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HomeMy WebLinkAbout0536 SHOOTFLYING HILL RD �, z �!'�ooX- �! �r� ill `�� �� y ,. o o _ „ i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. , Ma �. Z V:�� c p Parcel Application # 0 t r Health Division 2:a - L 6�l - , Date Issued Conservation Division F ;Application F Planning Dept. Permit Fee l 7 Date Definitive Plan Approved by Planning Board Historic = OKH Preservation/ Hyannis Project Street Address cfs' Village Owner �"�us e / �"aa-� �31• Rr�►. �s ddress - At a/K y ri A Telephone .5_aef—d 4,%'(00(9 (v Permit Re nest "r�1(�L L� �4P�y1� �v psi �' /c"✓Sw/ r ve.K Ors �alr�l�i) `'' � ® (' . .,,� ;�L Bu'�" ��� Square feet: 1 st floor: existing '✓ proposed _2nd floor: existing proposed Total new Zoning District' Flood Plain Groundwater:Overlay Project Valuation Jr,X Construction Type l Lot Size / T r ±5.�'• Grandfathered: t es ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure &O /s Historic House: ❑Yes da"'No On Old King's Highway: ❑Yes ilo Basement Type: ❑ Full Crawl ❑Walkout O,Other -54 on r—,oA t./-e4 D),W&-5Cn _ Basement Finished Area(sq.ft.) n /A Basement Unfinished Area (sq.ft) , Number of Baths: Full: existing__ new _ Half: existing new N =: Number of Bedrooms: _ 3 existing=new "� 0 Total Room Count (not including baths): existing new First FloorifRoo Counter�e Heat Type and Fuel: 3/Gas ❑ Oil ❑ Electric C/Other&"s� . � s� lel� -< w co yyPf�,, Central Air: ❑Yes ©'No Fireplaces: Existing 1L_New a-o Existing wood/c al stove: 6r' '6s ❑ No VA aA* A X Detached garage: ❑existing 0 new size_ ool: ❑existing ❑ new size _ Barn: ❑existing ❑ new size_ A IPAttached garage: ❑ existing ❑ new size _Shed: 2/existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # P I A Recorded ❑ Commercial ❑Yes UA No If yes, site plan review# Current Use Proposed Use APPLICANT-INFORMATION (BUILDER OR HOMEOWNER)-,_\ L Dame I&V-4 Telephone Number ��'�� Address License# &uLy;Ile 1 Jud ; AAel ,Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE A DATE / /0 �t FOR OFFICIAL USE ONLY ` APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE a OWNER � 8 DATE OF INSPECTION: E FOUNDATION FRAME INSULATION CO.ql t!�67 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL . GAS: ROUGH FINAL k FINAL BUILDING { i t DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachitsetts. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 :Y www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): J- ct,� O :Ay Address: 530 S!r©off fl hV A'// le� City/State/Zip: (A,,/tw),Ile /1?R Phone.#: 6-10,0-j(0V-(00.S Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. .❑ I am a general contractor and I " employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction .2.❑ ,I am a sole pioprietor or partner listed on the'attached sheet. T. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers'"comp. insurance comp.insurance. 10,❑Electrical repairs or additions 3 drequired.] 5. ❑ We are a corporation and its 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.❑Other comp.insurance required.] "Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy infomnation. 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 subcontractors and state whether or not those.entities have employees. If the subcontractors 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 Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration 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 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 certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: V o)!`v Official use only. Do not,write in this area,to be completed 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 '6.Other. Contact Person: : Phone#: v 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 bean 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 permittlicense 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 nolicy 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 may be provided to the applicant as proof that a valid affidavit is on file for futurepermits or licenses. A-new affidaviflriusfbe 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 bum leaves etc.)said persona is NOT required,to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should y�-Dave any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachuset is Department of Industrial Accidents Office of Investigation 600 Washington Street Boston,NIA 02111 Tel.# 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-774 Revised 11-22-06 www.mass.gov/dia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: �oQ� f�- 7 Site Address:, j'3� So„� y print Town: Applicant Phone: ''-ef-d `/—lP oB� Applicant Signature: Date of Application:_ NEW CONSTRUCT ON. choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE-AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Basement Slab ❑ Option 1: Fenestration exposed Wall Floor Perimeter Wall AFUE HSPF SEER U-factor floors R-Value R-Value R-Value R-Value R-Value and Depth National Appliance Energy 35 R-3 8 R-19 R-19 R-10 R-10, Conservation Act(NAECA)of 4 ft. 1987 as amended,minimums or greater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: 4 REScheck Version 4.1.2 or later variant software analysis must be completed - . (780 CMR 6107.3.2) REScheck--Web which can be accessed at http://www.ener� cy odes.gov/rescheek/ ADDITIONS,OR ALTERATIONS TO EXISTING BUILDINGS OVER:5 YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above: Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b-a) SF 100 x — _ % of glazing (b) Glazing area equals SF b a If glazing is<'40%.use the chart below.. If glazing is> 40.