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3610 MAIN ST./RTE 6A(BARN.)
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IAI 14, 4, g b .,., •,,..,.,,P' .r _� r�.;,� '`�~3e>zdlF r+ 9�' ' y. G". t_" 'yp,."ry'<N � k 3. m a n w G .�J gFtflrtott Town of Barnstable (00555_3 Permit# I " �� regulatory Services LFeces6n nl/rsfronr/suer/nre ^" B.A 2 ?ABLE, 610. ,1b Thomas F. Gciler, Director ARNS ABLE BuildingDivision vision Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Off-ice: 508-862-403 8 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY�x' S08-790-6230 Not Valid without RedX-Presto Imprinl Map/parcel Number 1-. b to Property Adciress CiJ �� A 1 � ��� l q Ic l' ' /A o 2-63- []'Residential Value of Work (� L{ c'aG` Minimum fee of$35,00 for work under$6000.00 Owner's Name & Address 3 l M lj l A S-f, &7< 1s X,) j e� j'y'A d. G� 0 Contractor's Narne Telephone Number _ Home Improvement Contractor License#(if applicable) Construction Supervisor's License# (if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor f�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 rood VRe-side f s I"V�'1IVi_Qv W GtiL.LU 8ofdoors [� Replacement Windows/doors/sliders. U-Value (maximum .35)# of windows *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 req ui red. SIGNATURE: 2AWPI:ILEST0RMS\bui1didg permit forms\fXPRESS.doc Zevised 0721 10 The Canrrrrorriveahlr ofMassachusetts - --- Department of IndustrialAccidents I� r Of ce of by1,estig aborts 600 LI'ashirzgtorr Street Boston 1' 4 02111 fi,ww.rrra.ss.gow'rlia 'Workers' Ccxmpensat on Insurance Afficlaxit: Builder:s/Contractors/Electriciaus/Plumbers Applicant Information Please Print Lenbh Name 70 i rv-� � 6 (4 1 A Address: G /0 4 1 P 1 1 az Cit-Y/'State.Jiip: Y S �►4 0 r) Phone #: °J 9 'i&,s 6 Are you an employer?Check the appropriate boa.. Type of project(required) 1..❑ I am a employer with 4. ❑ I am a general contractor and I erxzployers(felt and/or part=little). * Have hired the sub-contractors ❑.New constrnrc.tiou .❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship.and have no ewplo3Tes These sub-contractors have g- ❑.Demolition working :for rue in any capacity. employees and have workers' insurance.? 9• ❑.Building addition [No workers' comp.instrr comp-p- required.] 5. ❑ ode are.a corporation.and.its 10.❑Electrical repairs or additions 3.V-1 am a.homeowner doing all work officers have exercised their 11,❑Plumbing repairs or additions myself. [No 1vorkers'comp- right of exemption per i`IGL 12.❑Roof repairs insurance:required.]t c. 152, §l(4),and.we have no t r employees-[No Workers' 131910ther ewnp.:insurance.requited.] *Any appphcavr dat check box#1.must also 13ll out the,section bel",shorting their Nvrl ers'compensation poh.cy infoanxtioa- I Honieovmers wbo submit this affidavit indkatiug they are doing all'worlt and then]sire outside—tontructors must subnsih aaw affidavit indicating sncb- tC'ontractnrs that check this box Must attached are adduaon$h sheet showing tve:nsme of the sub-contractors and stale whether or not those entities have employees. If the sub-c.ontcactomhave employees,lhey.mntst provide their workers'comp.policy,number. I an-f are emrplr5wr that is providing workers':courpenrat oil insurance for rrty entployees. Beloit'is the policy rind jo.b site infor'Nta i011. Insurance Company Nance: Policy#or Self--ins.Lic.#: Expiration.Date. Job Site Address: City/State/Zip: Attach a copy of.thie workers'compensation policy declaration page(shovnng the policy number and eapu'ation 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 andr`or one-year imprisanmen.t,as well.m ci%ril penalties in the form of a STOP 1VORK 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, -1 do hetvkjr certify under tho pains and partathes nfpedury Mat the irrfortnationprovidi f above is true and correct. Se lure: ,�.r�6C �^ Date: D �� Phone M J P .3&2 -/0 .5 6 L e only. Do not writo tit this area,io be completed by city or town ofeiaL Cityvn: Permit/License# thority(circleone): Health ?.Building Department 3.City/Town Clerk 4, Electrical Inspector 5.Plumbing Inspector son: Phone M P�olHE Town of Barnstable Regulatory Services " >3�nj;Ass. uE, inss. Thomas F. Geiler, Director .