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0161 TERN LANE
Sr 9 ;:1„ � + . ;.*,.., r g - � .a .. ,.,. , p ..„�;, ,r a,s �`��•�b "' '° aih 'r' _�`'aE �+�� :',�E e r T �Y� d'�.,,b�'f J Cir. � —.1(... � ,.• ry .; "14�A i ,Y" .' ..:. ., �- re .a 1)..��.., E.:° ..S.�'+ 6./ Jf'••'4, ,1 ,�} ��. t, PA• ' -" , r �, -S i E +,�. ..w ,,• � rk , e�" A .,,+.. u µ r"1.:i�F t'ffa, .. .4 .. :... ..�,.._. .v ..r;,h. .....a � .._,ry ..a � :, ., .. ....�....y1i;;n. ,,,�,.. ..t,.... .�...:.'f. !au.'-(•-,aC< ...�:..;. ddf�`i `:vm .1'�f.. A!4 :��r:,r?' � �'��'.. . , ,7� '�X,.. �� '� Af• d¢'a: +*�f '�.1 ��,� N��� G���iyi �� its FILE * r � ,•4� �� � 'jam;"1 ' J?WKS Zoo- t e .33 t 4 ? t s ,+a r � r" r. P _ ? d. ' f - r i. f . 4 , �, qa r a a Z 1' f f f 1 N r.tl F t i li '4t I 3' Too A f.. p sYv 4, ^t t ';F E F . a L { t k L .t V of � PDT �Y 5-�' 3!• t t� i t ��' h E 4 A •A ri AdF.Y 1{ E i* S S t .i, , ll• €.r8 .Y 1 ;` Y e �S S 9 1t` OPIUM €ivK wxaMo,t MUMn Cg t k E S q, r t n { S x ( 1♦ - (r P 'dr y� 4 S� M;. ., f, •/ •.a .! d Imo.�•�t ,� - .",; ,.f{ �Yr - . a t aE f v S� s K -e t 4 D r 1, 5fi a� a d r §) ��4 rir 9 t �l' � A1G tt- •�@ 5x¢¢r ed E :f �c r v t9 3 oil fit..r, , r i Town of Barnstable �t"ETO�ti Regulatory Services Thomas F.Geiler,Director 9 MASS. � Building Division � 10 16;9 Y g. A`� Tom Perry,Building Commissioner V �'ifo MA'S 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623.0 PERMIT# � � C1 J�c�---- FEE:$ �S SHED REGISTRATION 120 square feet or less Location of shed(address) Village Property owner's name Telephone number !G X 11a. Size of Shed Map/Parcel# Sienature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? NCI Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 3� -37 900 , SF 1do1�8 La W�1 w i4a.aoou CENT /EO PLOT OlAV fi 7'/.cY 7-A4477 T.-/E IGVVZA rla4 L a :.4 T/C.L/ CE/�ITE�Y/L1� J5 OWN yE,eEO.I/COtiJpL YS W/�/,� SCA 7`'/►'�S"/OEM/.vE A//O SETBA Cl,, /5 9.3 �EQUi.2E�lE�'S ors' T.�/� 7"vvtiit/a�' ! 2�clsTAa .4�vb 4.5 . /(67 �orS 8 39 0C.4 T,EL:> _ PG �� .E3AXT,E,2s AYE /�t/C. �2EG/S7`E2E.4 L�{�c/p ,�U.e1��yar� /NS7-,2UiLl.�.t/T,.S't�,e1�E'Y€ Th�E �ST-.E.21�/L!�a �l•4ss. 5-170l/Lz> ,VO7-- 8� /C,4,t/7� YOUWSH TO OPEN A BUSINESS? For Your Information: . Business certificates (cost$40,00 for 4 years).. A business certificate ONLY REGISTERS YOUR NAME in town [which you must do'by M.G.L. -it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St. pHyannis. Take the completed.form to the Town.Clerk's Office, 1 st Fl., 367 Iviain St., Hyannis, MA 02601 (Town:Hall) and'get the Business Certificate that is required by law. y�Io/.tws- DATE: Fill in please: APPLICANT'S YOUR NAME/S: / BU INESS YOUR HOME ADDRESS: / �eAj �•ir• r , TELEPHONE # . Home Telephone Number.. S� - 7 g • O gfs 7 NAME OF CORPORATION: �.ST/Y.L^ ic+ : w C; NAME OF NEW BUSINESS OF:BUSINESS`': ': nioni �j«T IS THIS A HOME OCCUPATION? . -' YES:' NO : ADDRESS OF BUSINESSAG/ �E7bA .4,Z, MAP/PARCEL NtiMBERo� aid eL (Assessing): . When starting a new business there are several things you must do in order to be in compliance'with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST' GO T0,200 Main_St. - (corner of Yarmouth Rd'. & Main Street) to make sure you-have the appropriate permits:and licenses-required to legally operate.your business in,this town. w 1. BUILDING COMMISSIONER'S OFFICE. This individual has been informed of any permit requirements:that pertain to this type of business.' MUST COMPLY WITH HOME OCCUPATION Authori nature** RULES AND.REGULATIONS. FAILURE TO C MEN Y� 1 Ap V 2. BOARD OF HEA H This individual has been informed of the permit requirements,that pertain to this type of business: Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** . - COMMENTS: Town of Barnstable � E r Regulatory Services Richard V. Scali,Director s r Building Division * IIARNSfABr.E. + KAS& g Tom Perry,Building Commissioner 1639. 