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HomeMy WebLinkAbout0126 PLUM STREET OxfordNO. 152 1/3 ORA ESSEL E 10% U b © O U� � a d ( rl �"a, e Town of Barnstable Building ` Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept MASS. `� Posted Until Final Inspection Has Been Made. 039. Permit Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-1297 Applicant Name: Matthew Borowski Approvals Date Issued: 06/18/2020 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 12/18/2020 Foundation: Residential Map/Lot: 195-024 Zoning District: RF Sheathing: Location: 126 PLUM STREET,WEST BARNSTABLE Contractor Name: Framing: 1 Owner on Record: Borowski, Matthew& Kimberly Contractor License: 2 Address: 126 PLUM STREET Est. Project t Cost: $5,250.00 Chimney: WEST BARNSTABLE, MA 02668 Permit Fee: $85.00 Description: renovate existing unfinished area into two bedrooms Fee Paid: $85.00 Insulation: ^' ,g J1gJ2o Reviewers Note: Date: 6/18/2020 Final: Removing one window on the left side of the house. RMCK �,.<•r wl Plumbing/Gas Project Review Req: Rough Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. a , Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. f I •-�• Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is-installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Person con ng with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site _ Fire Department c All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town of Barnstable Building suaA Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept .MAIM `e$ Posted Until Final Inspection Has Been Made. Permit 39.. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit NO. B-20-1018 Applicant Name: Matthew Borowski Approvals Date Issued: 04/16/2020 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 10/16/2020 Foundation: Residential Map/Lot: 195-024 Zoning District: RF Sheathing: Location: 126 PLUM STREET,WEST BARNSTABLE Contractor Name: MATTHEW M BOROWSKI Framing: 1 Owner on Record: Borowski, Matthew&Kimberly Contractor License: CS-074669 2 Address: 126 PLUM STREET Est. Project Cost: $6,500.00 Chimney: WEST BARNSTABLE, MA 02668 Permit Fee: $85.00 Description: Install second floor 8x10 full bath. Insulation: 'S Fee Paid:, $85.00 Project Review Req: move smoke detector>3'from bathroom door,window Date: 4/16/2020 Final: �yl� needs to be tempered glass, both sashes. Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after:issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: 71 All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. I L Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Perso tracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). �+ Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: � J ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r:. Map /�Jr Parcel Application 4L i�36 I 21VZ Health Division Date Issued ;P_(9. lt�, Conservation Division Application Fee Planning Dept. Permit Fee �� Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project"StL7Villreet age---2 E)wn4'----? �,1�!/,.b,-z fY.g Address 1i94.�elephp—h—e---7), 'may 99y./9,90 Per_mit3equest_ � I = .vT I z� - :.Square feet: 1 st floor: existing a proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 'P_roject`Valuatio'n/6,�3a Construction Type ' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Familyy ❑ Two Family ❑ Multi-Family (# units) — C ZE Age of Existing Structure Historic House: ❑Yes ❑ No On Old Ki's Highway: ❑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 —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas U Oil ❑ Electric ❑ Other Central Air: ❑Yes "*U No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage existing, ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing , ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of App als Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review # Current Use � 7�5 l� 1�� Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 46Namez--� Zi�, -7 z" elephone Number--�� 9Zdj�-/�QU �Address, ��i-r _�� License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE�LU N �. DAT_EI*' rr _ FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. e X ADDRESS VILLAGE OWNER DATE OF INSPECTION: ; s FOUNDATION. FRAME ' FRAME INSULATION 1 FIREPLACE ELECTRICAL: ROUGH FINAL r_ >ti PLUMBING: ROUGH i FINAL r, GAS: ROUGH . FINAL s FINAL BUILDING t . DATE CLOSED OUT ASSOCIATION PLAN NO. } Town of Barnstable Regulatory Services MAMThomas F. Geiler,Director 6 ►`� Building Division Thomas Perry,CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: yA1-4, r7 Map/Parcel: I Jr 0 Project Address 126 Pui►t Sr, W8 Builder: 5"Im i The following items were noted on reviewing: 0)�V 9t.C—C--m I 4;V4 e-�o 25!� 406 r1f Of i Reviewed by: Date: 3 3 Q:Foriris Plhrvw'--- i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street s' Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �A�ddres� City/State/Z hone#: 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 have ship and have no employees These sub-'contractors8. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers'comp. insurance comp. insurance.1 \ )?requi 5. We are a corporation and its 10.❑ Electrical repairs or additions 3`��]�I ared.] ❑ �m a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.f. [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.[:1 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. 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 criminal penalties of a fine up to$1,50.0.00 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 certify under the pains andpenalties ofperjury that the information provided above is true and correct. Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia _ 1 Town of Barnstable ti a ° Regulatory Services ` BARNST"BLEHASS. Thomas F. Geiler, Director 'pf�s Building Division Tom Perry;Building Commissioner 200 Main Street, Hyannis,MA 02601 www.tow n.ba rnsta b l e.m a.us Office:. 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 3 — 13 JOB LOCAT OI N/ 6�f /y�—c �77� G.�iZ,c157�yblg number street /� QQ�village QLj HOMEOWNER",-__/O vrt �9�`b l name home phone /# work phone# CURRENT MAILING ADDRESS: � cy rty/to/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home"in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such*work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned "homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that /he/she will comply with said procedures and requirements. Signature of Homeowner_._.___f ' Approval of Building Official Note: Three-family dwellings containing 15,000 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 caret amend and adopt such a form/certification for use in your community. 0:\WPFILES\FORMS\building permit forms\EXPRESS.doc I • I • aexivsra'Hts, "t"SS. Town of Barnstable pTFD Mp't A Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street,' Hyannis,MA 02601 www.town.barnstable.ma.us ,�, e3- Office: 508-862-4038 Fax: 508-790-62�30 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: _(Address of Job) 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. QAWPFILES\FORMS\building permit fonnsEXPRESS.doc TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel D Application # Health Division Date Issued (I Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation /Hyannis -Project Street Address /ij?11 Village Ad. JA�� Owner ) ��r7 /Xv��/� Address /alp an .fit 75 / tTelephone ;771-y-/910 `�- Permit Request -kwllrl1c_ rc7Z. 106Z 52di9� '90 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑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 _new o � Total Room Count (not including baths): existing new First Floor R Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/ oal stove: ❑Y ❑ No Detached garage: ❑ existing El new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing O new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ry f NJ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION �t (BUILDER OR HOMEOWNER) ' Name Telephone_Number -7;2� Address /op/o License.# i /,9d� /`Gg e,=,6 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Zoz, ef !/G/�`'b DATE - �'� FOR OFFICIAL USE ONLY 1 APPLICATION-# DATE ISSUED j MAP/PARCEL NO. ST i ADDRESS VILLAGE 's OWNER 'r DATE OF INSPECTION: _FOUNDATION -: FRAME INSULATION FIREPLACE r' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL-'' FINAL BUILDING DATE CLOSED OUT { ASSOCIATION PLAN NO. t ,per The Commonwealth ofMassac usetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bI Name(Business/Orgauizadon/Individuai): . Address: City/State/Zip: � �. i� Phone.#: -1 Are you an employer? Check.the appropriate box: .Type of project(required):. 1.❑ I am a e to er with 4. ❑ I am a general contractor and I mp Y _ 6. ❑New construction . .'employees (full and/or part-time).* have hired the stab-contractors 2.❑ I am a'sole proprietor or partner- listed.on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have •g• ❑Demolition workingfor mein an capacity. employees and have workers' Y p tY• t. 9. ❑Building addition . . [No workers' comp. insurance comp.insurance. nc re ed 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions � . ] 3.9 I 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. tContractors that check this box.must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities bave 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.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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1-do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct Signature /ir? /7in Date: Phone#: Official use only. Do not write in this area, tb be completed by city.or town off ciaL City or,Town: Pei mit/License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information. and Instructions ` Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation.for their employees. Pursuant to.this statute,an employee is defined as"...every person in.the service of another under any contract of hire, express or implied,oral or written.." An employer is defined as an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or.the... .. ... _ receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant.wfio has not produced-acceptable evidence of compliance with the Insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until-acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you.have any questions regarding the law or if you are required to obtain a workers.' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials. Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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: 'he Commonwealth of Ma cs husats Departagnt of ladustu l A.ccideints Office of buyest%PdQas 600 Washington SUVA Boston, MA 02111 Tel.#C 17-727-4900 ext 406 or 1-M-MASSAF`F Revised 11-22-06 Fax 617-727-7749 V .M=gov/dia f. o�TME rati Town of Barnstable Regulatory Services = 31MMSTesrZ, + v Thomas F. Geiler,Director , �A i6g9.. �0 r�►9. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.mk.us Office: 508-862-4038 F 508-790-6230 Property Owner st C plete and Sign 's Section If Using uilder as Owner.of the subject property . hereby authorize' to act on my behalf, in all matters relative to wo authbrized by building permit (Address of.Job) Pool fences d alarms are the respon ibility of the applicant. Pools are not to be fill d or utilized before fence 's installed and all final inspections are erformed and accepted. i Signature of Owner Signature of pplicant Print Name Print Name Date Q:F0RMS:0WNERPERMISSI0NP00LS 6/2012 Town of Barnstable F: , Regulatory Services ; STABLE Thomas F.Geiler,Director MASS v� i639• .0� 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 HOMEOWNER LICENSE EXEMPTION 'Please Print DATE: fl-/ -1 0-7 J JOB LOCATION:__ ��Go //U/"( ✓� L(J Ji��IUS//Y( b number /'street villagee�/�T, "HOMEOWNER": i /��7 �/l ZZI name /- home phone#/ 1 work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF.HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor!' Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that hdshe 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 forrrYcertification for use in your community. Q:forms:homeexempt oco 1 �1 195 a 254. 8' 00 DIRT ROAD\ -- 64. \` 8' WIDE __ 30'- C.B. �'- LOT AREA y�~ _ � rz ��. k 2.10ACRES± co G w EXISTING DWELLING CONCRETE LOCATED BY FOUNDATION 1g•8' OTHERS -)3 20. 2' 395.80' 46.64' C.B. DCE #09-262 FOUNDATION PLOT PLAN PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE LOCATION 126 PLUM STREET WEST BARNSTABLE, MA SCALE : 1" = 80' DATE : OCTOBER 27, 2009 PREPARED FOR: REFERENCE : ASSESSIONS MAP 195 PARCEL 24 CHARLIE HALLETT PB 534 PG 9 1 HEREBY CERTIFY THAT THE STRUCTURE ��SNOFMgss SHOWN ON THIS PLAN IS LOCATED ON THE o�� DANIEL 9cy�m GROUND AS SHOWN HEREON. off 508-382-4541 O A. rax sos-ass-seso OJALA N downcape.com a No.40980 own cape e �ndineecin inc. �o . civil engineers p 2�7/O� land surveyors f-- 939 Ma/n Street ( Rte 6A) YARMOUTHPORT MA 02675 DATE REG. LAND SURVEYOR Town of Barnstable Geographic Information System July 1,2010 196034 216005 #241 % #868 196022003 21660200' 216002002 #218 #61 #49 216068 196032 1#219 196022001 96035 '`1# � #27 #200 . 2160020010 196036 #39 #209 19#190 2 �A�!f✓L6-'Q. •216001 #190 #830 196031 195012002 ii ��� 215013 #30 195039 #16 #81, #179 195012001 #12 195038 1 01 3# 195014 215012 #28 :i % 9104 #800 195040 19508 1V88 195016 215006 215030 215008 #161 #138 #88 #761�• #70 # �� #' 215009 215011 a . L 216007 �#261 °2#144#780 co _ 215014001 �• 195022'f 195021 1950201 Mp RD # #781 19504 1) ?y' 4;119` #103 #89- 19501� 215005-1 2150� • 63 #141 ■ #76�. # n #45 l l 215033 33A 215031 ' • _., �195024 � • #11 #126 216015001 G 195028043 215002 #765 195028042 11 #26 #754 �t #28 196025001 • 215001001► 21501 #0 5002 #732 #749 195004 215001002► Ab #0 195028003 #712 215#016001 195033 S `, #18 F� r #0 195025 �F R #50 1.'_ 196028004 9241 195028002 4y 21501w6002 �a# #736 215034002 215017 19S05 2 at t yho OP•E- #709 #o ck oR .�► 215034003 21501$_ 195027 #689 #0 195011 #640 215034001 �g5 #35 #675j 0 1941034 Feel#.7 ,9#6008 ,9#50009 194021 195029 #625 #661 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:195 Parcel:024 Q M boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:HALLETT,WILLIAM C 8 AMY E Total Assessed Value:$386900 Selected Parcel 1-=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:2.15 acres Abutters W, +'',, E boundaries and do not represent accurate relationships to physical features on the map Location:126 PLUM STREET syl such as building locations. Buffer I Citizen Web Request Page 1 of 3 y1 �ffr Logged In Citizen Request Management Thursday, February 4 2010 TOWN\mckecechnr Route to Users Search Requests Create Requests Request Information Request ID: 29119 Created: 2/4/2010 2:34:28 PM Status: Assigned To Staff Assigned To: Mckechnie, Robert Building Dept Anonymous: Yes Request Category: Work with out permit edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 2/19/2010 Change Estimated Jan February 2010 Mar Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 31 1 2 3 4 516 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 8 9 10 11 12 13 Created By: Shea, Sally Priority: Medium edit Building Dept Citation Numbers: edit Requestor Information Requestor Request HALLETT DETAILS: LOCATION: 126 PLUM STREET West Barnstable, Ma 02668 Request Parcel Number Map: 195Block: 024 Lot: 0 1001 PERSON REPORTS THERE IS A WHITE TEMPORARY GARAGE STYLE PLASTIC DOME STRUCTURE. THIS IS Parcel Lookup NOT PERMITTED BY OKH.THIS HAS BEEN THERE AT LEAST 2 AND 1/2 YEARS.THERE IS QUESTION OF THE SETBACKS FOR THE EXISTING TRAILER.THERE IS QUESTIONABLE LANDSCAPING ACTIVITES. Email: http://issgl2/lnternaIWRS/WRequest.aspx?ID=29119 2/4/2010 i Citizen Web Request Page 2 of 3 Edit Requestor Information Track Request Progress Request Work History: -Internal Note History: System entry on 2/4/2010 2:34:28 PM: Assigned to Mckechnie, Robert System entry on 2/4/2010 2:34:40 PM: Related Request 29120 Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) its f lux Spell Check ; Spell Check -Add document or image link: __ _ _ __ Browse... * You can also type in a folder name to see everything in the folder Current Links: Time worked on request: 1 Response time: IO *Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. '-J Save changes F Check to notify town employee below to review this request. ri Save Changes and notify Building Dept citizen* - -- Amara, William `= Close request — — --- - Close request and notify citizen* Brief message to reviewer: *notify works if email address was given Update Spell Check J http://issgl2/InternalWRS/WRequest.aspx?ID=29119 2/4/2010 Citizen Web Request Page 3 of 3 Public Use: Printer Friendly Version Internal Use: Printer Friendly Version V(5[-r 0 1--�h4 0 http://issgl2/lnternalWRS/WRegtiest.aspx?ID=29119 2/4/2010 Town of Barnstable Geographic Information System February 4,2010 mk f s ` g ; 3 F DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:195 Parcel:024 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected P w+ arcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:HALLETT,WILLIAM C&AMY E Total Assessed Value:$386900 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:2.15 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:126 PLUM STREET such as building locations. Buffer Aerial Photos Taken April 19,2008 Citizen Web Request Page I of 3 I.It BARNSTaru� 4 �N�w' Logged In Citizen Request Management Thursday,June 242010 TOWN\mckecechnr Route to Users Search Reauests Create Requests Changes saved Request Information Request ID: 29120 Created: 2/4/2010 2:34:40 PM Status: Closed Assigned To: Anderson, Robin Building Dept Anonymous: Yes Request Category: Zoning - Illegal business Routine work: No Estimate: No Date scheduled: Estimated 4/30/2010 Change Estimated Mar April 2010 May Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 28 29 30131 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 1 3 1 4 15T-61 7 8 Created By: Shea, Sally Priority: Medium Building Dept Citation Numbers: Requestor Information Requestor Request HALLETT DETAILS: LOCATION: 126 PLUM STREET West Barnstable, Ma 02668 Request Parcel Number PERSON REPORTS THERE IS A Map: 195 Block: 024 Lot: 00 0 WHITE TEMPORARY GARAGE STYLE PLASTIC DOME STRUCTURE.THIS IS Parcel Lookup NOT PERMITTED BY OKH. THIS HAS BEEN THERE AT LEAST 2 AND 1/2 YEARS.THERE IS QUESTION OF THE SETBACKS FOR THE EXISTING TRAILER.THERE IS QUESTIONABLE LANDSCAPING ACTIVITES. Email: http://issgl2/InternalWRS/WRequest.aspx?ID=29120 6/24/2010 Citizen Web Request Page 2 of 3 4 Track Request Progress Request Work History: Internal Note History: Entered on 3/4/2010 2:32:01 PM System entry on 2/4/2010 2:34:40 PM: by Perry,Tom Related Request 29119 Bob McKecknie is working on getting this resolved. System entry on 2/4/2010 2:34:40 PM: Entered on 6/24/2010 8:50:03 AM Assigned to Anderson, Robin by Mckechnie, Robert System entry on 3/4/2010 2:32:06 PM: Site was visited on 02/05/10 by myself and spoke with Mr. Hallett.The referenced trailer is on site Estimated completion changed from storing building materials that are being used to 2/19/2010 to 4/30/2010 construct a permitted (ref#200902131)garage/barn. The trailer is on Mr. Hallett's property. As for the System entry on 6/24/2010 8:56:38 AM: white plastic dome structure, Mr. Hallett has advised that it houses some equipment that will be moved Request Closed by mckechnr into the garage when it is done. It also is used to grow plants. He is pursuing an approval from OKH for this. Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) s+ i+� Spell Check Spell Wl k Add document or image link: Browse...F *You can also type in a folder name to see everything in the folder Current Links: Time worked on request: 3.00 Response time: 1.00 *Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. http://issgl2/Internal WRS/WRequest.aspx?ID=29120 6/24/2010 Citizen Web Request Page 3 of 3 Reopen r Reopen and notify citizen Reopenl Public Use: Printer Friendly Version Internal Use: Printer Friendly Version I http://issgl2/lnternalViRS/WRequest.aspx?ID=29120 6/24/2010 �P Aso . rrt-�+T t.�9Y' �aor� I�oT a�a ot� I&. w Rs fRap�t �+ D rs P ers, el 17c t4 pe bo �ts; o • ,. � ita ec - - s, u�_b.