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0064 BREAKWATER SHORES DR
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _ Parcel /61-77 Application # Health Division Date Issued /z/g S-!3 O� Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Zd7 Village A Owner Address / L � �c✓��� � y� Telephone � 1ec .Permit Request . � �" Al-�cv �L�- } Square feet: 1 st floor: existing ' proposed � � 2nd floor: existing U proposed � � tal gi' Zoning District Flood Plain_ Groundwater Overlay Project Valuation 20�2# K Construction Type " Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting doMmentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure s13 Historic House: ❑Yes M Wo On Old King's Highway: ❑Yes /lo Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) /7a2-// Number of Baths: Full: existing 2 new Half: existing I new Number of Bedrooms: 1-15- existing _new Total Room Count (not including baths): existing 7 new First Floor Room Count 3 Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes I(No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Flo 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 AppealsAuthorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ®(No If yes, site plan review# Current Use wesin��➢: Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name !/� ca.— �Gi�ei. Telephone Number ��g Address /.�2� /�v-,���rQ �r License # 9/19.�11�1 Home Improvement Contractor# /7.3 709 Worker's Compensation # ✓,4 11_U9A ALL CONSTRUCTION DEBRIS ®ESULTING FROM THIS PROJECT WILL BE TAKEN TO 11� SIGNATURE I`� DATE �1 l FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED WAP/PARCEL NO. ADDRESS VILLAGE n OWNER y DATE OF INSPECTION: i FOUNDATION FRAME f: r INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r Ir DATE CLOSED OUT ASSOCIATION PLAN NO. 3 < -40 z&o - �' J � LA 02/03/2014 6300 12978265 CRP 016301-433190 02/03/2014qim� 6300 12978266 CRP 016301-433190 02/03/2014 6300 12978267 CRP 016301-433150 02/03/2014 6300 12978268 CRP 016301-433150 02/03/2014 6300 12978269 CRP 016301-433150 02/03/2014 6300 12978270 CRP 016301-433190 02/03/2014 6300 12978271 CRP 016301-433150 02/03/2014 6300 12978276 CRP 016301-433190 02/03/2014 6300 12978393 CRP 016301-433180 02/03/2014 6300 12978411 CRP 016301-433170 02/03/2014 6300 12978413 CRP 016301-433190 02/03/2014 6300 12978414 CRP 016301-433150 Report generated: 02/03/2014 10:58 User: engelsej Program ID: arrctpst t Department of Indusb id Accidatir Office-oflnve*adans 690 WashbWon S&eet Boston,MA a2M fVK'M.Tlt��0l;fe�II AA�_ W�orlwre CompensaftmInsurmce 1�Buffil`rs/Co �ar Smbers n1+Acant YmfOrmafi= PIe2se PriBt XAw*bIY Name Z e—' citylstatwzip.4t/ Pl c#: .40s Are you an employer?Cheek the appropriate;bmc Type of pro] (required): 1- D] I am a employer with 4_ ❑I am a general contractor and I G_ El New construction (full mWorpart-time)_* have hired the sub-conbackmm 2-❑ I am a sole proprietor orpartner- listed on the attached sheet 7- �g ship and have no employees These sub-contractors Dave 8. n wadding forme in any capacity_ employees and have weulmrs' [lYfl workers'comp.insurance, camp-insuranct X Q-� ilch Bung addifiian dL] 5. We are a corporation and its 10_0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have eaarcised thekr 11-E]Plumbing repairs cr additions myself [No wodrers'corop right ofememptionper m(M ME]Roofrepam' insurance require&]t c.152,§1(41 and we hate no employees-[No workers' 13_POdw WIuz6,1s'4 comp-insurance reTired-], Any spp�ca�@rat chedrsbas;l amstalso ft11 oarthe sectioabelowshosriag 9he¢wosYecs'�mP",m�+�,e•policp i�omaatioa 1 Hameownem wbo submit this afiidsvit infficsting dLey am doing elf mot and then h¢E outside conhumm Est submits,new affidavit imiicstmg snciL tConftR^^Rthatcbeck thisbms most attached m additional sleet sfrowingthename oEthe sufa cas�xmsz and state ubetLa�natthase entitiesIure. emPlop M Iftbe sdr-coatar*ots base emplayees,they tnustpavide their workem'comp.porky mmtbet: lam an elnptnyer flrrltis providing trrorkars'cOlraPerisrrtivn illszlrartc8 for my enzpdOyees BdUIr is fire policy rout Job site ilfarmahbrr. Iasurance Company Name: �1r4�+�h� Policy 4 or S dlf--ins.Lie. 60/v2.3!?g F xpirationDate: 8�026/0`10/�i Job Site Addres ��/�,y"��rLv�7�i cJd�i ems' �i- CtitplStatelZtp: vszs.� �� Attach a copy of the workers'compensation policy-dedaratidm page(showing the policy ma e r and espuMt OR date). Failnre to se=e coverage as required under Section 25A of MOL c.152.can lead to the imposition of criminal penalties of it fine up to 31, MOD and/or one-pear imprisonment,as well as civR penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day a the Ja#or_ Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA a coverage verification. I do hereby cerhjy a i S andpeaawas Ofpedruy fllat the u fOrdr"ErwR pritw s is and conwr t tare Dtate: Phone# Oft lire vnljx Do not mitr ht this area,IW be armpleted by city urn aiffm d l City or Town: PermwLicense 4 Issuing Aatfwrityr(dude on* L Board of IIealtit 2.DaUd ing Depaz tmeat 3.C Ayffowa Clark 4.Electrical Inspector S.Piambing Inspector 6.over contact Person: phone t¥: 6 r CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOMM F,0/10/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TI CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZ REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to I certificate holder in lieu of such endorsement(s). PRODUCER NAME. JAMS R HINDb W Schlegel & Schlegel Insurance Brokers Inc PHONE 508-771-8381 508-771-0663 34 MAIN STREET EAI.Ext): (A/C.No). ADDRESS: SCHLEGELINSURANCE@VERIZON.NET PRODUCER CUSTOMER ID✓t: West Yarmouth, MA 02 673 INSURER($)AFFORDING COVERAGE NAIC I INSURED Viktar Tuleika Dba Tuleika BuildingC an LLC INSURERANGM INSURANCE 14788 �A Y. INsuRER BALM INS. 125 Berkshire Trail INSURER C: INSURER D: West Barnstable, MA 02668 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERT INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERI EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LiRR TYPE OF INSURANCE aJSR WVD POLICY NUMBER POLICY EFIF POLICY EXP(MMODIYYYY) (MMIDOIYYYY) LIMITS A GeNERALLIaeaITY MPI6593Q 09/30/201 09/30/2014 EACH OCCURRENCE $1,000,000 g COMMERCIAL GENERAL(�LIABILITY PREMISES(Es occurrence) $500,000 CLAIMS•MADE lJ OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY E PRQ- JECT LOC $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) S ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ t EXCESS LIAR CLAIMS-WADE AGGREGATE $ I DEDUCTIBLE 1 $ RETENTION S $ WORKERS COMPENSATION WC S-T-A-TT-7-777 i AND EMPLOYERS'LU1H111TY g TORY LIMITS ER YIN B ANY PROPRIETORIPARTNERIEXECUTIVE WC-5012398 08/26/201 08/26/2014 E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? D NIA ._ (Mandatory In NMI E.L.DISEASE-EA EMPLOYEE $ 100,000 R yes.describe under DESCRIPTION OF OPERATIONS belms E.L.DISEASE-POLICY LIMIT $ 500,000 77 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remaft Schedule,N more space la required) VICTAR TULEIKA HAS ELECTED COVERAGE ON HIS WORKERS COMPENSATION POLICY CERTIFICATE HOLDER CANCELLATION j SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRE$ ' n 01988-2009 ACORD-CORPORATION. All rights roe ACORD 26(2009109) The ACORD name and logo are registered marks of CORD 165�,� Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.bornstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1 kEL1Wia/J,11W9a J ,as Owner of the subject property hereby authorize �L��/L �u����L+Q to act on my behalf, in aU matters relative to work authorized by this building permit application for: G7 �ILL�AKI1/.t'��Z�B� L/p/dE l�lY,fNMir, /12� (Address of Job) A fZ1119 Signature of Owner D.to A&X SufE1-1h1A J Print Name It Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\tlsenldeeolliklAppOata\Loca)\MicrosoMWindows\Temporary Intemet FileslContenLOutlook\Sa7661)VA\EXPPESS.doc Revised 061313 <-��r �rriirrrr,irrrr�i�/� r �.flrrs.:rir�rrr//J . Orrice of Consumer Affairs .�c Business Regulation License or registration valid for individul use only _ " f COME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ry egistration• 173709 Type: Off ce of Consumer Affairs and Business Regulation. 10 Park Plaza - Suite 5170 xpiration: 11/4/2014 LLC � . t Boston, MA 02116 f; TULEIKA BUILDING COMPANY LLC, t VIKTAR TULEIKA �125 BERKSHIRE TRAIL W. BARNSTABLE, MA 02668 Undersecretary Not valid thout signature �x .4lf('Guide to Wood Construction in High 14 end:Areas: 110 n►ph ►f rr►d 7_olle Massachusetts Checklist for Compliance(780(-MR 5301.2.1.1)' 0 Check Compliance 1.1 SCOPE WindSpeed(3-sec. gust).................................................................. .................................................110 mph WindExposure Category.................................................................. .............................................................B 1.2 APPLICABILITY Number of Stories ..............................................................(Fig 2)............................ Z stories 5 2 stories RoofPitch ..........................................................................(Fig 2) ......................................... 25 12:12 MeanRoof Height ..........................................................:...(Fig 2)...............................................41 ft 5 33' BuildingWidth,W ...............................................................(Fig 3).............................................. ft 5 80' BuildingLength, L ..............................................................(Fig 3)............................................... ft 5 80' Building Aspect Ratio(L/W) ...............................................(Fig 4)........................:......................(.'fit 5 3:1 Nominal Height of Tallest Opening2 ...................................(Fig 4)............................................... + <_6.8" 1.3 FRAMING CONNECTIONS General compliance with framing connections........ ...........(Table 2)................................................................ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. ConcreteMasonry.................................................................... ................................................................ 2.2 ANCHORAGE TO FOUNDATION'3 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an aftemative in concretcronly Bolt Spacing-general ..........................................(Table 4)............................................... in. Bolt Spacing from endfjoint of plate ............................