NO. B-18-845 Applicant Name: Jon Walsh Approvals Date Issued: 03/29/2018' Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 09/29/2018 Foundation: Location: 37 MAUREEN ROAD,CENTERVILLE Map/Lot: 228-064 Zoning District: RC Sheathing: Owner on Record: ROGERS,WARREN JR& LORI :Contractor Name .Jon D Walsh Framing: 1 Address: 37 MAUREEN ROAD Contractor License CS=095605 2 . CENTERVILLE, MA 02532 LEst Project Cost: $3,300.00 J Chimney: Description: Strip Up old shingles and Installed new Shingles. Permit Fe $35.00 Insulation: `Fee Paid: $35.00 Project Review Req: Final: j t Date 3/29/2018 wfp Plumbing/Gas i Rough Plumbing: g- , — Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six'months after"issuance. Rough Gas: All work authorized by this permit shall conform to the approved application Aand the'approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures'shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in"a location clearly visible from,access street or road•and shall be maintained open foe public inspection for the entire duration of the work until the completion of the same_ ) Electrical ., Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Budding and Fire officials`are providedwon this permit. Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footings -c- , 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable REgE�PT " � 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-18-845 Date Recieved: 3/23/2018 Job Location: 37 MAUREEN ROAD,CENTERVILLE Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: Jon D Walsh State Lic. No: CS-095605 \ Address: Kingston, MA 02364 applicant Phone: (508) 580-0127 Q (Home)Owner's Name: ROGERS,WARREN JR& LORI Phone: (860)961-3592 \) (Home)Owner's Address: 37 MAUREEN ROAD, CENTERVILLE,MA 02532 Work Description: Strip Up old shingles and Installed new Shingles. Total Value Of Work To Be Performed: $3,300.00 w Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Jon Walsh 3/23/2018 (508)580-0127 Applicant' Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $3,300.00 Date Paid Amount Paid 1 Check#or CC# Pay Type Total Permit Fee: $35.00 3/23/2018 $35.00 XXXX XXXX XXXX credit Card 6911 ..... ........ ... ....... ... .......... ........ ....__. ......... ............... Total Permit Fee Paid: $35.00 f .2718 09:57a p.1 w �— rC,R� i 1 yo�1PI��U rmrun VrPWIL La Laa�'a.,n•u 1 I DAflPACc _._ __. �rlf�'[brin C.pfPfri��ll[.�rl�(:.::(fC�IIJC�r - Office of COnsumer Atfabs&BusineS6 ReguiationOrdy A> HOME IMPROVEMENT COIJTRICTOR Registration valid fardativlduat use return before the�pkaRion date B tpu�return to: `�='. 'l S Coca of Consumer Affairs and Business Radon .!:, ;��.' R& istratiors 10 Park Plaza-Suit-,5170 178i25 cW102018 Boston,MA 02116 ML INSTALLERS NY INC." Jon Walsh 36 Ames Street Brockton,MA 023ot : Undersecre�y Not valid without signature a� cri ZE C? v � C *10 r4'► Mar 2718 09:57a p.2 ,..c•,� Aj Ali 11116.� � CERTIFICATE OF LIB BRA'W INSURANCE F°"'�'�""°°"""�' 03127/2018 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFRMAT1VELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERft AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cwtiflego holder Is an ADDITIONAL INSURED,the policy(ies)must be endorse& If SUBROGATION IS WAIVED,Subject to the terms and conditions of the policy,certain policies pray require an endomernent. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- PRODUCER ACT Nicole Lee J&B INSURANCE AGENCY INC DBA ROCCO ROSEINSURANCE AGENCY PtIONE 508)584-710o FAx NO: ADORFEalA0. nicole@roccorose.com I 3$• - 360 Oak SthwtMuRaw)AFFoRomo covermoe Naas BROCKTON MA 02301 DrsuRERA: ACE AMERICAN INSURANCE CO 22667 INSURETI wSIL1RER e- ML INSTALLERS NY INC arc; _ .. INSURERD: 36AMES ST MSURPAE: BROCKTON MA D2301 INSURERF: COVERAGES CERTIFICATE NUMBER: 251157 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 ABJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L NSR MItTrPEOFL'aURANCE L BR POLICY MIMBEII �EFF POLICY EJIP LJWTS COERpAL GENERAL LIA&USY EACHOOCURRENCE fi O CIAMS4AADE D OCCUR _ ISES.r�aSoaoaranael _� ._ VED bs WA PERSONAL BT6 INJURY GEITLAGGREGATE LIMIT APPLIES PER: GENERALA ,EGATEO. POUCY❑JJECTT ❑LDC I PROIRJCTS c03IP/OPAGG S OTHER: ; a� AUTOMOBILE LIMLBY COMBINEDS t EUMIT f— !I acc, ANYAUTO BOOLYINJURY rperaorq S7 - ALL OIANEO SCHEDULED CIO AUTOS AUTOS NIA BODILY INJURY('rw ao ft* S.= HIREDAUTDS ALRNOI�WNFD PPROPEIarRTY DAMAGE S.,,Q IAMBRIa 1 e UAaHCLA,,..AADE OCCUR - EACH OCCURRENCE S EXCESS UAB NIA AGGREGATE S DED I I RETENTIONS S WAOI09RSCOMPEtNSAIM P� E ER AM e11�LOYERs'LIABILITY X Y!N 1 ANYPROPRIEMPJPART?43%MXECuTTVE E L.EACH ACCIDENT S 1,000 OOQ A D&-Aaw ImmeEkCUIDEOT wA wA wA 6S62UB1K21581118 03/25J2018 03/25/2019 EJ.07SEASE-EaewPlo s 1,000,000 Ala . I 11 .AIPdesnlMOFO E.LDfSEASE-POLICY LIMIT S 1,D00,000 I DESCRIPTION OF OPERATIONS belay 1 NIA I DESCRIPTION�OPERATIONS r LACATIONe I VEHICLES plcOlao 101,AadleorW Renarke BcheAWa,ruy W aRad'ea Mmwr.fpen h IegaDe4 Workers'Compensation benefits will be paid to Massactwsetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization Is given to Pay claims for benefits to employees in states other than Massachusetts fi the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the eViration date on the above policy precedes the Issue date of this certificate of Jnsu wmn The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gwAwdAffmkers-Comtlensabonfmvestigations/, CERTIFICATE HOLDER CANCELLATION SHOULDANYOF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPRtATM DATE THEREOF. NOTICE WILL BE DELIVERED IN Town Of Bamstable ACCORDANCEVOTHTHE POUCYP'ROVIMoNs. 200 Main St AUrH D REPRESENTATIVE Hyannis MA 02601 Daniel M CPCU,YIre Resident—Residual Market—MRIBMA • ®119SX2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable �. g F 3 �A r v Plans"Must b $ . . �, BlillCilll s Post This Card So That it is Uisible:From the Street pp o ed e Retained on Job and this,CardHARNVrABM Must be Kept Posted Until Final Inspection Has'Been Made w �� i X` R 'ta f gas °� Where a Cert�ficate� _ ; .�� . .., Per�mlt . � _ of Occu anc �s Re wired,suchBuildin shall Not'be Occu ied-u nt h iLa Fina) Ins ection as been made 4 .°" Permit No. B-18-481 Applicant Name: Craig Bishop Approvals Date Issued: 03/02/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 09/02/2018 Foundation: Location: 37 MAUREEN ROAD,CENTERVILLE Map/Lot 228 064 Zoning District: RC I Sheathing: Owner on Record: -ROGERS,WARREN JR&LORI ContractorName:`-h Craig P Bishop _ Framing: 1 Address- 37 MAUREEN.ROAD Contractor License h CSy1�09777 2 CENTERVILLE, MA 02532 � Est Project Cost:. $ 1,194.00 Chimney. Description: Air Sealing&Weatherization Permit Fee: , $85.00 J Insulation: Project Review P.eq: Paid:F $85.00 Fee .p Date 3/2/2018 Final: Plumbing/Gas Rough Plumbing: -r w.mr<--. �v.w.;k..,c •,. �� ,,Building Official - i : Final Plumbing: ems. This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after„issuance: Rough Gas: All work authorized by this permit shall conform to the approved application and the�approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall.be in compliance with the local zoning by-laws and codes. Final-Gas:. This permit shall be displayed in a location clearly visible from access street or,road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. fl, JElectrical The Certificate of occupancy will not.be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: .Minimum of Five Call Inspections Required for All Construction Work: 4 1.Foundation or Footing , '`' Rough: 2.Sheathing Inspection ' Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage ROu h: 