���e��ss etc. The pe it/lice tityhthts` y� 'e s and owner is a sole proprietor wi. o p oyees states that they have a wo Ilac ornpensati along with the completed affi e city file, along with the applicatio ry, -ermit/ more than one license/permit etc. to the s organization will satisfy the statutory require upon the renewal of a yearly license or permi annually. From time to time a representative of i come to your offices in order to review the workers' compensation laws. We ask that yo have questions in this regard, please contact you for your continued cooperation and suppo Sincerely, Gregory J. White Deputy Commissioner and General Counsel P.S. Copies of these affidavits are available on-li www.mass.gov/( TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Oo`Z7 Application # f� ��� Health Division Date Issued l Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address rizw-t Village Owner , �r Address Telephoney 99y�/9QC3 Permit Request /r, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay /Aroject Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑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 _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood%coal stove:. ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: 0 existing ❑ new;,size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: =� Zoning Board of Appeals Authorization ❑ .Appeal # Recorded ❑ w sr Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number ! Address l�io Q�UKI S\ License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE /Z� DATE �,1�!�0 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER -'DATE OF INSPECTION: FOUNDATION FRAME INSULATION ` FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ! 'FINAL BUILDING # l f f �7 DATE CLOSED OUT ; ASSOCIATION PLAN NO. ' *� The Commonwealth of Massachusetts Department of Industrial Accidents = 1 Office of Investigations 600 Washington Street t� Boston, MA 02111 yy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ise is7 bly Name (Business/Organizationflndivi dual): Address: �-1010 Q UC(�SZ City/State/Zip: 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.El 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. 5. ❑ We are a corporation and its ME]ME] Electrical repairs or additit required.] 3� I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additit 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. 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. 1 am an employer that is providing workers'compensation inscrance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie.#: 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 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 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 certify ender thepains andpenalties ofperjury that the information provided above is trice 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 Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed.to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(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 pen-nit or license is being requested,not the Department of Industrial Accidents. 'Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)-"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required.to complete this affidavit. The.Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617.-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia Tow)a of Barnstable of slue ropy o Regulatory Services s�uxsrAs� Thomas F. Geiler,Director Buildiug Division Tom Perry,Building Commissioner 200 Mairi•Strcgf Hyannis,MA 02601 wwwJown.barnstable.ma.us Office: S08-862-4038 Fax: S09-790-6230 HOT,EEOVINER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: V)� number street • village M1L'�—�`-1� name home phone.# workAom# . CURRENTMA1LiNAD G DRESS: ettyhowo state zip coat The current exemption for"homeowners" was extended to include owner-occupied dwellinu of six units or less and to allow bomcowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEO'SVXFR Pcrson(s)who owns a parcel of land on which be./sbe 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 under for all such work performed der the building permit. (Section 109.1.1) The undcrsigncd"homeowner"assumes responsibility for compliance with the State,Building Code and other applicable codes, bylaws,rules and regulations. The uzndcrsigncd"homeowner"certifie th s at he/sbc understands the Town of Bamstable Building Dcpartrpcnt minimum inspection procedures and requirements and that be/she will comply with said proccduncs and rcquircmcuts. Signatiue o omcowncr Approval of Building Official Note: Three-faintly dwellings containing 35,000 cubic feet or larger will be rcgturcd to comply with the State Building Code Section 127.0 Construction Control. HOMEOW'NERIS EXEMPTION The Code stales that "Any homeowner performing work for which a building perrrvt is required shall be exempt from the provisions of this section.(Sccticn I D9.1.1 -Licensing of construction Supervisors);provided that if the homcoryncr engages a po-son(s)for hire to do such work that such Homeownrx shall act as supervisor.,. Many honicownc s who use this exemption arc unaware that they art assuming the responsibilities of a supervisor(see Appendix'Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.1.S) This lack of awareness bftrn results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against thc unlicensed person as it would with a licensed Supavisar. The'homeowner acting as Supervisor is ultimatc)y responst'blc., To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homcowncr certify that he/she understands the responst'bilitics of a Supervisor. On the last page of this issue is R.form currently used by mmunity. several towns. 'You.may care t amend and adopt such a forrnkcrtifteation for use in your co m Y r Tawnn of B arnstab4e o . Regulatory Services ` 113tWAR.� Thomas F_ Geiler,Director �o Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barngtable.mq.us Office: 508-862-4038 Fax: 508-79( Property OwterMust Complete and Sign This Section If Using ABuilder as Owner of the.subject property hereby authonze to act oa my 6eh.alf, 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 foi-perm-it please',complete the Homeowners License Exemption Form on'the reverse side. TOWN Of BARNSTABLE i 1(D9 OCT 27 PM I: 50 D 'VISION 'op > 247 f-- -- -- - 254. _ --� ---------'---�f 0 �ROROWN `-DIRTY-- 8 ROAD\C— _-- I.P. 64.30' 8 E- -_— -_-__- C.B. a� LOT AREA zo 2.10 ACRES± 0 LA w EXISTING DWELLING CONCRETE LOCATED BY FOUNDATION 19,g• N OTHERS 20 2' co °p ,A v 395.80' P 46.64' C.B. DCE #09-262 FOUNDATION PLOT PLAN PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE LOCATION 126 PLUM STREET WEST BARNSTABLE, MA SCALE : 1" = 80' DATE : OCTOBER 27, 2009 PREPARED FOR: REFERENCE : ASSESSIOR'S MAP 195 PARCEL 24 CHARLIE HALLETT PB 534 PG 9 x-ZH Of!v/gSS I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE �° DANIEL yc GROUND AS SHOWN HEREON. o A. off 5oe-362-4541 " OJALA v fax sae-362-sego No.40980 downcape.com ® P Jews cope endinee�ind,inc, S S� civil eyo s ---(d�-L-7r/�-- ---__---- uRv---- ,�--- land surveyors 939 Mo/n Street ( Rio 6A) YARMOUTHPORT MA 02675 DATE REG. LAND SURVEYOR aq7 3 �V� 5 l PA OU A'l of Barnstable *Permit 0 ' Expires 6 mon'c%sJrom issue dale atOry ServlCes Fee as F. Geiler, Director ]ding Division y, CBO, Build ing.Commissioner treet, Hyannis, MA 02601 own.barnstab le.ma.us Fax: 508-790-6230 ICATION - RESIDENTIAL ONLY ithout Red X-Press Imprint inimum fee of$25.00 for work under$6000.00 TOWN OF BARNSTABLE BUILDING PERMITAPPLICATION Map 1S Parcel Day Pp A lication # 70 - Health"Division Date Issued . , e Conservation'Division Application Fee ' Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ' Historic - OKH Preservation/Hyannis Project Street Address Village ft,� Owner ` , rc sa Address io'7e, Telephone Permit Request Z!�",Lr :or'k 40M6WZ1d M_X5/ _ 1'106 TAD/ - 5 C/ 01,�Wd S uare feet: 1st floor: existing ro osed o2nd floor: existing ����'��sh ,q 913L�p P g proposed_Total new Zoning District Flood Plain Groundwater Overlay Project Valuation aW Construction Type Woor--;, Lot Size 46' •�sc Grandfathered: ❑Yes ZF No If yes, attach supporting documentation. Dwelling Type: Single Family J Two Family ❑ Multi-Family(# units) Age of Existing Structure D Historic House: ❑Yes /1 No On Old King's Highway: W Yes ❑ No Basement Type: A Full ! ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) 6 Basement Unfinished Area(sq.ft) %���(Y Number of Baths: Full: existing I new "f? -' Half: existing 0 new Number of Bedrooms: 1,2 existing d new Total Room Count (not including baths): existing �-,5 new b First Floor Room Count Heat Type and Fuel: ❑ Gas X Oil ❑ Electric ❑ Other Central Air: ❑Yes A No , Fireplaces: Existing New n Existing wood/coal stoves ❑Yes A No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing Anew size _ Barn: ❑ existing L3 new size_ Attached garage: ❑ existing ❑ new size _Shed: U existing ❑ new size _ Other: — CPI — r � v Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ �^ Commercial ❑Yes 1dD No If yes, site plan review# _ rr v — ­J M Current Use Proposed Use APPLICANT INFORMATION `, 77 (BUILDER OR HOMEOWNER) Name Telephone Number 5-2 --31 2--62& Address /�� ��,n � * License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE .� � ,,o,-i ,,y ,�� DATE z . FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED r MAP/PARCEL N0: ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION o , 64-of �IZG ,f FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ; PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i l DATE CLOSED OUT ASSOCIATION PLAN NO. } i 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/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): G(]i/.s Address: City/State/Zip: Are you an employer? Check the appropriate bog: 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.instuance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions a homeowner doing all work officers have exercised their il.❑Plumbing repairs or additions 3.0 I qu 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.� OtherilL�c�°,tc F��? comp.insurance required] g6od� (�izooa *Any applicant that checks box#I 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. 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 isproviding workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: . Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the bIA for insurance coverage verification. I do hereby certify under the pains•andpenalties ofperjury that the information provided above is true and correct. Signature: �,/ •��/ 1 � Date: 7/D d� — Phone# SUS S4 2 _'5_/ 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#: Ifformation and InsAr'uctions , 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 hue, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including.the legal representative's of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionany,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract fok the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone numbers) 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 maybe 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 hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-490.0 ext 406 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.m=.gov/dia i THE Town of Barnstable �pF Tp . Regulatory Services snttrisTwBt s, = Thomas F. Geilee,Director ,P MASS. 1679. Building. Division AIFD MPS p Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.toA,n.barnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB*LOCATION: M'ly /LJ/'Z /�� E.L�IC� /�Q�G&5' number street village "HOMEOWNER": .v� �/b 6 74 a-�5��`� name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Bamstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official . Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. -HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner perfofming work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of constiuction 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 fomi/certification for use in your community. oF1HEro 'Town of Barnstable Regulatory Services M MAS&B '� Thomas F. Geiler, Director Qjo t63q• �� . rFo,,,A�A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.mams Office: S08-862-4038 Fax: 508-790-6230 Property Owner Must C mplete and Sign This Section If Using A Builder as O er of the subject property hereby authorize to act on my behalf, • in all matters relative to work authorized by this ding permit application for:• (Addres 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. %1•cllD T,iC•f111R.lFA PFR MLCC1r1U I i -3 � N h k t j �Lc po,j V� � N hl \ 7 z 00 .t, TO THE BEST OF MY INFORMATION, "AS- BUILT" PLOT PLAN KNOWLEDGE, AND BELIEF THE _ BARNSTABLE, MASS. fo�.,�o q.r7�.✓ _ PLAN HAS BEEN LOCATEOW S GROUND AS INDICATED z� '° `� Y DATE SCALE o %mLcox JOB / 86-ate CLIENT 1/gLc e-r-T ' 3341 SWE'E'TSE'R ENGINEERING L, 9 d oP 235 GREAT WESTERN ROAD P.O. BOX 713 SOUTH ATE PROFESSIONAL LAND YOR DENNIS, MASS. 398-3922 FAX 398-3063 Page 1 of 1 F-41 [iVFR1 A.0 i v V,R. I 2 i, Fi" 2"x4' ,WE VIEW 14,PIG?:I 4- c 4" POSI G(O _ tl QAT"V .r �4, f a C ' t 1 r y T'4 • d w V1 I •• • Application to ®rb Rfttg'�; 3f bbiap Regional 3bfotorfc Miotrict'(2Drr mittee In the Town of Barnstable CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of. Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: . CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ® .New ElAddition ElAlteration C, � Indicate type of building: ❑ House ❑ Garage El .Commercial Other �`Gl� 2. Exterior Painting: ❑ r- a 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign . ❑ Repainting Existing Sign 4. Structure: Q Fence ❑ Wall ❑ Flagpole ® Other VIC-c K = TYPE OR PRINT LEGIBLY: DATE - 7- D `P rn ADDRESS OF PROPOSED WORK / 6 ASSESSOR'S MAP NO. OWNER ��i�/,�'� C /7�G'// / ASSESSOR'S LOT NO. HOME ADDRESS TELEPHONE NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR TELEPHONE NO. ,r 3 1 ADDRESS DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please-' ,r include locations of proposed signs. ,/ Signed Owner-Contractor-Agent For Committee Use Only —. This Certificate'is hereby Date -7/1 I V App d/Denied '! Committee Members' Signatures. 6 2007 TOWN OF 6P,4NST�;(3LE r ,�n �n 1 _TOR1C.._f�r1C:"FRV/11'10(\ `� � V \, �J�� .. ;a Ab� 1 INK .. 1[lot /'F } Y ` tsw S �q r z 3 4^ F x G ZSk-off fv S 3 , �' ' ti F c J ,, TO THE BEST OF MY INFORMATION, AS BUILT" PLOT KNOWLEDGE, AND BELIEF THE BARNSTABLE, MASSAN r _ ou,.�pq.n�.✓ SHOW S PLAN HAS BEEN LOCATE GROUND AS INDICATED DATE ��9y /y, i9 y ' `SCALE o • VIAA.U:�Mfi cr ZA Mom JOB tso.s,3a, r - CLIENT �l9cc�rT SWEET SER E'NGINE'E'RING oQ 235 GREAT P 0. BOXT7R3 ROAD 0 ATE PROFESSIONAL LAND YOR SOUTH DENNIS, MASS. 398-3922 02660 FAX 398-3063 f , �o4,NE roomy Barnstable Old Kings Highway Historic District Committee ,�Y o i MRNSTABLF- 200 Main Street, Hyamlis, MA 02601;TEL: 508-862-4787 Fax 508-862-4784 p MAS& a 1639* ream APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four(4)complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: Check all categories that apply, 1. Building construction: New ❑ Addition ❑ Alteration 2. Type of Building: ❑ House IZ Garage/barn ❑ Shed ❑ Commercial ❑ l�her o 3. Exterior Pamtin>; roof ❑ new roof ❑ color/material change, of trim, siding, window, r 4. Si�n : ❑ New Sign- ❑ Existing Sign ❑ Repainting Existing Sigm 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court OtherT 6. Pool ❑ swimming ❑ Other man-made pool Type or Print Legibly: Date: &17/0 09 Address of proposed work: House# Street: . ���)� �* Village Assessors Map Lot# Description of Proposed Work: Give particulars of work to be done: 2 S L �/ Agent or Contractor(print): Telephone.#: 5-0 Address: Contractor/Agent' signature: NOTE All applications mist be signed y the current owner Owner(print): ��� o,_, �' �� .. Telephone#: Owners mailing address: / ( �ta { t ,p, -� Owner's signature: _ _ For committee use only. This Certificate is he eby APPROVED Date ,2,S Members signatures 9 FEB 27 2009 .� TOWN OF BARNSTApBLEN -` - Any conditions of approval: 0/ Cedar sh;4 -les V 1 Q:I GivfD-GroupslOid Kings HighwaylOKH New AppIOKH Cert Appropriateness 07.doc I Town of Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 copies Foundation Type: (Max. 18" exposed) (material -brick/cement, other) � P'Ywod Cedar.5&7010. Siding Type 1�?'f material: Lr]rs ' Color: Chimney Material: / Color: Roof Material: (make & style) ����� =�d,zn rJ`?'�'�� Color: 22o�J C� Trim material V0,5D Color: 15eozdx_) Roof Pitch: (7/12 minimum) F_lu 10A)'r& Window: (make/model) 44,-50,c) ���� ���naterial __ fll04 color Size(s):_ Door style and make: Overchnvd '6vA material r4E-2 Q�,vs.S Color: X9iAed t7x/0 Garage Door, Style Size 1X,9 - r Material �_ Color&0k0_ gx 92 - Shutter Type/Material: Color: Gutter Type/Material: Color: Decks: material Size Color: Skylight, type/make/model/: A,yC��z3i),Q material Color: idc) Size: p Sign size: �`� Type/Materials: Color: AP ;qn1N MAR 25 LUUJ Fence Type (max 6') Style , material: Color: Town of ba l%h- old Kings Hi9 Nay Retaining wall: Material: Committee Lighting, freestanding on building illuminating sign Please provide samples of paint colors and manufacturers brochure of style of windows, doors,garagjor, fences, lamp posts etc ADDITIONAL INFORMATION: .00 Signed: (plan preparer) print name tel.no. Location of application: Street no. Street Village 2 Q:IGMD-Groups101d Kings Highwnyi0KHNew ApplOKH Cert Appropriateness 07.doc r 4. SIGNS Diagram of sign, showing graphics, size, design and height of post, color and materials. Spec sheet. Site Plan on a GIS map or mortgage survey, OR photographs OR to-scale sketch'of building elevation showing location of proposed sign; and any tree to be removed near a freestanding sign. Fee according to schedule. 5. FOR LIST OF ABUTTERS: PLEASE SEE OKH STAFF SIGNED (plan preparer) .�%���,�, ��� Print , Date:�`2-•,F 7- J Tel. Phone no's: NOTE APPROVED MAR 2 5 2009 The Old Kings Highway Historic District Committee MAY DENY INCOMPLETE APPLICATIONS Town of►i;ir.... Old Kina'� — .._v ATTENDANCE AT MEETINGS: If the applicant or his/her representative is not present during the hearing is scheduled, the application may be either CONTINUED OR DENIED APPEAL PERIOD APPROVED PLANS PLAN PICK UP There is a fourteen(14) day appeal period for approved plans. This is necessary for each Certificate of Appropriateness and/or Certificate for Demolition issued by the Old King's Highway Committee. Plans approved by the Old King's Highway Regional Historic District Committee may be picked up at Growth Management,Regulatory Division, 200 Main Street,Hyannis, after expiration of the 14 day appeal period. If the 14"'day falls on a Saturday, your plans will be available the afternoon of the following business day. DENIALS Applications that are denied may be appealed to the Old Kings Highway Regional Historic District Commission within 10 days of the filing of the decision with the Town Clerk. For more information, see the Bulletin of the Old Kings Highway District Commission. BUILDING PERMITS, OTHER AGENCY CONTACTS In most instances, before commencing work, a Building Permit is required. The Building Division will require a certified plot plan for new construction and/or demolition. Commercial work may require Site Plan approval. Demolitions: the applicant should check with the Building Division as to conformance with Zoning requirements. Other Regulatory Agencies at 200 Main St, Hyannis MA 02601: Building Division 508-862-4038 Conservation Division 508-862-4093 Health Division 508-862-4644 QUESTIONS ABOUT YOUR APPLICATION? PLEASE CALL THE BARNSTABLE OLD KINGS HIGHWAY OFFICE AT 508 862-4787 5 Q:IGMD-Groups101d Kings HighwaylOKH New AppIOKH Cert Approprinteness 07.doc i `' z3 k os cl N CA �1 Y6.6y- N�F TO THE BEST OF MY INFORMATION, "AS- BUILT" PLOT PLAN KNOWLEDGE, AND BELIEF THE BARNSTABLE, MASS. _ ov..�pq.n�.✓ __ SHOW S ���y PLAN HAS BEEN LOCATE N � s ,7 GROUND AS INDICATED ?3 �s� DATE SCALE o wtu!�.�a ov�iccrx ,. JOB CLIENT 44ye-c ITT tso.31341 .t SWEETSER ENGINEERING Y 235 GREAT WESTERN ROAD P.O. BOX 713 ATE PROFESSIONAL LAND VL YOR SOUTH DENNIS, MASS. 398-3922 02660 FAX 398-3063 s w TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION..,. Map �� Parcel"': �a�'� -'Application # 0d17(�.�� Health bivision Date Issued a C s ._. Conservation Division . .::Application Fee Planning Dept:; ;'Permit Fee, r Date Definitive Plan Approved by Planning Board ,( Historic - OKH. Preservation/Hyannis Project Street Address Village Owner /!�i//i9.� ef , � Address Telephone �7y 99y iI96 >Opermit Request �13� ,e1 u� Dr-I,�C E Fd: Square feet: 1 st floor: existing proposed 15 167 2nd floor: existing proposed 3a Total new % A v Zoning District; Flood Plain Groundwater Overlay -Project Valuation ;?5,QCo Construction Type Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family.. 