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Home My WebLink About0664 OLD STRAWBERRY HILL ROAD toy old I OfTtiET Town of Rarnst a l e *Permit# Expires 6 Wraiths from issue date Mg Regulatory Services FeenARN! i6 Thomas F. Geiler, Director �Alf�Mp�a Building ]Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barlistab I e.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number o nOSI Property Address Residential Value of Work bO� Minimum fee of$25.00 for work under$6000.00 /� Owner's Name&Address � 7` � 1, �e1 .s 70// Contractor's Name C�E'.�' � Telephone Number Home Improvement Contractor License #(if applicable) c) 6, ,j Construction Supervisor's License#(if applicable) 0dorkman's Compensation Insurance •-PRESS PERMIT Check one: ❑ I am a sole proprietor JUL - 1 2009 ❑ I am the Homeowner 01 have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Corn panyName Workman's Comp. Policy It 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 root) ❑ Re-side ;Replacement Windows. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations, i.e.Historic,Conservation,e(c. 'Note: Pro erty Owner must sign Property Owner Letter of Permission. provement Contractors License& Construct Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\Express\EXPRESSPERM IT.DOC Revise060409 dd�o`gegela�or Ucense ��, r BC•o�stru�boall n , GS.-16536 ggQ6 r. ��cense Ts, 1. $ 12112p0g 31 volt ►Qr► 1 r N pEN W ; Commis " ` gSE E STREE �g5PIN 6 SCR r�x y-- i� �C24Gk2'(11Lfust�[4 i Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR x Regtcation 160627 Ezp ray j ti 8/6/2010 Tr#' 27233 7 ? = Ype IAl Mduai STEPHEN IN C �ESVIfELL �.F s,. STE PHEN N `CRES ;.Ie .. 195 PINE•ST w �� CENTERVILLE MA'02632`s Administrator: • ��31_-v'_.tom. F`g.. License or registration valid for individul use-onl } only before the ezpiration`date. If found return`to: j oard of Building Regulations and Standards I One Ashburton Place Rm 1301 4 Boston,Ma.02108 4� Not valid withoutsignature To: KERRY INSURANCE AGENCY INC: SCO From: Deb ➢erochemont 4-28-09 7:21am p, Z of 4 . AIR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ODIYYYI) PRODUCER KERRY INSURANCE AGENCY INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION EASTHAM COMMON RTE 6 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT NORTH EASTHAM,MA 02651 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR E ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (508)255-8000 INSURED INSURERS AFFORDING COVERAGE NAIC# CRESWELL CONSTRUCTION CO INC INSURER A: g group 195 PINE STREET CENTERVILLE MA02632 INSURERS: INSURER C: INSURER U �^ COVERAGES NSURER E: { THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR DW POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION GENERAL LIABILITY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS MADE EJOCCUR PREMISES En occurrence $ . MED EXP An one person $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC PRODUCTS-COMP/OP AGG S JFrT AUTOMOBILE LIABILITY - - - ANY AUTO EaMBIINtlEerC SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY HIREDAUTOS (Perpomon) $ NON-OWNED AUTOS BODILY INJURY $ - (Per accident) 1 — PROPE.dar t) $RTYDAMAGE GARAGE LIABILITY (par Z ONLY $_ ANY AUTO AUTO O � - f OTHER THAN EA ACC $ - AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY _ OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE - - - - $ RETENTION $ $ A WORKERSCOMPENSATION AND EMPLOYERS, LIABILITY WC- 1-31S-342421-029 _4/19/2009 4/19/2010 WC STATU- OFFICERIMEMBEREXCLVOEUI CU7IVE Y❑ANY PROPRIETORIPARTNERIEXE YIN OTH- (tdantletoryln NH) El EACHACCIDENT $ 500Q00 �' - Iyas,IALdeeatbounder E.L.DISEASE-EA EMPLOYE $ 500000 SPEC PRDVISIONS below OTHER ; E.L.DISEASE-POLICY LIMIT $ 500000 1 DESCRIPTION OF OPERATIONS I LOCATIONS(VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANYOFTHEABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF BARNSTABLE BUILDING DEPARTMENT DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 7 DAYS WRn'TEN 230 SOUTH STREET NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAIURE TO DO SOSHALL HYANNIS MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS oR REPRESENTATIVES. - AUTHORIZED .EpR SENTATIVE JeH Eldridge /�{ � i� 0 ACORD 25(2009101) t CBRT NO., e885191 CLIENT COTE, 1342421 Deb Ceroc}econt 4/28/2009 7,14,09 AN page 1 Of 1 01988.2009 ACORD CORPORATION. All rights reserved. I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + d 600 Washington Street Boston, MA 02111 •�•yy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibl Name(Business/Organization/Individual): �� y'('�1 �GB�-`/�U�� Address: City/State/Zip: C'-er-/`7'+r-L/!