'Oren 1,t s 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: Phone#: Y•. �r-�"aa G l� Address: 0�O r / �R�(1....�L•�ti _,_._,. ....... :, _, Village: Ce•C,,Te I2C+,/ Name of Business-404k ep �G� �l•ST/'v e cc Type of Business: Map/Lot C-12 ' Ol INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. �+ • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. •' 'There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. - • No sign shall be displayed indicating the Customary Home Occupation. , • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersi ed,have read and the above restrictions for my home occupation I am registering. Applicant ` Date: Homeoc.doc Rev.103113 of t Town of Barnstable �tt4ff �. � Expires 6 months from issue 1 Regulatory Services Fee M �� **F� f � �rABuu, � 9�ArF A Richard V.Scali,Director 1639. CO7/31'1 q ♦0 U1 111.g-Divis1<p. ------ -- --- -- Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �l Not Valid without Red X-Press Imprint Map/parcel Number 4/? Property Address ❑ Residential Value of Wo k$ Minimum fee of$35.00 for work under$6000.00 . Owner's Name&Address qLl l_) Contractor's Name !/'/,/) S'g-Uec Telephone Number Home Improvement Contractor License#(if applicable) fiG l7 J Email: �y Construction Supervisor's License#(if applicable) 00 ?d �(y 6 ❑Workman's Compensation InsurancePERMIT Check one: ❑ I am a sole proprietor ❑ I am the Homeowner r`4 L;�`I have Worker's Compensation Insurance P Insurance Company Name BARNS BARNSTA13LE Workman's Comp. Policy � 0 4)Gl3 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) e-side 6 sg Replacement Windows/doors/sliders.U-Value (maximum.35)#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 Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: 2,e �- QAWPFILESTORWbuilding permit forms\EXPRESS.doc Revised 061313 1"�x,��`t� �rxerr�ss-�off'�"assr�e�zcs • Departinmt ref Incas iffI Accidents RastCan,MA 02111 Naf4�F1T 7rtfff.5;£gfaT3ft�If>:Workers' Gampensatial Lis-murices davit:Builders/�`antxactors/E ecfricians/Kumbers Angicant Infernriatio-n j - /f Please PrnQf Legibly Namfe(Birke G g`anizat ou&avidaao: A liress= �0 Y' ���o�i r /t'P• ---_ -: -_ CityfS atz/zip= Are you an employer: Checkl1e apprapriafe box: Type of. o'ect r 4. ❑ I=a general contractor and 1 e I e�tioa : 1.L1/ I am a esnp?oyer wifib 6_ ❑New�ns6iu�arz employees(full andforga t-#ime)-* hat ehirr the sub contractors. 2_❑ lain a sole propaetor orpartner- Iisfed on the attached sheet 7- ❑Remodeliag Ship and have no employees Reese sub-contractors have g- ❑Demolitioa -workingfur me many capacity emplo}�and have workers' Y � � � 9- ❑Building addition W1 0 wo_+#rers' comp_ius rranre comp_ii=auc� ]-❑ 'We,are a corpozation and-its 10_0 Electrical repairs or additions officers hatim exercised hi er 11_. Plambi a ticros I❑ �am a hQm*✓tnrn�f doinb all work- ❑ g�m-of addi Myself. o ivory' right of ex mptioaper M'GL 1- o comp- � Roof �ruzanc o required.]F c- 152�§1('4} and we l�e no ❑ g employees_[No comp_insurance rag6rer3_j 'Any spp'd ml thxt checks box 9l mush also fill out the sectioa bOow-s awmg mein policy in:ffimaxfiarL l Nnmecwnc—s w!io sabrnit rids affidsvit mdk3fag tiny Rue&mg`II rr�and then Lake outside coatraemrs nmst sabmA a mch- tCt u:ctrsrs fasa rE-rV this box mop t sttacI A as sddirinnaI sheet showing tLA 5 o flee mix z�staff vrhetler pcno:thosa faes 5arg Meyers- empioyee5,thv must pxuvide th-_r PorSeq�s'romp-policy nwnbrr_ I caYz am eutpi��r That isgmtiidrrtg tt�orkers'corrzpatasrtivn arzsatrrutc�}`Qr and errrpl�yecc�. �aZatr is fhepoTrc}rzrtd job ails infotmafio:r� /� - Ins�uance Pali- a or S if mg-I.i GU(SG ff d 9� o/c�dl� - Expiratio:ul rate_ Job Sites 3ddfess,/6 � 'i(l �`� Cib,,'Sta zip jE/%C�U/`(�' AttacIr a copy of the-w rkers'compensatiou'policy declaration gab(shaving the policy-ntmber and F.Tg tion date). Failure to secure coverage as required under SectSoEL 25-k of MGL c_ 152 can lead to the imposition ofcriminal penalties of a fine up to$1,500.00 andror om-ye:ar imprisonment,as well as civil penalises in fhe form of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator_ Be advised brat a copy of this statement:maybe forwarded to the Office of Im estigations of fhe DIET;for insm-once coverage wzification_ I do{sere&j,c'9Y<fV itnder tkepains ruin es of`p�zuy f#tatthe information prm2ded abai e fs true and correct !