0 Two Family ❑ Multi-Family (# units) Age of Existing Structure /a y/?s Historic House: ❑ Yes flR'No On Old King's Highway: ❑Yes W No Basement Type: A Full ❑ Crawl L1 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 _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing 0 new size—Pool: ❑ existing ❑ new size _ Barn: ❑ M ting ❑Apw ,�e_ e C� Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: aim o Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes A No If yes, site plan review # Current Use Proposed Use v n APPLICANT INFORMATION / (BUILDER OR HOMEOWNER) / Name _� .—r /Y�I�T� Telephone Number �!11,52 Address License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE /ZJ/ DATE 0 i 1 FOR OFFICIAL USE ONLY M. j APPLICATION# DATE ISSUED tr MAP/PARCEL NO. ADDRESS VILLAGE s OWNER r r DATE OF INSPECTION: F FOUNDATION ho z-X_Z A� FRAME Aeg- o INSULATION } FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL -GAS: ROUGH FINAL FINAL BUILDING hcr DATE CLOSED OUT ASSOCIATION PLAN NO. z f TKEr Town of Barnstable Regulatory 5eg4ces ' � SAATt3TAb LE, �. Thomas F. Geiler, Director Building Division prro Thomas Perry, CBO,Building Colu iissioner 200 Main Street, Hyannis,MA 02601 www.f own.b arrsta b le.tna.us 'Officet 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: #4LL E zr Map/Parcel: / R7 0 2 Project Address 46-1 au.m Builder: S '✓ Los The following items were noted on.reviewing- 70e C[ Cc0 �2 vLS �� Ji(.c. L T ........... - Reviewed by: Date: Q:Fo=:Plarvw r The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations 600 Washington Street Boston, MA 02111 :�• �y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): J,��,on� �� Address: /,-76 City/State/Zip: /0 &;WuXog� Z! Phone.#: z7y-,*W l fg0 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. Q I am a general contractor and I 6. ®New construction employees(full and/or part-tim.e).* have hired the sub-contractors .2.0 I am a sole proprietor or partner-' listed on the attached sheet. T. ❑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 3.4 I am a homeowner doing all work officers have exercised their I I. 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. lContractors 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 subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a.STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify""u)�nder the pains annd/pennaal1tiees ofperjury that the information provided above is true and correct. Signature: !il/.//.q�t /i//l�/�l Date: 0 4 Phone#:? Official use.only. Do not write in this area,tb be completed by city or town officiaL "City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation'for their.employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds\or building�a'ppurt6ria�thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit,to operate a business or to construct buildings in the commonwealth for any applicant who has not produced',.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,�a policy is requiredYoBe 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 pernut 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 compleie'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 Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 61742777749 Revised 11-22-06 A"I www.mass.gov/dia ' ' A WC Gudde to IVoVd Coosb-itc/io// hi F/�h 8�xd^�nx . : 1}0 no'h ��/dZonu / ° Massachusetts Checklist 1,01- Compl'ance (7130CN11K5301:211) Check Compliance 1.1 SCOPE Wind Speed (3-sec. guot)---------------------- ................................................ 110 mph Wind Exposure -------------_-------' --------------------.B Wind Exposure - .EngineohngRoquirodForEnUneProjoc -------------C ---_ � 1.2 APPLICABILITY Number nfStories(a roof which exceeds 8in 12 slope shall be considered a � Roof Pitch ------....---..---------_----'(Fig 2) ----_�����r��� ---- Mean Roof Height -----------------`--' 2)------x�---�----� ��7 BuUdingVV��.VV --------------------.' Rg3>------'--------' _--_ Length, L � � ------------'U�g3)-----------.-,*e-.. �07 ---'`= ' ----'' ' - ����� --' ��2,1 � Building Aspect Ratio(�/V) ................................................(Rg 4)----------��°�~`--��&�- . , --_- Num�ad He�h of O"�"�"2 --�(�g4)---------------�` �S�^ . ' ,_-= --------- � 1.3 FRAMING CONNECTIONS General compliance-with fram\�g connections....................(Table 2)..................... � ---_ � 2.1 FOUNDATION � Foundation Walls meeting requirements cf78OCIVIR54O41 Conunete------------------------------------------ --_- Concrete Masonry----------------------' ---------------...---,��W�' 2.2ANCHORAbETOFOUNDATON"' 0 WOAnchor Bolts,imbedded or 5/8"Proprietary Mechanical Anchors as an altemativ fil � 8okSpqo�g-gan�a| --------.----....�abha4)-----..�---'��- '---' BoltSpacinqhnmendfjointofplate-----.----U`ig ..................:----- mQ2" 8o�Embedment-cuncre�-------------'.U�Q -- ----------.�- ---- � � Bolt Embedment-masonry.................. ......................(Fig 5)............/............................. 15/ - ---_ � Plate VVasho��..............................................................(Fig 5)------------. 3^x3^o1/4" 3.1 FLOORS � Floor-framing member spans checked ...............................(per 7D0CkiR Chapter 55).......:--------- Maximum Floor Opening Dimension...................................(Fig 8)----_--'�--------.`J�*�� 12' Full Hm�N;Vu|S�doedF�orOp�n�go �sx�an��:m Exterior Wall U�gf�----- ...... - ........... _- -- AHaxknumFloorJoistSetbacko � �d ^ Support! dboa�ng VV��orShoonwaU-----.(�g7L---_------------.`_-- _--_ Maximum Cantilevered Floor Joists Supporting LoodboohngVVaUs,'orShaan«aU................(Fig8).................................. ?Floo!8na�ngotEndwa|�-----------------.(�ge)----------------------. _-_- Sheathing Type .........................................................(per T0VCIVIR Chapter 55)............................. Sheathing Thickness --------------..-..(per 780C�RChop�n55 ---' Floor' Sheathing Fastening..................................................(Table 2)./�� d naUnat���jnedgo/�����he� � 4.1 WALLS � Wall Height 6oadbeahng walls......................................................... 10 and Table 5)...........................___ft :510' | Nun'Loadboohng walls................................................. 1O and Table 5)........................... ___ft :5 27 � VVaU ------------------'A�g 1OondTab�5)------` k��%4^o.c. Spacing � �d ' � �/aUSh��Ofse� -----------------.'(F�s 7&8)--------------�__ ` � 4.2 �Wood EXTERIOR-WALLS 3 Studs � .Gable End Wall Bracing ic � - _____-v_--- __.._. �---- � and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. ..(Fig 11) -� --- � ---- | or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ft. spacing hn end joist or truss bays ____ Double Top Plate ~�' � Tob�O)------------��_ft --' ------------- ` | | I A WC Guide to Wood Cortstrt-tctiou itr High !,hind Areas: 110 rttph !-Virtd Zone Massachusetts Checklist for Compliance (780 Ci\lIft 5301.2.1.1)' Loadbearing Wall Connections • Lateral (no.of 16d common nails)................................(Tables 7)..................................................... Non=Loadbearng Wall Connections Lateral (no.of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) ;Header Spans ...............................................:.........(Table 9)..................................�ft in.5 11' Sill Plate Spans .................................. .....................(Table 9)...................:....:......... ft (�in.5 11' Full Height Studs�,(o of-studs).......................................(Table 9)............................. ....................................................... Non-Load Bearihg•W,aIIQpen'ingsc(record largest'opening but check all openings for compliance to Table 9) Header Spans... .�+`s.? ..................................(Table 9)..................................®a ft O in.5 12' Sill Plate Spans.... ................ .............................__(Table 9)...... ........................... ft M in.5 12" ; .Full Height Studs(no.of studs)....................................(Table 9)....................................................... Exterior Wall Sheathin'g,to Resist Uplift and Shear Simultaneously4 Minimum BuildindDirrip" ion, W Nominal Heigh of Tallest OpeningZ .... ...........................................................................__<6'8" Sheathing Type..............................................(note 4)............................................ ......-... Edge Nail Spacing................:.............:..........(Table 10 or note 4 if less)......................:. in. Field Nail Spacing ........ .... . .... Table 10 .................................................'2,' in. Shear Connection(no.of 16d common nails)(Table 10).......................................................A- Percent Full-Height Sheathing...................:...(Table 10)..................................................._ 5%,Additional Sheathing for Wall with Opening> 6'8"(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest Opening2........................................................................�n'Y5 6'8" Sheathing, pe..............................................(note 4)...................................................... * -._,a Ed a Nail,S rd (Table 11 or note 4 if less)........................ c in. g � rig......................... ............... Field Naill&teing..........................................(Table 11)................,................................ Lo in. Shhear Conne ion(no.of 16d common nails)(Table 11).......................................................%Air Percent Full-Height Sheathing.......................(Table 11)............................................:......41561. 5%Additional Sheathing for Wall with'Opening>6'8"(Design Concepts).................:.. Wall Cladding / Ratedfor Wind Speed?.............................................................. ......................... 1��: 14�+ ..... 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19) ..............L_ft 5 smaller of 2'or L13 Truss or Rafter Connections at Loadbearing Walls : Proprietary Connectors Uplift................................................(Table 12)............................................U=370 Of Lateral.............................................(Table 12).............................................L= If Shear............................:..................