/`k` e,44,s- Phone.#: .� Are you an employer? Check the appropriate bog: Type of project(required): 1.V 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. 1 am a sole proprietor or partner listed on the attached sheet. T. 0 Remodeling ship and have no employees These sub-contractors have g. Q Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp. insurance comp. insurance.$ required.] 5. [] We are a corporation and its 10.Q.Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]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 b`�f � —/17rPli»r comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. 1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 cnsnirial penalties of a fine rip 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 MIA for insurance coverage verification I do hereby certify un r the pains and penalties of perjury that the information provided above is true and correct. Si afore: Date: Phone#: 8 —.:2�-ca F only. Do not write in This area, to be completed by city or town officialn: Permit/License# thority(circle one): Ileaith 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: O 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 enrity, 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 dustee 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 sucli 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-contiactor(s)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 bum 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 luvestigatfons- .600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia f s T Town of Barnstable Regulatory Services rxM ags $ Thomas F. Geiler,Director E1 39-, &�� Building Division 0 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town_barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Owner of the subject property r hereby authorize -STT74r�7 t-SCi-'/ to act on my behalf, in all matters relative to work authorized by this building permit application for. ,(Address of Job) /f 7 /c Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. a 4 . z Town of Barnstable Regulatory Services Thomas F. Geiler,Director Building Division prFD a Tom Perry,Building Commissioner e 200 Mairi=Street`,—Hyaruiis;NfA 02601 _ _ -_ pt"Jown.barnstable_ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE-- JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended.to.iuclude 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. ,, -J' � - DEFINrTION OF HOMEOWNER Persons who owns a arcel of land.on which1e/she resides or intends to reside, on which there is, or is intended to- ( ) P be, a one or two-family dwelling, attached or detached strictures acces ory 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 witli the State Building Code and other applicable codes,bylaws,rules.and regulations. The undersigned."homeowner"certifies that.he/she understands the Town of Barnstable,BuildipgDapartment mi, unnm inspection procedures and requirements and that he/she will comply with said procedures and requirements. _ Signaturo of Homeowner Approval of Building Officia-1 Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Constriction 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 hamcowncr engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor... Many homeowners who use this exemption an unaware that they are assuring 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 rrspormbilitirs,many communities rcquire,as part of the permit application, that the homeowner certify that hdshc understands the respom'bilitics of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a forri-Vicertifi cation.for use in your community. OF 1HE l°� Town of Barnstable *Permit# P� ti Expires 6 months from issue_dote Regulatory Services Fee ems'" y BA ABLE,MAS ► c v mAss. $ Thomas F. Geiler, Director / plFD MP't A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number j �"� o Property Address G 0 12 T I Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address Contractor's Name Cr�.yC -f Telephone Number y�' �J '2 ✓ 1 Ionic Improvement Contractor License# (if applicable) /tGC1 `-�� 7 Construction Supervisor's License# (if applicable) ,&Workman's Compensation Insurance Check one: 6 Z�OCJ ❑ I am a sole proprietorA� ❑ I am the Homeowner pVo�N OF B�R��TAIL� 1 have Worker's Compensation Insurance Insurance Company Name 47-17-�- 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 _t ❑ Re-roof(not stripping: Going over existing layers of roof) Re-side ❑ Replacem'ent Windows/doors/sliders.. U-Value (maximum .44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. '"Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: PFII.I:STORMS\building permit forms\EXPRESS.doc Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Eleetridans/Plumbers Applicant Information Please Print Legibly 4 Name(Business/Organization/Individual): �%"`�P'Lwr /l� Address: 4; City/State/Zip: C� -P�t� �� A-1 Phone.