/ Sianatui 9. Bate_ Phone : ��G OffEciuf use and . Da not write in 6zis Area„to bs ca-mpteW by city ur form gfjic&L Cites or Town: _PeruritlL�cease 9 peening Au-thar4(arcle aae): 1.Board-of Hezlt'h Budding Department 1 CitWT,awn Clerk 4.Electrical Inspector S.plumbing Isqector 6.0ther Cc+sL-xct Ferson. Phone#r 6 Information and tn-structions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant—to this statute,an employee is defined as".._every person in the service of another under any contract of hire, express or implied, oral or written_" An employer is defined as"an individual.,parinersbip,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterpnse,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 appur tenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also steles that"every state or local licensing agency shall withhold,tlie issuance or renewal of a license or permit to operate a business or to construct baildiugs in the commonwealth .or:icy_ applicant who has not produced acceptable evidence of compliance oiith the insurance.coverage required." ` Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work uatl acceptable evidence of compliance vi h the insiz-aace requirements of this chapter have been presenter to the contacting authority." Applicants — Please fill out the workers' compensation affidavit completely,by checkiag the boxes that apply to;:rur situation and,i.f necessary,supply sub-contractor(s)name(s), addresses)and phone n,�be,-(s)along w h their cen.fica!e(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Pputnerhips(LLP)ve-ka, no employees other Than the members or partners,are not required to carry worker' compensation insurance. if an LLC or LLP does have employees, a policy is required. Be advised+hat this affidavit may be s b_„ftcd to the Department of industrial Accidents for confirmation of msz- nce nvtrage. Also be sure to sign anal date the afffida s t Die aff, _' it shoa,?d be returned to the city or town that the application for the permit or License is being requested, not the Dcpartineni of Industrial Accidents_ Should you have any questions regarding the law or if you are requied to obt;_in a workers' compensation policy,please caR by Department at the mmaber lister belo-,v. Self-insured companies slmuld enter heir self-inc'71rAnce license number on he appropriate at, City or Town O�zcials Please be sure that the affidavit is uxmplete and printed legibly. The Department has provided a tr ace at the bo tom of the affidavit for you to nlI out in-�e event the Office of lnvestigaiiom has to contact you regarding the applicant Please be sure to fill in the permiAlc-cnse number which-,,U be used as a refe-eace number. In a.d.diticn,an.applicant that must submit multiple pennit/license applications in any given year,need only submit one current policy information (ifne-cessary)and under"Job Site Address"the applicant should write"all locations in __(city or town)."A copy of the of 1i davit d2at has been officially stamped or marked by ide city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit m,.rst be Tilled out each year_Where a home owner or citizen is obtaining a license or perinit not related to anybusiness or ccnlMercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT req-,fed to complete this aidavit. The Office of luvestigtions would at to thank you in advance for your cooperation and shouldyou have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number. Commanwitaltlx of Massachust-,its D�_paztmtat Qf Industial Acci:dry is Gffice 03-Umvesfiptiml i 600 Washington Sint 02111 .k tI.14 61 7 727-49-W w 406 or I-aT,,-1\LA SS FE Revised4-24-07 Fax` 617-727-T`t91 -Vj .ma.s�goV, 1 a °ATE,MMIt]°'YY CERTIFICATE OF LIABILITY. INSURANCE "Y' 0211212014 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'1.an ADDITIONAL INSURED, the policy(Igs) must be endo►sSed. 