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0030 NICKERSON DRIVE (2)
__ . ___ _ w_ . .. _ _ _ . � �� �� J� II t . +r } .. i E. O �- , �' Town of Barnstable RECEre-r r + ,aA�,�ARMAS&LE 200 Main Street, Hyannis MA 02601 508-862-4038 - i6�9` At Application for Building Permit oil Application No: TB-17-3748 Date Recieved: 10/26/2017 Job Location: 30 NICKERSON DRIVE,COTUIT Permit For: Building-Shed-Residential-200 sf and under Contractor's Name: JAMES R MCGRATH State Lic. No: CSFA-073866 Address: BREWSTER, MA 02631 Applicant Phone: (978) 549-2739 (Home)Owner's Name: MCCORMACK;LISA J&JOHN Phone: (978)549-2739 (Home)Owner's Address: 177 LONG HILL ROAD, BOLTON, MA 01740 Work Description: 8xl2 shed to be built by Pine Harbor 15' setback from rear and right side property lines. Total Value Of Work To Be Performed: $3,000.00 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: lisa mccormack 10/26/2017 (978)549-2739 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $3,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $35.00 10/26/2017 $35.00 Credit Card 7486 Total Permit Fee Paid: $35.00 _ 7` "THIS 1S NOT A PERMIT Commonwealth of Massachusetts ® etal Permit Date: 03/10/2017 RAR Permit# Estimated Job Cost: $ Permit Fee: $ Plans Submitted: YES NO �" Plans Reviewed`. YES NO Business License# ` '- Applicant License# 3 YY Business Information: Property Owner/Job Location Information: Name: Tavano Mechanical Systems Name: McCormic Street: 270 Communication Way- Unit 1 B Street: 30 Nickerson Road City/Town: Hyannis, MA 02601 City/Town: Cotuit, MA 02635 Telephone: 508-932-5416 Telephone: 508-428-4219 Photo I.D. required/Copy of Photo I.D. attached: YES ' X NO Staff Initial J-1 /10--unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. -X— over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC X Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes[3 No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy 0 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. ' Check One Only Owner Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By [�Master Title ❑ Master-Restricted �-- City/Town ❑Journeyperson Signature of Licensee , Permit# �c ❑Journeyperson-Restricted License Number: �C` 7 Fee$ - ❑ Check at www.mass.aov/dpl Inspector Signature of Permit Approval T'he Commonwealth ofMl ssachusetts Departinent of Industrial accidents Office of Investigatiogs 600 Washington Street Boston,MA 02111 ww .mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/ le cians/Plumbers Applicant Information Please Print Lettibly Name(Business/Organizationadividual):. Tavano Mechanical Systems Address: 270 Communication Way-Unit 1 B City/State/Zip: Hyannis, MA 02601 Phone.#: 508-932-5416 Are you an employer?Check the appropriate bom of project re �. I am a general contractor and.I � -Type P i ( �'��- 1. I am a employer with ❑ 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: 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance. t'- 9. ❑Building addition required.] 5. ❑ We are a corporation and its I0.❑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.]t c.152,§1(4),and we have no - employees.[No workers' 13.0 Qthe; cones insurance required.] *Any applicant that checks box#1 most also M out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and thin hire outside contractors must submit a new affidavit indicating such— 3Conhactors that check this box mast attached an additional street sbowmg the name of the sub-contractors and state wbetner or not those entities have employees. If the sub-contractors have empioyees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A.I.M. Policy#or Self-ins.Lic.#: WCC-50050149582016A Expiration Date: 08/14/2017 Job Site Address: City/State/7,ip: 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 irnposition of criminal penalties of a fine up to$1,500.00 and/or one-year uriprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.06 a day against the violator. Be advised that a copy-of this siatema4 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under thepaba-andpenaliies ofperjury that the information provided above is true and correct. Si store: G�,i�---- Date: Phone k (�' �3.2-c5 i, — Official use only. Do not write in this area,to be conWided by city or town official. City or Town: Permit/License# ,Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk. 4.Electrical Inspector 5.Plumbing Inspector I 6.Other j Contact Person: Phone#: i I IK Tow of Barnstable Regulatory Services Hasa 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-b230 Property Owner Must Complete and Sign This Section If Usin-a A Builder as Ownet of the subject pzoperty hereby authorize / G� (//.,.