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Home My WebLink About0320 BEARSE'S WAY �2p QEH2sE i �tKE„oy Town of Barnstable *Permit 0:4� ►�-�,3��5 + E�ires 6 months from issue date Regulatory Services Fee BARNMASS. .� Mass. � Richard V.Scali,Director % k�- Building Division Paul Roma,Building Commissioner �► ,16 200 Main Street,Hyannis,MA 02601 �0 www.town.bamstable.ma.us Office: 508-862-4030 Fax: 508-790-6230 EXPRESSFERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ` Map/parcel Number 3 10 01 a Property Address �e.arSeS UJ0,y a on'l b Xo P-Rie'sidential Value of Work$ �O ►00O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �)In S 5 Q Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I sole proprietor En 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. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Q] Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side [^placement Windows/doors/sliders.U-Value 0, aq (maximum.32)#of windows #of doors: _ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance oft is 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 Improv ontractors License&Construction Supervisors License is required. ' SIGNATURE: (/� QAWPFILES\ ORMS\building permit forrr&'� RESS.doc 06/20/16 i 1 77m Comnromveakh qfMassadmseft Departiffgntcrfraih rfriadAccidaift fffike ofInivs6gations. 600 Washirl Eon Street Boston,MA 02111 fPrm-v-anas&govfdia War.lmrs' Compensation 7nsurauce davit BmilderslCaniractarsXlect icimm Plumbers Appltcan#Infurmafran Please Pant�e�tly Name Addr 6(9 �Fra(f L'L A\jey Cityf tatel v e I Phcno ua Are you an empbyer?:Check the appropriate bon Type of project(required}: I.❑ I am a employer with. 4 ❑I am a general contractor and I 6- ❑ �New cocFim employees(fish andfor partrtime�* have lured the sub-coatractors ,�y�� 2.El am a sole proprietor orpmtnr- listed on the attached sheet. 7. odeling. ship and have no employees . These sub-confractors hate S_ ❑Demolition woridng forme in any capacity. employees and hn a workers' IN4 wodmrs'comp.insurance, camp.imsuratx-I g-.❑B.ui1diag adxiifion 5_ ❑ We are a corparatian and its 10-❑Electrical repairs or a,drliteons d] officers have exercised their 3_�am a homeowner doing all work 11-❑Plumbing repairs or ada€itioms o workers riot of esemp6on per 1GIQ. myself - c.152,§l(4kandwehaveno 13_❑Roof repaizs i r�carranreieqIItEL'd.]t 13_❑Otfie[ employees-INN wodoers' cone_insurance require&] •AnyEMHczstfiatcberlsboa#lmnstalsafiIlrn�Ethesecfiaabciaa spar►d��theawodcers'c®pre�f,,,.pa&epiaFoemafio� I Uaereownem rho subm t this Ada«iv rating 6iey aS�m�elf�o�c and tfiea lam autsid�r nrc,,.��st SvTamit a nem aflida�t mdic ne sacTi fCaut<actMff t chffdr W box mast rftrh =additi— sheet dmwhsg the nameof the mb-cemdaacma and ststewhether ormaMnse eaddeshaRe employees.Ifibebnb-contacto shave anpployw-%t6eymusrpmuidethek!ranee&wmp.pGRU number- Jam an eeiploFer fltat is prn dual workers'compeatsadaan is nwaarce fbr my ourpkyees Betosv is titepaUcy road job sEte hzformahan. — InsurauceCompanyNatae: - Pffficy-,IkL or Self-im]Ur-- Ik iasI}ate: Job Site Address: city/Statezzip.