% proceed to"SUNROOM" section 780-CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling and Slab Perimeter Fenestration Wall Floor Basement Wall Exposed floors R-Value . U-factor R-Value R-Value R-value R-Value and Depth, .39 R-3 7 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may.be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls,and including any access openings). ' SUNROOM—An addition or alteration to an existing building/dwelling unit where the total ❑ o glazing area of said addition exceeds 40/o of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form(found in Appendix 120.P) r Town of Barnstable �0p THE rpky Regulatory Services Thomas F. Geiler,Director sAnNsrnmy, Mass. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 v ww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEN1 PTJON a Please Print DATE: JOB LOCATION: S� �J/ C��Af number street village ems "HOMEOWNER'': �OGi.L /Q���►MrF- � fi' 6 �/�G�6�G SDI i�3 - yra/e' - 6� � name 17 home phone# work phone# CURRENT MAILING ADDRESS: city/to state zip code , The.current exemption for"homeowners"was extended to include ownerloccupied 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 two-year period shall not be considered a homeowner. Such person who constructs more than one home in a "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. S' ature 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, HOKEOWNER'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 iom,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 afro unaware that they are assuming the responsibilities of a superyisor(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}r/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several lawns. You may care t amend and adopt such a formlcer6fication for use in your community. °pTHE T�y Town of Bairnstable a °^ Regulatory S.e>rvzces anx ASS Thomas F. Geiler, Director 1.639.AIE0µA�b 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 j as Owner of the subject property hereby authorize to act on my behalf, in altrnatters relative to work authorized by this building permit application for: (Address of job) Signature of Owner Date Print Name If Property Owner is app- l lease complete the Homeoa ne s License Exemption Form on th" reverse side. ® ® ® Engineering& R05ERT M. DE5R051ER5, PE. Design Co., inc. Consulting Engineer 508-946-5561 155 East Grove Street • Fo5t Office Box 649 Fax 508-946-1653 Middleborough, MA 02346 August 26, 2009 Project No.2009-235 Ms. Joan Remmes-Foy 7 Malcolm Road Stoughton,MA 02072 Re: Inspection and Evaluation of Roof Framing at 536 Shootflying Hill Road, Centerville,MA Ms. Remmes-Foy: You asked me to inspect and evaluate the framing of the main roof of the referenced residence. I understand that you are in the process of renovating the home and that you have questions regarding the roof framing scheme. On Wednesday,August 26, 2009, 1 visited the site to conduct a walk-through inspection. The home is a small, single-story, cottage-style structure with a gable roof. The building measures approximately 18' deep by 55' long overall. It has been conventionally-framed utilizing ordinary dimensional lumber products. The original structure was built in the early 1950's and was expanded by the addition of an ell to each side later. The exterior walls consist of 2x4 stud assemblies with a mix of board and plywood sheathing. The walls have double 2x4 plates and shoes. The roof framing consists of 2x6 rafters at 24" on center,which meet at a lx8 board ridge. The center living area of the home is framed with a cathedral roof/ceiling assembly. The lateral forces on the roof are accommodated by a series of structural cross ties at the top of plate level. These ties consist of a double 2x6 box that is fastened to the exterior wall plate and an adjacent rafter. These have been treated as decorative elements and a vertical 2x4 post has been added from the center of the tie beam to the underside of the ridge. Additionally, Ix6 board collar ties have been installed at approximately 48"on center. In my view,these are not effective. You plan to insulate and sheetrock the roof/ceiling assembly and to maintain the cathedral look with the cross beams to remain. In my opinion,you may safely do so, provided that you reinforce some the roof connections to meet current Code requirements. I recommend that you reinforce the connection between the tie beams and the roof/wall assembly by installing two Timberlok lag screws each through the rafter immediately adjacent to the beam and up through the double 2x4 plate into the tie beam. I a I also recommend that you fasten each rafter end to the double 2x4 wall plate with Simpson