�o �1 rt�(;� to act on my behalf, in all matters relative to work authorized by this budding g permit _ d i e ram (Address of Job) Pool fences and alarms are the responsibility of the,applicant, fools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. 4,1-avr S' tune o owner Signature of4pplicant Print Name Print Name Date Q:FORMS:OWNERPERMLSSIONPOOLS Client#: 762395 2TAVANOME AC006. CERTIFICATE OF LIABILITY INSURANCE rD YYY1) s/22ATE(MMtDD/MIDDI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Dowling&O'Neil Insurance Ag NAME: PHONE 508 775-1620 5087781218 973 lyannough Rd,PO Box 1990 &MAIL Ext: Alc No; ADDRESS: Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# 508 775.1620 INSURER A:Safety Indemnity INSURED INSURER B:Associated Employers Insurance Tavano Mechanical Systems LLC 201 Capes Trail INSURER CINSURER D West Barnstable,MA 02668 INSURER E: INSURER F: 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 CONTRACTOR 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. LTR TYPE OF INSURANCE ADDL SU8 POLICY EFF POLICY EXP IN SR WVD POLICY NUMBER MMMO MM/DD LIMITS A GENERAL LIABILITY BMA0024003 8/14/2016 08/1412017 EACH OCCURRENCE $1 000 000 lix COMMERCIAL GENERAL LIABILITY DgMA�E T �ENTED PREMISES Ea occurrence $500 OOO CLAIMS-MADE �OCCUR MED EXP(Any one person) $10 000 PD Ded:500 PERSONAL S ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCTOS HEDULED AUTOS AU BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB I CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WCCSODSO149582016A 08/14/2016 08/14/201 X w RsrATu- oTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town 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 REPRESENTATIVE 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S175434/M175412 CBD . T V ANo Heating & COO1ing RODNEY TAVANO•201 CAPES TPJUL• WEST 9ARNETABLE MA 02M (508)932.5416 • rodtavano eYahoo.com 9 , t ��x SME�TA1 WORFf Fy , . 4 {� >ISSUE3 Tt E F...... }RiG t1 Ei�t AS A TAVANO _ V"�BIAt�C+ �AIBLE,VA `_ '� Q HAS 3 t3�` 'is It h! Ft?LLCtWiN l �NSE 3 sYAANG CAL.41`STEMS ,,f 2Q I CJPsi 1 �. 1NESfi IARN�'�ASL fl66 ' CC ry y y q 5 Bowers, Edwin To: ewdrewec@comcast.net Subject: Permit/Application: E-2010-04537 at'30 NICKERSON.DRIVE,.COT off for Electrical - Minor To Whom it may concern Permit E-2010-04537 did not Pass Final inspection There is a remodel of the property ongoing and this permit was found to be open Please make arrangements to close this permit Thank You , Edwin Bowers - Town of Barnstable _ Building Inspector F 508-862-4025 1 V 1014ly Town of Barnstable Permit# Expires 6 months issue Regulatory Services Fee •AM AB rl NAM Richard V.Scali,Interim Director Building Division 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 y 1 Not Valid without Red X-Press Imprint Map/parcel Number t Prope Address 3,6 /\j 1�K_t4t&U&/ RJC) - criUF, . Residential Value of Work$ 600 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �' ��� �j 1� --� 0q!j 1 A w c`-lam teu CIS. yxj az 6i Contractor's Name L I N Telephone Number D 6— Home Improvement Contractor License#(if applicable) 1% Email: Construct' Supervisor's License#(if applicable) 1 X PRESS orkman's Compensation Insurance it Check one: ❑ I am a sole proprietor OCT 6 2014 ❑ I he Homeowner UL�Thave Worker's Compensation Insurance TOWN OF BAR p Insurance Company Name fn NSTAB�CC Workman's Comp.Policy# wn 00 Y(9 e i() l 1 7 Copy of Insurance Compliance Certificate must accompany each ach permit. Permit Request(check box) ❑ Re-roof(hur . ne nailed)(stripping old shingles) All construction debris will be taken to %) � C- U'J j�i 6S(� ❑Re of(hurricane nailed)(not stripping. Going over existing layers of roof i G(t) - e-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: T:IKEVIN_D\Building ChangesTXP SS PERMIT\EXPRESS.doc Revised 061313 r R 059.. Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO 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 1h.U�jC 6;171.1 . ,as Owner of the subject property hereby authorize S 1� )"e ih' U to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature o Owner Date CG Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN MBuilding Changes\EXPRESS PERMIT\EXPRESS.doc Revised 061313 Client#:38438 2CENTRALCA ACORM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 09/22/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER COATNA E: A T Dowling&O'Neil PHONE 508 775-1620 FA't Insurance Agency E-Ma� E'" a : 5087781218 c No ADDRESS: 973 lyannough Rd., PO Box 1990 INSURER(S)AFFORDING COVERAGE NAIC e Hyannis,MA 02601 lrlsuRER A:National Grange Mutual Insuranc INSURED Central Cape Construction Company,Inc. INSURERS:Associated Employers Insurance 820 Main Street INSURERC: Cotult,MA 02635 INSURER D INSURER E: INSURER F: 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS INSR WVO POLICY NUMBER MMIDD MMIDD LIMITS A GENERAL LIABILITY MP197640 11/14/2013 11/14/201 EEAACCHp�OECCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY �� PREMISES EaEoccccuErrence $500 000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1 OOO 000 GENERAL AGGREGATE $2,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UA13 CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WCC50050091992014A 5/14/2014 05/14/201 X WC STATU- OTH AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVEOFFICE E.L.EACH ACCIDENT $500 OOO (Mandatory In NH) EXCLUDED? N!A E.L.DISEASE-EA EMPLOYEE $500 000 (Mandatary In NH) IfEs ender CDSRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is required) Steve Devlin Is excluded from the workers compensation policy. Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Henry Sabena SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 121 Pervical Road - ACCORDANCE WITH THE POLICY PROVISIONS. East Falmouth,MA 02536 AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S137697/M137696 LS1 Office of Consumer Affairs and Business Regulation J -�� 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cot t c rtor Registration - -- -- Registration: 131841 Type: Private Corporation 2 Expiration: 9/26/2016 Tr# 256305 CENTRAL CAPE CONSTRUCTIONCO STEPHEN DEVLIN 820 MAIN ST. COTUIT, MA 02635 Update Address and return card.Mark reason for change. SCA1 2OM-o5n1 [) Address Renewal Employment Lost Card C_J llc fCG/Jf 7�lG»COCCtII�O�C%('GCl3.000�c1JC/(;3 y t Office of Consumer Affairs&Business Regulation License or registration valid for individul use only SOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: " Type: Office of Consumer Affairs and Business Regulation_ rR '1 3184110 Park Plaza-Suite 5170 r Expiration 912612016, Private Corporation t" -, -- f7 Boston,MA 02116 CENTRAL CAPE CONSTRU.CTIONCO.INC. STEPHEN DEVLIN I 820 MAIN ST '•.; -;;= g ��v�_o COTUIT,MA 02635 - Uudersecretary No valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-047993 ; STEPHEN J DEVL$1 820 MAIN ST j Cotuit•MA 02639 Expiration Commissioner Oy04/2016 I 1 1 - 4 The Commonwealth of Massachusetts Deparhnent of Industrial Accidents i f Office of Investigations r 600 Washington Street Boston,.-VA 02111 . 119t•w.nlass gm}ldla Workers' Compensation Insurance Affida«t: Builders/Contractors/Electiicians/Plumbers Applicant Information Please Print Lezibly Name.(BusinesslOrgmizationUdividual): -e q LWjV c e4x CG'Ad a V64 U i. Address: / City/State/Zip: J 7V+ r Z Phone#: �G� ` '�"7 d� 66 O Are you an employer?Check the Appropriate box: Type-of project(requu�etl): �1. ni a employer-with ❑ Y a general contractor and I 6 ❑Neu construction employees(full andlor part-time).* have hired the sub-contractors 2.❑ I tin a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These.sub-contractors have 8. ❑Demolition .corking 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 LF0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per hrfGL 12.❑Roof repairs insurance required.]g c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance.required.] *Anv applicant that checks box#1 ntnst also fill am the secdion belon,showing their workers'compensation policy information. 