#: Are you an employer? Check 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 g."❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'•-comp.-insurance comp. insurance. required.] 5. ❑ We are a corporation and its •10.0'Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp_ right of exemption per MGL 12.�Roof repairs insurance required.]t c. 152,employees. [ and or have no 13.❑Other _ employees.[No workers' . comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'co„pansation 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. rContractors that chcck this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have ployees,they must providb their workers'co„ip.policy number. I am an employer that is providing workers'compensation insurance far my employees Below is the policy and job site information. Insurance Company Name: t'. / ��' > ( C/1 �r Policy#or Self-ins.Lic.#: C Expiration Date: I L Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure fo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fin(;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 data copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct. Signature: Date: — 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Ins,ttuctions 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 engag m atom en rpnse inluddm`gtfie leg -represeh ative3r6f-a de=m-as 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, §250(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-contiactor(s)name(s),-address(es)andphone number(s)along with their certificate(s)of insur-ance. 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 UP 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 thaf a valid affidavit is on file for future permits or licenses. A neyv affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (ie.a dog license or permit to btirn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.dm*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. Tlae Commonwealth of MassadhuseM Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 TO. # 617-727-4900 ext-4.06 or 1-877-MASSAFE Fax# 617-727-7749 [Zevised 11-22-06 www.massg-ov/dia S , of� Tosti Town of Barnstable �. Regulatory Services vMAMg Thomas.F.Geiler,Director 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 50M62-4038 ' Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize � � C�" L,&/d� to act on my behalf, in all matters relative to work authorized by this building 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. O:FO RMS:O WNERFERMISSION Town of Barnstable Regulatory Services Thomas F. Geiler,Director CTL t RLRMRTF _ MA3.4 g ' �PrE1 P.. Building Division Tom Perry,Building Commissioner . .200-Main-Street Hyam is,-M*-026D 1 _. ..... ... _.._. . . _._.._..... www.town.barnstable-ma.us Office: 509-862-403 8 Fax: 508-790-6230 HOMEOWNER'LICENSE EXEMPTION Please Print DATE JOB LOCATION: _— number street village "HOMEOWNER!" name home phone 9 work phone# CURRENT MAILING ADDRESS: eity/wwo state ap code The current exemption for"homeowners"was extended to include owner-occupied dwelling 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. D'EFINTITON 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 siructures accessory to such use and/or farm structur6s. 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 b.e responsible for all such work performed under the buildin¢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 thathe/she understands the Town ofBarpstable,Buildwg Deparhncnt minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signahirc of Homeowner Approval of Building Official Note: Three-family.dwellings containing 35,00D cubic feet or larger will be required to comply with the Stan Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any beiff=wner perfmrmumg wrork for which a.building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensi mg of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeow ncr shall ad as supervisor." Many homeowners who use this exemption are unaware that they an assuming the responsibilities of a supervisor(see Appendix Q. Rules&Rcgulations'for Licensing Construction Supervisors,Section 2.15) This lack of awarmrss often results in serious problems,particularly when the homeowner hums unlicensed persons. In this case,our Board cammpt proceed against the unlicensed pesori as it would with a licensed Superosar. The homeowmer acting as Supervisor is uhimatrJy responsible. To=u=that the homeowner is fully aw vc of his/her msponsmbnlities,many communities require,as part of the permit application, that the homeowner certify that bdshe undastAm&the responsibilities of a Supervisor. Ou the last page of this issue is a farm currently used by several towns. You may care t amrnd and adopt sueb a fmTr&Icertification.for use in your community. Q:for.ns:homccxcmpt sor's map.and lot number ...... .