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I
t
-3 D /0 Q /a
F; r Town of Barnstable Permit# 3 I
p Expires 6 months from issue date
Regulatory Services Fee
• snxxszna[E
� M"39. Thomas F.Geiler,Director
t6 ��
ArfD Mp`l A
Building Division 00
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
Prop rty Address 4nz
Prop
Value of Work CA- Minimum fee of 35.00 for ork und
er der$6000.00
Owner's Name&Address e l/
Contractor's Name Telephone Numb YO 45-,
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's ompensation Insurance
Cho&one: t
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must accompany each permit. i ,/ ,
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)
Re-side
#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 copy of the H me Improvement Contractors License & Construction Supervisors License is
required.
SIGNATURE:
QAWPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 072110
L
.o�VErOwti Town of Barnstable
Regulatory Services
a r
NNIJA Ss.
Thomas F. Geiler,Director
019. " 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
Z , as Owner of the subject property
hereby authorize �� �t G�.-- to act on my behalf,
in altmatters relative to work authorized by this building permit application for:
(Address of job)
Signature of Owner ate
Print Name
If Property Owner is applying for permit please complete the Hom<eowflerS License
Exemption Form on th:e reverse side.
Town of Barnstable
Epp.(HE row
Regulatory Services
t Thomas F.Geiler,Director
saRNs-rwsrE.
M'' Building Division
$,,TFo sMat ate$
om Prry,Building Corrtnussioner .
2 Maien Street, Hyannis, MA 02601
RrWW.to-,n.barnstable.ma:us
Office: S08-862-4038 _ Fax: 5-08-790-6230
Home NER LICENSE EXEMPTION
)'lease Print
DATE:
JOB LOCATION:
number eet village
"HOMEOWNER":
name ho e phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current.exemption for"homeowners"was extended to incl de owner-o cu ied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does of posses a license,provided that the owner acts aS
supervisor.
DEFINTTION OF HO WN
Person(s) who owns a parcel of land on'which he/she resides or in nds to reside, on which there is,or is intended to-
be, a one or two-family dwelling,attached or detached structures ac e sory to such use and/or farm structures. A
person who constructs more than one home in a two-year period sha not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form accep . le to the Building Official, that he/she shall be
responsible for all such work performed under the buildingermit (�ection 109.1.1)
The undersigned"homeowner'assumes responsibility for com iance. ith the State Building Code and other
applicable codes, bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she unders nds the Town f Barnstable Building Department
minimum inspection procedures and requirements and the he/she will comp with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings conta' 'ng 35,000 cubic feet or larger will be r quired to comply with the
State Building Code Section 127.0 Construe 'on Control.
OMEOWNER'S EXEMPTION
The Code states that: "Any homeowner p• forming work for which a building permit is required shall be exempt from the provisions
of this section(Section lo9.1.1-Licensing of construction Supervisors);provided that if the homeowner engage a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption aic unaware that they arc assuming the responsibilitics of a su rvisor(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 responsibilitics,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilitics 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 fom>/certification for use in your community.
nw1 TTown ®f Barnstable *Permit#
Expires 66 nronths from issue date
" e Fee J
RA ABLF Regulatory Services
Y 1619. � Thomas F. Geiler, Director
plfD,"�YA Building Division
I"
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstab Ie.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
a Not Valid without Red X-Press Imprint
Map/parcel Number ✓
Prop t Address ( ��� Oc✓ �%� E=
Residential Value of Work Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address
tS
Contractor's Name Telephone Number f
Home Improvement Contractor License #(if applicable)
Construction Supervisor's License#(if applicable) X-PR E
❑Workman's Compensation Insurance JUL one: 2010
I am a sole proprietor
❑ I am the Homeowner TOWN OF BARNSTA8�,
❑ I have Worker's Compensation Insurance
Insurance Company Name ('� n
-Workman's Comp. Policy{l
Copy of Insurance Compliance Certificate must be on file.
Permit Request check box
Re-roof(stripping old shingles) All construction debris will be taken tobilk
(11—
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value (maximum .44)
*Where required:.Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc.
