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EXISTIN6SEPTIC SYSTEM Date Definitive Plan Approved by Planning Board LIMITED T0 #OF BEDROOMS Historic-OKH Preservation/Hyannis No Wit"t-i III, 9kro? Project Street Address 3(,ZS lid A Village Owner G.. d-rJ . EtoPK Address P © fJDx Co C,)r-"w ��sip�atf,4. Telephone 62)Sr - SD I - 1 Ss FS�1 N,1 Permit Request I S'Z)rz4 R4 50f: ion n wJ ON �� rl��r4C BMc.uT ! F =x—L-_n_AJA- y✓�OQCft OAJ -'f?, �1C/ �T/til G �A-t4 n f� P�lff fif�l P/C�i� Square feet: 1st floor: existing /S-0 proposed /36 2nd floor: existing /I/S-_0 proposed Total new / 36, Zoning District Flood Plain Groundwater Overlay Project Valuation So K. Construction Type a x y Lot Size 0 . 76, Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Uir� Two Family ❑ Multi-Family(#units) -r Age of Existing Structure_ja= Historic House: ❑Yes &NO On Old King's Highway: Bies ❑ No + Basement Type: mull Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) /J/II- Basement Unfinished Area(sq.ft) sF Number of Baths: Full: existing = new Half:existing 1 new I Number of Bedrooms: existing•. 4— new Total Room Count(not including baths): existing new First Floor Room Count S Heat Type and Fuel: ur as ❑Oil ❑Electric ❑Other Central Air: Qk] es ❑ No Fireplaces: Existing 1 New I Existing wood/coal stove: ❑Yes CN'No Detached garage:#rexisting ❑new size Pool:❑existing ❑new size Barn:Clre"xisting CB new size Z&.± Attached garage: ❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes U'No If yes,site plan review# -Current Use -Kes Proposed Use S v e*j e_ BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO .SIGNATURE - DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS; VILLAGE 2 OWNER DATE OF INSPECTION: FOUNDATION �/=o� FRAME � �(�U`( �� � l� b O" �� g All INSULATION 4 f tit O L O/L — ��� �o r2ct-f RB'Di� FIREPLACE B F7 C_ ELECTRICAL: ROUGH FINAL t- PLUMBING: ROUGH ,E, FINAL GAS: ROUGH FINAL FINAL BUILDING � A 1 00 •l • ca ! DATEICLOSED OUT [ ASSO TATIONrPLAN NO. e PROJEC NAME: ( a- Vol— � r> ADDRESS: �.3� PERMIT# PERMIT DATE: yr�0-5- M/P: LARGE ROLLED PLANS ARE : BOX Y7 SLOT-- Data entered in MAPS program on: By: i� The Commonwealth of Massachus. etts _ - Department of Industrial Accidents 600 Washington Street S' Boston,Mass. .02111 Workers', Com ensation.•Insurance Affidavit-General Businesses 9' S 11•,'i'sY+ii/� n. A'.( •'L(LL. '.Tr:l•+YW}a.p '$ .e „ •+ y i 1 name: �A2Aq,i,^1�_ tl4flJC.¢fP��11�� M tr .� J s address: city state: zip: phone# work site location (full address): ZS rq'k,A3 S 1• �A R IJS(A(3LE ❑ I am.a sole proprietor and have no one Business Type: ❑Retail❑RestaurantBai/Eating Establishment ' working in any capacity. ❑office❑ Sales(including Real Estate,P:utos etc.) ❑I am an em to cr with e1n•lo ees(full& art time.). [v�Other � %%G����/G r 1111011/r,,,/.,,�i.''I/D/� ���.10��� ////��0��/�0��� ] I am an.employer providing.workers compensation for my employees worldng on this job.. COlI1TieIlV•Jie]IIet �'' 1 :r. + .insdatice.co! .�^ I�:.�.. :y� 'r_%:,..:r:•:.. oll #'' - I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: company t ddress:. one, . 6ity . � .. yy .l.. i�t.• lIISllraIICe'CO. ���-/ VEMMMEMEM V. •+ coa aae•mU tip�n - address: :. .: . . . . .. .<• .. .r ; •. •#G c1iVc :phone. �ii':enc_cb fits r ' Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 all one years'imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that 0 copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under th p i s arfd penalties of perjury that the information provided above is true and correct f'y(i4 45— Signature Date . Print name c A D /�s' Phone# official use only do not write in this area to be completed by city or town official city or town: permittlicense# []Building Department []Licensing Board ❑check if immediate response is required ❑Selectmen's Office []Health Department , contact person: - phone#; ❑Other ' (revised Sept 2003) , Information and Instructions ati n f r e' . Massachusetts