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Home My WebLink About0040 HIGHLAND AVENUE IKEr Town of Barnstable *Permit#,ROn Od Ex i e 6 ntontlrs jro n issue date Regulatory Services RMITThomas F.Geiler, Director Ar�o �A� Building Division ® Zoo9 Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 (/ �ZV Property Address 1J 0 11i ill— A 4 XResidential Value of Work N,d CO O Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address T-eA ll t V0,,xb10eS Contractor's Name Kelel q( (/VQ � '^ �.J�f t Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 'J py,rb ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor X I am the Homeowner I have Worker's Compensation Insurance J Insurance Company Name I" ((/ ( SIT Workman's Comp.Policy# LA1C q0'�24P Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof} gKRe-side ❑ Replacement Windows. U-Value- (maximum ,44) *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. Home Improv nt Contractors License& retrstritet Supervisors License is required. SIGNATURE: 91 (nenn� Q:\WPFILES\FORMS\Express\EXPRESSPERMIT.DOC Revise06O4O9 E! The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 s�• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information C Please Print Legibly Name(Business/Organization/Individual):�L� Address 0 b Y 010 `- City/State/Zip: jT-(/�vt*( (,e Phone.#: �-L,?V Z-k q 4oI o Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors .2.❑ I am a sole proprietor or-partner- listed on the attached sheet. T. ❑Remodeling 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 workers'-comp.-insurance comp. insurance.# 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 I L❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ II Insurance Company Name: �t t,r, t 1/1 Policy#or Self-ins.Lic.M 1'/V G I..? f J �"! 7 qd Zf Expiration Date: 6/ fS/ 2-00 Job Site Address: 49 1 ►'f C I Li`fi Ali Ave City/State/Zip: 6�Lrilll 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 tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of A STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyy under the pains and penalties ofperjury that the information provided above is true and correct Sienature 9r1I�� Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authoritycircle one):( - 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 tiustee 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 vdth the insuance 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 you 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 s:lf-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(license 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 tcwn),".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, pl. se do not hesitate to give us a call. Th-_Department's address,telephone-and fax number: The C(6mmonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-NIASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable Regulatory Services RAJOISMASM 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 Property Owner Must Complete and Sign This Section If Using A Builder I, Jeot� ��/{ Itn as Owner of the subject property hereby authorize ( ( VIL�,��G�, to act on my behalf, in all matters relative to work authorized by this building permit application for. .(Address of Job) S tore of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RM S:O VAN ERP ERM IS S I ON r Town of Barnstable Regulatory Services Thomas F.Geiler,Director Yq, t639.. .� Building Division PIED Tom Perry,Building Commissioner .._...200 Main:Street,—Hyannis;MA 02601 _..... ... _.._. . . -www.town.barnstable-ma.us Office: 50 8-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CuR.RHNT MAILING ADDRESS: eityttown 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 structur6s. 