***Note: Property 0 ner must sign Property Owner Letter of Permission.
Home I ovetnent Contractors License& Construct Supervisors License is required.
SIGNATURE:
Q:\WPFILES\FORMS\Express\EXPRESSPERMIT.DOC
Revisc060,109
0
i
i
o Town of Barnstable
Regulatory Services
BARNsrAst..E. ' Thomas F. Geiler, Director
MAM
06jq' Building Division
�fD µAS Q
Tom Perry, Building Commissioner
200 Main Street,Hyannis,MA 02601
www,town..barnstablexaa.us
Fax: 508-790-6230
Office: 508-862-4038
Property Owner Must
Complete and Sign This Section.,
if Using A Builder
as Owner of the subject property
hereby authorize P0 w1 to act on my behalf)
in all matters relative to work authorized by this building permit application for:.
(Address of Job)
3� �r 0 U
7nature of Owner Date
o s ems-
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on th.e..reverse side.
Town of Barnstable -
YHFTp�O
Regulatory Services
i Thomas F. Geiler.,Director
• BArtNSrABLE,
Building Division
s639• ��
pIFDy a Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
wtyw.town.barnstable.ma.us
Fax 508-790-6230
Office: 508-862-4038 ,
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: village
number street
"HOM EOY(NER": work phone ll
name home phone 4
CURRENT MAILING ADDRESS:
city/town
state zip code
The current exemption for``homeowners"was ex tided to Inc] de owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for h e,who„do s not possess a license;provided that the owner acts as
supervisor.
DEFINITT 0 HOMEOWNER
Persons)who owns a parceln of land o which he/she si es or intends to reside, on which there is, Or is intended to
be,a one or two-family dwelling, attached or detached ctures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-y eriod shall not be considered a homeowner, Such
-homeowner"shall submit to the Building Official,o a fo acceptable to the Building Official,that be/she shall be
responsible,for all such work erformed under the b ildin ermit. (Section 109.1.1)
The undersigned "homeowner"assumes respons ility for com liance with the State Building Code and other
applicable codes,bylaws;rules and regulations
The undersigned "homeowner"certifies that e/she understands th Town of Barnstable Building Department
minimum inspection procedures and requir ments and that he/she 1 comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building OfEcial
Note; Three-farm dwellings containing 35,000 cubic feet or larger wi be required to comply with the
State Building Code Sec ' n 12?.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code stat at: "Any homeowner performing work for which a building permit is rcqui shall be exempt from the provisions
of this section(Section 9.1.1 -.Licensing of construction Supervisors);provided that if the homeowner a -ages a persons)for hire to do such
work,that such Nom wncr shall act as supervisor.:'
Many meowners who use this exemption are unaware that they arc assuming the responsibilities aa supervisor(see Appendix particularly
Rules&Regulations for Licensing Construcdon Supervisors,Section 2.15) This lack of awareness often resuhs' serious problcins, enscd
when the homeowner hires unlicensed persons, In this case,our Board cannot proceed against the unlicensed pc- n 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 responsibilitics,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. Oa 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.
n\wPTm F.C\FnRMS\homccxcmvt.DOC
oF� r Town of Barnstable *Permit#
Expires 6 mon s fr is ate
' Regulatory Services Fee
' HARNSTABLE,
�$ 163 �m� Thomas F. Geiler,Director
•oTED MA't�
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,NIA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6M
"EXPRESS PERMIT APPLICATION - RESIDENTIAL-ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address Add i/C/Y I.
�
residential Value of Work R? Minimum fee of S 5.00 for work under S6000.00
Owner's Name& Address / �— Z�41, � t
s
Contractor's Name � 4/A___. Telephone Numb r
Home Improvement Contractor License# (if applicable)
Construction Supervisor's License# (if applicable) 1
❑Workman's Compensation Insurance m�
PERM
Check one:
❑ I am a sole proprietor
❑ .,Pam the Homeowner Q� �A�N�-jA���
y[]'I have Worker's Co nsation Insurance
�----_ 'OWN
Insurance Company Name
Workman's Comp.Policy# e
Copy of Insurance Compliance ertificate must accompany each permit.