(Fig 5)....................................&_42- in.5 6"-12" Bolt Embedment-concrete.........................................(Fig 5)................................................-7 in.a 7" Bolt Embedment-masonry.........................................(Fig 5)............................................ in. z 15' PlateWasher...............................................................(Fig 5)...............................................t 3"x 3"x%". 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter P5).................................... Maximum Floor Opening Dimension...................................(Fig 6).........................P1, ft 5 12'or U2 or W/2 Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)........................................ Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7)...,................................................ — ft s d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8).................................................... — ft <_d FloorBracing at Endwalls...................................................(Fig 9)...................................................... .......... Floor Sheathing Type ........................................................(per 780 CMR Chapter 55)........................ Floor Sheathing Thickness ............................................... .(per 780 CMR Chapter 55)...................._. A in. Fidor Sheathing Fastening...................................................(Table 2).. 0 d nails at_1� in edge/ in field 4.1 WALLS Wall Height Loadbearing walls........................................................(Fig 10 and Table 5)..................... ft s 10' Non-Loadbearing walls................................................(Fig 10 and Table 5)......................G� ft s 20' Wall Stud Spacing ........................................................(Fig 10 and Table 5)................... in. 5 24"o.c. Wall Story Offsets ........................................................(Figs 7&8).......................................:....=ft s d 4.2 EXTERIOR WALLS3 Wood Studs Loadbearing walls............. ..........................................(Table 5)......Z .?...fit .....2x -ft +-in. i Non-Loadbearing walls................................................(Table 5)....... (a.. ......2xa�{ft'S in. Gable End Wall Bracing' Full Height Endwall Studs............................................(Fig 10).CP. ........................ WSP Attic Floor Length g . ......................................(Fig 11)........................ .,........ .. 3$ft>_W/3 Gypsum Ceiling Length (if WSP not used)...................(Fig 11).......................................... �— :_ $ftz0.9W 2 x 4 Continuous Lateral Brace @ 6 ft. o.c. .. (Fig 11).............................. ....... . ......... Double Top Plate �ZNOFMgss Splice Length _ . . .. (Fig 13 and Table6).141 i. S►.be.i. t!v ft _..... oy Slice Connection no. of 16d common nails) . .. .. ... (Table 6) . . ......... . z CUDILO Vim, �S r SL O e �l W/I t 5/ l� d. �o STRUCTURAL Cn No 34774 / 1 A9p 9F4IsTEP�G�a��Q 1i` . //3 FSSlONAL� fff a A WC Guide to Wood C'oaslrttrtiott in High tt'✓ind Areas: 11I1 mph Whirl%ue Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)` Loadbearing Wall Connections Lateral(no.of endnailed 16d common nails)..............(Table 7)........................................................� Non-Loadbearing Wall Connections Lateral(no.of endnailed 16d common nails)...............(Table 8)......................................................... 7.1 Load Bearing Wall Openings(record largest opening but check all openings for compliance 9) HeaderSpans ........................................................(Table 9)...............:.................. ft — in. Sill Plate Spans ........................................................(Table 9)................................r ft_in. <_ 11' Full Height Studs (no. of studs)...................................(Table 9)................................... Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table ) Header Spans........................_..............................:...(Table 9)................................aft ft in. 512'-�N Sill Plate-Spans...........................................................(Table 9)................................ =in. 5 12" Full Height Studs(no.of studs)....................................(Table 9).......................................................(L],(z— Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously° Minimum Building Dimension,W z 3$t Nominal Height of Tallest Opening2 ............ ........ ....................................................... Sheathing Type................... ( )......................................................1:5 3 8'........................... note 4 Edge Nail Spacing.........................................(Table 10 or note 4 if less)........................ in. Field Nail Spacing..........................................(Table 10)................................................. in. Shear Connection(no.of 16d common nails)(Table 10).............................................. ....... Percent Full-Height Sheathing....,. —� 9 9....:..................