HomeMy WebLinkAbout0107 LINCOLN ROAD I
I�
!1
AAAAAA r
�I
`t
t
lob ���
�'1�
i1� S��w� c:C �rT�"
http://viewnforce.cloudapp.net/CodeEnforcement/ReportW izard.aspx?t
Town. of Barnstable
��Er Building Department Services BUILDING DEP�
ti
Brian Florence, CBO 2QZQ
1URNS ABM = Building Commissioner JUL 1
pf All 200 Mzin street; Hyannis,MA 02601 WN OF BAR�S�ABLE
www.town.barustable.ma us W�
Office: 508-862-4038 � 1(plZC) Fax: 508-790-6230
FERMTV 16 23 FEE: $35.00
-SCAN E®
SHED REGISTRATION
RESIDENTIAL ONLY
200 square feet or less
Location of shed(address) Village
q o - H /1
.
operty owner's name Telephone mmiber
o Leo a eZ_ r
ize of S ed Map/Parcel#
ignat are Date
Oq
v � ►"l �� C. .G O JI/�.
Hyannis U-iin Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction? �C7
You must file with Old Kmg's Highway
Conservation Commission(signature is required)
Sign off boors for Conservation 8:00-9:30&3:304:30
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A
PLOYPLAN .
Q-forms-sbc&eg
REV:08/6/17
Town of Barnstable Geographic Information System October 5,2015
4 -
A
,
270028
n
�l
,t
• � "2c
` i
N
I
4112 270027
4,
4`
# 270058
107
„
#114
_
jFt
71,
air
„
x
v
270026
J ,
At
270069
I
- r
� f
t
to
+�
#102
+ 4 � �
DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:270 Parcel:027
boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel
Owner:HUERTA,MANUEL&TENEZACA, Total Assessed Value:$119700
1"=100'may not meet established map accuracy standards. The parcel lines on this map ;E
are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.13 acres Abutters
boundaries and do not represent accurate relationships to physical features on the map Location:107 LINCOLN ROAD t< j
such as building locations. Bufferfr/
Aerial Photos Taken July 10,2009
�1 Application number1 ` ......&...............................
Fee ........................ .....................................
SEP 0 G 2019 Building Inspectors Initials...... .
IN
Date Issued........... ... ... .............................
6c>? �
Map/Pa rcel.............:......a.2 ...........................
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: to L l i4 C v to
NUMBER- STREET VILLAGE
Owner's Name: l�Ly�, r� . Phone Number S O/
Email Address: c� C� L /7`c/ c� Cell Phone Number S Ck M.p
Project cost$ ', 0 O 0 Check one Residential Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a buildin a tin accordance with 780 CMR
Owner Signature- Date: b6
�—
TYPE OF WORK
Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization
❑ Doors(no header change)# Commercial Doors require an inspector's review
❑ Roof(not applying more than I layer of shingles)
Construction Debris will be going to 1)u s
CONTRACTOR'S INFORMATION
Contractor's name
Home Improvement Contractors Registration(if applicable)# (attach copy)
Construction Supervisor's License# (attach copy
)
Email of Contractor Phone number
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NU.MBER............................................................
*For Tents Only*
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides?Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent
Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required.
Natural Gas Yes No , if yes,a gas permit is required.
If food is being served at.your event please obtain a Health Department approval between the hours
of 8:00am-9.30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval.
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:,
Telephone Number lc�/ - � 11�_� _ Y Cell or Work number S Iq
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures,specific inspections and documentation required by 780
CMR and the Town of Bar able.
Signature Date
APPLICANT'S SIGNATURE
Signature Date
All permit applications are subject to a building official's approval prior to issuance.
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information I Please Print Legibly
Name (Business/Organization/Individual):
O / c
Address: L o
City/State/Zip: id id I X4 a _O b Phone#: O o 3
Are you an employer?4theck the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees an '
d have workers 9. ❑Building addition
o workers' comp.insurance comp.insurance.t
WI
quired.J 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3. am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi under th a'ns and naldes of perjury that the information provided above is true and correct.
-Signature: �' Date: -0
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions ,
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter'152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
office of Investigations
600 Washington.Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or'l-877-MASSAFE
Fax#617-727-7749
Revised 4-24-07
wvvw,mass.$ovfdia
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to o�te- ou must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office; 1st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and getthe Business Certificate that is
required by law.
