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*Perm
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— --�Cowri of-Barnstable it .�� -
Erpires 6 mot lss from issue dale
J Regulatory Services . Fee ,
* BARN
.P MASS. jj : I
GU�J�' Thomas F. Geiler, Director
PER
�Arfb MP�It``� 7 -
.®� Building Division
ly OF 8ARIVS Tom Perry,CBO, Building Commissioner
TABLE 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,,3.5 Q e0k
Property Address
i4Residcntial . Value of Work _ Minimum fee of$25.00 for work wider$6000.00 _
O\vne-'s Narne & Address
Contractor's Name .._._._ r{J l _Q� . _Telephone Number_
I lome Improvement Contractor License#(if applicable)- 11'tl f�-7 — ---
Construction Supervisor's License #(if applicable) GS / <"q
❑Worl�man's Compensation Insurance
Check one:
❑ I am a sole proprietor .
❑ I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp. Policy#�� ��'jjak 7'A
Copy of Insurance Compliance Certificate must be on file-.
Permit Request (check box)
11/Ze-roof(stripping old shingles) All construction debris will be taken to �l/,2,,��
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/coors/sliders. 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 Contr ictors.License is required.
SIGNATURE:
Q:'WPFIt.C-:S`.FORMS,,huilding permit forms\EXPRESS.doc
Revised 100608
SHETa,� Town of Barnstable
Regulatory Services
ELARy ' i E� Thomas F. Geiler,Director
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, "Z- e�;"'?V 5 ' , as Owner of the subject property
hereby authorize �JL/ - B,� to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Ass of job)
wf ,,,� o��► c
Signature of Owner Da
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
n•Cn DA l C.niUMV D PC 14 TQQ1n1J
ray
Town of Barnstable
�O f z
Regulatory Services
RA srA"B Thomas F. Geiler,Director
A►ss.
'� M
, t639. Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
vcrww.town.barnstable.ma.us
//"
Office: 508-862-4038 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village -
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/to state zip code
The current exemption for"homeowners"w extended to include owne occn ied dwellings of six units or less and
to allow homeowners to engage an individual r hire who does not po ess a license,provided that the owner acts as-
supervisor.
DE ITION OF HOMED ER
Person(s)who owns a parcel of land on which he he resides or int nds Eo reside, on which there is, or is intended to
be, a one or two-family dwelling, attached or deta ed structures ccessory to such use and/or farm structures. A
person who constructs more than one home in a tw ``year perio shall not be considered a homeowner. Such*
"homeowner"shall submit to the Building Official o4�a'form cceptable to the Building Official,that he/she shall be
res onsible for all such work erformed under the b din rmit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned."homeowner"certifies that he/she u der ds the Town of Barnstable Building Department
minimum inspection procedures and requirements d that e/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings c ntaining 35,000 cubic feet o larger will be required to comply with the
State Building Code Section 127.0 Cons ction Control.
/ HOMEOWNER'S EXEMPTION
The Code states that: "Any homeo}4a performing work for which a building p it is required shall.be-exempt from the provisions
of this section(Section 109.I.1-Licensing o/construction Supervisors);provided that if the h eowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this cmption are unaware that they are assuming the res onsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Cons ction Supervisors,Section 2.15) This lack of awarenes often results in serious.problems,particularly
when the homeowner hires unlicensed Td
ons. In this case,our Board cannot proceed against the u licensed person as it would with a licensed
Supervisor. The homeowner acting aservisor is ultimately responsible.
To ensure that the homcows fully aware of his/her responsibilities,many communities quire,as part of the permit application,
that the homeowner certify that he/sheerstands the responsibilities of a Supervisor. On the last page f this issue.is a form currently used by
severaf towns. You may care t amend' adopt such a form/certification.for use in your community.
Q:forms:homeexempt