Permit Request(check box)
PP❑
Re-roof(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ side
# of doors
Replacement Windows/doors/sliders. U-Value (maximum .44)#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 copy of the Ho e Improvement Contractors License& Construction Supervisors License is,
required.
SIGNATURE:
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 090809
t
o�T�,Fr Town of Barnstable
Regulatory Services
BARN5rABUE, - -Thomas F. Geiler, Director
MASS_ $
`b .0_19- Building D1v1s10i1
RFD MDi b
Tom Perry, Building Commissioner
200 Main Street;Hyannis,MA 02601
www.town..barnstable.ma.us
Fax: 508-790-6230
Office: 508-862-4038
Property Owner Must
Complete and Sign This Section
if Using A Builder
r
as Owner of the subject property
to act on my behalf)
hereby authorize r, CL�^
in all matters relative to -work authorized by this building permit application for:
(Address of Job)
0
Signature of Owner Date
Print Name
If Pro e Owner is applying for permit please complete the
Homeowners License Exemption Form on tbe.reverse side.
Town of Barnstable
o
Regulatory Services
Thomas F. Geiler,Director
' 1ARNSTABLE,
s
Building Division
Aj�O Mpg n Tom Perry,Building Commissioner
200 Main Street, Hyaruiis,MA 02601
ww-yv.t own.barns tab]e.ma.us
-� Fax: 508-790-6230
.Office: 508-862-4038 ,
HOMEOWNER LICENSE EX 1MPTION
Please Print
DATE:
JOB LOCATION: village
number street
"HOMEOWNER".: work phone 4
name home pho e 4
CURRENT MAILING ADDRESS:
city/town
state zip code
The current exemption.for"homeowners"was tende to in owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual fo hire ho does not possess a license, that the owner acts as
provided
supervisor.
DEFINI N OF HOMEOWNER
Person(s)who owns a parcel of land on which he/s e.resides or intends to reside, on which there is or is intended to
be,a one or two-family dwelling, attached Or deta. d structures accessory to such use and/or farm structures. A
person who constructs more than one home in a o- ear period shall not be considered a homeowner, Such
"homeowner"shall submit to the Building Off al on form acceptable to the Building Official,that he/she shall be
res onsible for all such work erformed under e buil in ermit. (Section 109.1.1)
The undersigned "homeowner"assumes res risibility fo compliance with the State Building Code and other
applicable codes,bylaws,rules and regulat' ns.
The undersigned "homeowner"certifies at he/she.understa ds the Town of Barnstable Building Department
minimum inspection procedures and re, irements and that he he,will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-famil dwellings containing 35,000 cubic feet or lar er will be required to comply with the
State Building Code Secti 127.0. Construction Control.
HOMEOWNER'S EXEMPTION
The Code states t: "Any homeowner performing work for which a building permit t required shall be exempt from the provisions
of this section(Section 10 . .1 -Licensing of construction Supervisors);provided that if the home o er engages a persons)for hire to do such
work,that such Homco cr shall act as supervisor."
Many hoin wners who use this exemption are unaware that they are assumng the respons��ilities of a supervisor(see Appendix ar
Rules&Regulatio for Licensing Construction Supervisors,Section 2.15) This lack of awareness often esuhs in serious problems,part cully
when the homeoVncr hires unlicensed persons, in this case,our Board cannot proceed against the unlicen 'd 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 responsibilitics,many communes require,ab part of.the permit application,
that the homeowner certify that he/she understands the rrsporisibiIitics 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.