DATE: Fill in please:
�I:u'..T••
t�jqu-tj l APPLICANT'S YOUR NAME/S: °
LlhV.iK. ?;:A-5 �:j .:�' �r;ic BUSINE YOUR HOME ADDRESS: V C '%� l/1
fa':ul ef 7^
ti,y �11' t l u,i rf 1'• 1i'f 2 7
> „p,,.•Y ' uwllly'��;1%
#: .
NAME OF CORPORATION:
NAME OF•NEW BUSINESS n CO TYPE OF BUSINESS U
15 THIS A HOME OCCUPATI f\I YES NO
ADDRESS OF BUSINESS. . 1— - f7 MAP/PARCEL NUMBER.� - [Assessing)
When starting a new business these are.several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth '
Rd. & Main Street)'to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
MUST COMPLY WITH HOME OCCUPATION
1. BUILDING COMMISSIONER'S FFICE RULES AND REGULATIONS. FAILURE TO
This individual has been in rme eny permit re r merits that pertain to this type of b siness. COMPLY MAY RESULT IN FINES_ .
Authorized S31gr
fftur ** \
COMMENTS:
ff
2. BOARD OF HEALTH
This individual has been informed of the permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS: '
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years . b business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) ;You must first,o tain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI.,367`` ain-_St.;°'Hy�nni's 'MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE °�`^ l S Fill in please:
APPLICANT'S YOUR NAME' Sty La
BUSINESS YOUR HOME ADDRESS: '� NG ca vt!�i S . 0 ,p G v
TELEPHONE #. Home Telephone Number 0 r
NAME OF CORPORATION:
NAME OF NEW BUSINESS L TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? .� YES NO
ADDRESS OF BUSINESS WW S MAP/PARCEL NUMBER (J (J (J 1 (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth
Rd. & Main Street) to a sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING CO ISSIO R'S OFFI
This individu I e info by rm' re uir is that pertain to this type of business. MUST COMPLY WITH HOME OCCUE :1 i iUi l
RULES AND REGULATIONS. FAILURE TO
tit _oriz i attire* - COMPLY MAY RESULT IN FINES.
MMENT
C
I j
2. BOARD OF I ALTH
This individual has been informed of the permit requirements that pertain to this type of business.
Authorized Signature*,*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
Town of Barnstable
Regulatory Services
Richard V.Scah,Director'
f F
Building Division 4
p a � �� Tom Perry,Building Commissioner
1
�'TFv,19L. 200 Main Street•,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Approved:
Fee:
{ Permit#: z- 1
HOME OCCUPATION REGISTRATION
Date:
Name: a do UR one Ph #: S O
y g :.
Address: (,( /j ��/�'/ Village: s
Name of Business: l/l (�C 1 1 y Vl CCU
Type of Business: o y `ram f i �; Map/Lot l�//� /(V
IN'r T: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling: there shall be no increase in noise or odor,no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there is .
no outside evidence of such use.
No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard. '
• There is no exterior storage or display of materials or equipment
• There are no commercial vehicles related to the Customary Home Occupation,other than.one van or one
pickup truck not to exceed one ton.capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be di splayed indicating the Customary Home Occupation. ,
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included..
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the,
dwelling unit
I,the undersigned,have read and with the above restrictions for my home occupation I am registering.
Applicant= Date: -O
2d fS
Homcocdoc Rev.103113
tr Town of Barnstable ' ,*Permit# ZD�SD31��
Fapires I]M-
Regulatory Services FeeU
• IMMSTnsl.E. `
9� 1KAS& Richard V.Scali,Director
ArEO MA'1 p ftC�'' y .
Building Division'
Tom Perry,CBO,Building Commissioner 0811 W
WIT
200 Main Street,Hyannis,MA 0260iUN 1
www.town.barnstable(ma+ O r�
Office: 508-862-4038 ' 1i Fax.- 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL 6 LY
Not Valid without Red X-Press Imprint
Map/parcel Number �J U
Property Address —�.(� Vf/ o�l// "(.7� (� IA l/�/� S_ I JA () Z6j C2 /
Residential Value of Work ar)O Minimum fe of$35.00 for work under$6000.00
Owner's Name&Address 1
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check.. e:
E1,411n.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.