General I;aws.chapter 152 section 25•regtures all employers.to provide workers compens: o o th tt. f� another tinder contract ervice o an employee is.defined as`ev erson in the s f any i e •, As noted from the 'law", . �P employ es q . . _ e express or implied, oral or written. of hire, xp �P • . An employer is defined as an individual,partnership, as ociation, corporation or oth legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including a legal representatives o deceased employer, or the receiver or trustee of an individual,partnership,,association or other le•al entity, employing loyees. •However the owner of a dwelling house having not more than three apartments and o resides therein, or e.occupant:of the.dwelling house of another who employs.person'to do.maintenance, construction or repair work on s ch dwelling house or on the grounds or building,appurtenant thereto shall not because of such emplo be deemed to a an employer. MGL chapter 152 section 25 also states that every state'or loc 'censing ag cy.shall withhold the issuance or renewal of a license or permit to operate a business or to construct b ' 'ngs in th .commonwealth for any applicant who has not produced acceptable evidence of compliance with the insur ce cove age required: Additionally, neither the commonwealth nor.any.of its political subdivisions shall enter into a y con act for the performance of public work until acceptable evidence of compliance with the insurance requirements o chapter have been presented to the contracting . authority. Applicants Please fill in the workers' compensation affidavit completely,, checkin the box that applies to your sittiation.. Please supply company name, address.and phone numbers along ' a certificate f insurance as all affidavits maybe submitted to the Department.of industrial Accidents for confirmatio of insurance co age. Also be sure to sign and date the affidavit. The affidavit should be returned to the city town that the appli tion for the permit or license is being requested, not the Department of°Industrial Accidents Should you have any q estions regarding the law or if you are required to•obtain a-workers' compensation policy, . ease call the D e number listed.below. epartment a th .• City or Towns . Please be sure that the affidavit is c lete andprinted legibly. The Department has rovided a space at the bottom of the affidavit for you to fill out in the ent the Office of Investigations has to contact you garding the applicant: Please be sure to fill;in the ermitllic a number.which will be used as a reference number. e.affidavits may.be.returned to the Department by mail or FAX.unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and hould 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 oln"of Imsugmens 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext:406 pFtHETp� The Town of Barnstable BARMASS. . MASS. ` Department of Health Safety and Environmental Services �� pTED MPS A Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspen� �iotif of Location Permit Number Owner Builder One notice to remain on job site,one notice on file in Building Department. The following items need correcting: vn x I , - 1 µ-f T o l S 7-�< Po 2 c A-I -6Ecl< 9140 vZ-b ktFA-6 � � � � N o N D o N N o u S E k-)14 L L M u Z- e2 �s4 L) rr 7-1 L- I-- v� l S 7- S ,a° 5 o 7i+C-62. T7414eq G—I* R14 G-- 6 taut— e 80 6—#kI46— tW o K u N 7-1 L P c. 14 N S 14- P- F 4p iAk a ve Please call: 508-862-4038 for re-inspection. Inspected by Date Fier Town of Barnstable Regulatory Services saxes Lr,� Thomas F.Geller,Director ie?9. Building Division 'OWED NIP' A . Tom Perry,Building Commissioner • 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-40S8 Permitno. Date�u� �p jL �-oDS AFFIDAVIT HOME RMTROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,on of°an addition tooany pre�existin.g'owner-occupied occupied ion, improvement,removal,demolition,or constructs building containing at least one but