� $ ,6MpiA, Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 518-8 62-403 8 Fax: 508-790-6230 -----------------------__ HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: ,36/D /yy�/ rVS7 /✓/�rn �� number street village J-HOMEOWNER" O r�'4'�1 1��91 hP 509 36 2 9105/0 name if home phone N work phone>f CURRENT MAILNG ADDRESS:alp/y n 1 P1 S4 ftrnstg6le. j1Z►� n �'� �� 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 prp�ceduorfc, requirements and that he/she will comply with said procedures and requirements, �a_nd n.cr 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.]27.0 Constructiori 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 ofconstruction 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 I amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 of try r�, + BARNFrA©LE, q� MASS.161q. Town of Barnstable �� �rFD MA'i A Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, M 02601 www.town.barnstable. a.us Office: 508-862- 038 Fax: 508-790-6230 Property ®w er Must Complete and Si n This Section If Using Builder I, s Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this bull ing ermit 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. Q:\WPFILESIFORMS\building permit forms\EXPRESS.doc Revi.Sr.ri 072110 °Ft T Town of Barnstable. *Permit# 4o�6 ? '1 Expires.6 months from.issue date Regulatory Services Fee _ sexrtsTAst�, : Thomas F.Geiler,Director 9 Mass.. �b 1639• Building Division ArFp�,ta Tom Perry,CBO, Building Commissioner 200 Main Street,HyanhN,MA 02601 www.t6wn.bamstable.ma.us Office: 508=862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY —7 Not Valid without Red X-Press Imprint Map/parcel Number Property Address �l/D /�%/U S 0[3 ❑Residential Value of Work a I0 _ Minimum fee of$25.00 for work under$6600.00. Owner's Name&Address J t /1 &P t Vj e, 'Contractor's Name Telephone Number HomeImprovement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor MSS PERMIT I am the Homeowner ❑ I have Worker's Compensation Insurance DEC I I ZOOS Insurance Company Name STABLE TOWN Op Workman's Comp. Policy# - - Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over .existing layers of roof) - ❑ Re-side []' Replacement Windows/doors slider .U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is requireQ! i? 1(� SIGNATURE: � 1r ¢'11�1 Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information f Please Print Legibly Name(Business/Organization/Individual): O 919 K)C Address: City/State/Zip: /P 1,394 p olio 3oPhone.#: Sbk 3C4 2 965_7b Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with . 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors .2:0 I am a sole proprietor or partner-. listed on the attached sheet. 7. .❑Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.EXI 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 subcontractors 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.Lie. M 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 erti,fy under the ains and penalties of perjury that the information provided above is true and correct signxtur _ Date: Phone#: 36 1 %S74 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-fo ing-engaged maJomt enteiprise;a3mclu�ng=the legal representatives�5f .d coased=empio3�er,-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)al,so states that"every state or local licensing a ncy shall withhold the issuance or renewal of a license or permit to operate a business or to construct buil ings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance ' the insurance coverage required." Additionally,MGL chapter 152,E§25C(7)states`Neither the commonwe. th nor any of its political subdivisions shall . enter into any contract for,the performance of public work until accepts le evidence of compliance with the insurance requirements of this chapter have been presented to the contracting an ority." Applicants Please fill out the workers'compensation affidavit completely,by Necking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)names),address(es)and phonnumber(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'compens Lion insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit y 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 applicatidn for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regard' 'g the law or if you are required to obtain a workers' . compensation policy,please call the Department aNhe mum er 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 'f In, stigations 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"IhApplicarit should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or mai*ed by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or li �nses. 