1 Homeowners who submit this affidasit indicating they are doing all worh and then]tine outside contractors must submit a new affidavit indicating such. Contractors that chaos this boat must attached an additional sheet showing the name of the sub•conimnors and state whether or not those entities have employees. If the sub-contractors have employees,they must pmvide their workers'comp.policy number. lain an employer that is prosiding workers'compensation insurance for nt►'employees. Below is the policy and job site information. / f Insurance Company Name: W a C t1,_E d ell Policy;t or Self-ins.Lic.9: Cl G - Expiration Date: / Job Site Address: 3 Q IVi - R CU�1 /� City?'state/Zip: La 9 i �i IR 6 !T Zef3j Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to sedge coverage as required under Section 25A of MGL a 15r2 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as ci%'il penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Dt ere bf°certtfy un er thepa' and penalties of petyn 7 that the irtforrnation prvidded abzn a is true and correct Si tune: Date. d v _ ^ Phone#: I 6 Offieial use arils'. Do not write in this area,to be completed by city or town ofcidL City or Town: Permitucense 9 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityll'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M 6 I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �/� ' Parcel ��O$�g Permit# 4g9 ��1 Health Division Date Issued / /3 Conservation Division Fee- . Tax Collector SG - ,. .8 1. Treasurer p :. Planning Dept. z Date Definitive Plan Approved by Planning Board �- Historic-OKH Preservation/Hyannis ' Project Street Address 3o ✓\1 e i<6RS0 A,l Village �� � 1 7— Owner IB&W 14J0,qi14 Address a Telephoned Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District —Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. F Dwelling Type: Single Family Li(/ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing '❑new size Attached garage: ❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r FOR OFFICIAL USE ONLY s PERMIT NO. DATE ISSUED "'• MAP/PARCEL NO. 7 ` ADDRESS VILLAGE OWNER . .° v - DATE OF INSPECTION `µ FOUNDATION FRAME INSULATION FIREPLACE -- ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL, E - GAS: ROUGH FINAL FINAL BUILDING,,- 3la� lo - •1� • e 4 DATE CLOSED OUT • ASSOCIATION PLAN NO. ' f The Commonwealth of Massachusetts —� Department of Industrial Accidents W 011Ice 011085 SUORS 600 Washington Street Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit name yz` N FIC rA location , �0 CitV U i phone# I am a homeowner performing all work myself. ❑ 1 am a sole rietor and have no one worlds in anvcapacity ❑ I am an employer providing workers' compensation for my employees working on this job. ::: comaanv mime address . ::.::;>;:::::;:::>:::. .. . crttn' ;::..:..shone#.. olicv ass ce co: _... ..F. ;.. ... I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who the following workers' compensation polices:.... : .::. :.:: :. :::: <.;::.:;«;.;:.>;::,;:.;;;:.;:::;;::;;.;:.;:<.;:;...:.;;>;.........,::....,,,::: ad >s:: :<::;;:><:>:::<::> > :::::::::::::::::::::::::::::::::............. ..n:.... ': •..... ......................................................................................................:::::.h?:::::v._•:::L}:...•: :::i4:i•iii:•i?ii•i?i:::}}::•.}i'ry:::.}•. :::::v}v::v::. ?i:Y:::•:w:::v.�:,.......... :;:jt•.:'s:;':i':::::'f ti:'+.::::ri::::i i............. %:^rrifi:isv'ii:";:?i::i:2:::rri`:v::i s%ii:r»>::<one>'' nh :.............................X. ....................................................,.........................................:... ... ,..:.:,. :.:::.::::::.::::::.::::... ....: :::::.:::::::::.:.:..:::._::::r .;::.:;:.;;:-;.;::;;::.;;:.;;::.;:.:<:::.:::.;::»:;::.:::::::::;;:.:;.::::;:.: ........................::...:....:.... �%. say.name: MMOVINIAIAN address•: ::... clti"` X. Cy2?: ? :?'> <> { '3isi::i;':; :;:?: i:; i`::; :<:?' ?+ii ``'iol aurance FaOme to secmz coverage IS required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to s1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pours and pens erjury that the information provided ajbove is trw and correct Lgie�� Signature LC Print name uR�.v /� Phone# official use only do not write in this area to be completed by city or town official city or town: petmittlicense# ❑Building Department ❑Licensing Board ❑checkif lmmedlate response is required ❑Selectmen's Office ❑Health Department contact person: phone ii; ❑Other 4evued 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any 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 an