- Attach a-copy of the warkwe compensationpolicg declaration page-(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.1572 can lead to the imposid=of criminal penalties of a fine up to SL.54a DO ar d for axle=year imprisonment:as we11 as civil penalties in Sre farm of a STOP WORK ORDER and a fine of up to 00 a dap a, ainst the violator_ Be ad<ised'did a copy of this zb&=mt mgy.be forwarded to the Office of Imvestegations off3te DIA for msurance ca yerifica#iom.: Jdo&r t-gby '! tzltdsr pains penalties afl7erjury that the uafortsw#ztrrtpm-i&dabm e is tn ct,u and corre $ivsaat**^R: Date 0V 16' Pbrtae ik a.OEdal uss early. Do rtat writs in fits area,to be campWad by City artown of idaL Croy or Town: Pernoitf-Icense;g IssuingAufi=4(dr&one): I.Board of Health :b.BwlXmg Department 3.f Ay{rmra Clerk 4 Elech ical Inspector 5.Phmbing inspector (.Other Contact Person Phone#: r J _ Information and Instructions 4 • 7 leaaTmcett5 Goal Laws chVEM 152 req=rz all=ployers to prUW&wow MMPMsafzon for ihenf HIIplOy=' p o this ,an arPlnyee Is Cla med as"_.evcxy pmrsan in the service of ancitier under any contract of hir$, esp}ress or implied,oral or wrifi m." Au employes is deimed as"an ind'iyirlual,parinexsh�,assocaion,cDrporafron or other legal erd>fy,or any two or more of the foregoing=gaged in a Joint ,and mclndmg ff=legal representBfLves of a deceased employer,or the receiver or trustee of an mdiyidnal,per,association or other legal entity,employing employees- However fhe owner of a.dwelling house having not morD than three aPm meats and who residw therein,or the occogant of the - dwelliug house of ano e other who rploys persons to do n3Abt=ance,e�stract;on or repair work.on such dwelling house or on the groUnds or builAmg app th=to,shaIlnotbmause of sorb employmeutbe deemedto be an employer." MC3L chapter 152,§25C(6)also states float"every state or local licensing agency shall withhold$ze issuance or renewal of a license or permit to operafe a business or to construct bwidfngs in the commonwealth for any applimntwho has notproduced acceptable evidence of cdmptian.ce with thm hmurance coverage required," AdditionaIly,MGL�pmr 152,§25�states¢Neiiirthe nor my ofifs political sub Sions shall enter into any contract for the performance ofpublic workunlsl acceptable evidence of compliance with the msurce•. requhemeu s of this chapter have been preseulii-,d in the co—,t,a�,a antTioi ity_„ Appr � Please fill ou± the workers' compensation affidavit compleinly,by g the boxes that apply to your situation and,if necessary,simply name(s), addresses)andphonemumber(s) aIongwifhtheir cet(fc zt*) of insmamce. Lzu:nte;LiaHUY Conipan;.es(LLC)or Limited LiabilityPartaexsbips(LIP)withno employees outer than the members or par(nexs,are not rbgtmed to corny worke&compensation insurance- If an LLC or LLP does have employees,apoiicyisrMpired- Be advised that this affidaykmaybe sabmrtfedto the Depadment of lndusftW Accidents inr confnmafion of insnz-an ce coverage. Also be sure to sign and date the of davit The:affidavit should + be returned to 1he city or town that the application for the permit or license is being requesbA not the Department of h2cba 'a Acmdm.ts. Shouldyou have.any gneslians regartlmg the law or ifyon M reginr- in obtain a wormers' compensation policy,please call thoe Department at the number Usted.below. Self-resod comPaaies shouIcI em'nr th5ir s elf-insIIr once license Cumber on the appropriate line. City or Town Of f Icials t - Please be sm-c that the affidavit is complete and priard.IegibIy. The Department has provided a space at the bottom of the affidavit for you to fM out in the event the Office of lavest�os has to 60ntact you regazdmg the applicant. Please be stn a to MI in the pen twlicense manber. which wM be used as a reference number. Iu addition,an applicant that mast submit multipIe pem<t/Iicense applic ations is any given year,need only submit one affidavit m&cafmg cent policy information Cif necessary)and under`job Site.A_dd_ress"the applicant should wrii-_"all locations n (city or town)--A copy of the affidavit that has been officially stamped or mimed by the city or town may be provided to