n\wvz'n F.C\FnRM:S\homccxcmot.DOC
OFT
Town of Barns
table
yQ -Regulator *Permit�OV t
pA i6 `0� Y erviCeS FxPires 6
Fee °from
rFo a Thomas F. Geiler,Director �
s
'Building
Tom Perry, D1ViSlOn
Y�CBO, Buildin
200 Mai Street,Hyannis,
Commissioner
Office.' S08-SFZ-4038 MA 02601
www•town.barnstable.ma,us
EXPRESS PERMIT _ 00,
APPLICATION
r/lap�P el Numbe, . 'z- Not l�alid without Red X Press SIDENTIAL ONLY Fax: 508-790-E
In rint
prop Address t� `l
Residential Value off
Work
Dzer's Name&AddressMinimum fee Of
$25.00 for work
under$6000.00
Con.tz-actor's Name
e Im rove � �
Horn P rnent Contractor License#(if a Tele
Pplicable) � � Phone Number �
Constrnction Supervisor's License#
if applicable)
❑WcV 'rkrnan's ompensation Insurance
Che one:
I am a sole proprietor I
m
am the Hoeowner
I have Worker's Com OCT - 9 2009
sation Insurance
Insurance Company Name
TOWN OF BARNSTASLE
Workman's Comp. Policy## B
Copy of Insurance Compliance (•�
Certificate must accom
permit Request(check box) panY each pert
❑ Re-roof(strippin
❑Re-roof gold shingles) All construction debris will be
(not stripping Going over taken to
❑ R side existing layers of roof)
Replacement Windows/doors/sliders. LT-Value
*Where required; Issuance of �1 (maximum
��� �s Permit does notexempt com ,44)#Of Adoors—
Note: compliance with other town de o WS� —
Property Owner department re
A copy Of the must sign Proper gulations,i.e.Historic,Conservation,etc.
required. A e Improvement O ntractors Licen er Of Per Df ermrssion.
SIGNATURE: se&.Construction Supervisors License is
FILESTORMS\buildin
Q:\WP gpennit fo�s\EXP
Revised 090809 REss.doc
"A
�1HETow Town of Barnstable
Regulatory Services
saiwsm e. Thomas F. Geiler,Director
1639.
�► � Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, Fa&"5- vase[[s , as Owner of the subject property
hereby authorize /�6 - �/�c� to act on my behalf,
in all matters relative to work authorized by this building permit application for.
led
(Address of Job)
Able Lo 4�
Signature of Owner D to
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FO RM S:0 WN ERP ERMIS SION
ofz►,E r�
Town of Barnstable
Regulatory Services `
r +
BARNSTAB Thomas F. Geiler,Director
MASS.
16 Building Division
A�fD►AA,I A
Tom Perry,Building Commissi ner
200 Main Street, Hyannis,MA 0 601
.town.barnstable.ma. s
Office: 508-862-4038 Fax: 508-790-6230
HOMEO R LICENSE EXEMPTION
lease Print
DATE:
JOB LOCATION:
number stre village
"HOMEOWNER": I
name home oneJ# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to clu e owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire wh does n t possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOME WNER
Person(s)who owns a parcel of land on which he/she r sides or int ds to reside,on which there is,or is intended to
be, a one or two-family dwelling,attached or detache structures ac essory to such use and/or farm structures. A
person who constructs more than one home in a two ear period shal not be considered a homeowner. Such
"homeowner"shall submit to the Building Official n a form accepta le to the Building Official, that he/she shall be
responsible for all such work erformed under the uildin permit. (S ction 109.1.1)
The undersigned"homeowner"assumes respon bility for compliance ith the State Building Code and other
applicable codes,bylaws,rules and regulatio
The undersigned"homeowner"certifies tha e/she understands the Town of Barnstable Building Department
minimum inspection procedures and requ' ments and that he/she will com ly with said procedures and
requirements.
Signature of Homeowner
g
Approval of Building Official
Note: Three-family wellings containing 35,000 cubic feet or larger 1 be required to comply with the
State Building Code Sectio 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states t t: "Any homeowner performing work for which a building permit is r uired shall be exempt from the provisions
of this section(Section 10 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 ofte results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlice sed 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 req 're,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page oflthis 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\bomeexempt.DOC
3Y#dz
OfIKEr, Town of Barnstable *Permit#
Expires 6(nonihs from issue(late
3 IARNSTABr_E,
r Regulatory Services FlJ , a--�
M $ Thomas F. Geiler, Director
�,F°►^��aRess P wilding Division
AUG Z 8 Tom Perry, CBO, Building Commissioner 44—.