H3 hurricane clips. Additionally, I recommend that you add a 2x4 rafter tie alongside each pair of rafters immediately below the ridge. These last two steps are to stiffen the roof system to meet the uplift and overturning forces associated with revised wind loads. You may safely remove the decorative vertical 2x4 element and the 1 x6 collar ties as part of this work. If reinforced as specified herein, and according to good construction practice,the roof framing will meet the structural requirements of the Massachusetts State Building Code, Seventh Edition. If you have any questions regarding this report, or if you require additional information,please do not hesitate to call. Very Truly Yours, jZN OF 4f4 Robert M.Desrosiers,P.E. RaBER R IERS m v Nu. 36770 ' STRUr*UpA,j e e p Engineering& Design Co., Inc. P.O. Box 649• Middleborough, MA 02346 508-946-3561 •Fax 508-946-1653 , BY DATE FILE SHEET _ 2(�-v9 z&t?-Z3s o�{ WLLI a SUBJECT t �_ ��iv/V► _V - ) F i AD ' 1 S _._ ...,. - _.._r ... ._.. _ f _ 1 i F f i f 3 , f-�- r 1 ' (T, , q P r ' i , i - , ro � T , , : , I , r i ) 1 : t r 4 , : : , f r 1 ' I �. 4 f !1 OF BERT M. 70 UCEURAI 4 . I7AL OFI E T Town of Barnstable *Peftfiit�P(�686 Expires 6 months from issue dale i Regulatory Services Fee i R i BARNSTABLE, fDSS.��`�� Thomas F. Geiler, Director Qi` � 109 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 Not Valid without Red X-Press Imprint Map/parcel Number Property Address —, �aj� S�� r�jlh^j �� / ref - ✓(//�� f� [.Residential Value of Work g�0 0 Minimum fee of$25.00 for work under$6000.00 T Owner's Name& Add ess J00--'t U� Contractor's Name_ Telephone Number I tome Improvement Contractor License# (if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: PERMIT 1 am a sole proprietor X,o PRESS 01 am the Homeowner ❑ 1 have Worker's Compensation Insurance FEB 2 7 2009 Insurance Company Name TOWN OF BARNSTABLE Workman's Comp. Policy#_ Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) [j/'Re-side [�Replacement Window do liders. U-Value_ (maximum .44) `Where required. Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATu11F: Q r'\h 11 111STOR. S\ wilding permit forms\EXPRESS.doc, Revised 10060 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): -J10GL,� — Address: �� s �y%Ir-l �// City/State/Zip: Phone.#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction ..2:0 I am a sole proprietor or partner-' listed on the attached sheet. 7. .❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'.-comp..insurance comp. insurance.$ _/equired] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.0 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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors 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. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration 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 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 certify under the pains-andpenalties ofperjury that the information provided above is true and correct. Signature: 41i:1 — Date: 4�/, _ Phone k /— o og 4 Official use only. Do not write in this area,to be completed 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 6.Other Contact Person: Phone#: Information and Insttuctions .. ' 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 _. oftheforegomg-engag inalomtenterpnse;a d-mi7u3m`g tfie — legarrepresen-tatiwe;zfyx"decmtased�mpk�erarthe- -:- 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 vMh 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 bum 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 ext 4Q6 or 1-977-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass_gov/dia i Town of Barnstable y�`P�Of THE Regulatory Services E t x�xNcr.rtr Thomas F. Geiler,Director Building Division �PffD�s Tom Pe .rry,Building Commissioner __. .. 200 Mairi:Street;Hyannis,Na 02601 _ ....._ ..... __ ._.. . www.town.barnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION l Please Print DATE: JOB LOCATION: 0491 number I street 1 / village "HOMEOWNER":-j'OGE-A 114. Mole�,LPf= Y SGI�dtoS�to�� name r�1 / hon-=phone # work phone# CURRENT MAILING ADDRESS: city/towot 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. DEFINMON 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 Barustable.Building Depar. nt minimum inspection procedures and requirements and that he/she will comply with said procedures and quirements. gnature of Roriieoimcr 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 hilt to do such work,that such Homeowner shall ad as supervisor." Many homeowners who use this exemption are unaware that they arc 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 fu1ly aware of his/her nsporimbi'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 fomr/certification.for use in your community. Q:forrrrs:homccxempt sTti Town of Barn-stable Regulatory Services • sAANsresM • MAs9. $, Thomas F.Geiler,Director 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 B uilde r as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. .