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 require o complete this affidavit. The Office of Investigations would like to thank you in lance for your coope tion 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 4f ee of InvestigatiGns 600 Washington Street Boston, MA 02111 TO. #617-727-4900 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia I' � t SHET �. Town of Barnstable Regulatory Services • BAMSIABM • MAss. $, Thomas F.Geiler,Director 9$'�E1619. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 509-790-6230 Property Owner Must Complete and Sign T ' Section If Usin A Bu' der L , as Owner of the subject property hereby authorize Z to act on my behalf, in all matters relative to work autho ' d by this building permit application for: (Address of ob) f Signature of Owner % Date Print Name f If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION Town of Barnstable �oFzKME rz Regulatory Services BAR,rSr"L ; Thomas F.Geiler,Director KAB& Building Division rFn Ma't Tom Perry,Building Commissioner www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 9- O `� JOB LOCATION: 3(e io IY)A 1 A Sf number street village �/ ( Tyi �lql ,3(oZ 9lo s� s F�mF "HOMEOWNER": (/ % name n ` home phone# work phone# CURRENT MAILING ADDRESS: U' Q /� O �! S Z �A-('j'�S 14 h lP &74 D.2 fo 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. DEFINTI'ION 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 requirements. S4 atir 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 community. Q:forms:homcexempt t1 *Permit# Town of Barnstable C� 1 rr Expires 6 months from issue date NO,V 9' 9 2-.'OOl Regulatory Services Fee { , 5f Thomas F.Geiler,Director Building Division a/r Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIA.L ONLY Not Valid without Red X--Press Imprint ' Map/parcel Number Property Address 10 ( Y j S T—CO E2/Residential Value of Work 0 0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address l 1 1 -i- {1 �� yA Contractor's Name -J 7 6 A-i-71 Ad ffwll"V Telephone Number,'? S 6D Q % cJ�6 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) 02'Re-roof(strippin r g old shingles) All construction debris will be taken to 1/U Vl ,3-k-r1111-n ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts ' Department of IndustrialAdcidents Office of Investigations _ 600 Washington Street Boston,MA 02111 , www.m ass.gov/dia Workers' Compensation Insurance.Affi'davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibl 7- Name(Business/Organizationgndividual):. J u i Address: 3 Co to M A n `�l ' City/State/Zip: 6 A-flA it 14 /Q / Phone A J k J (0, (0 S-10 Are you an employer? Check the appropriate box: -Type of project(required):, 1.❑ I am a employer with 4. ❑ I am a general contractor and T 6 ❑New construction . employees (full and/or part_time).* have hired the su'b-contractors 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet. 7, ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.$' 9• ❑Building addition required.] 5. ❑ We are a corporation and its 10,❑Electrical repairs or additions officers have exercised their 3.[vrI am a homeowner doing all work 11.[:1 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' . 1311 Other comp, insurance required.] , *Any applicant that checks box#1 must also f 1 out the section belowshowing 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. :Contractor;that check this box must attached an additional'sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must providt;their workers'comp.policy number, I am an employer that is providing workers'compensation insurance for my employees Below islhe 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 6. 