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 endomement(s). PRODUCER CONTACT' La Cowan Cowan Insurance Agency,Inc: PHONE ,978 3h.1451, PAX 976 521-4669 359 Main StreetE-MAIL to cowanInsurrince.com Haverhill MA 01830 INSURERS AFFORDING COVERAGE NAIC INSURER A: Associated Employers Insurance Company,. . INSURED .. INSURER - _ .... .: Cape Cod Construction Services Inc. .. INSURER C: .163 Tern LaneINSURER D Centerville MA 02632 `. INSURER E. INSURER 0 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY E%P POLICY NUMBER LIMITS' GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS-MADE a OCCUR a MED EXP Any one rson $ . PERSONAL&ADV INJURY $ GENERAL AGGREGATE ' $ GENT AGGREGATE LIMIT.APPLIES PER: PRODUCTS-COMP/OP AGG $ , POLICY PRO- LOC $ AUTOMOBILE LIABILITY. COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY,(Per peteor) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED Z., PROPERTY DAMAGE HIRED AUTOS AUTOS g UMBRELLA LIAB OCCUR `'. n: EACH OCCURRENCE: EXCESS LIAB HCLAIMS-MADE F ED AGGREGATE $ $ WORKERS COMPENSATION X F WC STATU OTH AND EMPLOYERS'LIABILITY rp YIN ANY PROPRIETOR/PARTNER/EXECUTI E.L.EACH ACCIDENT- $1000 000 A OFFICER/MEMBER EXCLUDED9 N/A WCC5011292012013 0812512013 0812512014 (Mandatory In NH) x. E.L.DISEASE-EA EMPLOYEE S 1000 000 D SCRes,describe under E E.L.DISEASE-POLICY LIMIT 1$11,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES.(Attach ACORD 101,Additional Remarks Schedule,If more space Is required), r s Residential construction mina emenL CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ON 'DATE THEREOF, NOTICE 200 Main Street ACCORDANCE EW T PROVISIONS. H THE POLICY WI LL BE DELIVERED IN • . Hyannis,MA 02601 AUTHO�EN�T�A Fax: 508 362.9001 . ©1988.2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010105) The ACORD name and logo are r gi red marks of ACORD Massachusetts 'Dep�rtment of Public Safety ' Board of Bui lding Regulations and.Standards Construction Supen-isor } �!YLicense: CS-072866 DAVID A SAURO. ' 163 TERN LANES "�A CENTERVILLE 14IA _ e J.�-•J1/Sl ► ,i ��� Expiration Commissioner 05/06/2015 a . �� ,` C���e���Unearzeueal�a��a.toac�ci�eltt i , Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR : ' ;. egistration; 1704J1' Type Expiration 10727/2015 > Private Corporatic' 4 t t' ix a CAPE COS CONSTRUCTION;SERVICES INC r DAVID SAURO I T. $'163 TERN LANE s J -w- CENTERVILLE,MA 02632 - � .I � -•Undersecretary: - ^ F -. _ ,• .'' '•';: n., it i -'' vx r , n T I � ETti Town of Barnstable Regulatory Services 9 $ Richard V.Scali,Director Building Division Tom-P-err Building Commissioner --- - 200 Main Street,Hyannis,MA 02601 www.tow n.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete-and Sign This Section If Using A Builder (/- ..J - 515�2-eO , as Owner of the subject property hereby authorize v/.6 � y 2G to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final . inspections are performed and accepted. Signature of Owner Signature of App cant Print Name Tint Name 4-y1dolv. Date ' Q TORMS:O WNEUERMIS SIONTPOOLS Town of Barnstable Regulatory Services �oFIKE TOJyy Richard V.Scali,Director BuiIding Division Tom Perry,Building Commissioner �9- .