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 Barustable,Buildi .g Deparhnent 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 wont for which a building permit is required shall be exempt from the provisions of this section(Section 1D9.1.1-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 responstbrlities of a supervisor(see Appendix Q, Rules&Ragulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly When the homeowner hl=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 respDmiln'lities,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 f m/rertification.for use in your community. Q:forms:homccxcmpt 1 i /, 1 y / UO 11 : 40 10 /'HIVI 41 / U L,j[! U13/ Uj ACORD,„ CERTIFICATE OF LIABILITY INSURANCE 11/19/2008 PRODUCER (508)540-2400 FAX: (508)289-4111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION -ray & MacDonald Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR J MacArthur Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Bourne MA 02532 INSURERS AFFORDING COVERAGE NAIC# . INSURED NSURER A:Quaker Special Risk Kendall & Welch Construction Inc NSURERB:Safety Insurance 39454 874 Main Street NSURERc:Liberty Mutual Ins Corp PO Bose 490 f :NSURER D Ostervllle MA 02655 NSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING AF REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAII THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIE: AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rINSR ADD'L INSRD TYPEOFINSURANCE POLICY NUMBER DATE POLICYMMFDDl1'VE PDATE MMIDDY�N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,OC DAMAGE TO RENTED5O,OC X COMMERCIAL GEh1ERAL LIABILITY PREMISES(Ea oxurrence1 $X CLAIMS MADE OCCUR LHB100D0343 6/15/2008 6/15/2009 MEDEXP(A-iV oneperson) $ 5,0( PERSONAL&ADV INJURY $ 1,000,0( GENERAL AGGREGATE $ 2,000,0( GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS iCTS-COMP/OP A G $ 1,000,0( - X POLICY PRO- IECT _OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO B ALL OwNEDAUTOS 5055064 6/15/2008 6/15/2009 BODILY INJURY X SCHEDULED AJTOS - - (Perperson) $ 250,0( X HIRED AUTOS - r 30DILYINJURY $. 500,0( X NON-O'PuNIED AUTOS (Per acadent) s PROPERTY DAMAGE $ 100,0( (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO .. � OTHER THAN EA.ACC $ AUTO ONLY' AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE Is OCCUR CLAIMS MADE jAGGREGATE Is Is DEDUCTIBLE Is RETENTION $ $ VNCSTATU- OTI-l- C WORKERS COMPENSATION AND TORY LIMIT FR EMPLOYERS'LIABILITY El EACH ACCIDENT $ 100,0 ANY FIROPRIETOR;PARTNER/EXECUTIVE 100,0 OFFICER/MEMBER EXCLUDED ..- WC131S354774028 6/15/2008 6/15/2009 EL DISEASE-EA EMPLOYEE$ If yes,cescnbe under - E.L.DISEASE-POLICY LIMIT $ 500,0 SPECIAL'PROVISIONS below _ - OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TI ToWn Of Falmouth EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO Mf 59 Town Hall Square 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,B Falmouth, MA 02540 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON T INSURER,ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE t S Ha=r"ington/SMH O ACORD CORPORATION' ACORD 25(2001/08) Page INS025(M.'is).02a 9219 J i"N'lassachusctts- Department of Public SafetN Board of Buildinl- Regulations and Standards Construction Supervisor License License: CS 70086 Restricted to: 00 DAMON L KENDALL I om. qZi 48 KOMPASS DR " FALMOUTH, MA 02536 r,• Expiration: 11/21/2010 ('nnnti eiunct Tr#: 6479 �T/le Boar o uo ldm e ulat�on g g s an =an5ar One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement:Contractor Registration Registration: 128405 Type: Partnership Expiration: 4/5/2011 Tr# 282001 KENDALL & WELCH CONSTRUCTION " DAMON KENDALL P.O. BOX 490 OSTERVILLE, MA 02655 Update Address and return card.Mark reason for change. Address Renewal iF1 Employment r_ Lost Card )PS-CA1 0 40M-08/08-DD/B]SS/LIFORRMCA108212008 ✓fZC �JO'/7!/11G0��U!/CQ�GiL �✓��f/�y((Q�� . •. ....- Board of Building Regulatio s and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 128405 Board of Building Regulations and Standards One Ashburton Ex i n Place Rm 1 ration:=: 301 ..•' P ,,. 4/5/2011 Tr# 282001 Boston,Ma.02108 Type Partnership KENDALL&WELCH CONSTRUCTION DAMON KENDALL 54 KOMPASS DR FALMOUTH,MA 02536 = :%' Administrator Not valid without signature I �Q0 �15 . OF `�'®�� n of Barnstable *Permit# { Er �6 ni s f�ceth issue date Regulatai y Services ELA"STASLE, Thomas P. Geller, Director t1,ss 1659. �� Builcling Division PrFo t.