(Table 10)...............................---....... 2 X38 , 5%Additional Sheathing fy Wall with O ing>6'8"(Design Concepts). Sr....51, l 17,5 Maximum Building Dimension, L- �f�'(� 1 r ) 30� u Nominal Height of Tallest Opening2......................................................................1 s 68" SheathingType..............................................(note 4)...................................................... Edge Nail Spacing.........................................(Table 11 or note 4 if less)................N� ..... _L_in. Field Nail Spacing................................._......(Table 11)................................................. i Shear Connection(no.of 16d common nails)(Table 11)................................................. Percent Full-Height Sheathing .... )........................... . . ° - 9 g................... (Table 11 . . ........... °x 5 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)... Srt.... if Wall Cladding -'- Ratedfor Wind Speed?.............................................................. ................................................................ 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ................................................... (Figure 19).............1--2ft 5 smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors 2�SA Uplift................................................(Table 12)............................................U= Lateral.............................................(Table 12).............................................L=,f m_ Shear............ .......(Table 12).......1..................�..,..,...I. .....�S= Ridge Strap Connections, if ollar i not�er page 21..... (Table 13),OP...:r x[i .'.T= -;LSTv4 l Gable Rake Outlooker.........................................(Figure 20).........Pr�ft<_smaller of 2'or U2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............... .........................U= , lb. Lateral(no. of 16d common nails)...(Table 14).............. ........................L= _ Ib. Roof Sheathing Type...................................................(per 780 CMR Chapters 58 a20 59).................. Roof Sheathing Thickness........................................... ......................... .......t.. .... in.t 7/16-WSP Roof Sheathing Fastening...........................................(Table 2)..k. .�... t......ttt.���.. A.b.C`.... Notes: 1. This checklist must 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: I a. Steel Straps per Figure 5tV/1Q,dU 0(LUt Q�,JtM�s L( l� Z a� b. 20 Gage Straps per Figure 11 IrJ P� LerAwm / c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a 2. Exception: Opening heights of up to 8 ft. shall be permitted when 5%is added to the percent full-height rhea requirements shown in Tables 10 and 11. of MASSA 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness. pressure treated#2- �� cy� r � g C�Uj Rp1, N No 0 4, A 9FGIS�� C>� 9�FfSSIONP�� i i Full Height Studs. Full height Studs,hall ntcet the same requirements as exterior %call°studs Double Top Plate ,elected i n "cable 5 (See page 12). The mininunrt number of full height studs at Plata Uplift Strop each e tuf the header,hall n��i he less Refer to Table 7 or 8 than half the number of Studs replaced O) ppUto►15)j I*TZ � by the opening in accordance with Table �t. Full heil!ht studs shall he °nni i'pc [ted [�_ Double Header replace an equi%alent numher of iack studs. when adequate gra\itx connections Full j I !--Jack Stud A —�!! i - ar Height prop ided. �t �I! , ` Header Uplift Strap Stud ! ry SIII Plate Refer to Table 9 Window Sill Plates. ti1axinuurt Span; for ` �kinduti sill plates used in exterior walls shall ;; I not exceed the spans given in Table 9. Strop to, ►�P-'�'"( i ! Foundation D Connections around Wall Openings. Header and/or Girder to Stud 6 D, I ; Connections. headers and/or girder to f 1 N� Surd connections shall he in accordance -' with the requirements given in 'fable Bottom Plate Window sill plate to stud connections ,hall he in accordance \rith the requirements glen in Table 1). Top and Bottom Plate to Full Height Figure 17. Studs and Headers Around Wall Openings Studs. Each full height stud shall be connected in accordance with the . l requirements given in Table 9. . - Table 9. Wall Openings—Headers in Loadbearing Walls Header Span (ft) ...dumber of Full-Hsi ght Studs, Uplift (!b.) Lateral (Ib.) 2 2 - 2x4 1 277 132 3 2 - 20 2 416 198 4 2 - 2x4 _2 554 264 5 ( 2 - 2x4 3 693 330 6 !" 2 - 2x6 f` 3 831 396 7 I 2- 2x8 3 970 462 8 2 - 2x 12 3 1.108 528 9`; 3- 2x10 3 1,247 594 10 3- 202 4 1 ,385 660 11 4- 200 4 1.524 726 � i I �� N�t�h � � 3)► \ I W5P E ,A 0.ImmulKe �. I r IN'Tf��tFA1hYE P.DIs� . I f�#�ItN C� �4AMIt3 G I ! I d1N1hY ,TlP tI1�MP� ,TYP. I I I � ,I' I• r ��tr I � MIA. 3' mom. r -- - - —_ - --t — • P�N�1. __.......... -- �\J- . ti\ W S P ATTAC H M E N T mo'f To gCGAl�E POR VERT• M0 -AORIZ. 4TTAGAMBMT NOTES: Wood Structural Panels shall be minirrwm thickness of 7/16-and be installed as follows: i. Panels shaU be installed with strength axis parallel to studs. 