�� 200 Main Street, Hyannis,MA 02601 '°rED ,� www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION _ Please Print DATE: a JOB LOCATION: number _ street village "HOMEOWNER": name home phone;y. work phone# 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 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 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 &ReguIations 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:\WPFII.ES\FORMS\building permit forms\EXPRESS.doc Revised 061313 �l D690 Town of Barnstable *Permit# Regulatory Services Fee Exp6 rode « anzuvsrABIZ + 9� Mnss. Richard V.Scali,Interim Director AlfO MA't� Building Division (6—k)�?,(1 f L4 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 - www.towri:bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Map/parcel Number o2/61 G/Fl Property Address /6/ Ff-Residential Value of Work$W,,XV 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address )"94e 0 Contractor's Name Telephone Number 79 y 4197' a cd 6 Home Improvement Contractor License#(if applicable) 76 4V 7/ EmailC141e.,c✓!e-e- e Construction Supervisor's License#(if applicable) .S ` 0 7d 60 6 rifr H � ❑Workman's Compensation Insurance Check one: ��� ❑ I am a sole proprietor ,�3 2q14 ❑ I am the Homeowner 0'I have Worker's Compensation Insurance Insurance Company Name ..7=�US A-Co Workman's Comp.Policy# 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 AAIMvst,- � A SCi'iCA Replacement Windows/doors/sliders.U-Value .36 (maximum.35)#of windows Z #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 Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 { %4 tir 7"he Col`nmunnwalth ofMassat~kusetts Department of Indristrial Accidents Office oflnvestigations 600 Washington Street y Boston,MA 02111 wm .mas&gov/ilia Workers' Compensation Insurance Affidavit $uilders/Contr actorslEEledricians/Plu nbers Applicant Inf©rmatian SS may,, Please Print Legibly Name Musiuessiorganizationffu&idual): (70 J C(J'ysT/tiCT7�/ti ��'yl4_.P Address: ?CityfState(Zipc �.�r���ilG� ��f Phi# —7 vc -, ;�o A:re u an employer:`Check the appropriate boa: Type of project(requu-ed�: I am a employer with 4_ ❑ I am a general contractor and I * have hued.the sub-contractors 6- ❑New construction employees(furl and/or part.-time. 7_ Itr�sodelin 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ g ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity- employees and have workers' 9_ ❑Building addition [No wow' comp.lnstuance comp.insurance.i required.] 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11_❑Plumbing repairs or additions myself[No workers'comp- right of exemption per MGL 12..❑Roof repairs insurance required.]1 c. 152,§1(4),and we have no employees-(No workers' 13_06ther���ocv�taG9ce comp.insurance required-]! *Any appb:=that checks box#1 must also fill out the section below shoaving iheu workers'compensation policy infnrmstiam I Homeowners who submit this affidavit in icating they are doing all waak a"then hive aatside tontaactors mast submit anew affidamit indicating sa h. f Contractors that check this box mast attached as additional sheet shoo the n�a of the sub-centracton and state whether or not those enuitks hwe employees. Ifthe sub-contactors have employees,they must provide their workers'romp.policy number. Iam an empioywr thatis prmidirig itorkers'congmisaation insurance far lay enrpiojTes. Below is thepoiicy and job site ixfmwadon. Iusmance Company Name: 6VY, ,(, Policy 9 or ins.Lie. .c/e srG/l0-<-1o20/c 2 Rxpiration Date: Job Site Address/Z&,> City/Statel7ip:.re tiTZ' e`/�i Aftach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andfor one-year imprisonment,as well as civic penalties in the form of.a STOP WORK ORDER and a 1-me ofup to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of hnrestigations of the DIA for insurance coverage verification- I do hereby c ' 'under the pains a natlies ofpedu.rt tltatHte it;formadan prmaded aboire is tine and correct Si Date: �7 Phone#: �fj:iciatI arse onkV. Do Trot write in this area,to be completed by city or town official City or Town: PermitlLicense-9 Issuing Aatharity(circle one): 1.Board of Health 3.