not more than four dwelling limits or to structures which are adi scent to such residence or building be done by registered contractors,with certain exceptions,along with other requirelnmts. Estimated Cost Type of Work: Address of Work: 3(m Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 3 owl' duig not owner-occupied er pulling own permit Notice is hereby given that: UNREGISTERED Oyy�ERS PULLING THEIR OWN PEHOMEO�ROVEMEALING�WORKDO NOT HAVE CONTRACTORS FOR APPLICABLE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND IJr(pERMGL c.142A. SIGNED UNDERPENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Coutracto . ame Registration No. S 0 er's Name Date Q:forms:homeafFidav RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE , New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET W LIVING SPACE 0 NE / � l� aI square feet x$96/sq.foot= I x.0041= 5 `pus frombelow(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) a(p� square feet x$32/sq.ft.= SSA� x.0041= 3�• 7 ACCESSORY STRUCTURE>120.sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMIITS Open Porch x$30.00= 3D• D O (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= �S• o 0 (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 t�oc�Te e� ® r-�E RTv No 13r= ACCU RAYS STANDARD LEGEND NOTE:not all symbols will appear on a map GOLF COURSE FAIRWWAY EDGE OF DECIDUOUS TREES ~~~ EDGE OF BRUSH ORCHARD OR NURSERY ""`,T"'G"'"V EDGE OF CONIFEROUS TREES a: ' .. - .- / �._f'• MARSH AREA ........ .. ......... EDGE OF WATER DIRT ROAD ' DRIVEWAY C�v�us�rvo►f►�y 1 -- / PARKING LOT �—PAVED ROAD DRAINAGE DITCH �.........._..._� p v PATH/TRAIL /1 �e (Aegis�� W006eo � 8 xs"�cF�p -. .._\ PARCEL LINE (.t. cc,( � F—)�S � �\� T�-1�9' O� � MAP 326 E--MAP# I rll�,/f_ LJ� �j Ali 021— PARCEL NUMBER MAP 317 / 1 i l0 J 0>� �(L #367 E HOUSE NUMBER �. �i ;' �u C — 2 FOOT CONTOUR LINE O 4 2 m —!0 10 FOOT CONTOUR LINE �, Elevation based on NGVD29 S # 3625 SPOT ELEVATION cx_xc=1 STONE WALL N011VAU3SN00 318V NUV8 r � R> -X—X- FENCE RETAINING WALL RAIL ROAD TRACK y soot z Z H V STONE JETTY Pow SWIMMING POOL PORCH/DECK 3 [/� / BUILDING/STRUCTURE DOCK/PIER 2AN dOA) FA)6 HYDRANT SN �apdy s,®0(v�iC �flve STP�` 6 VANE O MANHOLE 1 V -Sew a r 3l7/Oy/ a POST 0" FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H I C 1 N F O R M A T 1 O N S Y S T E M S U N I T v SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel fines are only graphic representations DATA SOURCES: Planimetria(man-made features)were interpreted from 1995 aerial photographs by The James 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and, W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD UTILTIY POLE a TOWER w e 0 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. PlanimEtria,topography,and vegetation were mapped to meet National Map Accuracy Standards s 1 INCH=40 FEET* enlarged scale. on the map. at o scale of 1"=100'.Parcel lines were digitized from FY2004 Town of Barnstable Assessors tax maps. ¢ LIGHT POLE O ELECTRIC BOX Town of Barnstable FZHE ip�,_ Regulatory Services Thomas F.Geller,Director EAMSTABIA "t" Building Division 9� 1639. � ATfD MA'ia Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �/ Please Print DATE: �I '"`/�� � JOB LOCATION: 3G 2-5- �/1�l N �i 9f1I�N 4Ti4 Or � number street village . A C,/ f;/�S' S-og 362- 1969 `HOINSO (" a pry �ryN y work hone# name �Q home phone# P CURRENT MAII MO ADDRESS: 1 © f�X ` y A4 iq,4 CSC J 1 D city/town state zip code. The current exemption for"homeowners"was extended to include owner-occ�ied 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 snvervisor. DEFINITION OF HOMEOWNER Persons)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 vermit. -(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 inspectio procedures and requirements and that he/she will comply with said procedures and requirements V � . 