6. All horizontal jointa'shall occur over and be nailed to framing. iii. On single story constrvcdon.panels shall be attached to bottom plates and top memberpf the double top plate. iv. On two story constructf6 ,upper panels shall be attached to the top member of rite upper double top plate and to band joist at bottom of panel.Upper attmchment of lower panel shall be made to band joist and lower attachment trade to lowest plate at first floor framing. Y. Horizontal nail spacing at double top platm band joists, and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment Mmv TT 711 vu i .i�1 � I• I I J O I I to ► _ I• I' I' N 1 i I II .a I i ► _ 1� at W�SP g44�►T tNC� WSP ATTACHMENT . No7 TO 5GA4� . top IG L vRlZoWTAL A-TTA CH M bNT - GENERAL NOTES AND MATERIAL SPECIFICATIONS: (Residential IRC Construction) SK-1 FOUNDATIONS 1.All workmanship to conform to the requirements of the Massachusetts State Building Code,latest edition. 2. For site location and grading information,see Site Plan,by others. 3. Assumed net allowable soil bearing capacity,q=3000 psf,for a medium sand/gravel composition. Other soils encountered, contact the Engineer of Record. 4. Concrete: Minimum 28 day strength,fc=3000 psi,3/4"aggregate,designed per American Concrete Institute Code,latest issue,maximum slump=4". a.) Anchor bolts ASTM A307 galvanized,min.5/8"diameter, 12"long,w/2-1/2"hook spaced per Code Checklist,or in concrete piers w/Simpson ABU-series base;SPACED 2'o/c for slab-on-grade construction(i.e.Garage,Basement,etc.). b.) All walls to have min.2#4 top horizontal,2"clear,to prevent shrinkage c.) All walls longer than 25' shall have vertical control joint with waterstopping between wall joint. FRAMING 1.All workmanship to conform to the requirements of the Massachusetts State Building Code,latest edition. 2.Structural Design Loads: Dead Loads:Actual Weight of Building Components Live Loads:Snow Load =30 psf(plus drift)with applicable reduction ATTIC Storage=20 psf Living Floor=40 psf Sleeping Floor=30 psf Decks and Balconies=40 psf Wind Load: Criteria used for 110 MPH Exposure B or C as noted per plans 3. Structural Steel: (as required) a. ASTM A572 Grade 50;shop paint with rust inhibitive paint.Thru-Bolts: ASTM A307, 1/2"diameter;punched holes: 9/16"diameter. b. Welds: Shop weld cap and base plates to columns;shop weld bearing plates to beams;use E70xx electodes. Alternatively,field weld by certified welders. c. Deflection Criteria: L/360 total load deflection. 4.Timber Framing: a.All new timber framing:Spruce-Pine-Fir No.2 with Fb=1000psi,E=1,300,000 psi,or better. b.Pressure treated timber(P.T.):Southern Pine with Fb=1300 psi,E=11600,000 psi,or better. c.Laminated Veneer Lumber:All L.V.L.shall be 1.9E L.V.L.with Fb=2925 psi,E=1,900 ksi,Fv=285 psi,Fc_per=750 psi, Fc_par=3035 psi. Parallam(PSL):All PSL shall be min. 1.9E ES with Fb=2900 psi,E=1,900 ksi,Fv=285 psi,Fc_pet=750 psi, Fc_par=2900 psi. Note that Microllam and Parallam may be used interchangeably. 1. Deflection Criteria: L/480 Live Load,L/360 Total Load 2. Optional: Provide shop drawing submittal of engineered lumber systems for approval prior to materials purchasing. 5.Metal Connectors: As manufactured by Simpson Strong-Tie Co.shall be handled and installed per manufacturer requirements,with all nail holes filled,with the size nail as specified by mfgr.or herein. a. Rafter to Ridge Beam: Simpson LSSU-series,or Simpson Straps over top of plywood,spaced 16"o/c; Rafter to Ridge Plate: Collar ties min. Ix6@ 16"o/c at top or Simpson Straps over top of plywood spaced 16"o/c b. Rafter ends to top plate: Simpson H2.5A c. Band Joist: Simpson straps at 4'o/c: CS-14R-48"centered at band joist 6.Bolts: Bolts in wood framing shall be standard machine bolts unless noted otherwise.Bolt holes in wood shall be 1/32"larger than bolt diameter.Bolt heads and nuts shall bear on standard malleable iron washers,or square plate washers.All nuts shall be retightened at completion of job. 7.Blocking: a.Blocking shall be solid blocking,2x minimum,and full depth of member. b.Stud Walls:provide blocking at 8'-0"o/c,maximum height. Corners to be blocked at 48"o/c with plywood edge nailing to this blocking for the first 48"of these building corners. c.Nailing Schedule: Solid Blocking to Bearing 2-8d toenails ea.side Blocking Between Studs 2-10d toenails ea.end,or 2-16d end-nails ea.End d. New Framing:Provide 2x blocking for 2 joist/rafter bays and spaced 48"o/c in joist and rafter plane at all edges;attach plywood edges to this blocking 8.Nailing Schedule: All nailing shall be in accordance with Appendix 120.Q,unless noted herein specifically. Multiple Studs 16d @ 12"staggered a.All nails shall be common wire nails. b. Sub-bore where;nails tend to split wood. 9. Headers less than T-0",use 2-2x6;all others per MA State Building Code. i 'O .00, r'` LOT 13 10,000.0 f S F. 0 0.22 f A C. ^ I 386• N N � o O O EXIS77NG DECK Q DWELLING 20.S• GARAGE PROP 185. ?D,g• 700 00, �_, 2p JA OF �f1�L LP.'O� TO THE BEST OF MY INFORMATION, PROPOSED PLOT PLAN KNOWLEDGE, AND BELIEF THE BARNSTABLE, MASS. STRUCTURES SHOWN ON THIS PLAN LOT 13, PL. BK, 165 PG, 111 HAS BEEN LOCATED ON THE GROUND DATE 10L31Z13 SCALE 1" = 20' " AS INDICATED. JOB 7332-00 CLIENT SUTELMAN I 10131 13 �� 1 SWEETSER ENGINEERING / 203 SETUCKET ROAD DATE PROFESSIONAL LANDS VEYOR PO BOX 713 SOUTH DENNIS, MA 02660 off. 508-385-6900 fax. 508-385-6991 C.