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Home My WebLink About0251 OLD CRAIGVILLE ROAD '� -r. ." ..: t, `. C.'....'.. �.. ; .:_-., y.. .., .�,. _y; �1 � V y��ti1� '�� i� �Y•rt � S. �� c r any 110 Mason MY too of Jll k1 �7 w r t i 4J < ASK 1 1- �v r a "4" 4"`Y •t, 64. Ttd t7 A � Sna'i, � .x s r J ,"i ! 1.✓5 x r "9;4 w � :^, 2 w,�ti �} ',r ? ! '171F A P h. a a i ,1 r 1 4 x e , h3 4 t S i r, yh3JW29� Town of Barnstable * CD� a of Permit# Expires 6 months fro issue date Regulatory Services FeeMASS snarvsresis, 10� Thomas F.Geiler,Director iOTEp MA't" Building Division "PRESS PERM' Tom Perry,CBO, Building Commissioner PERMIT. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us APR O 6 2012 Office: 508-862-4038 Fax: 508=790-6230 EXPRESS PERMIT APPLICATION - RES ff Not Valid without Red X-Press Imprint STABLE. Map/parcel Number Property Address 251 f l l L nn�-Cy-�-� ❑Residential Value of Work yC M oMinimum fee of$35.00 for work under$6000.00 Owner's Name&Address (,1�!t_uEaL.t �e' l I Old Cpealr:Vit_- p Contractor's Name Reis C"Y1 Telephone Number_, �j r u 1p Home Improvement.Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor �f I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name i 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 r ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑Fence over 6' #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A co me Improvement Contractors License&Construction Supervisors License is r wired SIGNATURE: V' - Q:\WPFILES\FORMS\building permit fbrms\EXPRESS.doc Revised 051811 The Commanweahb ofMassachusetts Lk9whnent of lnihEstrial Accidentr UJTwe of lnvoestigations 600 Washington Shwet Boston,MW02111 wrt►.mass gov1dia Workers'tampensatku Insurance Affidavit Builders/Contracbars/Ekctricians/Plambers Applicant Information Please Print Lezibly AM �-� Otd , City/s k�s (M 95 Are you an employer?Check the appropriate box: T ofproject r 4. I am a Type (Ted): 1.❑ I am H employ er with ❑ general contractor and i G. New constzirctiou employees(full and/or part-time}.* have hired_the sub-contractws 2.❑ I am a sole propAetor 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- employes and.have Workers' q El Building addition [Nd ntorl�ers'Damp_mstuawce required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions I am a homebwner doing all.wodc officers have exercised their 11-❑Plumbing repairs or additions myself.[No worbers'comp- right of exemption per MGL 12.❑Roof repairs insurance e&]i c.152, §1C4k and we have no employees-[No workers' 13.❑Other comp-insuzzxz required-] .=y applied that checks boa#1 mast also fill out flee section below showing their workers'compensation policy information. Iiomoeoavners u1m submit this afEdavir indicating they ate doing alp waa}aced then hire outside connactors must subasit a new affidavit indicating such. FContractors that check this ban tmst attached as additional suet showing the name of the sub-ca ntration and state whether ormot$tose entities have emph yees..If the sub<onm c=have employees;they must provide their,workers'comp.policy number. I am an emptayer that is providing worker'co afon.insurance for my empJojves $elow is the policy and job site informati ri Insurance Company Name: Policy#or Self ins.Lic.4: Expiration Date: Job Site Address: City/statdzip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under SeCtiort 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or once-ytar imprisorment,as well as civil penalties in the form of a STOP WORK ORDER and a Iml e ofup to S250-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA fiw insurance ge verification. Ida hereby cRrti q e � an atties ofpedury�that the informatim prat Ard abo►�s is true and correct tine: - Dom_-----'-> (o f Z Phi-g wrA .2)C4 co t L19� . tJVWOt use only. Do not write in this area,to be compLeteyd by city or town official CYty or Town: PermitfLicease# Issuing Authority(circle one):: 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone# MASS. 1639. Town of Barnstable - `0� Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ' Office: 508-862-40 Fax: 508-790-6230' Property Owner Mu mplete and Sign Thi Section If Using 1� B r I, , a `weer of the subject property - hereby authorize A to act on ray behalf, in all matters relative to work authorized by b ' diu pernut application for: (Address/of J )r. f /�r Signature of Owner ." ` Date " Print Name If Property Owner is applying for permi please complete the Homeowners License Exem tion Form on the t : reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revised 051811 �IHE Town of Barnstable Regulatory Services MASS. Thomas F.Geiler,Director ` 1659. 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 �J Please Print DATE:_ G- 11--�� , JOB LOCATION: _ I old ' V I CO � A QQ kS number street village "HOMEOWNER": ��Lu M-k �G��S S Q3 Zy L- H i name home phone# work phone# CURRENT MAILING ADDRESS: cC A�-kQ CuS A ROV IZ 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 rsi ed eu' ents ertifies that he/she understands the Town of Barnstable Building Department minimum inspection proc dare r that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building-Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as:supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules'&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC Revised 051811