0 o eowner 4 - ' 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 sors);provided that if the homeowner engages a person(s)for hire to do such of this section(Section 109.1.1-Licensing of construction Supervi 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 a' when the homeowner hires unlicensed persons. In this case,out Board cannot proceed against the unlicensed person as it would with a licensed .= Supervisor. The homeowner acting as Supervisor is ultimately responsible. To sure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, en 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. H r O:form -.bomeexempt BOISE- BC CALC®2003 DESIGN REPORT - US Thursday, May 05,2005 09:49 Triple 1 3/4" x 11 7/8" VERSA-LAM®3100 SP File Name: Gary Hopkins.BCC: FB01 Job Name: Hopkins.Residence Description: Header leading to kitchen Address: 93625 Main St J j Specifier: City,State,Zip: Barnstable;Ma Designer: Bill Campbell Customer: Gary Hopkins Company: Shepley Wood Products Code reports: ICBO 5512, NER 629 Misc: 2 5 4 T-T-T-7- 3 1 Standard Load-40 psf l 10 psf Tributary 10-00-00 i Mal a 10, BO 131 6240 Ibs LL 6240 Ibs ILL 3210 Ibs DL 3210 Ibs DL Total Horizontal Length-12-00-00 General Data Load Summary Version: US Imperial ID Description Load Type Ref. Start End Type Value Trib. Dur. S Standard Load Unf.Area Left 00-00-00 12-00-00 Live 40 psf 10-00-00 100% Member Type: Floor Beam j Dead 10 psf 10-00-00 90% Number of Spans: 1 1 ceiling shed Unf.Area Left 00-00-00 12-00-00 Live 5 psf 03-06-00 100% Left Cantilever: No Dead 10 psf 03-06-00 90% Right Cantilever: No 2 wall Unf. Lin. Left 00-00-00 12-00-00 Live 0 plf n/a 90% Dead 80 plf n/a 90% Slope: 0/12 3 shed Roof Unf.Area Left 00-00-00 12-00-00 Live 35 psf 03-06-00 115% Tributary: 10-00-00 Dead 15 psf 03-06-00 90% 4 Attic Unf.Area Left 00-00-00 12-00-00 Live 20 psf 10-00-00 100% Dead 10 psf 10-00-00 90% 5 Main Roof Unf.Area Left 00-00-00 12-00-00 Live 30 psf 10-00-00 115% Live Load: 40 psf Dead 15 psf 10-00-00 90% Dead Load: 10 psf Partition Load: 0 psf Controls Summary Duration: 100 Control Type Value %Allowable Duration Load Case Span Location Moment 28351 ft-Ibs 77.3% 115% 3 1 -Internal Disclosure Neg.Moment 0 ft-Ibs n/a 100% The completeness and accuracy of End Shear 7892 Ibs 56.9% 115% 3 1 -Left the input must be verified by anyone Total Load Defl. U287(0.502") 83.6% 3 1 who would rely on the output as Live Load Defl. U435(0.331") 82.8% 3 1 evidence of suitability for a Max Defl. 0.502" 50.2% 3 1 particular application. The output above is based upon building Notes code-accepted design properties Design meets Code minimum(U240)Total load deflection criteria. and analysis methods. Installation Design meets Code minimum(U360)Live load deflection criteria. of BOISE engineered wood Design meets arbitrary(1")Maximum load deflection criteria. products must be in accordance Minimum bearing length for BO is 2-1/8". with the current Installation Guide Minimum bearing length for B1 is 2-1/8". and the applicable building codes. Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+1/2 intermediate bearing To obtain an Installation Guide or if you have any questions,please call (800)232-0788 before beginning product installation. BC CALCO, BC FRAMERS, BCI®, BC RIM BOARD M, BC OSB RIM BOARD M, BOISE GLULAMT^^ VERSA-LAMS,VERSA-RIMS, VERSA-RIM PLUS®, VERSA-STRANDTOA, VERSA-STUDS,ALLJOISTO and AJSTm are trademarks of Boise Cascade Corporation. Page 1 of 2 BOiSE- BC CALCO 2003 DESIGN REPORT - US Thursday, May 05,2005 09:49 Triple 1 3/4" x 11 7/8" VERSA-LAM(g) 3100 SP File Name: Gary Hopkins.BCC: FB01 Job Name: Hopkins Residence Description: Header leading to kitchen Address: 3625 Main St Specifier: City,State,Zip: Barnstable, Ma Designer: Bill Campbell Customer: Gary Hopkins Company: Shepley Wood Products Code reports: ICBO 5512, NER 629 Misc: Connection Diagram Consult project design professional of record or BOISE technical representative for connection design Nailing schedule applies to both sides of the member. Member has no side loads. Connectors are: 16d Sinker