such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 contacting authority. "Applicants frtyT ZZZ Please fill in the workers compensation affidavit completely,by checking the box that applies to your situation and .;supplymg company names,address and phone numbers along with a certificate of insurance as all affidavits maybe 'x a��a k submitted to the Department of Industrial Accidents for canfimration 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimit/Iicense number-which will be used as a reference number. The affidavits may be to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents A(Iice of Insesugatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat 406, 409 or 375 The Town of Barnstable sni:NsrnaM 9� 1�$ Regulatory Services �Eo ono. Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. .C 11 1 Type of Work: W F%A I..�l Estimated Cost-va ©mom ca Address of Work: —'7) Owner's Name: J R,i w�a A-rK Date of Application: �. o V. d r C�- oc'0 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR DateOwner's Na q:for :Affidav °F THE The Town of Barnstable '* iA ASTABLE, MAS Regulatory Services 1639. ♦0 10rEn l„a+A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: L L/ JOB LOCATION: 3 d /�!/G1�C9 R S r7k �. �� ► number street village "HOMEOWNER L,:;W6 l@vl name me phone# work phone# CURRENT MAILING ADDRESS: 2C> ZC�eRSD^L `N-C-P C i3s— 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 2pedures and requirements. Signatu of Ho eo.er 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. Q:FORMS:EXEMPTN Engineering Dept. (3rd floor) Map O l Parcel D c52 Permit# Q/ ` House# ?a Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) $ ANY ,�j �/I/ �'�'�,� Xu/,o0 Conservation Office(4th floor)(8:30-9:30/1:00-2:00)ois! Tor/ � e kx- 19 F BARNS'fICBLE ..MAS6. �rFO TOWN OF BARNSTABLL s 9. '' Building Permit Application Project *ddressQN I CIC �is�[ t� Village C& ,;i i Owner �54 f-p—L,k 1!�c. i:$ t_ ��, cc Address 4b Telephone A, C: Permit Request M- OQ P .— R CJ 0 t4 CL �sCy t M rf First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ In pnn„ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 0/Two Family ❑ Multi-Family(#units) Age of Existing Structure O �` Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other aLi --P Basement Finished Area(sq.ft.) '11� Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing / New Half: Existing l -2 New No.of Bedrooms: Existing__2 --New-- Total Room Count(not including baths): Existing_ New First Floor Room Count c l� Heat Type and Fuel: ❑Gas it ❑Electric ❑Other Central Air es ❑No Fireplaces: Existing New Existing wood/coal stove fffes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) 't�'X ,2 G r ; C, 6a ft iL- I - X ❑Attached(size) ❑Barn(size) U-N—one ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes U10 If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / BUILDIN ERMIT DENIED FOR TII LLOWING REASON(S) , 2, 4'I fi`a 1e'• . s i v.�-.aLccui7fY Y,�,�C,s x rin!� :?T r.arr., r*y,:,.,._, �i»nf.S .>rI r'l TPrt3#fil�,{17r'1 Ti3 tlr::i1 1+4•i+ ' s .. x I I r. a I TOnJ AJ cc-) � o Q 4 NO, Gibraltar NOW Corp. 9 p y For Marketing Dept. Use Only , Where Buyer Heard About Gibraltar ..428 Boston Street U.S.Route One Buyer , ...,. e initials. 1. Topsfield, MA 619831 y ..(508) 887-2424 �' r' 2: 1. r 3. 2. Date 19 . Buyer 1's name and phone number _. ;' .,Buyer 2's name and phone numbe r ,; Buyer 1's address(street,town, state and zip.code) Buyer 2's address(street,town,state and-zip code) 01 We-he eby agree toi`ell, and Buyer and any Co-Buyer shown above agree to buy in good faith subject to the terms and conditions set forth below and upon the reverse side hereof,the following: SWIM AREA Your Pool has the features and accessories checkedbelow: OUTSIDE DIMENSIONS I�Sand Filtration,System 3-G-90 steel Buttresses and SupportsVacuum.Cleaner 3 ,'rDeluxe High Rate , r�,/ with baked acrylic finish U Main Bottom Drain :Y ❑..Standard;. , IYInterlocking G-90 Steel Side Panels ❑''Aluminum Coping , ❑Aluminum Fence ?"Virgin Vinyl Printed Liner ❑ Pump Ca'"Flush In Wall Skimmer ' I -In Pool Ladder C^i'Deluxe ❑'T u fde k ❑/Stainless Steel ,Standard U 7"Bottom Oveling Channel ❑ Aluminum ; Al t-ar arter Chemicals IV, . uminum Outside Ladder ; , Cr Test Kit ._ • . t °,►3"Approximate 4'depth •�_ y K t aJ -_..< n .:: '.