�'t a w Tom Perry, C130, 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 Not t/aiid tvithout Red X-Press Imprint Map/parcel Number C�7C) Property Address—�� t l (All ol— Residential Value of Work ( n�� _ Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address TC4,6 . �t0A SeA Contractor's Name Q,,ho Telephone Number ; 5-�I Home Improvement ement Contractor License# (if applicable) X E. a R ❑Workmat 's Compensation Insurance SEP "' 2 2008 Check one: ❑ 1.am a sole proprietor ''OWN OF BARNSTABLE ❑ I am the Homeowner. . [!?7 have Worker's Compensation Insurance Insurance Company Name 6'e'- Workman's Comp. Policy# Vu G Copy of Insurance Compliance Certificate must be on file. Permit Request(check.box). Re-roof(stripping old shingles) All construction debris will be taken to td iC' ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maxi.mum..44) *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 Horne Improvement Contractors License is required. SIGNATURE: Q:\V,TFILESTOItMS\building permit forms\EXPnSS.doc Revi.gno O m - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street • Bostam, MA 02111 1 www.mass.gov/dia Workers' Compensation'Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A a.Ucnt Information / L Please Print Le 'bl Name (Buses iz s/OrkanationlfndMduan: in Address: City/State/Zip:0 tf ?_�SS Phone.#: A,r�e,yoouu an employer? Check tjte appropriate hor: Type of project(required): 1.I� 1 am a eu�loycr with `i'y� 4. ❑ I am a general contractor and I 6. ❑New construction . employees(full andlorport-time).* have hired the shb--contractors 2.❑ I am a sole proprietor or partner- listed an the attached sheet [7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition employees and have workers' working for me in any capacity. 9. ❑ Building addition . [No workers' �p.-ins,n-,�nre We are in cr orpo .� 10. Electrical repairs or additions rf-z rued.] 5: [] We arc a carparatian and its ❑ p , 3.❑ I qu a homeowner doing all work officers have exercised their 11.[]Plumbing repairs m additions myself. [No workers' comp. right of exemption per MGL 12 (Roof repairs incnranCC r t c. 152, §1(4),and we have no egmrr ] employees. [No workers" 13. Other C nm.insurance required.] *Any agpiimnt that al=ks bar-#1 must also 0 out the section bclorw showing their workers'wnpcnsation policy information. t Harncatvnas who submit this affidavit it 6Mfing trey are doing all work and then hire outside contractrsnrs must submit a new affidavit indiralingsuch tCantnctors that cbmt this box zmst atfaehod an additional shcet.sbowing the name of the sub-contractors and state whctha or not thost entities have employe s. If the sub-contractors have en playccr,.they must providh their wr rkrar'comp.policy number. I tuts an employer that is providing workers compensation insurance for my employees. Below is the polity and job site infarmalzont. ^�^ Insurance Company Name: 1i S L! 0 It' Expiration Date: � ( �J Z�3(' Policy#or Self-ins.Lie.#: 1 Job Site Address: L(. (� s �.i9 n /� V� City/Statdzip:!Y- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to sec coverage as requimd unde e r Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a secure, fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statamcri th t may be forwarded to e Office of Investigations of the!)IA for ingjKr ce coverage vcrlficatian. Ida her under a paws•and penaL es cf perjury th the information provided above.is true and correct Datc: Si Phone# for— Tv 9 o O fxial use only. Do not write in this area, tb be completed by city or town offccIaL City or Town: PermitUcense# Issusng Authority(circle one): 1.Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Phone#: _ °p'(HEr ti Town of Barnstable Regulatory Services BARN STABLE, ` Thomas F. Geiler,Director M.rfo,r,,,ya Building Division Tom Perry, Building Commissioner. 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder r, a n Uk,Y1qk &I , as Owner of the subject property hereby authorize 1�`�/l� I Lf/�IC� C'�n ) -- to act on my behalf, in all.matters relative to work authorized by this building permit application for: (Address of Job) Si ature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable �opTHE r � Regulatory Services " Thomas F. Geller, Director * swxtisTwsrzi, :• MASS. 1619. Building Division pTFD a Tom Perry,.Building Commissioner . 