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Town of Barnstable *Permit# a 6 G� 869
Expires 6 months from issae date
p °^ Regulatory Services Fee
.asq. m �n Richard V.Scali,Director
TOWN 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 PEPMT APPLICATION - RESIDENTIAL ONLY
i Map/parcel Number Not Valid without Red X-Press Imprint
a��I ��� y '
Property Address <,I)()O `-j
Residential Value of Work$ i QD(D Minimum fee of$3.5.00 for work under$6000.00
Owner's Name&Address \CJ1A'�w� `C
Contractor's Name VA,->—s'�z Telephone Number
Home Improvement Contractor License#(if applicable) Email:kc-t+-P&J (A0(2)C 1AA�-
-C:s'lr
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one: -
❑�am a sole proprietor
LJ 1 am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit RrR�
check box) ` `'`C�"s
roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
JA_
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.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:gA
operty Owner insign Property Owner Letter of Permission.
cop of the Ho a Improvement Contractors License&Construction Supervisors License is
qui
SIGNATURE:
T N
C:\Users\Decollik\AppData\Local\MicrosoR\Windows\Te or Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc
Revised 040215
Town of Barnstable
F. Regulatory Services
Richard V.Scali,Director
Building Division
HAMSTM e. ' Tom Perry,Building Commissioner
MASS
039, ���� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
/ I c DATE: Please Print
( J i
JOB LOCATION: \ \� �i �^ C�M^`�/`y\ `\CL
number 1 (� street y /l� village
"<HOMEOWNER": lC l �'� G_� ( 4� t
name home phone# work phone#
CURRENT MAILING ADDRESS:
/`ti \ 'S fA-1 111��_
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,'a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws Iles and regulations.
u ersi d"hom er"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
p o educes require a is and that he/she will comply 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
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 t amend and adopt such a form/certification for use in
your community.
C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc
Revised 040215
May 22 08 01 : 31p Barnstable Housing Author 15087789312 p. 4
ZONING VERIFICATION
TO: Linda Edson
FROM: Kim M. Gomez - Leased Housing Coordinator
RE: Legal Rental Unit Verification
Address:
Village:
Unit Type; 1 .> <<, %{ Bedroom Size:
Map & Parcel No.: GS�
The owner of the above listed property is entering into a contract with us for the
rental of the property as listed above.
Please verify by signing below that the unit is legal and meets all zoning
requirements for a rental in the town of Barnstable. If it does not, please list reason
here:
l -.e_—
Thank y tryour a ' e in this matter.
L
S re Print name
� s- a •
Date-
VIA FAX: 790-6230 MRVP Section 8
Rev. 8/06
R
THE'Owti Town of Barnstable *permit# 6(91
Expires 6months;from Issue date
h TABLE
• RegulatWrAM I d
HaaxsTesre, •
Fee
9 MASS' Thomas F.Geiler,D' ect r
AIM
- 03
BilllCll510II
Tom Perry, Building Co on r
200 Main Str
Office: 508-862-4038 -
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X Press Imprint
Map/parcel Number
T _
Property Address '
i�ntial ValueofWork
Owner's Name&AddressVa,/��_1: 1) 4
lot) —EL14- u:{2 X C) L^
Contractor's Name I Telephone Number m_ 9CV 1
Home Improvement Contractor License#(if applicable) /C� ��C9
Construction Supervisor's License#(if applicable)
r onan's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am taZemeowner
ve Worker's Compensation Insurance
Insurance Company Name Old t�YL�(3Y!
Workman's Comp.Policy# S C (,r- U l C)2
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will betaken to
❑Re-roof(not stripping. Going over existing layers of roofl
❑ Re-side
/ r
eplacement Windows. U-Value t -5 I (ma imum.44)
❑ Other(specify)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
Signata
Q:Forms:expmtrg ,
Revised121901