5.Prior to Covering Structural Members(Frame Inspection) g g 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. ' Work shall not proceed until the Inspector has approved the various stages of construction. '+ Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable *Permit# -60 (o it 6 n the rom issue date rT $ e Regulatory Services . BAMMBLK KAM Xomas F.Geiler;Director Building Division 7/1 Yj, Tom Perry,CBO, Building Commissioner TOWN OF BARS 200 Main Street,Hyannis,MA 02601 TABLE www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY �r l Not Valid without Red X.Press Imprint Map/parcel Numbez ZOO Property Address g r [Residential Value of Work e d Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address :.c�,.� _ ti •�cf' C(�t �, S'7',,nx� e ✓iil �L 3631 Li G Ly C)!�d l[c C c L3 iQ:�g� o SIQr . ✓S J �r�[�✓y do Contractor's Namea.rn /1�. �-J"7`-!- yL r �-�► v Telephone Number Y 3 6— • G Z Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Che�1c one: I am a sole proprietor ❑ I am the Homeowner 71 have Worker's Compensation Insurance Insurance Company Name ci 1J C l L'rl.� Workman's Comp.Policy# 1< u /3 00 `71/V '7 2-,— Y— Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors 0 Replacement Windows/doors/sliders.U-.Value- O', )_ (maximum.35)#of windows_I/— ❑ 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 required. SIGNATURE: Q:\WPFILES\FO \b ilding permit forms\EXPRESS.doC ; Revised 053012 71ursinessjkegulatiOn, Office of Consumer affairs and 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 p ;�. t Home Improvement Contractor Registration Registration; 158718 Type: Individual >` Expiration: 2/26/2014 Trtk 221312 JAMES.A. MILANO JAMES MILANO 38 WINTER ST = YARMOUTHPORT, MA 02675 Update Address and return card.Mark reason for change. Address Renewal Employment Ej Lost Card DPS-CA1 v 50M-04104-G101216 Regulation License or registration valid for individul use only Office of Consumer Affairs&Baseness Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: ";158718 Type: 10 Park Plaza-Suite 5170 Expiration: .2/2612014 Individual Boston,MA 02116 JA S A.MILANO) - t JAMES MILANO 38 WINTER ST YARMOUTHPORT MA 02675 Undersecretary Not valid without signature Massachusetts- Department of Public Sateth Board of Building Regulations and Standards ds Construction Supervisor License License: CS 15046 JAMES A MILANO 38 WINTER ST YARMOUTH, MA 02675 �-- - �� Expiration: 11/5/2013 (ummissivacr Tr#: 7809 i 4a The Crrmmonweakh o•f Massachnsetts DITarbnent o,f Industrial Accidar& f, ice of Investigations 600 Washington Street Boston,CIA 92111 f Mn?n& gov/dia Workers' Compensation Insurance davit:Builders/Con/raetars[FJk tL i,e ansfPlumbiers Applicant Information / Please Print Le�lb me tY Name Musss�Or� ola&dividuau: —J e2:-11 �' � �y `GL✓1� Are an employer?Check the appropriate box: T of project r 4. I am a contractor and I Type e - 7 (required): 1. I am a employer With � ❑ gettesal 6: ❑flew constttuction employees(fail and/or part-time).* have hired the suit-tx�ntrwu rs 2-❑ I air a sole proprietor or partner- listed on the attached sheet ?_ ❑Remodeling ship and have no employees These:sub-contractors have g- ❑Demolition kvatking for me in any capacity. employees and have vvad rs' [No tvofloers' comp-insurance comp-insurancr-1 9- ❑Budding addition required] 5. ❑ We area Corporation and its lU_❑Electrical repairs or additions th 3:❑ officers have eaerdsed eir I am a homeowner doing all work 11_❑Plumbing repairs or additions mysetf[No workers'comp. right of exemption per MGL 12.