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Town of Barnstable *Permit# Yoot THE Ibis,
(7 1
�'p Ex�o�res 6 months from issue date
sip Building Department Fee
KIRNSTABL,* Brian Florence,CBOC61 3
Buildin Commissioner,s� +, epr r0,,A 200 Main Street,Hyannis,MA 02)60 f u� 1�
www.town.barnstable.ma.us NOV 2120�7
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
�'\o \ I Not Valid without Red X-Press Imprint
Map/parcel Number b
Property Address (347 /1%ez-wcc.Y /1)2iosTA-gar /u-4 02630
Residential Value of Work$ /DCX). CPC-) Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address 14, iS 7sbv 71E 4(0 u r;- 11-L-v w�
W4-
02-630
Contractor's Name - Telephone Number 779 2—Q�3 .33e37
Home Improvement Contractor License#(if applicable) AJ Email:
Construction Supervisor's License#(if applicable) A-Ai.
['Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
• I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name PA
Workman's Comp.Policy# A1/4
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
y Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors:
*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:
1'
Q:\WPFILES\FORIvIS\EXPRESS2017
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oFTHE To, •
, Building Department
;• � / ,,*,r % Brian Florence CBO ,
• Building Commissioner
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v MA9a $ 200 Main Street, Hyannis,MA 02601
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• Ar&D, Ptb. www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION•
Please Print
DATE: Z i /�®1/ 2-0 f
JOB LOCATION: g'( a- �"l-n,j 4'4IC-'i'
number street village
"HOMEOWNER": C-/9IZ ISP 1/ 5�{y .-' - �7/ ..O 9 sr cc??
name home phone# work phone#
•
CURRENT MAILING ADDRESS: dd( d-1--'i-Z-4i�
• s.7/1Pu6 61-la
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor. •
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
•
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control. •
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required
shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);
provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act
as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of
. a supervisor(see Appendix Q,Rules&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 to amend
and adopt such a form/certification for use in your community.
,,o*THE rqi Town of Barnstable .
1 �.► 9. Building Department
.
BARNSTABLE. ` Brian Florence,CBO
\D Mass.
k��� Building Commissioner
ot
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
•
•
Property Owner Must
Co E lete and Sign This Section
•
If Using A Builder
I, ,as Owner of the subject property
•
hereby authorize to act on my behalf,
in all matters relative to work authorized b this b ding permit application for:
• (Address of Jo•1
**Pool fences and alarms are the res.ors bility of the applicant. Pools
are not to be filled or utilized be'ore fen e is installed and all final
inspections are performed and :ccepted.
Signature of Owner Signature o •pplicant
•
Print Name Print Name
Date
Q:FORMS:OWNERPERMISSIONPOOLS
Rev:10/17 •