ffio applicant as-prooff tbat a valid affidavit is on file for future permits or licenses A new affidavit must be filled out care year.Where a home owner or citizen is obtainutg a license or peunitnot related�D any bn iwm or commercial vie (ie_a dog license or pew to bum Iewcs etc_)said person is NOT regmred to complete this affidavit The Office of Ines gHtiO s would lire to tlisnk you in.advance for your cooper tionand should you have any questions, please do not hesitato to give us a caIL The Departments address,telephone and fax number_ tit of Iv&Ct#s . Depart6lmt Qf�AGcidents Q�ce of�e�[�g�tio� - �Q �E�11F Ta 4 617- -4- Mft 406 Qr 1--9 IAA M xev1sea424-07 _ g� 7 Town of Barnstable Regulatory Services oxTM� Richard V.Scali,Director Building Division t Paul Roma,Building Commissioner KAM e39. �� 200 Main Street, Hyannis,MA 02601 Epp www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: C�o Please Print I A l�� 0� �1� JOB LOCATION: 3 DD C S o Q n n) S number street fvillage -xolv>EowNER° -�\ -s` ��-6 - name Uhome phone# work phone# CURRENT MAILING ADDRESS: �CJ 0.l�Y 1 eel,= e,j cityhown I 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 at he/she understands the Town of Barnstable Building Department minimum inspection proced ynd require en d 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 forms\EXPRESS.doc 06/20/16 Town of Barnstable Regulatory Services UJINSUIUX ILAM Richard V. Scab,Director 639 s . �� 5 ` Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 509-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 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) **Pool fences and alaxms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature-of Owner Signature of Applicant Print Name Print Name Date QXOR AS:OWNERPERMISSIONPOOIS Parcel Detail Page 1 of 3 -w Wr �ti^'f� PAA�,'�v'' ,,': Sx"�" .g,aIsL' :K✓U;/"1",�+ .I., z , c s<, _ Logged In As: Pa ree I Detail Tuesday,November 8 2016 Parcel Lookup Parcel Info Parcel ID 310-010 M� I Developer Lot SLOT 3 Location 52-0 BEARSE'S WAY— Pri Frontage Sec Road ..< I Sec Frontage . Village Hyannis I Fire District HYANNIS Town sewer exists at this address FNO l Road Index 109 Asbuilt Septic Scan: .. 3100101 Interactive Map z i Owner Info .�.� Owner JACOBS, RUTH M.ESTF CO- `%SGOURITSAS,JOHN I Owner i�...,�,. ,,,,,�,,.,.,. F I streets F68 FAIRVIEW AVENUE street2 city DUDLEY ( "state MA I zip 0 5571— (Country Land......Info . ................ ....................................................... .. ...... . ........ ......... .... ......... Acres 0.41 use Single Fam MDL-01 I zoning RB Nghbd 0104 Topography%Level -"" I Road Utilities All Publio,Gas � I Location Construction Info Building 1.of 1 Year 1957 � �� Roof Gable/Hip " exc Aluminum Sidng Built Struct wall Living Roof AC Area 1460 cover Asph/F GIs/Cmp Type None style Ranch � µ � wall Drywall " Roo Bed Bedrooms Model Residential Flms oor iCarpet � Ro ms 2 Full-0 Half m Heat � x Rooms Grade verage Minus T Hot Water 6 Rooms Stories 1 St0 Heat Oil Found ti "Conc. Block ry Fuel aon Gross 3852 Area Permit History Issue Date Purpose Permit# Amount Insp Date Comments 10/26/2016 SidN`Vind/Roof/Door 16-3016 $7,000 Reroof(stripping old shingles) _.. http://issgl2/intranet/propdata/ParcelDetail.aspx?ID-25558 11/8/2016 Parcel Detail Page 2 of 3 Date Who Purpose 10/22/2013 12:00:00 AM Denise Radley In Office Review 5/8/2003 12:00:00 AM Paul Talbot Meas/Est 3/21/2001 12:00:00 AM SM Meas/Listed-Interior Access 10/15/1987 12:00:00 AM ML Meas/Listed-Interior Access _._.._._._..............._................_...._._.._._....... m.........