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 (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. r
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.
SIGNATURE: J� ''Lj A
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 040215
- HA
' ts'IC F— exslE`=f ra ray^ fir-iris iarr �iarg
�60�
Ot
10 Ia=ac=.pkggrwih 4-❑IMrt8 c =dl
hn,6lz&tom [] `
❑ I a=a sole gr r❑rpatb2f!r- Hgfed on the dbtcheA sib 7- ❑RP*�'^�"�*
ships aad �na em€plo�ees Zhu sab o 1i4-ve g- ❑ g
gme arty capard ees�1 vas'
5.❑ Wemea ffiaadh5 i�-❑ alsegaimccadr ions
• ,�.. i- -. -I ohs hex .sad t;�
a h dour 4 vM Ito Ping MpaiM or Mkrd i
=YmEf INSwmk='=np-
M§Its aAw aD
cds Tirs c u g g am III- ^►fa-wm a rwzt n xa2sar�c r—d3ritm .sath_
Est the tbia bar_—&wed ra �;fr,T 4T s tben�enf ffn= rr�i s m3 rsnnrE�s fi�c>_
�tIoye�s_Ift�e�h-cI�e�?a�ee�&egamstgmvide�srwa�a'aumg.pa3n��mbe� � �
iuir.�ar ls�p�s rizatis p trorlrets'c }ar tsp emgtnyass �e7vtF is fhrpa medJob=hr
Tacm=ce Go=1pffiy =a-
FORL-y:9crSef-inr,Iic--&- 1" r�fisnrri fg-
c Id
Aiiach a copy of tb3--•#•aria`mxnprmatirm polio-dcab=6=page(4Mtri3g tht:!FOY-Y amm>ber arr3 data dstr-L):
Fa��fo sern+r�cav�tags as retrireduzrdesetfiSA n .c I5 cart lead to inzgorifinr of caminal of a
fsae•og tr) Da tl6 andfc r one-yeari as ven as d-xa gam=m ffm f—of it STGF WGRX ORDER-and a Eno
cTuFby$250-DO a dayagainffieviolatnr- Rearm $dacopyofiisis nmybefadedtcrtb:5Df5=of
F of ifie DTA fnf iasm-m=mv=zge vccESadkm-
1&7 _nxver fiFisP=X anal er rr�p B urp ffr+ � ornI za—i-o-a�p-rave al/2ave it hug tmrt as
kiz
�a cmr -- Dv zwt ivdhrift�r m eaf is bg=4&w by cry rzr frz uffiiiQ£
(RLT or' bw= Fmmibli msc 9
�cKh=
C,=2sl L ws dmpter 152 ryes aU ennployam to px�wort=='c=0P=ZF6on f$ihza-Muplaycrs.
Pms to t3zis s fap�e is domed as a--c Y p=SM m foe sr Mot of another=Idrs arty COIL—Mt gfbae,
or implied, anal crvritt�
An MPL5g f:r is dfisd as an>ndividiral,partnershm, cm,ccapox�or other lenal easy,or aay tyro Or more
bfffie k0gomg d m Ljoid and iffi leg-Arcpres=t&v=of a deed eaoployca;-or the
receives cr tMstr--,-of an MaTIdMIL pMtoersbzp,sssoccaiion az other:legal MtdY,eMploymg eanployees_ However file
owner of-E.d-weff ag$ousehavagnotnuam than.tfuee aparhn�and who resides ffie nA�Hie ocettp3nt of the
dwelling house of m=6=whD employs pmmns to do ,construction-or repair work on such dweED o house
or on ate grouads or bmRdmg apprtenartt ihereta sh&n not b___ _D of such employment be dewed to be-an eanpio5,six."
MM r��"r 152,'§25C(6)also sW=ihd`Mvezy s1�or Ioea.I liming agericg Sh2z wi'ldihoId ffie issuance,or
rmewaa erf a�s:e or permit to operate a business or to consfracd bmadiings in the mnraonweaIth for any
applicant who has not p6duced acceptable n idmce of coiaphance with the hmn-an=covei�ge req�-rA-
Addit jo,ajT,,IAM chapter>52,§25CM sus neither fe commaa ealth nor arty of its political svbdivisioz2s shalt
Mjn any mntart for the perf IMBn=of pDbF=wor$untU acceptable evidence of Minuet vrith the; cr . ce
z etp =±s of fins chapter have been pmeo�d to the co�xari�g azdb oriiy.'