(Address of Job) Signature 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 W NE RP ERM IS S IO N i �'THE r� Town of Barnstable *Permit ks Z 6. ti Expires 6 months from issue date Regulatory Services Fee BABNSTABIA Thomas F.Geiler,Director 94, %6 9. .0� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY yy ) Not Valid without Red X-Press Imprint Map/parcel Number 1 CI �LI Property Address 1 ev 6 4 � `/ L Residential Value of Work�f 3,coo Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name fl I Telephone Number�S Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor c�Iam the Homeowner ®PRESS PERMIT ❑ I have Worker's Compensation Insurance MAY 2 2 2008 Insurance Company Name TOWN Or BARNSTABLE workman's Comp.Policy# 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) [2/Re-side [2' Replacement Windows/doors/sliders.U-Valuewr (maximum. *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 is require �t/,�y 9s .' � Z� SIGNATURE: ��✓�C� ti .�—z�_ goal -40 Q:\WPFILES\FORMS\building permit formsEXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of IndustriafAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LehiblY- Name(Business/Qrganization/Individuan: Address: 53to City/State/Zip: A rx 2 I Phone.#: (�76 t) 6 l_7 F19 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet 7. El Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.-msuiance camp•insurance t required] 5. We are a corporation and its 10.[]Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised then 11.❑Plumbing repairs or additions.: myself[No workers' comp. right of exemption per MGL 12.FRoof repairs insurance required,]t C. 152, §1(4), and we have no employees. [No workers' 1311 Other comp.insurance required]. *Any applicant that chw3m box#1 must also HU out the section below showing their workcrs'compeziwAon 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. TCantractors 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 providb 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: Policy#or Self-ins.Lie.#: Expiration 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 crimiTal 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 certify under_the ' sand penalties of perjury that the information provided above is true and correct: Si �!a:4,e^"' - atur Data• — Phone#- Official use only. Do not write in this area,to be completed by city or town off slat City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r � 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 ovmore 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, §25g6)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,i.f necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certi.ficate(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/license applications in any given year,need only submit our,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 may be 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 fo any business or commercial venture (i.e. a dog license or permit to bum 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,tclephone-and fax number. :The C6mmonwealth of Massachm(<Us Dgwtment of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TO. # 617-727-4900 ext 4.06 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 . www,mass.gov/dia Town of Barnstable �pF1HE tti Regulatory Services � Y snxtvstetrt a Thomas F.Geiler,Director 9 MASS. 039. Building Division �TFD hM't A Tom Perry,Building Commissioner . 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION /r / Please Print DATE: JOB LOCATION: �3`� S t1lX7T lY)1�S l I t�1 �ocxe ` f YU1'�Z' number p street/ 6 village I "HOMEOWNER": CNt Q 2WlVw�f 111 �SO D) Z to wd (p name17 home phone# work phone# CURRENT MAILING ADDRESS: �'l�C1Cl Utn�► 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 buildingpermit. (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 require Signature of H meowner . .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 persons)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. °FtHErg,,� Town of Barnstable Regulatory Services. �sAxxMsAr.►si.E$ Thomas F. Geiler,Director $'0le019.rs�m 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 g If Using A Builder I I0 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: 53 (P shool,�ins Irl>� Qac� (Address of Job) S1zz��g . Signature of Owner Date 1 Q19_MYY\pS Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable *Permit# S �•s Erptres 6 nionW from Issue date Regulatory Services Fee �UnC�J1 s6¢r � Thomas F.Gefleri Director Building Division Tom Perry, Building Commissioner 200 Main Street,.Hyannis,MA 02601 X-P R E S S LXR7,.." Office: 508-8624038 x: 508-790-6230 JUN ! 