❑ of repairs hmxa ce require ]S c.152,§1(4X and we have no employees-[No workers' 13.10tither R e- comp-mstuw&e mtluired-] w';ti 6 L-i. • Y Plita Estchecksboa#1mast also filloutthe section below showing theirworker'rompensatiaap.1kY #Homeoar�ers who submit this Lffibwff indicating'dwy are doing all wank and them hue outside connvctars must submit anew affidavit indicating su& tCantmctuFs that check tits boa.must attached an additional sheet showing the aam,e of the sub-cantrwAm xnd:state whether armor ftse emitim hxm- employees..If the contaetnss have employees,they must provide their workm'comp.policy number. I am an emplo}w that is prvv&1b g workers'congmmadon.insurance far my empkv wex Bdary is the policy and job site iaforrrralirrrn.. Insurance Company Name', ✓A /r, Policy#or Self-ins-Uc.#: U P3 ®"7 ✓y FxptrationDate: Job Site Address: t �t.y J/'a• t C i t y / S t a t e/Zip : C �•e✓c/d' +j� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).. Failure to secure coverage as raequired under Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a . fine up to$1500-00 and/or one-year imp r sonme4 as well as civil penalties in the form of.a STOP WORK ORDER and a fine ofup to$250-00 a.day against the violator- Be advised that a copy ofthis statement may be fi nwarded to the Office of Investigations of1he DIA for insurance coverage verification. I do hereby C f3'aJtder thapains andpenahY&of 'ury thatthe informat'J,proWArd above is and correct Signature. t Bate: Z' p �y p Phone#: 7 G` tiflRial use only.. Do not write in this area,to be coniplete+d by city or,town of,�rciat City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building.Department 3.C tyfPown Clerk "d.Electrical Inspector S.Plumbing Inspector. 6.Other Contact Person: Phone!!: 6 * snxxsresi.E. i MASS. Town of Barnstable 9A 1639. '�p1FD MA't� Regulatory Services Thomas F.Geiler,Director Building Division ` Thomas Perry,CB0 Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us t Office: 508-862-4038 Fax: 508-790-6230 ' Property Owner Must Complete and Sign This Section If Using A Builder g✓I , as Owner of the subject property hereby authorize �""1 i "' �� `" �- to act on my behalf, in all matters relative to work authorized by this building permit application for: Ce (Address of Job) Signature of Owner Print Name If Property Owner is a 1 n for permit,- lease complete the Homeowners License Exemption Form on the P �Y PP yi g P ,P P P reverse side. QAWPHLESTORMS\bui]ding permit forms\E eRESS.doc Devised 051811 EVE _Town of Barnstable Regulatory Services i snsiv .14 ` Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXENT TION �_ Please Print DATE: � � / JOB LOCATIO ^ l?\LUJiG K .1 t,/ numbe Ns,,street village f 1 name 1 ) e phone# work phone# CURRENT MAILING ADDRESS: D 3 !4;G Li®. �`ae T(- ).5-� Cal "�dQ C-bfe)p/ d F® ` ;z-0 city/town state zip code The current exemption for"homeowners"was extended to inclu a own -occu ied dwellings ofrsix units or less and to allow homeowners to engage an individual for hire who does not pos ss a lice rovided that the owner•acts'ds su ervisor. DEFWPTI OF HOMED R Person(s)who owns a parcel of land on which he/she resides r intends to reside, which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory t such use and/or farm s ctures. A person wbo constructs more than one . home in a two-year period shall not be considered a homeo er. Such"homeowner"s 11 submit to the Building Official—on a form acceptable to the Building Official,that he/she shall be res onsible for all such work erfo ed under the buildiii ermit. (Section 109.1.1) Fhe undersigned"homeowner"assumes responsibility or compliance with the'State'Building Code other applicable codes, rylaws,rules and regulations. Me undersigned"homeowner"certifies that he/she der`stands the Town of Barnstable Building,D.epartment minimum inspection . )rocedures and requirements and that he/she will mply with said procedures and requirements. 