-.._..................................._......._...................._._____..............................................._..._...._........................._....................................M....................... __.. Sales History Line Sale Date Owner Book/Page Sale Price 1 6/9/2014 JACOBS, RUTH M ESTATE OF BA14PO830EA $0 2 1/14/1978 JACOBS, RUTH M #D623510 $0 3 1/8/1959 JACOBS, DAVID D & RUTH M C22893 $0 4 4/28/2016 SGOURITSAS, JOHN C209353 $203,705 5 2/3/2016 NATIONSTAR MORTGAGE LLC D/B/A C208685 $207,557 ..Assessment History.............. ......... ........... ......... Save Building Total Parcel # Year Value XF Value OB Value Land Value Value 1 2016 $92,700 $43,100 $1,100 $71,700 $208,600 2 2015 $95,600 $45,000 $900 $69,800 $211,300 3 2014 $95,600 $45,000 $1,000 $69,800 $211,400 4 2013 $95,600 $45,000 $1,000 $69,800 $211,400 5 2012 $95,600 $43,900 $800 $69,800 $210,100 6 2011 $133,800 $3,000 $0 $69,800 $206,600 7 2010 $133,700 $3,000 $0 $107,300 $244,000 8 2009 $124,900 $2,500 $0 $144,200 $271,600 9 2008 $151,700 $2,500 $0 $150,300 $304,500 11 2007 $151,000 $2,500 $0 $150,300 $303,800 12 2006 $138,500 $2,500 $0 $153,800 $294,800 13 2005 $125,800 $2,400 $0 $104,700 $232,900 14 2004 $102,000 $2,400 $0 $83,800 $188,200 15 2003 $92,100 $2,400 $0 $39,300 $133,800 16 2002 $92,100 $2,400 $0 $39,300 $133,800 17 .2001 $90,600 $2,400 $0 $39,300 $132,300 18 2000 $77,500 $2,300 $0 $24,800 $104,600 19 1999 $77,500 $2,300 $0 $24,800 $104,600 20 1998 $77,500 $2,300 $0 $24,800 $104,600 21 1997 $73,400 $0 $0 $21,300 $94,700 22 1996 $73,400 $0 $0 $21,300 $94,700 23 1995 $73,400 $0 $0 $21,300 $94,700 24 1994 $68,200 $0 $0 $25,500 $93,700 25 1993 $68,200 $0 $0 $25,500 $93,700 26 1992 $77,600 $0 $0 $28,400 $106,000 27 1991 $93,200 $0 $0 $46,100 $139,300 28 1990 $93,200 $0 $0 $46,100 $139,300 29 1989 $93,200 $0 $0 $46,100 $139,300 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=25558 11/8/2016 O � Town of Barnstable *Permit ,CJ wee 6 monthsjrom issue date Regulatory Services 11AMSrAB14 MAS& Richard V.Scali,Director 163g6 10� t p Building Division Paul Roma,Building Commisst6'n,er ®c' 200 Main Street,Hyannis,MA V26i�V jl 3 ?Q www.town.barnstable.ma.us 0)ca �6 Office: 508-862-4038 !1�] Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL O°1Y Map/parcel Number 3 '0 ^ D)0 Not Valid without Red X-Press Imprint Property Address0rSeS 04 residential Value of Work$ 6 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address r0i -Dud 2y Contractor's Name 1 b'S3 T-a4Telephone Number —5O8 1 a2 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor Rfam the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Req est(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 (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 I pro on ractors License&Construction Supervisors License is required. SIGNATUR1g, Q:\WPFILESIFO permit form XPRESS.doc 06/20/16 1 Gl _ 21e Camm'ompealth a,f Mrrssadrrtse& Depar'trneut a,frad-mbial Accldadg Office of hnwsdga -wu. 600 Washington Street Bastpn,41A 02111 wrtnumaxagorldifa Wcw1+2rS' Cun3peniafii•anInsurauce ffid vit:Bmdlders/C IIm r-act6rsMectL cISIIs/Phunbers App Infarmafzau Please Pxint E llv Name �Ona1l d ko �cy�t� n ve. CitgfSlatef e U0 n12 S 63 Phone Are j'au an employer?:Qteckthe appropriate boj: Type of project(required): I.❑ I am a employer with 4 al confmctor and I 6. [:]New eonsiUadic.a employees(full and br part limed* - have hired i a sub-conbmdors 2.❑ I am a sole prgpFietor arpartner- listed on the attached sheet 7. ❑Remodeling ship and have no employees Mese seb-conftc#ors have g Demolitioa wadzing forme in any capacity: employees andhave workers' JNQ wod� g'pomp_fizm=nce comp.meTerarN e l g..