�.3.�. �.,........ �J�' Sbc,,711".- SYS K4 MUST S T C_ P�o*THE Tory R Sewage Permit number ... ..�j......<.... ...................... .JS7 "nLlm "� {� +"t�+ °" IN C0NP, ;UA,..:,C- House number. ...:...:.................:..:....! G. ..y I� i 1{v!r v r BAsMAO&LE. -TOWN ", OF BARNSTABLE BUILDING .INSPECTOR IF APPLICATION FOR PERMIT TO ......................................................osruct D7 reip..... Wood frame � TYPE OF CONSTRUCTION. ...........:....... ................................................19...83 TO THE`INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to''the following,information: Location Lot 2 01d Strawberry..:•H :.11s:..Roada...Hyanni .................•:..: ..,....•.••........•. ........................ Proposed Use .........S iml.e...f amily...................:......:... . :............................... Zoning District ......,Resident�,al.....................................Fi:re District Name of Owner .....James...K.....Smith...........................Address ........Barnstable.................................................. Name of Builder ...James,. K... Smith .,,.:,,•.............Address ........Barnstable f ............ .....................:........................................... Name of Architect ............................................ .............Address ..............................:.. .......... ............ ...................................... Number of Rooms........5..... oured c.........................:............................ ` ..............................Foundation .. ?.................. Exterior ...claVboard.9...wsc..A till :....................... ..............:..................Rdof n. . ..::........slJha.lt Floors ......O. k.........................................................................Int r'or, .........d..r.YWaal... ......................................................... Heating .:. ....... .........................:...Plumbing .... Fireplace .......Dn.2...................................................................Approximate Cost .........!i5.,aQ.0............................ .... Definitive Plan Approved by Planning Board -------------------—-----------19________. Area 1.. ........ . Diagram of`.Lot and Building with Dimensions Y Fee SUBJECT-TO APPROVAL OF BOARD OF' HEALTH �OaJ,d 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 ....... .....V.....A/.. f..4l.......... 5190 Construction Supervisor's License .................:.........:........ SkIITH, JAMES K. 25194 One Story _ } ................. Permit for .................................... z.nsI.s... '.ain .].y..AW. .7,�...... .......... ` Location Lot 2, 6.64 Old Strawberry Hill Rd. .......... .............................................. _ - _� Hyannis .. .................................................... ................ Owner James K. Smi.th ............................ .. ............ A Type of Construction• ...Frame.......................... J { Permit Granted ..-- June...15 ..............19 83 � e Date of Inspection rDate Completed ..... .......19 :r oil/ t f ; t` /UCH Gf'14'S�Ce //1 w a � TOWN OF BARNSTABLE Permit No. ___ 51.-9 4 ------------------ Building Inspector a Cash --------------------- e3 — r . - + o. OCCUPANCY PERMIT Bond -----------X-/Q�1� Issued to James K. Smith - Address Lot 2, 664 01A Strawak erry Hil I Rnaa _ Hyannis Wiring Inspector l './�'1�.rL� ' Inspection date Plumbing Inspector/ � �/ Inspection date r ... _ Gas Inspector l � .� Inspection date c t. X]Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ........................................... «.« ........ ........................................ ................... «............... Building Inspector `,�INGLC- FAMILY( - � BEOQAoM .,._, ►JO GARBAGE• (�WNDEtZ 0 DAiL.�Y FLOW .. 110 X 3 - 33O6.PD, h 5F-PTIG -rA►.JIK = 330x150% ",49J;6.P0. v - u5c- %000 GA%-. - i o15Po5AL PIT u5E too0 GAL. Ns 150 (BOTTOM A2EA= .. 1�� 5 F•_ . . � 9?� � � . 