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 µ The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt 'rom the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner !ngages 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 esults in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot roceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is .ltimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part,of the ermit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page f this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in our community. :\WPFII-MFORWbuilding permit forms\EXPR.ESS.doc .evised 051811 TRAVELERS Jft , WORKERS COMPENSATION O AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6KUB-0072N72-8-12) RENEWAL OF (6KUB-0072N72-8-11 ) INSURER: THE TRAVELERS INDEMNITY COMPANY NCCI CO CODE: 11347 INS4RED: PRODUCER: MILANO, JAMES A EASTERN INS GROUP LLC 38 WINTER STREET 233 W CENTRAL ST YARMOUTHPORT MA 02675 NATIClk MA 01760 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 02-20-12 to 02-20-13 12:01 A.M. at the Insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA m a- B. EMPLOYERS LIABILITY INSURANCE: Part Two of the;polIcy applies to work in each stateaisted in item 3.A. The limits of our liability under Part Two are: o_ , Bodily Injury by Acgident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 policy Limit Bodily Injury by Diseasa: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A m- D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORS..MENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 01-27-12 WC ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: EASTERN INS GROUP LLC 2132KY 000548 pFIKE rqt, Town of Barnstable Permit# � ti Expires 6 mar!rs fror r issue da Regulatory Services Fee * BARNSTABLE, v "'ASS' Thomas F. Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstab le.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 OLQ� Property Address ,� 1 lQ y��C� C kA br j() 11� plA a L 63 eResidential Value of Work Cad, a 4 Minimum fee of$35.00 for work under$6000.00 Owner's Name& Address S ;1/,— 45 W✓1� -Z, 9 i Contractor's Name / es Telephone Number /✓� Home Improvement Contractor License#(if applicable) �ZA Construction Supervisor's License#(if applicable) /\/ Q ❑Workman's Compensation Insurance v SS PERMIT Check one: PRE ❑ I am a sole proprietor JUL_ 16 2010 911ram the Homeowner ❑ I have Worker's Compensation Insurance.. MOWN OF BARNSTABLE Insurance Company Name Workman's.Comp. Pol icy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(c eck box) J t Re-roof(stripping old shingles) All construction debris will "IT taken to v S^" 6.�`" ' ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *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 required. : - SIGNATURE: -----f-~ , Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 070110 ' The Commorrsvee lllr of M- assachiisetts -- -- Departnterrt of Indrtsjiial Accicle tits. :. Office of Investigations f A. 6qO Washington Street Boston,AL4 O?III �.,. ftymv.ivass.govldlia Workers' Compensation Insurance-Affida-vit: Builders/Conti'actat-slElec"tiicr:rrls/Plumbers Applicant Information Please Print Legibly Name.(Businem/Orgmuzationlindividual): e �r./ o�/✓► Address: , .:J „ r.� ` City/Statel2iv: L f �/ Phone##_ �lJ Are you an employer?Check the appropriated box. Type of poled{required): 1_❑ I am a employer1. ❑ I am a general contractor and I with 6' ❑Neu=constxuctiorZ employees(full and/or part-time).* have lured the sub-contractors 2..ElI am a sole proprietor or partner- listed on the attached sheet . .❑ Remodeling ship and have no employees These sub-contractors ha.e 9. ❑`Demohtion- working :for me in any c employees and have workers' capacity. ! 9. ❑.Building addition t;orkers'comp_insurance comp_insurance. ed.:] . ❑ We,area corporation.and its 1tJ.0 Electrical repairs or additions 1 I am a homemnter doing,all work officers have exercised their 11.0 Plumbing repairer or additions;: myself. [No workers'camp. right of exeutption.per MGL 12.