• �S8 PRO✓�7332-00�dwg�7332-CPP© 2013 SWEETSER ENGINEERING I DepaAment of public Safe Board of Bulldf*ngt M and St oddWs Construction super g"NO lftMS d ,. VIKTAR V TUI LE WA 12 HERMSMIRI * west Barnst w MA 01668 3 Unrestricted - Budd* _ v use groupwhich contain less ,than 33.000cubic f (fig I m of Spam. Failure to Msess a current: on of the Massachuse"s: -. ng Code 'is cause for revocaiion of this license. Fix-OPS tiewdiAg WOM0001i'v'- i fm ' 'A 1 T TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION _ft , � � ` Map � �� Parcel JC Application # �C Q o 8 Health Division Date Issued —7 Conservation Division Application Fee S Planning Dept. i - Permit Fee Ilk IL D_: ' i�q♦r r i Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis /a Project Street Address 0 9WIGeU0_AZ --740pLPy /J Village f Owner !�` Address 3� Telephone Q W6a Permit Request e/ `ze41 �dSquar feet 1st floor: existingproposed 2n floor: propose �- "o' a 5' new Zoning District Flood Plain A10 Groundwater Overlay Project Valuation W Construction Type Lot Size D,23 Ats Grandfathered: ❑Yes UgNo If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure /1W9 Historic House: ❑Yes C4lo On Old King's Highway: ❑ �Yes Basement Type: P Full ❑ Crawl ❑Walkout ❑ Other< c -/ AW/ S-1� a! ri? Basement Finished Area (sq.ft.) ��� Basement Unfinished Area (sq.ft) Number of Baths: Full: existing .� new %S Half: existing e-9 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: WYes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:Vexisting ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes A No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name y���o� 70keX Telephone Numbe412.9 Address �`�1 e �I License # Home Improvement Contractor# Email Lark l�+L �/r2 400, 091l Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ' v FOR OFFICIAL USE ONLY APPLICATION# BATE 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 DATE CLOSED OUT ASSOCIATION PLAN NO. lne c,ommonweaun ofmassacnuseus Deparment of Indusfrial Accidents Off ice of Invesfigations 600 Washington Street Boston,MA 02111 www.mass govhUa Workers' Compensation Insurance Affidavit Buflders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizationar div&e): Par i� G os rl �L- Address: City/state/Zip: 7��`1� /� Dd26 s Phone k :�228 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 3 4. ❑ I am a general contractor and I - employees(full and/or part-time).* have hired the sub-contractors 6 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. R Remodeling ontractors have ship and have no employees' These sub-c6ntractors 8. E]Demolition working for me in any capacity. employees and have workers' o workers'] .insurance comp.inst�ce J 9. ❑Building addition rcquired. �� 5. We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work � 11.❑Plumbing repairs or additions mysel.£ [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance reed.]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 fiH out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sob-contractors and st&_whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'camp.policy nnmbm I am an employer that is providung workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ,�7/91 1hs Policy.#or Self-ins.Lic.#: �- ��/�3q� Expiration Date: 9`�6 Job Site Address: � �e� �tl.1s-es E/r City/State/Zip. /W Attach a copy of the workers' compensation policy declaration page(showing the policy number and iration date). Failure to secure coverage as required under Section 25A of MGL a 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK-ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct S_imnature L//ei Date: Phone#: c_IJP -` ��✓ " b���J� 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.EIectri6al Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees: Pursuant to this stage,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 iamu:ance requirements of this chapter have been presented to the contracting authority." Applicants PIease 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 time 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 (Le.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 lavestigations 600 Washington Street. ' Boston,MA 02111 Tel.#f 17-727-4900 ext 406 or 1-877-NW, AFB Revised 4-24-07. Fax#617-727-7749. wwwmmgoWdia i— CS �es��r�t�siable 1t�A �, Unres de -efts nfay,use upa==v z ch . n less 33- cubic feet.(991 of enclosed$p 3 y, stx pas s CUVjen 441 ofij.he' State atfiW rg L J C2 us for srctatl ft' i se. t Office of Consumer Affairs&Busiliess Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: i egistration: 173709 Type: Office of Consumer Affairs and Business Regulation r piration: 11/112014 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 ULEIKA BUILDING COMPANY LLC. 