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Home My WebLink About0146 LINCOLN ROAD 14 Town of Barnstable *Permit Tt� e t# � Expires 6 mont�from issue date Regulatory Services Fee- • &UMSTABLE. MASS. Richard V.Scali,Director �FDMA'la �� Building Division Tom Perry,CBO,Building Commissioner FEB U 12016 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us TOWN OF BARNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1 Property Address_4(7 L L" C0L%.& "Z %�0 Ck �.1.v�,i O�'e �� o a�.cq Q Residential Value of Work$ o`� 110 -6 O Minimu ee of$35.00 for work under$6000.00, .—*'2 /1 X Owner's Name&Addres 7 G/ G t>G Contractor's Name L Telephone Number -S O 3 6 7 7 ` q 7 Home Improvement Contractor License#(if applicable) 1,3 9 3 q,2 Email: djWA t/4,S"j Construction Supervisor's License#(if applicable) _0/0'7 1&�� K-orkman's Compensation Insurance Check one: a ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurances / Insurance.Company Name y`i• � _a t C l �jj r Workman's Comp.Policy# 2, 5 1 O 4,610,41 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 )410kd PT 4( ❑R - oof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows r #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 Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\Decollik\AppData\Loca w,.so WmdowsUemporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 OF IKErqy, saatvsrAsi.e, 9� MASS.: ,m� Town of Barnstable Regulatory Services . - Richard V.Scali,Director ' Building Division - Thomas Perry,CBO Building Commissioner 200.Main Stx et Hyannis,MA 02601 www.town.iiarnstable.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 L �uA a ro o.4-0---It to act on my behalf, in all matters relative to work authorized by this building permit application for: s l6 L4� �. Cud Z•� C'i,�-.ysd6 C . �'A Q A(,°� (Address of Job) _ F o -to y Sign a her Date Pnnt Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\2PIO.I.DHR\EXPRESS.doc Revised 040215. 21e Commonnwaltla©f Massacltusetts De paphnent of Industrial Accidents Office ofI'nvestigations 606 Washington Street Boston,JVA#211I wnw.nias govIdira Workers' Compensation Insurance Affidavit: Builders/Co a asJEk-ctricianls/Plambe-s Applicant Information Please Print Legib1 Name(Bad,�Oagan -- Adc m0lag CityrrstareJZig: e one#_. O c 7— 72 If Are you an employer?Check hie appropriate box: 4. I am s esal contractor and Type of project(required): 1.[�I am a employer with ❑ 6. ❑New construction employees(fish and/or part-time)-s have:hared the:sub-contractors 2,.❑ I am a sole proprietor or partner- listed on.the attached sheen 7. M Remodeling ship and have no employees These sob-contractors have 8- ❑Dtmrolitioo. working for me in any capacity- employees and have wod=s' 9. ❑Building.addition. [No workers'comp.insurance comp.insuraaMe-$ required] 5. ❑. We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11- Plumbing repairs or additions 3.❑ I sin a homeowner doing all work ❑ g p. myself o workers' right of exemption.per MGL my � imp- l2.❑Hoof repairs insurance requinA.]t C. 152,§1(4X and we have no employees.[No workers' IIEI other comp.:insurance required-] 'Aay applic=that cbeck.s bax#I rust also fill ow the section below showing iiiea Woakers'coappensationpolicy imfirmmation- i Homeowners Who submit affidavit-di -,imp they aiE dsnag all work and tben.hue oIltAd'e COIQtnlCinrs U7ffi'Si dnhmffi fi 7reW affidavit mdreatnir SILCIL tContractors dial chalk this box must attached an additions]sheet dhowing the name of the sub-cemrtra�ciars and:stare Whether airnot those entities Pave empbryees. If the dvb-cantnctors have employees,they must provide their warkers'comp.policy omnber- I ate an employer that is prvvhhWg svorkars'congmnsation insurance for aaq employ ties. Below is the pallid au diab site inlformiad n, Insurance Company Narme Policy#or Self-ins-Uc_#:. E�Le5 OK Expirationl3ate: Job Site Address- e City/State/Zip: Attach a copy of the workers",compensation policy declhratim page:(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGI.c. 152 can lead to the,imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as welt as civil penalties in the forma 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 forwarded to the Office:of Investigations of the DIA for insurance coverage veri fication- I do hemby card&under the pains and penalties oaf pedetrp that the informahonpa^oW ded above is&W and correct Signature: Me9�lcu �Eiln MC1�R.CQ�A Date: � Phone#: Off Feial stse only- De not trite in this area,to be completed by city or tmwn offi at City or Town: PermitUcense Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.CiVrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other. Contact Person: Phone 9: Town of Barnstable .Regulatory Services �p'THE rpf, Richard V.Scali,Director Building Division t 1AMSTABLE. Tom Perry,Building Commissioner MASS. 1639• �� 200 Main Street, Hyannis,MA 02601 ArE p � www.iown.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: j 1 ,,,,fI Q. JOB LOCATION:: 1 —C l•lil.�V�� % �'R�'4-K 6AIr�s l'e 44A a�L 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 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 an irements and that he/she will comply with said procedures and requirements. r Si?natuti 5me6wrier - K 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'persoris.-In this-case,our Board cannot proceed against the unlicensed personas 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. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\21`10I DHR\EXPRESS.doc Revised 040215 ( f 1 i Massachusetts Department of Public Safety 5 Board of Building Regulations and Standards - ! g _ License:,C$-006419 r< Construction Supervisor - I DANIELPALMAS! _, v� 4 24 SEA MARSH RD '' _ CENTERVILLE MA 02632. e ley, •}'+�u1�. - { M^^ CA-- Expiration: _ - Cofmissioner 07/12/20,17 ok a 3 ti P r r� 1 � t � � C�/�e�y�in�aoraccec��C�a�'�L'cc��ac�u��nI,�, � • - � - = , » Office of Consumer Affairs&`Business_Regulation - _ HOME IMPROVEMENT CONTRAG OR r. Registration . 