5 p S.F x I• o tj 0 G•P o" G� '� -TOTAL. pA I LY FLov! - 330 (,PD, .Ex�s-r, 98 7 PER.Co�QTIOW RATE : I"IN ZMIN o12_L�j iX�;� rio "TK• i OF bfgss Fd ARD of ALAN Gv, ed,' SAXTER H>' - Na 2:.048 a No. 2 0 0 3 QtSTfL �' `3 b F 2vy SU:.V�C'� orik E TPp .. o F� =loo.o TE��T ayw c.TE,e ,CG • o s Za4,q S 1oo'u tNV, INV. t«+EPT�G 9G..g Z loan INS! yL.6 TPNK r. G,�2A✓Ec- PIT ICY. INY. G . WAS>aGD GL6A 6TvNG ., G'orne,5c 90.p iCERTIFIGp PL07 PL_A. 1, Iz� SG.o P42.UPIL� o �A� L O C A't 10 N p!O SCALE �jCALE VATrc .✓ Ho P t-A to REP 62EN GE 1 tE RT1FY THAT 'THE �OvND.4Tiso S WI`J f HEREO/•l GOMC�I-`(5 YJITN"CHE S l P6.LIN� _. _ ... �,aT � .. AIJD SET2AGK - 'TO W N 'O.F N-D 1 S�/�7— LOCATED •WITww 1-IE F�-OdD PLv.tN �� PA-r E BA-ATsee. 1JYE INC. REG I-5T E_?_vD II.A►J D 5 u 2Y�c�/oEs ; ' T4115 Pl.,�.I�l l5 NOT gASFaU pld AN` dSTESZ.VIt..LE MA~`�s. II IIJ.5TR.uMENT Su2Vey 4"TNE oFF5E:T5 6uou1� _ s NoT DE VSEOTb pETEFCl^INS t_cT I_1t-1E�j APPLIGA► !T �CS� /YJ/7jf Assessor's map and lot number ...... - . PROF THE wage Permit. number ... ..3 ........................................... y< d } Z 33AW TABLE, i House number .................................! G. .. ..................... 9 NAM d p rwr �O 1639• \00� TOWN -OF -BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........Cons.t u.ct. Dwe.41nlz. ..................................................................... Wood frame TYPEOF CONSTRUCTION ..................................................................................................................................... Ma.. ..8 .........................19...83 TO THE INSPECTOR OF BUILDINGS: ff' The undersigned hereby applies for a permit according to the following information: Location Zoe ....01d. ...S.trawber Hills Road H, annis .. .... .. .. .................. `Y...............................r.......51............................... ProposedUse Singlea ............................................................................................................................... Zoning District .......Res.ident�.al....................................Fire District .............................................................................. .. .................... Name of Owner ......e7r'3,.T1TG's K.e...$1Sil�Yl...........................Address ........:DaZ'215able.. ..........................,............ Name of Builder ....J3Il1E'S �. .... ............. . Smith ..............Address ........BaTnSthb G'................................................. .. . ............. Nameof Architect" ..................................................................Address .................................................................................... Number of Rooms ..., ......Foundation ..PQ R�'O...0 02 QXA E'.......................5..... .......................................... Exterior ...CZ;a..Dbo.q,�d... WSC..&......................................l Roofing ........a9pY1at......................................................... fi .............................Interior .....'.',...ry.W...32 Floors .....Oa;k........................................... � .......................................................... Heating ?. . ..... ......r ?.!-�J................ ...........Plumbing ... .. t 1 ......................................................... Fireplace .......0:>'1P...................................................................Approximate Cost .........5.5.a.0.0n......................................... Definitive Plan Approved by Planning Board -----------_-------------------19--------. Area .......................................... Diagram of Lot and Building with Dimensions x Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH r Y pp � S . 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 ....... � .....J�, ,. M.. �..l .......... Construction Supervisor's License . .. 0 :g SMITH, JAMES K. A=273-206 2514 One Story No ................. Permit for .................................... Single Family Dwelling .......................................... Location ....Lot 2, 664 Old Strawberry Hill Rd. Hyannis ........................................................................ .:: .. Owner .....James K. Smith ............................................................ Type of Construction Frame ................................................................................ Plot ............................. Lot ................................ Permit Granted „June 15, 19 83 Date of Inspection ....................................19 Date Completed ......................................19 Sbu !vf a3 %zy6� 1 U-0( 2 gas a W�kj-09,-�, 7