A-gphcaxtts
Please fill ost the worms'compensation affidavit complefnly,by checking the boxes that apply to your siinzfien and,if
ner=ary, supply sib-confrauaz{s)name{=).addresses)and phone-Tm ea{s)along with their cea��nc�s).of
insurance_ Umitnd Liab l y Compamt:s(LLC)or Limifnd.Liabibty Pmtoenbips P2)ono emp)oyees other ffiaa the
members or partners,are notrequired to cauy v,*a±='compensfion`;n s< =_ If an LLC or LLP does Have
employes;a policy is mqu i�tc Be advised that this affidavitmay be submitted in the Department of Indulsnial
Accidemts for confrtmation ofin nce Cov=Bga AIso be sm-e to sign and date the affidavit. The affidavit should
be ratrnned the city or town that the application.for the permit or licrmsse is being recfuest�not tare De tpm n ent of
Industrial Aceidsnts. Should you.have any gne t=tvmT the 1 or you are requited in obtain a v*orlcers
compensationpolicy,please caIl the Deparfinet at the number Estrd below. Self insured companies should eatc.r their
self-m�=licehe n=Bcr on tht appropriate line.
Ctity,or Town Officials : ...
Please be store i the affida4rt fs can leir:and gzinfed l5' The:Depmtmenf has provided a spare at,he b
of the affiiiavdf for you.to fill out in the event&m Office o f h yr rfi�nris has to contact.you regaFding the applicau '
Please be s le to fIl.in the pezmht icense number which vrill be used as a reference number. In addition an applicant
that must submit multiple pem lylicenSe applitadons in any given year,need only submit one affidavit indicaf ag current =
policy infnrmntian Cifneccessary)and under'J'ab Site Address'the applicant should writ-,'all locations in (city or
town).-A copy of tine affidavit tha±has been officially stamped ar marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on fiat for fl±=permits or licenses. Anew affidavit must be Elect out earh
year_Where a home owner or cifizm is obiadnia inri to a license or permit not o-any business or commercial Yentvr-
(i e.a dog li cemr,or permit to bora leaves etn.)said person is NOT rmgcdccd to czmplctr this affidaYit
The Office of lnvestigations would h- tD ihmkyou.in advance foryour cooperation,and shouldyou.have auy qursbons,
please do nothesi afr to gimiis a call_
The Depaztment's address,tnlcphone and f x:numbrr:
` ha CammCaMMM ofl as�a�hn s
.Dmtt cif Arts
TOL44 6I7-727-4 Q�±466 Qr I-
Rovised 4-24-Q T F�
,,44�pFTHE fp�� .
+ iARNSTABL&.
MASS. � Town of Barnstable
ArFp�a
Regulatory Services
Richard V.Scali,Director
Building Division
Thomas Perry,CBO
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
as Owner of the subject property
hereby authorize to act on my alf,,
in all matters relative to work authorized by this building permit applicatio r:
(Address of Job)
26(9-
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
QAWPFILESTORMS\building permit formsT)TRESS.doc
Revised 040215 t
Town of Barnstable
Regulatory Services
oFt rWy,� Richard V.Scali,Director '
Building Division d
BARNSfAB14 ' Tom Perry,Building Commissioner F
MASS.
E1 aim 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
/J -- Please Print
DATE: r, 0 (� , O' C
(JOB LO� C O V C
number / ystreet' �7 village t�
"HOMEOWNER"") K:� /1.1 VUQ yfK— ^ � J�l j�
name home phone# work phone# .
C MA1LING ADDl SS: f fi 14 C. �(/� � JC�t kwi S "A— OeA(-,0( _
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 buildingpgrmit. (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
proceclures and re ' e nts and that he/she will comply with said procedures and requirements.
m,
(Signature of Homeo
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 t amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 040215
Assessor's office(1st Floor):
Assessor's map and lot number • e9 ��2 c�TNrt>o
Conservation
Board of Health(3rd floor): •
Sewage Permit number = sss K"&
� rua
Engineering Department(3rd floor):
House number Rio Var
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only'
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO /c SZOP
TYPE OF CONSTRUCTION _ (./Gam
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location A6'7 Ai/I car,I{ gyp_ �/ � {,��5 l`71-f'S
Proposed Use Zoning District P 13 Fire District F,/
Name of Owner 1,�7e Address /0 `9 r�f�c—1 p2c0
Name of Builder �� �'��'Z ���'� c� Address /P 0 /17 i925 2V s fir''Ccf
Name of Architect Address
Number of Rooms Foundation
Exterior Roofing Y6/ wr'y�s� c y
Floors Interior
Heating Plumbing
Fireplace Approximate Cost 11530
Area
Diagram of Lot and Building with Dimensions Fee �U
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.