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 CERTIFICATE OF LIABILITY INSURANCE ', ` , DATE(MMID°'YYYY) r02,11.,20114 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(les):must be endorsed. if SUBROGATION.IS WAIVED,;subject to . the terms and conditions of the policy, certain policies.rnay.require an endorsement:' A statement on this certificate does noEconfer rights to the certificate holder in lieu of such endorsement(s). PRODUCER af' CONTACT '.La' Cowan Cowan Insurance Agency,Inc. - PHONE4AX No " :978,372-1451 PAxii-J 918 5214669 359 Main Street E MDREiS AIL Aariy0cowaniniurance.com HaVerI1111 MA 01830 `WSURER(Sl AFFORDING COVERAGE NAIC N' r INSURER A E Associated Em to ers Insurance Company INSURED INSU i:.' ` Cape Cod Construction Services Inc.: ' a RE C, 163 Tern Lane INSURERD: Centerville MA 02632INS RiER E a r INSUEkRF': _ - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF,INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THEJNSURED 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 CL'AIM$: j.. INSR ADDLSUBR ' POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY i 4 I EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ' $ ' 1 CLAIMS MADE' OCCUR t MED EXP An'one eraon $ I. t r . PERSONAL B ADV INJURY $ . ' GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER �'1•' • PRODUCTS'COMPIOP AGG PRO-, _ _ + POLICY LOC - AUTOMOBILE LIABILITY. COMBINED SINGLE LIMIT E ANY AUTO ,,.•. y.,.: " BODILY INJURY(Per,person) $ ALLOWNED SCHEDULED '_ BODILY INJURY Poe,accident $ AUTOS AUTOS ( 1 HIRED AUTOS AUTOSNON-O "N PROPERTY DAMAGE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAe CLAIMS-MADE �, 'I AGGREGATE $ DE ET i - i '. - WORKERS COMPENSATION i X_ WC STATU- OTH- AND EMPLOYERS'LIABILITY 1 ANY PROPRIETORIPARTNERIEXECUTIV Y I H EL EACH ACCIDENT $1 OOO OOO I A' OFFICERIMEMBER EXCLUDED9, NIA WCC5011292012013 0812512013 0812512014 . (Mandatory In NH If ea describe under 00 000 ( ry 1 E.L."DISEASE-EAEMPLCIYEE $1 y E.L.DISEASE-E I I N P bel I POLICY LIMIT $1006 000 DESCRIPTION OF OPERATIONS I LOCATIONS4 VEHICLES(Attach ACORD 101;Additional Remarks Scliadule,If more space Is required) r s Residential construction mana ement' x' CERTIFICATE HOLDER CANCELLATION 4 ONrt1 Of.Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 'EXPIRATION; DATE;THEREOF,' NOTICE WILL BE DELIVERED `IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPR ENTA Fax: 508 362.9001 If 01988-2010 ACORD CORPORATION: All rights reserved. ACORD 25(2010/05) The ACORD name and logo are r gi red marks of ACORD` :r Massachusetts Department of Pubfic Safety !` Board of Buil ding Regulations and Standards Construction Supervisor License: CS-072866 DAVED A SAURO ` 163 TERN LANES d "� CENTERVILLE A'IA Q _ /-mays Expiration ; Commissioner 05/06/2015 o Vlie �poo�zo�iaruuea 4ba4aacfuiae( > i Office of Consumer Affairs&Business Regulation s. OME IMPROVEMENT CONTRACTOR.. i egistration• <17d471 Type ` •:a j ® Expiration 10/27/201-5 Private Corpora is � W r GAPE COD CONS TRUTION�SERVICES, INC DAVID! SAURO ,� 3 f p .i 163•TERN LANE c :,�; ;, 'r•4 ��G=--�9�-p _ CENTERVILLE,MA 02632 Undersecretary , a. I - I �� - { A - Town of Barnstable *Permit# Expires 6 on hs rom issue date Regulatory Services Fee BAMSTABM 9� amass.1639. Thomas F.Geiler,Director �0 Ajfp�.tA Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.nia.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY I `ot Valid without Red X-Press Imprint Map/parcel Number ( � o l �/ Property Address t Residential Value of Work$.�, 000 — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �,q Contractor's Name �i9fil� �.9ti.