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 maybe forwarded to the Office,of Investigations of the DIA for insurance coverage verification. I do hereby cer;!Oy under the pains-and penalties ofperjury that the information provided above is true and correct: Sienature: Date: Phone°# •�� g fo J��p Official use only. Do not write in this area,Yo be completed by city or town affilcial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical InspectoEImpector 6. Other Contact Person: Phone#: pp1HEr Town of Barnstable Regulatory Services snxxsTnsLe. 9 MASS. $ Thomas F. Geiler,Director Fo;9;ra�` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Sec 'on If Using A Builder as Owner of the subject property here authorize to act on my behalf, in all matters relative to work authors by this building permit application for: (Address of b) tore of Ow r Date 01 - �� ( VuL ZntONe y Owner is applying for permit please complete the Homeo ners License n Form on the reverse side. Q:FORMS:OWNERPERMISSION pF SHE Town of Barnstable � tp�� Regulatory Services * BARNSTABLE. * Thomas F.Geiler,Director MASS. 1639• Building Division TEv �s Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print /�' DATE: `L �/ " 7 ,n r JOBLOCATION: �Q �,v P_ number (n '/��/) street p y village "HOMEOWNER':1/ 6 /Y7 IIV L/ 5J 0 4o 9&,5—`Q 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- period shall not be considered a homeowner. Such P ear Y "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. PP � Y � � 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 quirements. gna�Ho- 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:fomu:homeexempt i opIKE Town of Barnstable *Permit# 7�' O Expires 6 months from issue date EAMsTAMS. : Regulatory Services Fee � 1� Thomas F.Geiler,Director prEC MA'i t'� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 AUG 3 2004 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY pNot Valid without Red X-Press Imprint ARN STABLE Map/parcel Number ��l 0 / a Property Address JL LO ffl ,41,A) c>fr P,P 4 �Mt:bs"/p (Residential Value of Work Minimum fee of$25.00 for work under$6000.00 a , 4* Owner's Name&Address C) Contractor's Name �_ /77� Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor 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(strippingold shin les All construction debris will be taken to shingles) ❑Re-roof(not stripping. Going over . existing layers of roof) ❑ Re-side E17(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,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improveme retractors License is required. Signature ` Q:Forms:' trg Revise0630 4 ..,/ O.Frt±1AHtC h�R80A N Co..* / f 7 Locus 1wro,e .. CnSNNO �. � iOGtJS MAP SCALE 1'. 20OV' / r�.r-�—� OR REGIVAY USE ONLY ASSCSYOR:uAP .117 PARCLL 18 .. BOOK ♦02 00 74 1 ERfer CER%Y rI-T ME PROPERrl K0RmP0.t1 REALrY nWST� q't - t1NES SNOVAt ON TNM"ARE THE LNES OONT f*MVAUS ANo MARRY Dorn VALE;. Lm10jrG E111St1NC OMNE11,00S.AA10 11.E g 0% 11604 PO 165 1 OsES Of T.1E SMEETS ANO NAYS SKDWN ARE 'MOSS Of PUBLIC OR PMVATC SMEETS OR RAY Au1EADY EVAGLISNEO.AND MAT - I.0 NEW LMES MR DLY*"Of Ei1571W .l•k )-KRSMP OR TOR NEW W&VS, ARE SHOWN . :zwWiYE J1 pATC "K A.P L.S. o- a' / / �� B AR��1 MLM, TY 1 lJ V • � 2s.e0a Srf MAR 2 1 2004 N��w•TC,Q 6' REISCM r^ARUM mCMAS E.CtlNNM '� \ DD 5746 Pc 243 ^b - �, /• / 1 CERt1n iwlr rpS PLAN tu3 pREPAREO n - OF NE NCE YNm R OF A E AS AD ri IED Di NE REpS1ANt3 Qr OEEtrS As ADOaED : - AOAARY 1• 1976. n 203, 2 4 AND AMENDED JANUtAy T. 190 h. PATE E A9E7AENT B ,,� LAR.A B�YUNSON 7,263 SE.t ,f Oe S124 PG t" .. LOT t PLAN SOCK 002 PO 74 - Ay,081 Sik - •6t tKALh'*MT a 00;PA2 Pc 55 TR EASEMENT PLAN OF LAND IN a / q�1 91Eo H/►RNSAHI+Fi, MA jlvu� �` ~ HARRY BOTSIVALES SCALE' t'- W DAM MOVEMM 16.2000 X •,'�i D n,(/ ¢1RE ` Ma1sE J d�/�. bARRM r. j0KS Do n"PC Jae rho. down cape engineering. inc. �::e9• sr� 1; y Tre61�}2o r LECENO CIVIL ENGINEERS a ` 1►tr P �O.0 .-CONCRETE 9MND raw � LAND SURVEYORS 9©4 ®eta It. p6rumuuL, roe 02M Assessor's office(1 st Floor): SYSTEM MU E t Assessor's map and lot number 317 0/6 ��,e�.