Name
Construction Supervisor's License ����
F'RAZIER, MRS.
Pe
rmit ermit For
35075 RE—ROOF '
k -
Single Family Dwelling y
Location
107 Lincoln Road .
Hyannis -
Mrs. Frazier ° #
Owner ,
Type of Construction Frame `
1 ,
Plot Lot
i a
Permit Granted May 2 2 ; 19 9 2' ,
Date of Inspection 19
1
Date Completed /z2f9V 19 -
S Y 4
1
� i 1
r
C�
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map_ Parcel 7RI � ermit# C/
Health Divisions —6"Z17116181-�� JUL 2QQ� ate Issued
Conservation Division s < '7 ��® ®/ C _-Fee ! i1
?/�!4 ----------------
Tax Collector S e0 ��➢'L -..TEE
Treasurer �` `` iD -)STALLED IN COMPLIANCE
WITH TITLE 5
Planning Dept. !/� �— ENVIRONMENTAL CODE AND AF'tMAN?MW, OBTAIN
Date Definitive Plan Approved by Planning Board TOWN REGMLATIONS 0 ROAD OPENING PERM
t;
lJ All ENGINEERING 3l I
Historic-OKH Preservation/Hyannis �''��-
Project Street Address IV�
Village
Owner /�2T,5�v2 cfL�iiYG � r�2�r�Y� � Address "
Telephone 5 09 YZ 5— 6 3
Permit Request
Square feet: 1st floor: existing JW69 proposed /1;, 2nd floor: existing C proposed 0 Total new 76 52
�po
� Valuation Zoning District Kla Flood Plain Groundwater Overlay
Construction Type
Lot Size 60•,�C/00 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family W. Two Family ❑ Multi-Family(#units)
Age of Existing Structure S 7 A" a Historic House: ❑Yes j0 No On Old King's Highway: ❑Yes $No
Basement Type: ❑ Full ❑Crawl ❑Walkout )0 Other
Basement Finished Area(sq.ft.) 10 Basement Unfinished Area(sq.ft) 026
Number of Baths: Full: existing new Half: existing y new
Number of Bedrooms: existing new _ Z
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑Gas 4 Oil ❑ Electric ❑Other
Central Air: ❑Yes YNo Fireplaces: Existing t2 New Existing wood/coal stove: ❑Yes W No
Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garage: ❑existing ❑new size �'` Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use — Proposed Use r
BUILDER INFORMATION
Name iL / v ��'— � �G�' Telephone Number
Address �� �`��� License# �' �
/1-9 L` ` Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,�� %LAST (G— ,�i
-• l
SIGNATURE DATE "' ( — ��
FOR OFFICIAL USE ONLY
y ,
;t PERMIT NO. r
DATE ISSUED
MAP/PARCEL NO. µ
ADDRESS VILLAGE
OWNER
J
DATE OF-INSPECTION: r '
t FOUNDATION
FRAME
INSULATION
FIREPLACE ..:
ELECTRICAL: ROUGH , FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
4 DATE CLOSED OUT r
' ASSOCIATION PLAN NO. '
3
`r
r
The Town of Barnstante
Regulatory Services
1 39•
Thomas F. Geiler, Director
Building Division
Elbert Uishoeffer, Building Commissioner
367 Main Street,Hyannis MA 02601
Fax: 508-790-6230
Office: 508-862-4038
F
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation.repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing Owner-Occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors.with certain exceptions,along with other
requirements. 1
Type of Work:
�f Estimated Cost `.o
Amws
Address of Work: J
Owners Name: T
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded bylaw
❑Job Under$1,000
[]Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH HAVE
• UNREGISTERED
CONTRACTORS FOR APPLICABLE GU� o�D NO
ACCESS TO THE ARBITRA�lR � �FUNDUNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
Date Contractor Name
Registration No.