Z009 200 Main Street, Hyannis, MA 02601
N OF 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 s
Prope ety Address4
Residential Value of Work (Minimum Fee of$25.00 for work under$6000.00
Owner's Name&Address fL� l
l�-
Contractor's Name (/1 - Telephone Number
Home Improvement Contractor License 9 (if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's ompensation Insurance
ICh one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compepsf tion Insurance
Insurance Company Name /
Workman's Comp. Policy# A
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 room
(R'e-side �2� Fly St` �TdZr�l jI. � �-C+
❑ Replacement Windows. U-Value (maximum .44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations, i.e. Historic,Conservation,etc.
***Note: 1114Property Ow r must sign Property Owner Letter of Permission,
Horr�.Impr Contractors License& Construct Supervisors License is required.
SIGNATURE:
Q:\WPFILES\FORMS\Express\EXPRESSPERMIT. OC
YKEt, ti Town of Barnstable
Regulatory Services
w a
M_&%M Thomas F. Geiler,Director
Building Division
m
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601 .
www.town_barnstable.ma.us
Office: 508-862-4039 Fax: 508-790-62
Property Owner Must
Complete and Sign This Section
If Using A Builder
ais t C6 kC C., as Owner of the subject property
hereby authorize Aeoef yew- to act on my behalf,
in all matters relative to work authorized by this building permit application for:
C-29 r 0 a-P-0 '4
(Address of fob)
ignature of Owner Date
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Town of BarAstable
�YtaE r�
ti
Regulatory ervzces
t t Thomas F. Geiler. Director
• s�xt�tsrA.at.e.
t Building ]Di�visiou
PrFD a Tom Perry,Building/Commissioner
o .. ... - 200 Main Sorer Hyamiis,MA 02601
wwtw.tow n.barnstable-ma.us
Office: 509-862-4039 Fax: 508-790-6230
Hol%1:EOVNER LI sF EXEMPTION
Plea e Print
DATE:
JOB LOCATION:
number ;trcet village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The ctnrent exemption for"homeowners" exten d to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individ 1 for hire v o does not possess a ticcnse,provided that the owner acts as
supervisor.
nEF9,TMDN O HOMEOWNER
Persons)who owns a parcel of land o which he/she resid or intends to reside, on which there is, or is intended to-
be, a one or two-family dwelling, atta ed or detached struc es accessory to such use and/or farm structures. A
person who constructs more than on home in a two-year pen d shall not be considered a homeowner. Such
"homeowner" shall submit to the B 'ding Official on a form a ceptable to the Building Official,that he/she shall be
responsible for all such work erf under the buildin e 't. (Section 109.1.1)
The undersigned"homeowner" sumes responsibility for compli cc with the State Building Code and other
applicable codes, bylaws,rule and regulations.
The undersigned."homeo r"certifies that-he/she understands the To of$arnstable,Building Department
rrnn;rnum inspection pros ures and requirements and that he/she will c mply with said procedures and
requirements.
Signatim of Homeowner
Approval of Building cial
Note: cc-family dwellings containing 35,000 cubic feet or larger be required to comply with the
State Building :ode Section 127.0 Construction Control.
HOMMOWNER'S EXEMPTION
The Code states that: "Any homeowocr performing work for which a building permit is requ' shall be exempt from the provisions
of this section(Section 109.1.1 -Licarsing of construction Supervisors);provided that if the homeowner m cs 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 arc assuming the responsibilities of avisor(sce Appendix Q,
Rules&Regulations for Ucetuing Construction Supervisors,Section 2.15) This lack of awareness often results in 'ous problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person' it would with a licensed
en
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilitics,many communities require,as part of the permit application,
that the homeowner certify thkt he/she understands the respombilitirs of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may can t amend and adopt such a fon cartification.for.use in your community.