139392 _{ DANIEL P ALMAS�sz CEN TERVILLE MA 02632 s m - Undersecretary { s a f y ,acoRo® CERTIFICATE OF LIABILITY INSURANCE �'�`"�'D011"'"' 2/1/16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEACT JIM HINDMAN Schlegel 6 Schlegel Ins Broker PHONE FAX 34 Main Street E-MAIL ' (508) 771-8381 / No: (506) 771-0663 ADDRESS: schlegelinsurance@gmail.com West Yarmouth, MA 02673 INSURE S AFFORDING COVERAGE NAIC# INSURERA:NGM INSURANCE COMPANY 14788 INSURED INSURER B:AIM MUTUAL IM CONSTRUCTION CORP INSURERC: 187 SANDELWOOD DRIVE INSURER D: COTUIT, MA 02635 INSURER E: I NSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POUCY EXP LTR TYPE OF INSURANCE IN SR WVD POUCY NUMBER M/DD/Y MM/DDfYYYY LIMITS A GENERALLIABILITY MPT3157P 7/14/15 7/14/16 EACH OCCURRENCE $ 11000,000 }( COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ZMIS occurrence) $ 500,000 CLAIMS-MADE Fx—]OCCUR ME EXP(Anyone person) $ 10,000 PERSO NA L&ADV I NJU RY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELWITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acciderd $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ _AUTOS Peraccident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B, WORKERS COMPENSATION WC-1000543 12/19/15 12/19/16 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIEIOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $ 100,000 OFFICE RIMEMBER.EXCLUDED? Y N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY Limrr I $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regui red) CORPORATE OFFICERS HAVE ELECTED NOT TO BE COVERED UNDER THEIR CURRENT WORKERS COMP POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CAPE REALTY INC ACCORDANCE WITH THE POLICY PROVISIONS. 299 MAIN STREET WEST YARMOUTH MA 02673 AUTHORIZED RE S NTATIVE ©1 88 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registere s of ACORD Phone: Fax: (508) 428-3466 E-Mail: DSTAN35 9 @YAHOO.COM I A �TKE, , Town of Barnstable *Permit#a b o o a� a-co �f �p Expires 6 months from issue date Regulatory Services Fee * BARN LE, + Thomas F.Geiler,Director i63 Building Division ArFD MA'I A � � C__ Perry,CBO, Building Commissioner T APR 2 4 - 210 Main Street,Hyannis,MA 02601 o� �08 www.town.barnstable.ma.us Office: 508-862--iT3�,q�n/ Fax: 508-790-6230 EXPagON VIIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �� V 0-) � _ l Property Address -P7 10 L14cc©I L Rd.. A/V�Jf 7Y1 [24e"sidential Value of Work Lo© , O d Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �p��1 C)V)(A�4 L, 1 . Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor R-I am the Homeowner ❑ I have Worker's Compensation Insurance . Insurance Company Name Workman's Comp.Policy# 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) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum,361 *Where required: Issuance of this pemvt does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. i ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 i The Commonwealth of Massachusetts Department of Industrial Accidents 1-71 Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers Applicant Information ` Please Print Leg biy �1vame-(Business/Organization/Individual): DCZ," [Do\no q `"g i 42- Address4 I-. c 1r1 G© 1 City/_StatgZip --- _cxv\v\ 5• .c� hone.#: �-Aryonn employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.❑ I am a employer with � 6. New construction . employees(full and/or part time).* have hired the stab-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 g, E]Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.-insurance comp.lnsurance.x required.] 5. We are a corporation and its 10.�'Electrical repairs or additions 3 "Irani a Homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions -r-- *� right of exemption per MGL mysel£,[Noworkers=comp. 12:( `"Roofrepairs_ ncrtran re tF- 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'comprnsation 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 thatehwk 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 subcontractors have employees,they must pmvidb 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 tip 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 Investijzations of the WA for insurance coverage verification. I do hereby c under pains-and enalties of perjury that the information provided ove is tru and correct Si attire. � 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 moirethre than e 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 nurnber listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Towa 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 permittlicense 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 born leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations wound 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 Dgwtnent of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TO. #617-727-4900 ext 4-06 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia i oF�HEr Town of Barnstable Regulatory Services + BMMSTA13M • KAS& Thomas F. Geiler,Director 4'AIFo; 6. Building Division Tom Perry, Building Commissioner 200 Main-Street, Hyannis,MA 02601 ' www.town.ba rnsta ble.ma.us Office: 508-862` 38 Fax: 508-790-6230 \ Property ner Must Complete an Sign This Section If U 1ng A Builder I , as Owner of the subject property hereby authorize to act on my behalf, in all matters relati a to work authorized by this b ing permit application for: (Address of Job) Signature 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 Barnstable �pFTHE Tti Regulatory Services Thomas F. Geiler,Director ` awxrtsTwat.�. _ ' r MASS. 1639. �� Building Division PIED a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 vt'ww.town.barnstable.ma.us Office: 508-862-4038 . . Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION l^ Please Print DATE: JOB LOCATION:- 1 Ll,neolh Rol. 9 VC7 jo h number street. —� village "HOMEOWNER!%. name home phone# work phone# CURRENT MAILING ADDRESS: �,o�il P 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 procedures and re irements ignature o omeo r 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.