(Table 12)............................................S= plf Ridge Strap Connections, if collar ties not used per page 21... (Table 13)............................... 7plf Gable Rake Outlooker..........................................(Figure 20) .......,..... O ft_<smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U=_�Vff Ib. Lateral(no. of 16d common nails)...(Table 14)........................................L=0 Roof Sheathing Type................:..................................(per 780 CMR Chapters 58 an/ds59) ............ Roof Sheathing Thickness.....................................:.....* YR ............................................. in. >_7/16'WSP RoofSheathing Fastening............................................(Table 2)......................................................... Notes: 1. This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of 780 CMR.5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are,not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 � c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5% is-added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade. �t r Town of Barnstable Regulatory Services BA NSMBLE, + Thomas F.Geiler,Director 039. ,�� Building Division TfD MA'I to ' 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: JOB LOCATION: /PZo number street village "HOMEOWNER":��)i/�� ?Fy-1 9�O ZZ name home p oh ne# work phone# CURRENT MAILING ADDRESS:_ �// /i Leo ' //j/-T Z-5� I/•560 i Ail Oho% city/town state zip 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,f rovided 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 bylamrS rules and reg latinnS YY •»•• , 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. � 1 4w�,-L /,-7 / Signature of Homeowner Approval of Building Official Note: Three-fanuly dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC THE Town.of Barnstable Regulatory Services BAMSTABLE. Thomas'F. Geiler,Director MAM .0� 'Olpp (A 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 T '. Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to wor' uthorized b this building ermit a lication for: Y g P PP (Address ofzJob) S 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:FORMS:OWNERPERMISSION i i U,5' - 6 V.-3c-) .9 rz c1 N J Z3Z J 3 � .l ti F TO THE BEST OF MY INFORMATION, "AS- BUILT" PLOT PLAN KNOWLEDGE, AND BELIEF THE _ BARNSTABLE, MASS. _ ov�o-5 .n�.✓ __ SHOW S �' v . PLAN HAS BEEN LOCATE N s �Lsi..J GROUND AS INDICATED �� � ���`� DATE SAY l y, lg7'tf SCALE 1"=6o' o ,vacm - . . JOB /Y 8b-�U CL.I EN T 1/qc.c w_r> 3,3�, Y -S'WEETSER ENGINEERING y S aP 235 GREAT WESTERN ROAD 9 P.O. BOX 713 ATE PROFESSIONAL LAND YOR SOUTH DENNIS, MASS. 398-3922 02660 FAX 398-3063 V Ask R tv 33, bK ✓ \ y � � fl I / -Fol A)3 PI16S16A.A5 , w� pGtvp f 310 \, AFL- 3 6 31y OK / vsic l �rr£sca��o6� 9Q,�► tl ,:�� �>�- t ► ► ii sill � ► I I1111 � II1 � 1111 1 � � ) J � )/� wde 4a.t) 61 � l� a f/OZ Illy" ysX `I ; � . 0 0, __ . � �� `?� � � � . i '?'� 1 ,. t r f � .. ' n Z O � c i r I j - 1 east cape engineering, inc. 44 Route 28 P.O. Box 1525 CIVIL ENGINEERING Orleans,MA 02653 LAND SURVEYING WATER RESOURCES LAND COURT ENVIRONMENTAL 508-255-7120 PHONE SITE PLANNING SANITARY CERTIFIED PLANS STRUCTURAL 508-255-3176 FAX WATERFRONT May 14, 2009 Building Department Town of Barnstable 200 Main Street Hyannis, MA 02601 RE: 'Structural Ridge Review,Hallett Barn, 126 Plum Street, W. Barnstable East Cape Engineering, Inc has completed a review of the plans for a proposed barn/garage for the Hallett Residence located at 126 Plum Street in West Barnstable. The purpose of this review was to design the structural ridge necessary to support the cathedral ceiling proposed for the majority of the building. An analysis was completed for a structural ridge of length 30 feet supporting the 36 feet wide gable roof system. Based on our analysis,the required structural ridge is (4) 1 3/4"x 20"lvls (Microllam or equivalent). This beam meets minimum strength and deflection (1/240)requirements of the building code. Due to the end reactions of the ridge beam,the header over the 10 foot door is required to be(3) 1 3/4"x 11 7/8"lvls and the beam to support the second floor loft storage area and ridge post is required to be (3) 1 3/4"x 14" lvls. If there are any questions on this matter, feel free to contact me at any time. �H OF Ssy c� ° R K A. �c Sincerely, McK - ZIE , CIVIL N No. 39068 M 'k A. McKenzie,P.E. Treasurer, East Cape Engine r E�G� cc. William Hallett HALLET BARN WIND MOMENT FRAME Friday,September 04,2009 Page 1 Multiframe3D Version 10.03 \1Serverlc\sttuctures\multlframe files\09-1331hallet moment frame 2 for bam.mfd I Sections E0 HSS5x5x1/2 ®W8x24 7 w W8x24 X X 'n,N 6 U) Y 2 _ W8x24 y = W8x24 I 1 _I N N Nf NI X N N cn N U) I I I 3Y i ( I x 9n, nl„ ICI 4 lr,l� -511 77 - effy-1�190 east cape engineering, inc. 44 Route 28 P.O. Box 1525 CIVIL ENGINEERING Orleans,MA 02653 LAND SURVEYING WATER RESOURCES LAND COURT ENVIRONMENTAL 508-255-7120 PHONE SITE PLANNING SANITARY CERTIFIED PLANS STRUCTURAL 508-255-3176 FAX WATERFRONT September 4, 2009 Mr. William Hallet 126 Plum Street W. Barnstable, MA 02668 RE: Wind Design Review,Barn Front Elevation, 126 Plum Street, W. Barnstable Dear Mr. Hallet, Per our discussions,you asked East Cape Engineering, Inc to complete an engineering review and design for the front elevation of your proposed barn due to the elevation failing the requirements of the Massachusetts Checklist for 110 mph, Exposure B wind design requirements. We completed analysis and calculations for the wind pressures on the building to determine the required structural elements necessary to resist the wind shear forces on the front elevation of the barn. Based on this analysis,the following findings and design requirements were determined: • The wind shear loads on the front elevation exceed the allowable design loads for the use of APA Portal Wall elements in the four sections of wall available on the elevation. • We have designed a steel moment frame consisting of HSS5x5x1/2 steel tube columns and W8x24 steel headers. The frame will require installation of a welded base plate and embedded anchor bolts to attach it to the foundation wall and field welding of the columns to the beams. • The design is based on reduced 10 foot tall wall heights for the building as well as two 10 foot high garage doors at the ends with one 12 foot tall door in the middle. We have attached the frame geometry and our standard detail for steel moment frames for your review(this detail is typical and not specific to the geometry of your project). We recommend contacting the steel provider to have them provide shop drawings of the frame for fabrication and construction. If you have any questions, feel free to give me a call. tN OF k4&, Sincerely, 9cy A. GN Mark c e, P.FlvlL co Treasurer, Eas AnifN ' c. GISTE��o��� �sS�GNAL ECG CN of 3 � I , 5 r., ? I: cD�� ci— CIO t i h I .7:Z� II c� is � I I I IIi I i I I i I i I i I + .p ..s n o 6 a � I I x rl ' into fr r u t. I # I } IJI rw o � ru I . 40 40 9O I �I � r j d % itC —Y.-Al — . a M F �. c11- • i a_ . _1 LV; I i I a9 j o f • f � ' �_.... .. =o 1._.... . QI I Q I. �k �__ �O-W •V i; a .• fl _.. .43 It I o 1 `.e.cl� I ICE -jr- Ch...................... _ I '.9 i r S 3 ri cl CD SL VL- jA t so q S IN S"- ra` c V E v Zr � ^ ` 2 kp O J 1 A V JI J y x a M 1 a 3©�'Engineering Dept.(3rd floor) Map -0 Parcel �o?�/ Permit# - ' House Date Issued - i _ 2 Board of Health(3rd floor)(8:15 -9:30/1:00-4:30)!�Z=Z/(, ,*,g��/4f6ee . ) i Conservation Office(4th floor)(8:30-9:30/1:00-2:00) ' Planning Dept. (1st floor/SchoolAdmin. Bldg.) ,�I &-&Vtm ON FdcQ - DGULATIONS is. ONIPLIANCE Definitive Plan Appro ed by Planning Board 19 1� � LE 5 TOWN OF BARNSTABLE EOVvIA � N�TOW Building Permit Application Project Stree ress /;QCn '���,-7 ::�! Village- 1k)F-14 Owner Address i' Telephone - � .d' =` r7r5 j �►/w '�j Permit Request S; k,,y„`IV 'Jut�i�o • First Floor /_3�/�/ s are fee oor le Zoe « A,niAX4quare feet Construction Type Apo 1) Estimated Project Cost $ /0,eRo Zoning District Flood Plain Water Protection Lot Size cla=r �92,b2 Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway a Yes ❑No Basement Type: ,W Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New_� Half: Existing New No.of Bedrooms: Existing New r-'2 Total Room Count(not including baths): Existing New �_First Floor Room Count Heat Type and Fuel: ❑Gas A Oil ❑Electric ❑Other Central Air ❑Yes JW No Fireplaces: Existing New —L Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use t�J C Builder Information Name S \"AA Telephone Number r Address License# V Home Improvement Contractor# _ Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR FOLLOWING REASON(S) 4 v'^ e - FOR OFFICIAL USE ONLY PERMIT NO. ' DATE ISSUED r . MAP/PARCEL NO. t ADDRESS r VILLAGE OWNER DATE OF INSPECTION: 3 FOUNDATION ) FRAME INSULATION r FIREPLACE ELECTRICAL: ROU H FINAL PLUMBING: ROUGH FINAL GAS: ROUGH t'n FINAL y FINAL BUILDING it �" O r``v,(✓ m 12: DATE CLOSED OUT;' F— 16- n ASSOCIATION PLAN O.h_< r10®Q { ms Qcu I � � � t MAScheck COMPLIANCE REPORT Massachusetts Energy Code I Permit # I MAScheck Software Version 2 .01 I I. I Checked by,/-Date I CITY: Barnstable ' STATE: Massachusetts vim' HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 1-7-1999 COMPLIANCE: PASSES Required UA = 441 Your Home = 415 r Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value U ---------------------------------------------------------------------------- CEILINGS . 1260 30.0 0.0 4 WALLS: Wood Frame, 16" O.C. 2536 13.0 0.0 20 GLAZING: Windows or Doors 218 0.400 8 DOORS 42 0.350 1 FLOORS: Over Unconditioned Space 1260 19.0 0.0 6 ---------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4 .4. 1 Builder/Designer CX 1)ylpA_ AD! Date 1_ • 9 I f MAScheck INSPECTION CHECKLIST "Massachusetts Energy Code MAScheck Software Version 2.01 DATE: 1-7-1999 Bldg. Dept. Use CEILINGS: [ ] 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C. , R-13 Comments/Location WINDOWS AND GLASS DOORS: [ J 1. U-value: 0.4 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] 1. U-value: 0.35 Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 Comments/Location I AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. . I . i VAPOR RETARDER: � [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] ( Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts shall be insulated per Table J4 .4 .7. 