'IKTAR TULEIKA 25 BERKSHIRE TRAIL 1. BARNSTABLE, MA 02668 -- _ Undersecretary Not valid thout signature I t7 , CERTIFICATE OF LIABILITY INSURANCE r OAMOM 10/10/201 TM TE ti MINIIM Aa A K%T= OF 8lORM�TtON ID ONLY A oONRWIN NO MOM UPOII THt 1aB11T8�IGITo HOLDER CERTFICAIE DOH NOT APPEBBiAWA LY Oil IHATRTELY AMID, MCMW Olt ALTER TH IK COMA= APPMM 8Y TM P+ 8E1+OIN. Tm CHDATE OF swum= DOH NOT OONaTR= A CONTRA r HnN .TIEI MUM aNRIIfEIt(a). AUTH RIEPIHBRATtME OR PRODUC13L AND THE CERnFICATE HOLD6fl. tlw taHlw OW eonaBmw of Uw Poiry. eoHtdll Po§dm AAb m*ft an GrAow.m.nt A reHtiewR on 60 m0losb doss not oonM nalMs aHODcrb noidw b Ben crouch � wwoueee =1 Musa a BIamB01aT 6ah10"1 i Schlegel Iasnraaoa Brokers xna 508-771-8381 08-771-04 36 mm saltlQ! Ao a BaBl.nrr gw)�/s villommr— CUBTOMMC Seat Masoatt, ao 02673 MWAMMA1�01aNOc0YmMr viktar Ssleika Dba ?aleika Baildiaq Coapaa=,uc ..a■H.asat sale. 123 Berkshire Vail raulac: relaalo: TPast Basastable, IML 02660 Alwaoer: covmon Cwrvq"TE NUII--- REVISM t THIS IS TO CERM THAT THE POLICIES OF INSURAllm LISTED BELOW HAW BEEN Issm TO THE INBLMW NAMEO ABM Fm THE BaMCATM. NDTVMTIMIAMM ANY REpuaRBTMe91T. T OR CONDmON OF ANY CONTRACT OR OTHER OOCLAWIT MITH RESPECT TO 0M CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE DMIL RAICE AFFORM BY THE POLICIES OESCFEIIEp HEREIN IS SUBJECT TO ALL THE EXCLUSIONS AND COIDITIONS OF SUCH POUF,L UMM MOM MAY HAVE BEEN REDUCED BY PAM CLAM In1rRorrlwwANaa wN wYo PONOYiL A{Narx IArHr ft V 3WX6393Q /30 09/30/20M MAN •1,000,0 z QVINAMMLOeAJMLUABLM was�ea_ •b00,000 aAsw�uoe ®cam �WiMI)arHrH $10,000 PAMONILaAMMAM 01,000,0 GDAbULAGORMAr A2,000,0 GIIIIAGGIMMINUMAPPUMPlI! PRODUCir•QCIPWAM 02,000,0 POLICY a Lroc 0 . ANPOaO UANLM cconsmspom wr 0 AW ARO Cb scdft0 ALL 01Ml97AyI0d r00UMMAwfts -0 t rolwaADAlHror 900LYNIUvemwooftro 0 MMALITM Pitapaw Ira A NOMGIMMALIM a s< awlaHwuns Ocelw t a WAR Ao0Rr0 M • Ert ass s Affrea N 0 «alrvllr000aamHOr r 8 ter ~ ^' Y�N VC-5012398 /26 00/26/201/ e t EACH ACCOMS lle�a>lemtOltlos» � VIA r 100,000 aw+eea yeL ~N nNAlr r rLOOL4W-QA6WWM 6100,000 lw rlrM >H:awlrrlonasoreanoHw�rl. rLaAeArr.PeucruHrr • 300,000 oocl�nanaerar►nOHactoestloHa�veAas><wrsAeolw»H.Acwaral.r�alslr,r,r..sgwrlgrr.q vzcma TWAIITL 10►8 XLWM COVXRL= ON Rua 1ORnM CO INUM ►s'IGN V=Cr CIERTWCAT!HOLM CANCELLATHM SHOM ANY OF THl AMM 0MCIIiMBIIIp POLmn tE QANCULM M TNB BIPBIA m "n THBIrOP. NCffEa tttLL pdyp AOCOt#DNCE tMfN fItIDUCY P�IBB�, A rAOA I I L f ACORDZaQ00N0/) 711PACOIINILtaFi/IepisAt�lew/tat�Ald snRNSTAst.E. 9� 0:19. Town of Barnstable Regulatory Services Richard V.Scali,Interim Director 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 Property Owner Must Complete and Sign This Section If Using A Builder I Ara �x � C � Owner f h property I, 1 ' {� `� ,as O e o the subject p pe ty hereby authorize V 1 KTA P--TA LE 11ZA Y A Ty LC! to act on my behalf, in all matters relative to work authorized by this building permit application for: Cl 6ff CZA lwhli�g We- 1"00 (Address of Job) Signature of Owner Date Alex" 4��11-IAILI Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN_D\Building Changes\EXPRESS PERMIMXPRESS.doe Revised 061313 Commonwealth .of Massachusetts Sheet Metal Permit Map3 U to Parcel -PRESS i, A H Date Permit# t APB 2 '_. 2G'4 J Estimated.Job Cost: $ `>6-"-y,w Permit Fee: CC) Plans Submitted: YES NO�'TOV 09 BAtR RiMR: YES No �� Business License## 2,: Applicant License# � el BusinessInformation: Property Orm /Job. Lo o Info 'on: J�,cl� L�h Name: ✓fit//rza �P_Q_G� Name: Street:,20 C y -7—rG,,�G Streefi T Y' ,�L.J��Gf'��C�✓�C, �� i^ r City/Town:CA•�'+e; 91-6G 5 1 LlL Cityrrown: Telephone ` t32`�V`6�7 _ Telephone: Photo ID.required/Copy of Photo I.D. attached: YES. t N stw Inhw J-1/ unrestricted license i I J-2 I M-2-restricted to dwellings 3-storie8 or less and commercial up to 10'000 sq. fl./2-stories or less i Residential: 1-2 family-4z""Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept Approval Institutional- Other Square Footage: under 10,000 sq.ft. Zver.10,000 sq.ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: I3VAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing I i Provide detailed description of work to be done: i 4 j .INSURANCE COVERAGE' � . � I have a'current liability insurance policy or its equivalent which meeis the requirements of M.G:L Ch.-112 Yes® Rfo❑ ff you:have checked Jg,:indicabe the type..:of coverage by checkng the appropriate.box below: A liability`insurance policy Other type of indemnity El Bond ❑ lOWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement j Check One:Only Owner ©---' Agent ❑ l Signature.of Owner or Owner's Agent j By checking this bo , hereby certify that ail of the details and information I have submitted(or entered)regarding this application are true and accurate to.the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building'Code and Chapter 112 of the General taws. Duct inspection required prior to,insulation installation:YES, NO i ,ProgMs InMections Date Comments Final Inspection Date Comments i Type,of�Uce�nse: 3Y ![d'ivtaster Me ❑Master-Restricted ;y�----� �tylTown ❑ I J.oumeyperson Signature of Licensee �errn ❑J.oumeyperson-Restricted j License Number. 3 e-1Y Lee$ Check-at www.mass.aov/dn1 I I nspector Signature:of Permit Approval ; The Commonwealth ofMassachusetfs Department ofl"ndu trid accidents Office pflnveshgations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers'Compensation Insurance Af9daviit:Bulders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezbly Name pusines Orgenization4ndivid14:._ GL ve.-✓2 6 /-,�J� i�lt �`Z.< tl -Address: � ��-s �-,-��•.� -' - . City/StatelZip G�S� y�' `G Phone.