OR
Date Owner's Name
q:for=:Affidav
FEE VALUE WORKSHEET
LIVING SPACE
(2000 sq ft or greater) square feet x$115/sq.foot=
(less than 2000 sq ft) square feet x$96/sq. foot=
(affordable housing) square feet x$57/sq.foot=
(4013 or low income)
GARAGE(UNFINISHED) square feet x$25/sq.foot=
PORCH square feet x$20/sq. foot=
DECK square feet x$15/sq.foot=
ALTERATIONS/RENOVATIONS
OF EXISTING SPACE . . . . . . . cost=. . . . . . . . . . . . . . . .
Total Project Fee Value
Office Use Only
Permit Fee
a
projcost
M CMR Appendix J
` Table J521b(continued)
Prescriptive Packages for One and Two-Family Residential Buildings Heated witb Fossil Fuel
MAXIMUM MINIMUM
Glazing GIazing Ceiling Wall Floor Basement Slab Hcaung/Cooling
Area'(%) U.value' R-value' R value' R-valueJ Weil pfttmeter Equipment Efficiency
PackageR value° R Luc'5701 to 6500 Hating Degree Days'
Q 12% 0.40 38 13 19 10 6 Normal
R 12% 0.52 30 19 19 10 6 Normal
S 12% 0.50 38 13 19 10 6 85 AFUE
T 15% 0.36 38 13 25 NIA NIA Normal
U 15% 0.46 38 19 19 10 6 Normal
V 15% 0.44 38 13 25 NIA NIA 85 AFUE
W 15% 0.52 30 19 19 10 6 85 AFUE
X 18% 0.32 38 13 25 N/A NIA Nomtal
Y 18% 0.42 38 1 19 25 NIA N/A Normal
Z 18% 0.42 38 13 19 10' _ 6 90 AFUE
AA 19% 0.50 30 19 1 19 10 6 90 AFUE
1. ADDRESS OF PROPERTY:
2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS:
3. SQUARE FOOTAGE OF ALL GLAZING:
4. %GLAZING AREA(#3 DIVIDED BY 92): 0 r?,5
5. SELECT PACKAGE(Q--AA-see chart.above):
NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS
ARE AVAILABLE. ASK US FOR THIS INFORMATION.
BUILDING INSPECTOR APPROVAL:
YES: NO:
q-forms-f980303a
The Commonwealth of Massachusetts
=� Department of Industrial Accidents
— oxce oilarestioatioos
600 Washington Street
Boston,Mass. 02111
Workers' Com ensation.Insurance Affidavit
name //7t-771- 1.1 AL-
location /(C e
ci
F!r�/f�l�f�-�' � ��� hone#
[jrI am a homeowner perfo g all work myself.
❑ I am a sole rietor and have no one world in anv capacity
% %%%%%%%%%%%%%%��%%/%/��% %%%%//%%%/%%%///%%%%%%/%/%/G%%%%%%��%%/G/O////%///%/�%%%%%%%%%%%/�%%%%//%�%�%%�%/
I am an e 1 roviding workers' compensation for my employees worlang on this job.
a omaanv name- "....
dress:. X.
hone#.
ctttn
9itsurance:car
..
❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who
have
thefollowin workers' compensation polices:
mP :.:.:::;«.:<.;;:..;;;;::;.;;;:.::;:.:...;;.;;;;<.:«<.;;:.:::: :.;;:.;:<.;::;:::.>;:.;:;::;:;.;;.>„>,
g _.......: :::::::::::::..._ .:::.:::::::::::............................_..__........:;.
com an .name.: :.: :....:.. ..... . .. .0.
address
...
::`e
on h
.....................
:'D ::.v;a:;;•i::
:.Y.•::r::::::::
.....................................................................................................................
:::::::::::::::::::.�:::::v::.�::.:�:::::.� :•:::::.�::::::::::::•:::.................. ..................:..................................
.........................:: :::.ii:isv::•iii}:::.:iL};isti•ii:�iiiiiiii v:;<:;:ii......:ii:i......iiii::...,:; i:ii::!tii:vviiv:•:Cvi4:<i�iiii:{ii•:i:iiii:ii::•'r:+4:'::v.'...