1. DUCT CONSTRUCTION: [ ] All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer' s installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. [ ] I SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. [ ] HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in. ) : PIPE SIZES (in. ) fi HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2 .5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2 .0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 _ 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 [ ] CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in. ) : PIPE SIZES (in. ) NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F) : RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2 .0+" 170-180 0.5 1.0 1.5 2 .0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only) i I Tv-'c+'n.^-�'r--'--'u••'v -I?w;rYv�..�.w.,..F��„,,.r.�.r-�.. �o..sxa.-t.;.rou-.: ...-.-. -.,•.�.- .- .. ....,.��r+�aFxatk<c 7'.+fw..-..irw+e'9bt`' o-vv - .s>.....-, - .-- , t I `oFINE r The Town of Barnstable BARNSTABLE. Department of Health Safety'and Environmental Services MASS. �► 039. �0 �Ev►�a+° Building Division 367 Main Street,Hyannis,- MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection--- ('V� Location I .Permit Number "3 O ;2 C� Owner Builder One notice to remain on jobsite, one notice on file in Building Department. i The following items need correcting: em ( � ) - l. R e-- _jroCSC CP ( ( Imo. S-74tft S 1 i P 2 c D cX P PL 2 �c>r• s i J n iL —'U A�p14 , r�P t o C K r-e f t'j, /'l Ar t C' ✓f4�4­, 2-P S i _0 JP-r--F A--t-'r o I i • 1 Please call: '508-790-6227 for re-inspection. Inspected by Date 111 r I o� i C/ `'��i!/� � �� �a,l�t�iLfC/� �`� ` ��� 2�rt� �sE-�� - a� �, � ,s I ' r ��r zs ko8 � N Ind g � N n 0 3 95,72- /�'�►.mac. �,�h TO THE BEST OF MY INFORMATION, "AS- BUILT" PLOT PLAN KNOWLEDGE, AND BELIEF THE BARNSTABLE, MASS. PLAN HAS BEEN LOCATE .�-soor�: S�'Y GROUND AS INDICATED _�' � `g�.°� DATE /s'7AY /y, i97� SCALE /"-=6a' o WujAT--A N o �c� JOB !S�5 -av CLIENT .31341� SWEETSER ENGINEERING 4ATE 235 GREAT WESTERN ROAD P.O. BOX 713 PROFESSIONAL LANDS ~�YOR SOUTH DENNIS, MASS. 398-3922 02660 FAX 398-3063 • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. JOB LOCATION Number Street address Section of town "HOMEOWNER" ��, �- '77 ;7/ -7/ Name Home phone Work phone RESENT 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) 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 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';;-B'ii'ildiiig Officia. on a form acceptable to the Building Official, that he/she shall`:.'be' 'responsiblF for all such work performed under the building permit. (Section\ '109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Sta= Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands . the Town of Barnstable Building Depart3ment minimum inspection procedures and requirements and that he/she will compl 'with said procedures and requirements. HOMEOWNER'S SIGNATURE �ll.�v�-s �i/�alx� APPROVAL OF BUILDING OFFICIAL r Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION .l r The code state that: "Any. Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home Owne: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section .2. 15) . This lack of awareneE often results in serious problems, particularly when the Home Owner hires unlicensed. persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home ''Owner* actir. as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/Ater responsibilities, mar. communities require, as part of the permit application, that the Home Owner 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-. m The Commonwealth of Massachusetts Si_ rl.i Department of Industrial Accidents Office 91111yestf9atfoos 600 Washington Street Boston,Mass. 02111 Workers' Cornensation Insurance Affidavit name: location city l_ �1�// Z� O���O 3 5 bhone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any ca acity ❑ I am an emplover providing workers compensation for my employees working on this job. com nnv name: address: city phone#: "insurance co: Rolicy# ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have` ��06t7(�S'36_ 00&9S the following workers' compensation policcs: ✓companv name 1� �DIP/''l5 Address 30� L�f�C)F�fz/8� /Y6/i.YpU Z dty �o y��rro���h � �a�� phone#• in9ornnce co. "' companv name / lJ �/address: ab S ✓rih„ go cv ;::.: _ p hone#: � a� d :::';; :::.>:.:.:�•> :: .>,'>:.' . .:..: :. itunrance co.. /% Failure to secure.coveeage as required under Section 15A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,S00.00 and/or one yea 'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I under-stand h that a _ copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penallies of perjury that the information provided above is truo and correct Signatures /ir� /)�9� Date Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permitNcense isECC31 Building Department []Licensing Board Selectmen's Orrice❑checititlmmediate response is required Health Departmentcontact person: phone N; Other ` (tevum9/95P1A) . M Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a . dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract,for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants .. ` Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurarice as all affidavits 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 Accidebts. Should you have any.questions regarding the"law"or if you are required to obtain a,workers' compensation policy,please call the Department`at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly..The Department has piovided a space at the bottom of ilie 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,p&ia itllicense number which will be used as a reference number. The affidavits may be retu'rii io ` the Department by mail or.FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents o lee of Invesduadons 600 Washington Street .._. Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-49.00 ext. 406, 409 or 375 J_ MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2.0 �/ CP16cked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 4-21-1998 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required UA = 448 Your Home = 375 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1260 30.0 0.0 44 WALLS: Wood Frame, 16" O.C. 2536 15.0 3.0 169 GLAZING: Windows or Doors 218 0.400 87 DOORS 42 0.350 15 FLOORS: Over Unconditioned Space 1260 19.0 60 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4. Builder/Designer /v C� Date l MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 DATE: 4-21-1998 Bldg. Dept. Use CEILINGS: [ J 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C. , R-15 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U-value: 0.40 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] 1. U-value: 0.35 Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building, envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4.4 . MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only) ------------------------- �� Z.)o Application to •'� Old Kings Highway Regional Historic District Committee 'in the Town of Barnstable fora CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ® New Building ❑ Addition Q Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ] Other 2. Exterior Painting: 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑.Repainting existing sign 4. Structure: Q Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE 1K ADDRESS OF PROPOSED WORK�a=�� ���• �4� ��IP- ASSESSORS MAP NO. OWNER �� �mV E � I l ASSESSORS LOT NO. CH HOME ADDRESS ` ��C I� �`P_ ISJ�CUIL� A ��IDYO TEL. NO. '�M_'Aa% is .FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of ad* cent pro rty owners across any public street or way. (Attach additional sheet if necessary).Ste, (� �rA_ aq% an 5 b AGENT OR CONTRACTOR �>>r11iA`M 5 \l\1�n1� - TEL. NO` "- ADDRESS 1C71��\ 1O►1n ("S`; 002 1S . CA -Oa 6N DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8,other side), including materials to be used; if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations.of new signs...(Attach additional sheet, if necessary). Sk .1.,III .i •.� 'i fill FEB 19 !998 II�i� ti���U ,J Signed -^u Owner-Contractor-Agent i. Space below line for Committee use. ..--Received-by­H-07E'--°— *- ' _ J ii ! F date I The Certifi a is hereby R ��✓�`( Date 'lgY Approved'. IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal perio �_) provided in the Act. Disapproved 7 4 Town of Barnstable Old King s Highway Historic District Committee SPEC SHEET CHMWEY TYPE Q 1(' COLOR S ROOF MATERIAL �r-�(��' COLOR PITCH \b WINDOSr� SIZE TRIM COLOR C YLUL)La Rb DOORS' 5 COLOR SHUTTERS �1 COLOR GiTTTERS DECK �11� GARAGE: DOORS_ �I COLOR SIGXZ I1llA COLORS SIGNS COLORS SIGNS . . OLORS FENCE = COLOR �'-- '-� , E7` NOTES:: :: Pill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the.plot plan, landscape plan and elevation plans. when applicable. Plot plan need not be •Certified^-� for new homes, but should show all structures on the lot to scale. SPECSHT C �y r t J Tltc• Contntonivel 111t of Ahis.vachusctts Dcparlttrcnt of ludustrial Accidents • officeof/fly 19a1/ons 600 l f'a.0itt, tun S1rcc1 Boston. Ma.u. 02111 Workers' Compensation Insurance AlMd:avit i ii 'in int rm i�ri• P1- —p ^•-••�-•�- - __.__ �_ _ location- a S `off cin• 0S;6 (e-0 ` l s; t ►V ltA- /nhonc H CD I am a homeowner performing all work myself. I am a sole proprietor and have no one Nvg1kingy in any ca G I am an emplover providing workers* ton for my employees wor in ton this job. aeon cam n:tmc: /adclres�• its /hone 0- insurance rn. licv# [i I am a sole proprietor. bener contr tor, or homeo% er(circle arc) and ha a hired the contractors listed below who hziv the folloNving workers' comp nsation o ' es: cam ans nnine- atltlrC5S7 I�sirs: hone fit• insnrnncr rn. rinfiev M p cnm nns nnmc: t\CCC.�thiresc: city hnne Of- insurance c olic•fi Attach additional sheet if neccssary�; - . =- -'- 7 T�'^'"-`� '^— —•�"y.