�.L Telephone Number Home Improvement Contractor License#(if applicable) �✓ Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Xsi"RESS PE!'11f/IIT Check one: ❑ I am a sole proprietor ❑ I am the Homeowner A U G —.2 2013 VI have Worker's Compensation Insurance Insurance Company Name G wq �c. -mil.S'G"9 G, whi mr B^RNSTABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ st(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 ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#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 Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit formS\EXPRESS.dOC Revised 060513 �..1 The Commonwealth of Vassachusefts Depaarhn+ent of Indust7ial Accidents Oflwe of Investigations e 600 Washington Street Boston,M4 02111 wtoir mas&govldia Workers' Compensation Insarrnce Affidavit:B.uildersfContractorslF;ectricians/Mumbers Applicant Information Please Print Legibly Name(BusmesslOrgenizationlIndividnal): Address: City/State/Zip Phone Are you an employer?Check the appropriate box: Type of project r 4. I am a contractor and I �� PT ] �egnired): LVI am a employer with ©�. ❑ ; 6. 0 New construction employees(M and/or part-time).* have hired the sub-contractors. Z_❑ I am a sole proprietor or partner listed on the attached sheet, 7. ❑Remodeling ship and have no employees These -contractors have g_ ❑Demolition. working for me in any capacity. employees and have workers' 9_ ❑Building addition [No workers' comp.insurance comp.insurance-/ required] 5. ❑ We are a corporation.and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LD Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.o ofrepairs insurance required.]b c. 152,§1(4),and we have no employees.[No workers' 13_0 Other comp_insurance required.] *Any applicant that checks boat#1 must also fill out the section below showing their we d m'compensation policy information*Hnmeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new of idnit indicating such. TContractors that check this boa must attached as additions!sheet showing the name of the soli-contractors and state whether or not those entities have wVkyees. If the sub-contractors bare employees,they must provide their workers'comp.policy number. Tam ari erplolw tltat is preiiditig tt�orke-rs'compensation inswranceforray employees. Below is the policy anal job site information. Insurance Company Name: C tJ`i/i9 �c• Litr sU/y}ti �P Policy#or Self-inss_Lic.4. &Ut-X7 SG//c;P*d Expiation 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 Section.25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORE:ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance;coverage verification. T do herely c fy under thepains a onabias ofpetjury that the inforrrtation primided above is bite and correct Si tore: - Date: Phone#: `� G Official use only. Do not write in this Area,to be completed by city or town ofrciaL City or Town: PermitUcense It Issuing Authority(tsrele one): 1.Board of Health 2.Building Department 3.City1rown Clerk; 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute, an employee is defined as"...every person in the service of another under any contract 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, §25C(6)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,MGL chapter 152, §25C(7)states"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 contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required- Be advised that this affidavit 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/lice-rise applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your 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 office of investigations - 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 eA 406 or 1-977-MASWE Revised 4-24-07 Fax#617-727-7749 www.mass-govldia 5000) J 9 o . 62Z?D CERTIFICATE OF LIABILITY INSURANCE 1 DATE(M�;oONYY.Y) 012012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER§ NO RIGHTS UPON THE CERTIFICATEIHOLDER. 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(les) must;be endoroed. If'SUeROGATION 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 Ileu of such endorsements. PRODUCER - CONTACT La Cowan Cowan Insurance Agency,Inc, - - PHONE 978 372.1451 FAX 978 521-4669 Ha Main Street .M L )a cowaninsurance.Fom Haverhill MA 01830" - ,. . -.. ,.. ... . -. C 4. Assoclated Em to are Insurance Company, an , INSURED ." .