-)..;, o� 6.ALLEI)IN COiWP Board of Health(3rd floor): e17 TITLE. Sewage Permit number f� 7—�-/z 6151,e � , E. • Engineering Department(3rd floor): n' �/• ENVIRONMENTAL ADLE. . House number 3(o/d �� �REGUL�TI® 3 '°' ®� Definitive Plan Approved by Planning Boardfuf a YAY d� APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARN STABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO eEPlNCE EX/ST/A/4 EGL (A"CHEA/ I AIU/t/ORY) TYPE OF CONSTRUCTION MOOD -F�2,9ME 7 19 8/ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .3610 a,9/A/ ch- ARA/S7,18.4 AF o 7 ` Proposed Use I�'ES/DENT/�9C. Zoning District RF-Z Fire District 5,09,eNJ 7&34 F ✓eNN ✓ k'uHAJ Name of Owner /G9REA/ /fC DENT Address PO45a-r ZOS Cagw 9oulo A14 OZ637 Name of Builder SGL F Address SAME Name of Architect I7OAWES INC. Address 0,eLE/91Vs /y�7 02-653 Number of Rooms +3 Foundation e0 VCRC-7-6 Exterior Wy/7'E C'ECKk JH1A/GLG.S Roofing 'V rPHgL 7- Floors • WooD Interior .fHC,c7- T0CK Heating Ea'l.ST/A/G GAS —NOT !T/4 Plumbing 66/0,'eR *V,/OYc Fireplace A✓d Approximate Cost *20, 000 Area .�� �D J�ff Diagram of Lot and Building with Dimensions Fee r Aeo R 4-46D 1A0/,/`0A/ 2/X 2 i( 50 y Ex/s ri�vG /2 X 2 y Z88 /✓ET /NcR�A.TE 2/fd�ff. I 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. Construction Supervisor's License KUHN, JOHN J. & KAREN K. DENT No 32793 Permit For BUILD ADDITION fiw ' Single Family Dwelling Location 3610 Main Street r Barnstable John J. Kuhn & Karen K. Dent Owner Type of Construction Frame Plot Lot- Permit Granted April 12, 19 89 Date of Inspection 19 3 ' Date 66mpleted i9 CL- nl ; TOWN OF BARNSTABLE BUILDING DEPARTMENT, HOMEOWNER LICENSE EXEMPTION Please print. DATE ,4/- 7 _89 JOB LOCATION �36/0 e,gi„/ f'7 ("64 BA,eiJJTABLF um er 3Lreez address ection Of town "HOMEOWNER" JvHN eUW 362-93y/ Rew-& DE T 3 6 2- 973/ 39 -/2Oro I ame name phone ri or pliane PRESENT MAILING ADDRESS �p fox 20S Cup-iM�9 0ui0 M,9 i ty town. 02637 fate ip CC e The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or ess anCTt allow such homeowners to engage an in- ivi ua for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section , DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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. ection , The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations_ The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Bui ]ding Department 'minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. ' HOMEOWNER'S SIGNATURE -ems APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet,*• or larger, will be re to comply with State Building Code Section 127.0, Construction Control required . 8 _ • HOME OWNER 'S EXEMPTION The Code state that4: Any Home Owner performing work for which a building Permit Is required shall be exempt from the (Section 109. 1 . 1 — Lic sing of Construction Supervisorrs)slonsovlafhls section Home. Owner engages a pers,on(s) for hire to do such work, . ed that if a shall act as supervisor . ° _ hat such Home Owner Man r 4 Y Home Owners who use this exemptlon, are unaware Ith,at they . are the responslblllties of a sup.`rvlsor (see A assuming, for Licensing Construction Supervisors, Sectlone2tl�d5)Q' This and Regulations often results In serious problems, his lack of awareness ! unlicensed persons. particularly�when the Home Owner hires unllcensed in this c se. 'our �,Boa;rd cannot proceed against the Person as It would with II ensed Supervisor . The Home Owner acting as supervisor Is ultimately. responslbl To ensure that the Home Owner is full communities require,. as y aw e of his/her responsibilities, many certify that he/she understands fthe erespoPermlsibppltieslofra supervisor that the . Owner last page of this . lssue Is a form current�y us b care to amend and adopt such a form/certificatlo for use In On the Y several towns. You may Your community. l f f i v -O-Z Dv vo k \ Oo E-- N 22 35 Z D t28,ro?-' `- 1.1 Z4'31'4o"E c.B....�`-_-: P� `�`'�AS M NT L set #; fence 4. o 83. o cb325o,g3' 2s`48'so"w m I S Zq° IS' S 6` c� W/A Lo+ ➢ r `J co L-UC! Lt✓ ` Yflj UENTIN R . Mil_DR m , 3 ! i ` w f � �:�' , . 1 �, � ' k i ti,. ,� � �/ j ` � •.f � -�. .� .. ,k� � �.., t ., Kos _ � �� i ,,3 � � �_ � .