......................................:...............................:....:.
.....................................................................................
............... ........ .............................i...... ..............................................................
.... ................... .......................................::::::::::::.....: .n�v•
.......5................. .:..... .......:........................................................
:Jl: :.::::i;'>:%'.::: :iis :...I.:_:.i:::j•:ti;:;,i:>::::'.:!::L?;:i:.isTi•:::?::>::::isir<.+::c.:::%:::>::::i:i:::i:iti:.::::
:'•:•::iiii:••:::::.: '::::-iiii::'i:::isy:.ii:4i:'isiJ:•ii;i}:•}:Jii::•:ii:`J::::i:<:Ft::::{:::isiii::Y.}ii •i:•i':+'vi::::'�::>::<iii:t:%::':<::::::•ry::i•:i':i:t'::::':'::::ii:..:. R/►
:.;:. ...... :.::.:.....:..::...:•:...:.
address, :.
"
CIt+
.,.'.
li
fu�uraece
X.
0
fi;
Faunre to secure coverage as required under Section 25A of MGL 152 can lead to e imposition of criminal penalties of a fine up to SI,S00.00 and/or
th
one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Offlce of Investigations of the DIA for coverage verification.
enalties of perju 1�inlvrmation provided above is trap and coned
I do hereby certify under the pouts and p
Signature Date
Print name ye- -� xl /��z /y 1 'C- Phone#
ofgdal use only do not write in this area to be completed by city or town official
city or town: permit/license# []Building Department
❑Licensing Board
❑check H immediate response is required ❑Selecbnen's Office
❑Health Department
contact person: phone#; -- ❑Other
Oevised 9/95 PJA)
. I
..
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the-"law", an employee is defined as every person in the service of another under any contract
of hire, express or implied, oral or written. r
An employer is defined as an individual, partnership; association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and.including the legal representatives of a deceased employer, or the receiver or
trustee of an individual,partnership, association or other legal entity, employing employees.'However the owner of a
dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of
another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and
ers along with a certificate of insurance as all affidavits maybe
supplying company names, address and phone numb
t
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
. date the affidavit. The affidavit should be returned to the city or town that the application for the penaait or license is
being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you
are required to obtain a workers' compensation policy,please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the Permit/license number which will be used as a reference number. The affidavits may be returned io
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions•
please do not hesitate to give us a call.
'lye Department's address,telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of lmrestlgatlons
600 Washington Street
Boston, Ma. 02111
fax#: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
Town of Barnstable
p Regulatory Services
- Ftr+e r°wti Thomas F. Geiler,Director
o,•
Building Division
anxxsrnsce.
v MAW.' Peter F.DiMatteo,Building Commissioner
.
i63939� ♦0
367 Main Street, Hyannis, MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Building Permit Procedure for Residential Addition Or Remodel Or Dock
1. Determine map and parcel number and enter it on application. (This information may be
obtained from the Engineering or Building Dept.)
2. Plot plan or mortgage survey required for any addition.
3. Historic District Commission approval required prior to construction/demolition for any
properties located in a Historic District:
• Old Kings Highway Historic District (north of the Mid Cape Highway)
• Hyannis Main Street Waterfront Historic District (See map for boundaries)
• Historic Preservation (if applicable).
4. 4 sets of house plans measuring 11"x 17",scaled 1/4"= 1" & fully dimensionalized
are required. Plans must include a foundation,cross section, framing schedule, insulation detail
&floor plan showing location of smoke detectors (located with a Red `S'.) Once approved, 3
stamped sets willbe returned w/Building Permit for distribution to the Fire Dept.,the Electrician
&the job site.
5. Approval from the following departments must be obtained:
Health Department(3rd floor Town Hall-8:30-9:30 a.mJ1:00- 2:00 p.m.)
Tax Collector- 1st floor Town Hall
Conservation Department(4th floor Town Hall) (8:30-9:30 a.mJ1:00-2:00 p.m.)
Treasurer-3rd floor School Administration Building
6. Workers Compensation Insurance Affidavit form must be submitted for any workers hired.
In the event the homeowner takes out the permit, subcontractors hired must supply this.
7. Energy Compliance Form.
8. Home Improvement Contractor Affidavit must be submitted.,
9. Copies of the following licenses are required: Construction Supervisors License&Home
Improvement Contractor's License-if anyone other than the homeowner applies for the
permit.