-._' _ _--�s-��s--._...._._. � - �:aye•_ ....w.::��s. Failure to secure cos cr:t>:c:ts required un cr Section A of 111 L 152 can Icad to the imposition of criminal penalties of a line up to SI.500.UU andiur one wars' imprisonment as well as civil(cn21tic3 in the In of a OP IVORK ORDER and a fine of 5100.00 a day against me. 1 understand that a Copy of this maectocnt may be foncardcd to the Office of Inv igati s of the D1A for coverage verification. I do her reify ruttier t/ pain• ttd p' al 'es o perjure•that njormation provided above is true and correct. Si_nature -_^ - natc L'l Print name 1S Vo �Y� Phone# ' ".,.con ly do not write in this rrca to be completed b% tiny or town official w ' city or town: permit/license# r 1fiuildin.Department C3Liccnsing Board rr I] check if immediate response is required c3scleetmen's Office f F 011caith Department EE contact person: phone#: rJ01her 4: f. Information and Instructions Massac!uscus Gencral Laws chapter 152 section 25 requires all employers to provide workers' Wmpcnsatian forth i4f.. enmplrn•ees. As quoted from the "laa". an emtpluree is defined as every person in the senricc of another under any contract of hire, express or implied. oral or written. An emplurer is defined as an individual. partnership. association. corporation or other legal entity•. or ally two or me the foregoing enuaued in a joint enterprise. and including the le al.rcpresentativcs of a deceased employer. or the rccciver or tnistce of an individual , partnership. association or other legal entity, employing employees. However owner of a dwelling, house having not more than three apartments and who resides therein. or-,thc occupant of the d% clling house of another who employs persons to do maintenance construction or repair work on such dwelling he or oil the `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an empio%•e MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance oi•, P ti renewal of a license or hermit to operate a business or to construct buildings in the commonwealth for sny applicant 11•110 has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall eii.te'r.into:,anv,.eontrart for the performance of public work until acceptable evidence of compliance with the insurance requii=ementsof this chapter been presented to the contractinc authority. Applicants. Please fill in the workers' coinpensation affidavit complete]-,, by checking the box that applies to your situation and Supplying company names.address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance co%•era`e. Also be sure to sign and date the affidavit. -.Tlme affidavit should be retW,rned to the city or town that the application for the permit or license is being requested•, not tileDepartment Deparent of Industrial Accidents. ,Should you have am' questions regarding the "taw" or if you are require. to obtain a workers* coinpensation policy, please call the Department at the number listed below. . Cin• or Towns t Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office ofInvestiaations ha_!, to contact you regarding the applicant. Pit be sure to fill'in the permit/license number which will be used as a reference number. T'he affidavits may be returned the Department Ily mail or FAX unless other arrangements have been made. The Office of Investigations would like to..thank you in advance for you cooperation and should you have any questic please do not hesitate to _give us a cell. . The Deparunent's address. telephone and fax number- The Commonwealth Of Massachusetts Department of Industrial Accidents _•. office of Investigations : 600 NN'ashington Street - Boston,Ma. 02111 fax #: (617) 727-7749 77.7-jOn 1 out anF. 409 or 375 rI j�•�tl� i�"` ,«'�•.c++...la.:•.iu.Ww.ir.....•n+►�a�s��:•:,y'a`,:.�n` .'_•r--„�;: '.1�'. �i ! l:tplll.7/tQH.I/ICCl�.�� DEPARTMENT OF,PUBLIC SAFETY E , CONSTRUCTION SUPERVISOR LICENSE , k +" Nueber. - Expires: Restric.ttffi: 100 282,OIID MIllARO � I + OSTERYILLE, HA 02655 , 'fir A:R�....�. .•w 4r.ry.aA.ANMA1�Nli.111.� 1 �IM ♦ ' ...._GNtMII•InSN NA!M!11/11rt'�N i'I r IJ e "1,i �M • Il a � •• • _, �+- 5 j���� 4 �t�wa���or� 9l..kaeac+(w,ia.A3 .��.._ ��' _�I,t�=pnYy�.1{M�ii�...71.17f}It.1HNN• yr' HOHE,,IMPRO IfMENT CONTR CT 775 t�� � A .OR,� - . 6d fi:�, qy � kRegIstra�t14�� 117293Aii TYP9; IIIDIVIDUAL"� 1 _ t+.�` (ji {rr 'EipypTrai{t ion 09/18/}9yy8 :1`•��• ,� M'3�3�'+'11� ■ .����l,x�•�'iy't I �.,.i'I'1{'..iJ ' '--i•�"k'�►�=ti�. � DENIS'!J'`°�COL9ATN �t.'1 �, .I �'{'`���►�t��"������j2824,Ol0�MIll RD J+ ,•� 3 'I �� "� ' . RUILIt:'MA'02655� ,+t14 ADMIMS7AATOR{�)i`I 51 ���{��?fiJr� f r� �� r., -�� �� 5 . , • 1 1 M1. c t • 1 . Town of Barnstable Geographic Information System October 5,2009 95039 179 O195013 #23 Q 195015 195036 ` 195016 #61� -0 N 130 199014� # *76 #0� t'G O #104 3• IPA O N90Cp"DAD 195038 �P 195022 lssozllU - i1119 #103 ,95n2rl --_ � O#75 #� 195019,r 215005 195041 :`a [� #63 #141 195024 #126 195028043 #26 i 195028042 #28 195033 #0 195025001 #0 195025 #60 19502SOM #18 0 56 Feet 195028004 ^# ozeooz 2 15001002 #24 `� DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:195 Parcel:024 M boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel Owner:HALLETT,WILLIAM C 8 AMY E Total Assessed Value:$391100 1'=100'may not meet established map accuracy standards. The parcel lines on this map w F. are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:2.15 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:126 PLUM STREET such as building locations. Buffer !r. i i TOWN OF BARNSTABLE CERTIFICATE OF -OCCUPANCY. PARCEL ID 195 024 GEOBASE •ID 12157 .ADDRESS 126 PLUM .STREET PHONE W BARNSTABLE ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT .. DISTRICT WB PERMIT 46895 DESCRIPTION ' PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY ( CONTRACTORS: Department of Health, Safety ARCHITECTS: ` and.Environmental Services TOTAL FEES: THE BOND $.00 .•,,;�;;��� Ox . CONSTRUCTION COSTS $.00 ' Qi► 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE P 11E"' ; * BARNSUBM • �.' MASS. i639. BUIL IV I N BY DATE ISSUED 06/19/2000 EXPIRATION. DATE . ' I,A:2.'1'"'T a+3L,te17 - I DE VL+LC3R .N"S y l DE(iCRIPTIU l .:T,t�(;1,I'� z AMI1Y '��«IE .Adt't` . SIEV- "1'Ir 1ti�ti � .c •��> 'pk�Tt"1tT Tyr1 ' E:1.IIT.t; T;TT.,E' NEW R)"S D'ENTIA+, W,DG MT21 'Rf"1 wtv ER Department of Health, Safety and Environmental Services � ��`,��, •�•�;� : � �Try • SO won L01 ;,,NG �PRIVATE a' BARN BM ; MASS. BUILDING DIVISION` BYI��•.�-i,r .ems^,.,,,-.�. ,,it F TSSfjw, 04, '?3./190; XXPITLP.TIUN DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY,ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.OTREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROMTHE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT-FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE -REQUIRED FOR * 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE gNICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. E -�F4.FINAL INSPECTION BEFORE OCCUPANCY. j BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 0-r / o e 2~ 7 -7 F `in 3 GL,C" n 1 �ErING INSPECTION APPROVA $ ENGINEERING DEPA TMENT D OF AL OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS ` . THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD,CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS .,:,,TEL3f0HONE OR WRITTEN NOTIFICA- TI ON. NOTED f''i'- `�VE., - '� y;TION BUILDING P .ERM '�IT r m s� f E• F 1 I ! I 1 1 I I - DOUBLE TOP PLATES OF WALL CONSTRUCTION NOTES: I 1)WELD BASE PLATES TO VERTICAL TUBE STEEL POSTS. POSTS ! TO BE ATTACHED TO CONCRETE FOUNDATION WITH(2)-58" THREADED ROD WITH SIMPSON SET EPDXY WITH 10"MIN. W 8x24 STEEL BEAM EMBEDMENT. 2)WELD ALL EDGES OF TOP PLATES TO BOTTOM FLANGE OF STEEL BEAM WITH CONTINUOUS WELD IN THE FIELD. 6"x 12"x 1/2"TOP PLATE 6"x 12"x I/2"TOP PLATE 6"x 10"x 1/2"TOP PLATE 3)ATTACH 2X NAILERS TO STEEL BEAM WITH y"DIAMETER THRU BOLTS AT 32"O.C.ALTERNATING EACH SIDE OF BEAM WEB. i 5"x 5"x%"TUBE STEEL POST 5"x 5"x y"TUBE STEEL POST 4)CONTRACTOR TO VERIFY ALL DIMENSIONS PRIOR TO CONSTRUCTION. y"TUBE STEEL POST 5"x 10"x 1/2"BASE PLATE 6"x 12"x 1/2"BASE PLATE 6"x 12"x 1/2"BASE PLATE 1 STEEL MOMENT FRAME (NOT TO SCALE) i MF Ag 7 �'• _ _ -. .. ��' '� � ;� �: .ice, f • !� �-�- c;� Q r _ ; r - I it t N1 ' {{ v" 5:p-r u E4 - ' ._{ • F/Z f I 1 '�i ; 4 - E V �_-- i •cr t I I —_ -- NK _ _ t c0 ! I . , , f_ , 9X I i A-21 lit i pp C_. 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MANNI o- e Hcwr F Ez DB 4653 PG 127 DB 1466 PG 727 GO NTS/ DB 5541 PG 151 S CE Rono 12 8,26* E R�GN 0 MO CB/ FND �y 6'I° FND STONE WAV-1- 91 _ 24�4 _----------- LOCATION OF " S 80° E Ll LO WALL CB PER PB 173 PG a�40'46"ter__ _ '- -�29�4 254.0 STONE W LOCUS MAP SCALE 1 = 2000' �� FND -__N GROWN DIRT Ro _ 8 _ OVER AD FOR REGISTRY USE ONLY 30.45' �42.9 _ _ -- 2 01-D 8 N 22°10'34" W � - ^"CB W�E ��`. %� S 81°22'04" ASSESSORS MAP 195 % Ste- � IP 64 30' E PARCEL 24 �% 18.53' FND ZONING: RF �� CB % c� N 28 � \ � Cp. ; SET °02'25" W � FRONTAGE-150' AREA-43,560 SF 03 o 31.88 J N 22°32'05" W `�\� I Lai' AREA 3� � SETBACKS: FRONT - 30' c� N SIDE - 15 b \ \ � o Area = 91,508 sq.ft± � � 2.10 Acres± o a REAR — 15 33.77' SHAPE = 21.4 CO FLOODZONE C BARNSTABLE N 17059'44" W M ` r _ co tl N/F COMMUNITY PANEL #250001 0015 C Nt 84°57'37" co ° AR 8956&PGEBECCA BUFFUM AUGUST 19, 1985 y �- W Q `n DB 349 CB 50.01' so OWNER OF RECORD: 42.15 / \ FND CB N 13040'21" W � CHRISTOPHER P. KUHN Is-- ------ FND I 239 PRINCE AVENUE SET S 15047'21" W j 395 72' MARSTON MILLS, MA 02648 27.89' " '\ � 30.63' 1 N 85°00' " N 17052'48 W G " 26.06 SE , 50 w Z CB REFERENCE: 7.14' - '� '� N 89 18'01" W FND S84 0246.64' '40"W N 14°00'33" W { 0.10' DEED BOOK 10551 PAGE 341 a 1 NOT TO O ' STONES SCALE FOUND N/F D , TOWN OF BARNSTABLEco CONSERVATION N/F N DB 6602 PG 192 STEPHEN H. ROWLAND DB 9b53 'PG 45 DB 10513 513 PG 240 LEGEND DH FND -o- UTILITY POLE PLAN OF LAND IN co WEST BARNS TABLE BARNS TABLE MA • PREPARED FOR /'+ jJ T �+ r�/� ]� TJ T I HEREBY CERTIFY THAT THE PROPERTY l�lZ R1 iJ 1 V P ER P. KUHN DIVIDING DIINGNES HEEXISTINNG OWNERSHIPS,OWN ON THIS PLAN RAND THEE THE N ES LINES OF THE STREETS AND WAYS SHOWN ARE t. THOSE OF PUBLIC OR PRIVATE STREETS OR WAYS ALREADY ESTABLISHED, AND THAT NO NEW LINES FOR DIVISION OF EXISTING f x 5os 3s-ao 1 CERTIFY THAT THIS PLAN WAS MADE IN SCALE: 1" = 50' OWNERSHIP OR FOR NEW WAYS, ARE SHOWN. - ACCORDANCE WITH REGISTRY OF DEEDS I REGULATIONS EFFECTIVE JANUARY 1, 1976. DATE: APRIL 2, 1997 down cape engineering, inc. - CIVIL ENGINEERS (�(<<� LAND SURVEYORS 50 0 50 100 150 Feet DATE ARNE H.H. OJALA�P.L.S. 939 main st. yarmouth, ma DATE ARNE A-joJALA- P.L.S. '