❑�IIildtIIg addition. 5_ We are a corporatiaa and its 10-❑Electrical repairs er additions d- 1� 3 J +am a bo mwner doing all work ofile'crave exercised their I L Q Plumbing repairs or additioms myself[No workers'campy. tight n� �£ m of mTin per 10 Roof reairs ere�red_]t 2,� f e have 13.Of?ther employees.(No workers' cam-insurance Vie-) •day app�cavtd;at cbedsbos ff1 mast ilia fiIIa�the sectioabeTawshas¢iug�e¢zvos?ceis'eompeasatinapeTugiafoemsaaos gO�7eOptIl4is ad7o sabot dais ddd2vit tr.Butmg&ey gM daing RU wax anA Ibex him auntside co=Rcfarsamst subatanewaffidsvd'mdirsiin sacT fCaairatmathatc]�ec3ci}d5baa�mvstatYachmd�sdditionaish;e�tshotefagthen�oflhes¢b-ca�s��a�elstafexheth�arnott8osee�esbsee employees.IfthemiTa tacta haveemployep-%Iheyamsrpmvidedllea wodma'tomp.policy"—bm lam an srlipLor flint isprouPrIing ivrrrkets"conrpertsaftort utsrirartcs far a<c}T e�rrrpla}nees $etoev is flea prrLicy rurd jab rite information Insurance Company Dame: Policy 4 or Self-ins.Lines �irationDdte= Job�A$.ddre= 3d0 J�ea rS e s W CGS! City1Stawzip: i S Attach 2-00PY of the workers'compensationpoNcy declaration page(showing the policy,numier and respiration date). Fame to secure coverage as required under Section 25A of MCff-c_157 can lead to the imposition of criminal penalises of a fine uP to 11,54a 00 and1or on- --- imprison as well as tivil penalties in the form of a STOP WORT ORDER and a free of up-to 0-00 a day against the violator. Be advised that a copy of this sbkmennt may.be fxwarded to the Office of IIIveskgafions oftl a DIA.for msmance cove ge im ification T d'a[MrAr under Pains pmaZffar efred W7 that the iufarmw m pmidrd abmw is tnu acid carmd Phone OfiTrial use anly. Do zwt write is M3 area,to be wimpleted by city sr tarn rr,0%daL City or Town: Permhff icense A Issuing Antherity(carIe true): L Board of Health Department 3.Cftyfrawn Clerk d Electrical Faspector 5.PhunUmg Inspector 6.Other Contact Person: Phone#- -- 6 ormation and lastrnctioans Massac i asa is Geber'al Laws chapter 152 mgah--es all en egloycrs to provide W01IO&eomPeasation for then-employees. Pursuaaito#his staff,as mpIoyre'is defined as"_everyperscra in the service Of mafher Bad=any ca[ract ofhirr, esgress or impIimt oral or vzftb=" An ezVk yer is defined as"an inch idnal,partnership,associsiion;corporation or other legal exrEdy,or any two or more of the foregoing engaged in a Joint else,and inchrdmg fbe Iegal=esent8frVm Of a.deceased employer,or the receiver or tustee of as mdividnal,pmrfneashT,association or ofherlegal entity,eonploymg emPIOYees- However the ow=of a.dwelling house having not more than three apartments and who resides therein,or the occopant oftbe - dweIIjmg house of another who employs pmsons to do mamt�n ce,cansf uct an or repair .on such dwelling Jiouse or on.the grounds or bmVmg appvrtnnantth=tn shaIInOtbmause ofsach employmm the d=nedto be as eroployCr." MCA cbapira 152,§25C(6)also that"every state or Iocal licensing agency shall withhold$re issuance or renewal of a Iiceme.or permit to operate a business or to construct buildings m the commonwealth for any applicant who has not produced acceptable evidence of cdmplranm with the iusur-ance.coverage required_" Additionally,MCrL chapter 152,§25C(7)stains Neiiherthe c�wealthnor�y of its Political subdivisions shall enter mtO any contract for theperEmmanm ofpublic wozicaobI acceptable evidence of compHgo.