7 2005 Fa EXPRESS PERMrr APPLICATION - RESIDENTS tAlM S -_ r q Not Valid without Red X-Press Imprint "- B'4 R �1`,7` Upiparcel Number 2 'roperty Address Residential Value of Work --(1O. ®y A✓0411nimum fee of•$25.00 for work under$6000.00 )Wner's Name&Address 70a..i m rl' • 3U� �•��/ate ��l�l-��-�'�i� ��7�o �ontractor_s_Name . Telephone Number ��_�� � �4?9,j C t// S—� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ am a sole proprietor Q/I=the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ©4e-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) [ Ile-side [/Replacement Windows. U Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other tows department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature /01 QForms: g Revise0630 4 Aft The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 °,M s�•�`� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatio d' 'd w 1- Address: 4d h �,�o� �S�r R11 404 �61 City/State/Zip: �,� rU> jet /�d�° Phone#" ��°��d& Y— 9 y Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ 1 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. $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition o workers' comp. insurance 5. ❑ We are a corporation and its equired.]am officers have exercised their 10.❑ Electrical repairs or additions 3. I a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.U1400f repairs , insurance required.] employees. [No workers' eq ] t 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. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration 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 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 certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Dater Phone# Official use only. Do not write in this area,to be completed 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 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 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-contractor(s)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 permittlicense 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 may be 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 bum 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 ext 406 or 17877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia I pFIKE,py, Town of]Barnstable *Permit#� 773) m'40 Expires 6 onths front issue date • Regulatory Services Fee #ZStoo * BAMSTABLE, ' r MASS. $ Thomas F.Geiler,Director s 39. �A 6 a ' Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 y Office: 508-862-4038 ^-PRESS Pry. Fax: 508-790-6230 N 1 O 2004 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONL Not Valid without Red X-Press Imprint Map/parcel Number 143 q TOWN OF BARNST;=;�: Property Pro a Address ,3-3�° �S40o�' W i /� 4044 or P ❑Residential Value of Work Owner's Name&Address jeadl 1ff`uMes '300, q!/aidu� Contractor's Name—. A /A Telephone Numbedsy�J Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: y ❑ I am a sole proprietor U4am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 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 �a ®S7y ❑Re-roof(not stripping. Going over existing layers of roof) [D/Re-side D-1Replacement 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 Improvement Contractors License is required. Signature 0 QTorms:ex trg Revise053003 �FTNE 11 Town of Barnstable *Permit# `yips Expire 6 months from issue date snxxs'rnstie, : Regulatory Services Fee 2 uv Q . Thomas F.Geiler,Director Op s65939 A�0 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRESS PERV7, Office: 508-862-4038 Fax: 508-790-6230 MAR 1 9 2003 EXPRESS PERMIT APPLICATION - RESIDMdiTtlU a)LY:�NSTASLE - Not Valid without Red X-Press Imprint Map/parcel Number ©c4 q Property Address �3� �//CG / jn. 74-11 OQ d ❑Residential Value of Work Owner's Name &Address .Tp a.11 /• 4emm 7-S 30d A�/la x-cf ,�L G07S1� a4 Al 1 0d 7' a Contractor's Name Telephone Numbe/ 3-2- /9 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ Larn a sole proprietor F-ZK,am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) / �e-roof(stripping old shingles) All construction debris will be taken to daow- � 44,F,11 ❑Re-roof(not stripping. Going over existing layers of roof) 0--R/e-side ❑ Replacement Windows. U-Value (maximum.44) [t-6ther(specify) �Imo.,'LA` l� Du�S *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. Signature C A d Q:Fomrs:ex trg Revised121901 The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 iffice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: o s/d0�I�y/��.� 77'`1 /0 ef—d• �Gii 'd%A number street village "HOMEOWNER j': eQi► �ZGy/l�1fS (J`­d 6 name / home phone# work phone# CURRENTMAILINGADDRESS: ��� 777q��Qec ci /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 B ainstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. IP afore 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 far 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 fnrTn currentiv used by several towns. You may care t amend and adoat such a form/certification for use in vour community. - _ ...:��n':ii'.-i'�.",Ys^e'.^�p�:x-•anxv^�v7m*lat.l��ew5.smrf:itv'v'-.':st�sisi�':n:.�r.•Y�_.�:'rsT.�cam-s,..:*_ex..::�. -�.W,'.Y.Yrv�au!yssa,.ro n;K'.-,r�in.:..._r__ar..,..c,...: .kv;�-:r..- .:;C�r,+;g,�^�va-...•��i..nk�:s..2 _ r...._...�sL.3:+.+w� ".._iW'tawu...o..r.r.:`r_:r'aas3l;t..r::esa+.•v'ls+�`=-2.:Ce5e'.'�?n`•..`S�:ergG+Ac:-#.7atCvvrs�c+:.�G�: s.�ssn..s;.:X.r'CG+sern i,�:.TM..:ttva<'..:.:- ��+ �f,- � .• _ c'��sua!f6r:.was•�t:a,a�at�cYaawu,::;ac.?�i+itn�cr.>se..nvr.Awms,•?.�ww� �T A. • 3 ��� ? �y�0��� I A i yY� � • j 40 I 3 r, 1 cJ V i e,.:F,...�,�..,�.�.:�.�.»,�:.�,<.�M-�-,:a;...b�:,�.�.�->�•;.-�...�....���,:�_,ate—._=c.�.;�..�.,..�..,1: .�.:r ,.�_�: �.� _... _�,,�.._x-:..< a..._M��..:..:�. ..�-.,,�:... ,_. _,..,. _ . � • - as