+ 3 :4 Z • -J Y( 5 `S a2 a r 5' �. �tx j ��'� f FI Your pool includes only.those features and accessories specifically'Mated herein�and those included by the manufacturer of such pool unless otherwise indicated in"venting in this agreement ASSEMBLY:Your pool will be assembled by Q you '"a us I The Connttonivealth of.4fassachusetts Department of Industrial Accidents r" J i t OlJiceo/127MV9.7017s i"-:,J 600 ff'ashingron Street Boston, Alas. (12111 h Workers' Compensation Insurance Affidavit rplicant information: Please PRIIVTIesjy name tV t-li _ 1 ,V�t—' �3 Cs-/�Ma c G L.�1< Ci. o � ion• -- - city c \ i ��--t� �� nhone 0 LP?� _- � 9� 0 1 am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. company name: ail ti ress• ' citl: phone�#• incurnce co Solicy# I am i general contractor, r homeowner(ci cle one)and have hired the contractors listed below who have the following wort ers' compensation polices: coml2am•name: •ttidress• i�. Qf it-*: F t eE-1•- l 1 ' I PC phone#: J 22)- insurance co. G- e—k U4 holicy# LAJ C X 960 ;......ri':-::. ....:'�:_•':•.:. ._... vCf7•«:.•.;,.::7{�*rti�••�•9••T'•:..1"r.Yt✓F:.t:R.;���-�......'�r•.-••r-cbi'�'��;�'T7''�,f►,�n'!!''�:F•:: �+.u; :r_r-•rr,r•���agG�-r..�.-.i. cnmPnnv name: address- city Phone#.- insurance co 11olicy# _ AttachadditionalsheeiiftiecesSL + `�LJ�r::F '�►��'Y:;` {: _':== r�."r'� a"��"1s�' =._y � ��i +o. Failure to secure coverage as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of s fine up to 51.500.00 andior one years'imprisonment as well as civil penalties in the form of a STOP\VORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the OMcc of investigations of the DIA for coverage verification. I do hereht certij under the pains and penahies of perjure•that the information provided above is true and correct Si_nature �. ` —w�--�-- Date Print name I✓�l l )i 9 R►—t C-'12*n M PJ Phone#. �Q 11�1 omcial use only do not write in this area to be completed by city or town official r � city or town: permit/liccnse# CBuilding Department C3Liccnsing Board O check if immediate response is required 13Sclectmen's Office [3Ilc21th Department contact person: phone#: riOther , irevised 3;95 PJAI Information and Instructions Massachusetts.General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their t,r employees. As quoted from the "law". an entploree is defined as every person in the service of another under ally contract of hire, express or implied, oral or written. An enrplt trer is defined as an individual. partnership, association. corporation or other legal entity, or any two or more of the forcgoing enLaucd 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,.vho employs persons to do maintenance , construction or repair work on such dwelling house or oft the ,rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall %withhold the issuance of- 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. 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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits 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 tite 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. min- or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of In-esti=atioils would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. - The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone 9: (617) 727-4900 ext. 406, 409 or 375 l • . TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE .. JOB• LOCATION 5.0 Number Street address Section of town "HOMEOWNER" I't� U RU Un &M �-3cs'•- �''� 3 9°i9'- �=� Name N Home phone Work phone � / PRESENT MAILING ADDRESS L48 (COO City_t1own State. Z i c; The current exem tion for "homeowners" w /P as extended to inclu a owner-occ-. dwellings of six units or less and to allow such homeowners to engage an dividual for hire who does not possess a license, provided that the owne: acts as supervisor'. DEFINITION OF HOMEOWNER: Person(sl who owns a parcel of land on which he/she resides or intends tc side, on which there is, or is intended to be, a one to six family dwell- attached or detached structures accessory to such use and/or farm structi A person who constructs more than one home in a two-year period shall not considered a homeowner. Such "homeowner". shall submit to the Building Of on a form acceptable to the Building Official, that he/she shall be resnc for all such work performed under the building permit. . (Section 109.1.1) The undersigned "homeowner" assumes .responsibility for compliance with th Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requiremt, and that he/she will cO.,,CAL with said proce ures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING 4� Note: Three family dwellings 35,000 cubic feet, or larger, will be requir to comply with State Building Code Section 127.0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which. bu 3 permit is required shall be exempt from the provisions of this sectior. (Section 109.1. 