=vibh tie msa =c-6.. regmm nerts of this cbapi have been presented tD the ca—*I�alljhoi ay_" Applicants Please fill out the wml=,compensation affidavit completely,by chc&ciag the boxes ffia±apply to your siinaiion and,if necessary,supply sob-contractor(s)name(s). (es)and phone m— er(s) along with their=tifrca#e(s) of insurance. Limited Liability Companies(LLC)or Lamited.LiabRity'PmInerabips(LIP)wiano employees other than the members or paltneas,are not requaed to catty wo3:ke&campensalim fi s•orance. If an LLC or 112 does have employees,a.policy is required. Be advised that this affidayrmaybe submitted to the Depa-iment of Industrial Accidents for conEmnaiion ofmmi==coverage. Also be sure to sign and data the af7rdaYit The affidavit should•- t, be retOmed to!he,city or town that the application for file permit or license is being regne not the Department of Industrial Es_=dmts. Shouldyou have any questions regarding the law or ifyou are rcquwedto obtain a woik=' compensation policy,please call the Depaxtramt at the number listed below. SeJf-fin red companies should enter tier s elf;,,W ran a:e license nmuber on the appropriate line. City or Town Of xdal� f - Please be sore that tee affidavit is complete and prmird legibly. The Department has provided a space at the bottom of the affidavit for your fiIl omt in the event the Office oflnv - tion has to coabv tyouregm:dmgthe applicant Please b e sure to f171 in the pm�irt/license number which will be used as a reference number- In-addition,an applicant that must submit multiple pe=Whcense.applic ations m any given year,need only submit one affidavit mdic ding current p olicy mfannation(if n= ssa y)and ands`job Sim fiAc�ress"fie applir,�should write"all locations in (chy or town).$A copy of the-affidavit that has been of icial Iy stamped or mazked by tha city Or gown may be provided to the applicant as prool'that a valid affidavit is on file for fzdnre pemzzis or<liceases_ Anew affidav>tmust be famed Ott each year.Where a home owner or citizen is obtaining a license or permit no#related in any busiD=Or co almm=ci veufrrre is NOT to Ie#e this affidavit (io_ a dog license or pcn�in ham Ie�mac.)said rcrs� rxpn� M� The Office of Ines igations would h -to thank you in advance for your coopmmfion and should you have any questions, please dfl not hesitate in give us a caIL The Department's address,inlephone and fax Cr:numb -TIL,- *Off Departnmt cif ICd1 Accdent% Q.�itae of� �fio� MA E 111 Tf,-1.4 617-727-4900= E 406 4r 1-�RMMSAFE Fax 617` 27 7749 xevised.4-24-07 - wxaaMgaVjdiRL Town of Barnstable s Regulatory Services Richard V.Scaly Director qua Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 509-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I , as Owner of the subject property hereby authorize o act on my behally in all matters relative to work authorized by building p t application for. 0' ed ) ' **Pool fences and ansibility of th plicant Pools are not to be fille fence is installe and all final inspections are ppted. Signature-of Owner Signature of Applicant r Print Name Print Name Date QTORMS.OWNBRPERMISSIONPOOLS I Town of Barnstable Regulatory Services ox'THE Richard V.Scali,Director Building Division t = Paul Roma,Building Commissioner MAW bss. �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print t DATE: .. �'1 r► JOB LOCATION: 0 number village "HOMEOWNEW jAin name C home phone# work phone# CURRENT MAILING ADDRESS_: o6-3-1 city/townf 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 derstands the Town of Barnstable Building Department minimum inspection proc !. s and requirem s e will comply with said procedures and requirements. v �Sifture 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 shalFact 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. 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