200 Main Street, Hyannis, MA 02601 vrww.town.b arnsiabl e.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. 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 -year period shall not be considered a homeowner. Such person who constructs more than one home in a two "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 log.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a pmon(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption aie 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. 08/02/2008 09: 18 FAX 5085635587 MURRAY&MACOONALD 1a002/002 ACORD, CERTIFICATE OF LIABILITY INSURANCE 9/22%2ooa PRODUCER (500)540-2400 SAX: (50A)289-4111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Murray & >`lacDonald Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 550 MACArtAUr Blvd. ALTER THE COVERAGE AFPORDED BY THE POLICIES BELOW. Bourne MA 02532 INSURERS AFFORDING COVERAGE NAIC# INSURED WEARER A'Quaker Special Risk Kendall & Weld Construction Inc INSURER Safety IASurance 39454 674 Delaln Street INSURER c Liberty IIDAtual Ins cozp PO BOX 490 INSURER 0 Omterville M01 026SS INSURER E' VEMWES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWTHSTANDINO ANY REQUIREMENT,TERM OR CONDITION OF ANY CONYRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED MEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. kTE LIMIT§§HOVVN MAY HAVE BEE JUDUCED BY PAID CLAIMS, INDR ADO'L TYPE OF INBURANU-E POLICY NUMBER PCUCY EFFECTIVE POLICY EXPIRATION DATE MlDDJYY DATE fMMjDOfYY1 LIMITS GENERAL LIABILITY -EACK-00CURRIFISCE 0 1,000,000 X COMMERCIAL GENERAL LIABILITY - DAMAG TO ELATED PR e S 50,000 A X CLAIMSMADE 1:10CCUri LH510000343 6/15/2008 6/15/2009 MCDC%P fAnv on&pmrw 5,000 PERSONAL1,000,000 CENERALAGGAFGA'IE - $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' 1 000 000 X1 POII. PR LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ANY AUTO (Ee SCO dOAt) B ALL OMEDAUTOS 5055064 6/15/2008 6/15/2009 BODILY INJURY X SCHEDULED AUTOS (Puporaon) s 250,000 X HIREDAUTOS BODILY INJURY s 500,000 X NON-OWNED AUTOS (Pereccrdura) PROPQ14TY DAMAGE $ 100,000 (Per ecadenq OARA6E LIABILITY AUTO ONLY-PA ACITIORINT s ANY ALITO OTHER THAN Ea(LC S . AUTO ONLY EXCES6/UmBRELLA LIABILITY -ACH OCCURRENCE 8 OCCUR ©CLPJMS MADE ACCRECATIF ry DEDUCTOLIS 8 RETENTION C WORKERS COMPENSATION AND AT C O EMPLOVERS'LIABILITY ANY PROPRIEYOR/PARTNER/E)(ECUTIVE E L EACH ACCID-NT 100,000 OFFICERIMIEMOEREXCLUDED? MC1319354774028 6/15/2008 6/1b/2009 EL DISEASE-FA EMFLOYEES 100,000 IlyoG,dNo-Me under PROVISIONS EL DISEASE-POLICY LIMB 500,000 OTHER OESCMI'TION OF OPERATIONBA.00ATIONSIVENICLESIEXCLUSIONS ADDED BY ENDOROGIMENT)HPECIAL PRO ISIONB CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE A90VE OUSCRI61110 POLICIES BB CANCBLL60 09FORB THE Town Of Barnstable EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Building DiLvision 10 DAYS WRITTEN NOTICE TO THE MRTIRCATE HOLCSR NAMED TO THE LEFT,9U'1 367 bAiL St- - FAILURE TO DO 80 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Hyannis,- NIX 02601 INSURER ITO AGENTS ORREPRESENTATIVBB. AUTHORIZED REPRESENTATIVE ' S Idarsinglon/SMH ��e"�.: fr�`e6b�� '` ACORD 25(2001/08) 0 ACORD CORPORATION 198E INS0251oloo)oe, Pear 1 or 2 `Bo ard of Building Regula ions,and Standards One Ashburton Place - Room 1301 k Boston; Massachusetts'02,108. k _ Home Improvement Contractor Registration Registration:. 128405 Type: Partnership ' Expiration:: 4/5/2009, Tr# 129989 ' KENDALL&-WELCH CONSTRUCTION DAMON -KENDALL ', : .. :., 54 KOMPASS DR. FAL MOUTH, MA 02536 Update Address and return card.'Mark reason for change. DPS-CA1 0 soon-osros Pcsaso ❑ Address'-E]°Renewal' Employment E] Lost Card . ✓fLC -C/Jd7YV!➢247LCl�P.dALiL d�✓l!LQOdCZC1LU.dC�.6 - 6 , Board of Building Regulations and Standards-. License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards j Registratlon: .128405 One Ashburton Place Rm 1301 Expiration: 4/5/2009,- Tr# 129989 Boston,Ma.02108 • Type: Partnership KENDALL&WELCH CONSTRUCTION DAMON KENDALL 54 KOMPASS DR. FALMOUTH,MA 02536 Administrator Not valid without signature,