-.. . - Cape Cod Construction Serviced Inc. ¢ 163 Tern Lane Centerville MA 02632 { 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 ADOL UBR TYPE OF INSURANCE POLICY -U POLIC E F MBER POLICY ExP GENERAL LIABILITY 1 LIMITS - E CH OC URRENC COMMERCIAL GENERAL LIABILITY 0 GE TO RENTED. CLAIMS-MADE OCCUR - eon .. �. - R AL a INJURY GEN'LAGGRE ATE LIMIT APP LIES PER: ERALA GREGAT POLICY PRO• LOC '- P �ODUCTS-C P/OPAGG - - 1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) AUTOS AUTOS BODILY INJURY(Par aedderu) _ HIRED AUTOS NON-OWNED. .AUTOS.. UMBRELLA LIAR OCCUR - i EXCESS LIAR CLAIMS-MADE k - EACH OCCURRENCE -AGGREGATE WORKERS COMPENSATION - _ " AND EMPLOYERS'LIABILITY - " x WC STATU- OTH- ANY PROPRIETORIPARTNERIEXECUTIV� - - - A OFFICERI In NHR EXCLUDED? lLJ NIA WCC5011292012012 0811512012 0812512013 E.L.EA A CID ENr 100 000 - If ea,describe under E.L.DI SE-lA EMPLOEE1100,000 p 3 below E.0 DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attich ACORD 101,Addlllonal Rsmarka Schedule,If mon spew is nqulnd) Residential construction mans ement CERTIFICATE HOLDER CANCELLATION Town of Barnstable _ Ir` SHOULDANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL.BE DELIVERED IN A _Y ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 ;agiter.d REP NTA E Fax: 508 362-9001 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name�and logo marks of ACORD -- �l e -�omvrwoeurea,�l� .�,aaaac/Z.�aelta Office of Consumer Affairs&Bo siness Regulation I. 3 HOME IMPROVEMENT CONTRACTOR,' M Registration 1704 ") TYpe°, Expiration: 1b12')'/,204, Private Corporatioi, CA COD CONS iTRkIff 6 S ICES, INC. - j � DAVID SAURO \ 163 TERN-LANE CENTERVILLE,MA 0----1 Undersecretary ° Massachusetts -Department of Public Safety L & Board of Building Regulations.and Standards Construction Supervisor t License: CS-072866 " DAVED A SAURO, 163 TERN�LANE- to CENTERVILLE RA Expiration x Commissioner 05/06/2015. . . as i �mE r Town of Barnstable Regulatory Services aaxi A rE MASS. Thomas F.Geiler,Director ss. 1639. 16 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 Property Owner Must Complete and Sign This Section If Using,A Builder I, -� Ur� �C ,as Owner of the subject property hereby authorize �u2_Gi to act on my behalf, in all matters relative to work authorized by this building permit. (Address of Job) , **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPUMISSIONPOOLS 62012 4J 1f� BIKE� Town of Barnstable Regulatory Services 9> wscEhUss. i' Thomas F.Geiler,Director 1639.. &61 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 EXEMPTION ~ Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": _ name home phone# work phone# 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. DEFINTHON 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 requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or Iarger 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\Loca]\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPR-SS.doc Revised 053012 The Town of Barnstable Department of Health, Safety and Environmental Services Building Division MAM 6 9. 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: 7 j Name: Address: T'6lY7 Azmc' AM, l63 village:�����/l�� Type of Business: C Map/Lot: e:W0� INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance, provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector;a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit, located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. •--No sign"shall be_displayed indicating the Customary Home Occupation. - _If _ _ the Customary-Home-Occupation is listed or.advertised as a business,the street address shall not be l included..----4 • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: �� G�/ `l