10. Homeowner License Exemption Form must be submitted if homeowner is acting as general
contractor or builder for the project.
11. Fee must be paid upon submittal of application.
NOTE:No wall is to be covered before wiring,plumbing and frame inspection.
Q Iorms:permits 2
rev:062801
rie Vi anznwoxueai o�✓vlaGaac�iuCa
BOARD OF RUILDINNG S
,.; License: CONSTRUCTION SUPERVISOR
Number'CS 034647
[ 0 %03l 002 Tr.no: N64.6
Restrii'cted'fg�tiflOr�
AR2TF JR+ BF !
Z'89"NEWTOWNiROAQ ':. ( r .
MAL2'Sl ONS MILLS MA 02648 Admtnistr�tgaa'
. .. ...� ✓/LE,V/G i72'iii�(Yyu!!/CGLLCit... ii l�ZddG�:/2L14�1Le(. r�
Board of Building Regulations and Standards
HOME IM:PPRGVEMENT CONTRACTOR
a
ug
Reglsjra�l0n 1-43820
�' 4iE�Xpirat at O % /2003
a
z ,s �E
3 pelydividual
ARTHUR F BEL ki E; A R
ARTHUR BELANd'
289 NEWTOWN RD W r�
MARSTONS MILLS,MA 02648
Administrator
J
of IHE Tpy,
do
i The Town of Barnstable
* IARNSfABLE,
9�AMAM, s`0 Regulatory Services
rEo,,,pr Thomas F. Geiler, Director_
Building Division
Peter F. DiMatteo, Building Commissioner
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: �7 `/ / 2ool
JOB LOCATION: 1
number street village
..HOMEOWNER ��/G� U� �CL/pi � GY2 Q'�S _3
name home phone# work phone#
CURRENT MAILING ADDRESS:!22
6!2 K, Vi?'
r 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
proced nd 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 t amend and adopt such a form/certification for use in your com ut`ty.
Q:FORMS:EXEMPTN
r
_— C9 ae t
A•cea 6197 s
O Prr -
d
N
z4.t \�,.; f the cfwe�Gi z1iown ij Located
as shown and *e Z4 the 4etbacle
w/ .`.. �cecyuticexent� of the gown of
�N`3 4et (oO.oO C`S t
Ancobt Road public 40 wide
Site plan of Cand in Rgann i 4, Piq i
90 i lq4thu& 6atandery ,
6eini- a tot 6y deed in bk I0520 pq, 337
Scale 1"-30 Date 1-I6-97
q.0 Cape Cnq.. e&,t rtq
49 Patbo2 road
Hgan,", M 02601
t
Nr� n(� ..
LI ::.
� i 13ED�o0�1 -� 02
Ki72-JEN - ,DYI Nro
El
c�lr�,�Fr
� t
o
Lll//NG ROOM
56DAZ 001n �* l
/0"9" X /0137"
I
i
I
B�LI�NGE6� HOU5E I07 LINCOLN RDRO % "-/'-0„ 7- 7-0/
is
M
i
r 1
c � 1
j
.51
6FDQ�0/yI ��
X
�HE�S SMOKE DETECTORS O.K.
Ee^PNSTA LE UILDING DEPT.
13ED�ZDo/'? /
S'S" X/0'3t„
8EL191Vt= \ HQV-5E F400k- PMN NEW l07 LlAfOLN PORD '/y =l �-0" 7- y-0/ /9. f 13.
i
i
r �
r
i
i
I
Ek'!ST1 NG HOD17ION i
CEMENT JBLQCIC GoNCRE
FOUN,9�770/Y k// moiIwGS
I I
I . I
l3ELt9NGER MOUSE FDO�dD�TIOhI iO'7 LJ�I DLN RO19D 4"=s=0`' 7- 7-0/ �7FI
1
t
is
c
- i
G-E
x PLYL-100,9
-FAODOR
Ctl
1 k� �E/tt�ClG
" 701ST
1�, DC•
PLYV OO-o
1G " O.C. t
445
e
aX6" PT, SiLI S '
FO rJNORT/ON
� Dip 4
HOUSE . Fe-417r -4- INSWOTION eor7 l l�d�'O!N ���9J ® ®,_®., 7- 9-®! A.�. 3•