r
0 k // C L
T Town of Barnstable *Permit#,O�67 / 7/L
Expires 6 months from issue date
Regulatory Services Fee s- c9--10)
AS& 1�� Thomas F.Geiler,Director
` Building Division
Tom Perry,CBO, Building Commissioner PERMIT
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us Fax: S�if�1n1
Office: 508-862-4038 Y996;39006
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONTIMN OF BARNSTABLE
�g Not Valid without:Red X-Press Imprint
Map/parcel Number
a
YResidential
Address
Value of Work Minimum fee of$25.00 for wo nder$6000.00
"M/l/m �'�e�—h
Owner's Name&Address
/7 Arj-"�W,— �/660L 41V
Contractor's Name Telephone Numb e
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
---�o
❑Workman's ompensation Insurance
Chp6k one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensati n Insurance
Insurz:ice Company Name /WAIA /
Workman's Comp.Policy# M 9 ?1 — /( ?) � —
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)
de si;/Replacement
Windows. U-Value .Z0(maximum.44)
17106
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Noperty Owner must sign Properw Owner Letter of Permission.
ome Improvement ntractor icense is required.
SIGNATURE: (�/�/
Q:Forms:expmtrg tom- \% I� I�- s--
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Revise071405 6 u � .��
P
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Yet v-v-,.oP4✓f'
ob- 362-
r Assessor's map and lot number _
SYSTEM MUST b� _
THE Toy
................�.".. ........... ....:... SEPTIC S
Sewage Permit number INSTALLED IN COMPLIAN
House number .:Z. 14/tom.......:................ WITH TITLE 5 Z BABNAB
ASTa LE.
ENVIRONMENTAL CODE A a, 163q. 0�
WN REGULATICNS �o�ava`
TOWN OF BARNS
ABLE
BUILDING INSPECTOR
APPLICATION. FOR' PERMIT TO .......Du.:. ........I...4AR.. .................... ........................::.........................
TYPE OF' CONSTRUCTION ........F. e�v.. 4.................:........................................................................................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ! .. .!a ..........!..c�................ ................
ProposedUse ..... .t.!?s�.. .ca........F..A.N..... . ..........................................................................................................................
Zoning District .... .. . ......................................................Fire District ...............................................
...........
Name of Owner ....G-X'r--SA.....C...... ....:..........Address ,.,. .rY.cAS........ q......1.4.cjxvi.......IKX..U.Z
Name of Builder ....... .^^.`4...........................................Address e'
......................................................:.............................
Name of Architect .....T,.m. ....... .......................Address ...... t.. .......tm ......laex�...v..%.r.n0q.LC......
Number of Rooms ......1.3........................................................Foundation ..CoP.rt. ¢.r�t.�, .......................:........................
Exterior ........C.I..� G r,
....�. ..........................................................Roofing ..........a......(�.......5.1,;.rc�.1..,.................................•.....
i
Floors ..... ......C AA.e-s..)............................Interior .................................................................................... i
Heating
. .....: f�.............................Plumbing ...... ...............................
i
a
Fireplace ... ............................................................................Approximate. Cost ..1. .Q.,..a.o.. ...................................... .
Definitive Plan Approved by Planning Board _11I�__________________19 �__. Area �.l...1� ....5. ............
Diagram of Lot and Building with Dimensions Fee
SUB ECT TO APPROVAL OF BOARD OF HEALTH
A1s •_ � s
kv
VX
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. n
Name ...... tYt/Y...V ....................
Construction Supervisor's License
JOHNSON, GARY C.
%I AL No 28720 ' Permit for .... Two Story
................. ................................
...Single...Fam.i.1y. ...Dwelling. e 1.1.i.n g.............................. . .... . ...... . . ....
281 Oakmont Road
Location .................................................................
.................... �A a
Gary C. Johnson
Owner ..................................................................
Type of Construction ...Frame
.......................................
................................................. ..............................
Plot ............................ Lot ....................
Permit Granted December 2, 85
........................................19
......19 4Date'of,Inspection
Date Completed ..�i20077:!jyO...I......19
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LOCATION
SCALE DATE
PLAN REFERENCE ARIWCr. .AP.?—:. .. .
v E. N . . . . . . . . . . . . . . . . . . .
E
�. No. 26100 tee; I CERTIFY THAT THE
`E 1p ISTE``� es' SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
t L s`y AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
WHEN CONSTRUCTED.
DATE ipBS
REGISTERED LAND SURVER