1 - Licensing of Construction Supervisors) ; provided tt Home Owner engages a persons) for hire to do such work, that such Hon shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assu the responsibilities of a supervisor (see Appendix Q, Rules and Regula for .licensing Construction* Supervisors, Section 2.15) . This lack of a often results in serious problems, particularly when the Home Owner hi unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home Owne as supervisor is ultimately 'responsible. .•�. .�• To ensure that the Home Owner is fully aware of his/her responsibiliti communities require, as part of the permit application, that the Rome '( certify that he/she understands the responsibilities of a supervisor. last page of this issue is a form currently used by several towns. Yot care to amend and adopt such a form/certification for use in your comma r , J The Town of Barnstable • asarrsreszE. • °659. Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERBUT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: �0,i cwC 1'© Est.Cost i © ® 00 Address of Work: � � i L ��-�s c," e� Owner's Name J, �L+ - �`�u V, t'�2�ATE Date of Permit Application: le5- I hereby certify that: Registration is not required for the following reason(s): Work excluded by law _ _ ob under$1,000. Building not owner-occupied :;Zowner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR Date Owner's N e A �1 Assessor's office(1st Floor): Assessor's map and;lot number Conservation Board of Health(3rd floor): . '` t DAD77T�D6 ! Sewage*Permit number. / � rua Engineering Department(3rd floor): `� eo te39. House number : 38 Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:3,0-9:30 A.M.,and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO BUILD A DECK TYPE OF CONSTRUCTION 19 q� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 30 Ni V—korRQr P.eady--Getldi-t Proposed Use neck Zoning District 2L Fire District Cotuit Name of Owner R,ur7 ingame, ShJerTl A Address Name of Builder h O&E R —1;K E%,l7 Address Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost ©� Area ,:�)-3 Diagram of Lot and Building with Dimensions Fee �� ( , OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License BURLINGAME, SHERYL A. i No 35336 Permit For BUILD DECK. Single Family Dwelling _ Location 30 Nickerson Road � 1 Cotuit 1 + Owner Sheryl A. Burlingame �f Type of Construction Frame i r Plot Lot Permit Granted August 31 , 19 92 Date of Inspection 19 Date Completed 19 3 r 1 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE ��� sk, Iggv i JOB LOCATION 3 0 Number Street Address Section Of Town "HOMEOWNER" _�U121 1 NC3(�M� �rt a Yl Name Home Phone Work Phone PRESENT MAILING ADDRESS 30 �� La �� Doti d z� 3s i City/Town State Zip Code The current exemption for "homeowners" was extended to include owner- occupied dwellings of six units or less and toallow such 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, resides or intends to reside, on which there is, or is intended to be', a one to six 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, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. MISCS -.. i HOME OWNER'S EXEMPTION The code states that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do`- such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see A endix les for Licensing Construction Supervisors, Section 2. 155) .RuThisand lackeoflat'ions awareness often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the unlicensed personas it would with licensed supervisor. The Home Owner acting as supervisor is ultimately responsible. To - ensure that the Home Owner is fully aware of his/her responsibilities, many communities require,, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. i j r i� it �