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`Y Town of Barnstable *Permit# �qo)
"�i months from issue date
Building Depar r , f._ 1
&UMSTmLE, : Brian Florence,C"I
v� 1659. � Building Commissioner NOV I j 201i
RFD MAMA 200 Main Street,Hyannis,MA 02601 N
www.town.bamstable.ma.ft�p
Office: 508-862-4038 ! �! Fax: 508-790-6230
EXPRESS PEFMT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address V .T M I�}
Residential Value of Work$ i Sbo .oo Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address 9xb i CQ_ '" W
4NQ• 5)9
Contractor's Name ?Awo, Telephone Number _�;Vi:
Home Improvement Contractor License#(if applicable) Email:P_AQ: i ►Lyo o hAAAa„I-csy�
Construction Supervisor's License#(if applicable) u 1.l
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name llyl
Workman's Comp.Policy#��j
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)
❑ Re-side
Replacement Windows/doors/sliders.U-Value t�;b o (maximum.32)#of windows 11—
#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
require .
SIGNATURE: P711
D�
Q MPFILESTORMSTMESS2017 �Q
�VVEE Town of Barnstable
Building Department Services
• '" KAS& • Brian Florence,CBO
16"5R`� Building Commissioner
200 Main Street,Hyannis;MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-700-6230
Property Owner Must
Complete and Sign This Section -
If Usiriz A Builder
as Owner of the subject property
hereby authorize C--�6 to act on my behalf
in all matters relative to work authorized by this building permit application for.
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
ections are performed and accepted.
ignature f Owner %nature o Applicant
Print Name Print Name
)114g
Date
Q:FORMS:OWNERPERMISSIONPOOLS
Rev:09/16/17
Town of Barnstable-
Building Department Services
Brian Florence,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
MMOTAIM
• www.town.barnstable.maus
Office: 508-862-403 8 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
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 wliich`there ii,or is intended to be,a one or3two-
fa>aily dwelling,attached or detached sauctuaes 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 lie 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
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.
Q.\WPFILES\FORMS\building permit fotms\EXPRESS.doc
08/16/17
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