❑Roof repairs- instuance required.]T c. 152, §l{4),and we have no employees.[No workers' 1�.❑'tJther comp.insurauce.reguired.] *Any apphcant that checks box f1 mist also fill out the section below showing their workers'compeusation policy information 7 L omeowners wbo submit ibis affidavit indicating they are:doing all work and then hire outside cauuactors:nust submit a new aMilavitindicating such_ lContractors that check this box must attached,m additions!sheet show-tag the name of the sub-contracliors and state whether or not those entities h2ve eaVloyees. If the'sub-contcectors have empboyees,theywitst.prouzde their workers.,comp.policy number. ` I orrr an employer that is providing workers'co►►rpertsnhirrt iftsurancefor iris e►►rtSlayees. "Betas is ta?te poJecy'and f ob site inforr zadon y Insurance Company Name: Policy#or Self-ins-Lis". #: d Expiriition Matey ' Job Site Address: City,`St:atelZp::, Attach a copy°of the barkers'compensation poUcy declaration page,(showing the policy*ntimber and expiration date). Failure to secure coverage as required under Section.25A of MGL c. 1.52 can lead to the imposition of criminal penalties of a fine up to$1,500..00 and/or one-}ear imprisonment,as well.as ci-%il penalties in the form of a S ECfP SVOItP ORDER and a.fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be fix-warded to the Office of Investigations of the.DIA for imsurance coverage verification. I do Jrembt certify under thepains and penalties ofperjtur tJta:t the in forrtwfion prmzded abtaiw is true and correct r Si=ature:. Date: Phone#_ O• ciaL use oitl}. Do not write in this.area,to be completed by city or town ofciaL, City or Town: Perinit?Ucense Iss:uingAuthority(circle"one): 1.Board of Health 2.Building Department 3.Cty/Tali ►Clerk 4.Electrical Inspector,S.Plumbing inspector 6.Other Contact Person: Phone#c u Town of Barnstable o 'Regulatory ,services i trrsraste, s639. Thomas F. Geiler,Director ` 1639 $ Building Division 1� ATED MAC A . Tom Perry, Building Commissioner. r 200 Main Street, Hyannis,MA 02601 mvw.t6wn.barnstable:rmi.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ..;. r 'Please Print ' DATE: /� V ✓ W 0 Z7/ '7 JOB LOCATION: r+_I i4 VT number street' village "HOMEOWNER": name home phone work phone fl CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside; on which there is,or is intended to be a one ortwo-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.ficial on.a form.acceptable to the Building Official, that he/she shall be r�slLonsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"a ssumes.responsibility for compliance with the State Building,Code and other applicable codes,bylaws,rules and regulations. - E 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 Homeowner Approval of 1.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." s exemption are unaware that they are assurrung the responsibilities of a supervisor(see Appendix Q, Many homeowners who use thi 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:\WPFLLES\FORMS\homeexempt.DOC Town of Barnstable Regulatory Services : BA"STaffi.E, ' Thomas F. Geiler, Director Mass. 019. Ib Building Division °TpD►dp 4 b Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 -vvww.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 Property C*ner Must ` rnplete and Sign T Section If Using A Bu der I , as Owner of the subject property hereby authorize to act on my behalf, . in all matters relative to work authorize this building permit application for: (Ad ress of Job c Signature of Owner - ---Date--) Print Name If Property awn is applying for permit please omplete the Homeowners License Exemption Form on the reverse side.