Nails a=2" d b=3" _ c=4" a d=12" — • • • e=3" 0 T 0 C e 0 0 -1 � b Page 2 of 2 ,- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel o`[ Permit# A!9 it ' Health Division7f, /` Date Issued Conservation Division s i/�o b�-6®c_3�' Fee 4 (51 15 Tax Collector v 1 -SEPTIC SYSTEM mUST E Treasurer. f (�`�- -/2—e—� 012�IZ�00 INSTALLED IN COMPLIANCE WITH TITLE 5 Planning Dept. ENVIRONMENTAL , O'O�� �e Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 3625 MAIN ST. SAIZNSTAgLE , MA 02-637 CuMMAQ\I I V Village BAMSIABLE' Owner QoQERT ACID A1115oN HIOt Address 3625 ►SIN 57f, ummAay lD Telephone Permit Request QOp-LI� $g k�D r4,1:-VJ P0 P-t- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation ®/ o Zoning District Flood Plain Groundwater Overlay / Construction Type Lot Size 06 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family W Two Family ❑ Multi-Family(#units) Age of Existing Structure 150 YEARS Historic House: N Yes ❑No On Old King's Highway: IQ Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing S new Total Room Count(not including baths): existing 10 new First Floor Room Count Heat Type and Fuel: ❑Gas W Oil ❑Electric ❑Other G1 Central Air: ❑Yes M No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 06 No Detached garage:0 existing ❑new size Pool:❑existing ❑new size Barn:❑existing Cl new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION r Name 0>N 14 t P Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RES LTING FROM THIS PROJECT WILL BE TAKEN TO In 46 SIGNATURE DATE a z� D FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED- ?''` MAP/PARCEL NO- IK J ADDRESS VILLAGE OWNER` DATE OF INSPECTION: FOUNDATION r„ FRAME 7C INSULATION FIREPLACE t ELECTRICAL: ROUGH TiNAL r t PLUMBING: ROUGH . FINAL ; . GAS: ROUGH FINAL FINAL BUILDING X DATE CLOSED OUT - s ASSOCIATION PLAN NO. ` f . � The Town of Barnstable Department of Health Safety and Environmental Services 1*3 ram, . Building Division 367 Main Street,Hyannis MA 02601 ` Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230, Building Commission: Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such)residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Ps R&14 nl�1LVL'('Il)l� Estimated Cost , Address of Work: 3 0 1 N ,?TPZ ET G V NM M A RV Q . NA 0 2-W Owner's Name: � E GILD QN N 1� Date of Application: ° 11) �Q I hereby certify that: Registration is not required for the following reason(s): Work excluded by law E]Job Under S1,000 Building not owner-occupied lROwner pulling own permit Notice is hereby given.that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY .I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR Dat 1 Owner's Name q:forms:Affidav EST/MA TED PROJECT COST WORKSHEET Value LIVING SPACE (high end construction) square feet X$115/sq. foot= (above average construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X$25/sq. foot= PORCH square feet X$20/sq. foot= 0 Z •on DECK square feet X$15/sq. foot OTHER square feet X$??/sq. foot= Total Estimated Project Cost tin • 00 t The Town of Barnstable FINE Tp��O Department of Health Safety and Environmental Services Building Division BMWSTABLE, 367 Main Street,Hyannis MA 02601 MASS. 1639. plBO MA't A Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Q Please Print DATE: O" yS 2 BOO JOB LOCATION: number street L / village "HOMEOWNER": tt lvLJD1�I �"r �-7��'�i1�i —�0 277 namE — home phone# work p one# CURRENT MAILING ADDRESS: &8 X SD cv^�MA�fi�In 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,provide d 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 minim inspection procedures and requirements and that he/she will comply with said proceM r ' ements. Signature of Ho owner 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN ..bra*rw�nuwro.�...¢w+..;arxarrvwm�u.,✓+vcr�lti*.rnm�rn arrww.rmq�w�rr�e�nX.mNt®ifNe��.4Nrtirpmy�,pY�®uq W iY�ir1Y 1 i AS LDT 4? t� 2 r F z i s f R' '�, :'r"UTE:.:. 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