`: ����i��2 A,ree..you an employer?Checkthe appropriate box: -Type of project(r ' equired):; s 1.11.am a employer with_ 4. ❑ I am a general contractor and I have hired the M b-contractors 6. 0 New contraction . employees(fall and/or part time).*. 2..❑ I am.a'sole proprietor or partner- listed on the-attached sheet: 7. Ming These sub-contractors have ship and have no employees These ❑Demolition • worlang for me irr any capacity, employees and have workers' 9. []Building addition [No workers'comp.insurance comp.insnr�ce.t required-] 5. ❑ We area corporation and its 10:❑Electrical repairs or additions officers have exercised their '3.El am a homeowner cluing till work 11.❑Phanbiag repairs or additions- myself[No workers'comp. right of exemption per Mt TL 12. hoof airs insurance t c.152,§1(4),,and we have no ❑ j' employees.[No workers' 13..❑ Osier COMP.insMMW required:] "Any appliamt that cbw4m box#1 must dso till outt he section below showing their worlass'eompensitim.policy infmmation- t Homeowners who sWmnitthis affidavit k&=ting they are doing all`wmk and then hire outside contractors must submit a new affidavitmdicaring such. *Conhactars.thitcheck this box must attached an additional sheet showing the name of the subcontractors and state whether ornoi those entities have employees. Er the subcdnt actts bs,de cmpluyem they mu stprovidC their wod=s''comp.policy number. Iam an employer that isproviding workers'compensation insurance for my employees. Below k thepolicy and job site information. Insurance Company Name: Policy#or Self-ins..Lie.# CG( J 2 72 Expiration Date: f �/ Yob Site Address: y �l /,//lfG ��'1i.0(Le.— 17ir City/State/Zip:_GY�/�1�//2 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 free tip to$1,500.00 and/or one-year imprisonment,as well.as civil penalties in the farm 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.statemmdt maybe forwarded to the Office of lnvestigations:of the DIA.forr insurance coverage verification. I do hereby semi under the.pains•and enahles ofper,wy that the information providedd aab�ow its true and correct; Data: Phone# Official use only. Do not wrtte.ne this area.to be completed by city or town officiaL City dir Tdtrn::' Permit/License one)-�Usuing Authority(circle Board of Health. ..Building Department:3.City/Town Clerk 4.Electrical Inspector Z.Plumbing Inspector 6.Other Contact Person: •Phone lh - i 1 ' Town of Barnstable Regulatory Services • M 88 Thomas F.Gefler,Director + � Bniiding Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable:ma.us Office: 568-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section ff Using A.Builder I, as Owner of the subject J property hereby authorize d /.77 r c to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the.applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:F0RMs:0WNMPERNSSI0NP00l:s r TAVANOMECH Client#:281696 DATE(MMJDD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 1/17/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO7THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE OF NSURANCE DOES NOT CONSTTUTE A CONTRACT BETWEEN TOHE SSUNG SURER(S),AUTOLIFFORDED BY THE VERAGE A BELOW.THIS CERTIFICATE _ REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder Is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject o the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder to lieu of such endorsemeni(s). CC Anne PRODUCER NO E:C SanZO 508-945-9136 HUB International New England Airr tin.E,1:508.945-7863 Ne E-MAIL arntesanzo@hubintentational,com 265 Orleans Road ADORES.: N Chatham MA 02650 _�— INSURER(S)AFFORo1NOCOVERAGE HAIC# 508-945-7863 1NSURERA.Hartford Insurance Co INSURERB:Safety Indemnity Insurance Co IHsua£o Tavano Mechanical Systems LLC INSURERC: 201 Capes Trail INSURERD: W Barnstable,MA 02668 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN h1AY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS ADDLSUBR POLICY EFF POLICY EXP INSR TYPEOFtNSURANCE SR W1I0 POLICY NUMBER MMtDD MMlOD1YYYY A GENERAL LIABILITY 08SBMZQ6456 8/14/2013 08/14/2014 FACH OCCURRENCE 51 000 000 DAtdA%T Cj ENTED s300 OOO P EMI. S a occurrence) X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR ME0E1CP(AnYoneperson) s10 aao PERSONAL&AOV["'JURY $1,0001000 GENERALAGGREGA'rE s2,000 000 PRODUCTS-CO%IPi0P AGO- s2,000 000_ GENT AGGREGATE LIMIT APPLIES PER: $ 1 POLICY n JECT I ►LOC COMBINED SINGLE LI1.IT B . B/2812013 08/28/2014 LEA a«Ident AUTOMOBILE LIABILITY 6210665 000ILYINJURY(Pet person) $250,000 ANY AUTO BODILY INJURY(Per accident) S500,000 ALL OWNED X SCHEDULED AUTOS PROPERTY DAMAGE $500,000 NON•01VNE0 Per a ttidenl X HIRED AUTOS X AUTOS - S UMBRELLA OCCUR EACH OCCURRENCE 5 LEXCESS LIAB C1A131S-AU1DE AGGREGATE S _ DEO RETENTION$ \VC STATU- OTH- A WORKERS COMPENSATION 08WECLG5272 811412013 08/141201 AND EMPLOYERS'LIABILITY ANY PROPRIETOWPARTNERlEXECUTNE Y I N E.L.EACH ACCIDENT S1 OO OOO OFFICEROMEMBER EXCLUDEOT H J A E.L.DISEASE-FA EIMPLOVEE S100,000 (Mandatory In NH) it yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS be:ow DESCRIPTION OF OPERATIONS!LOCATIONS t VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is roqulred) CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN , 200 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 Of 1 The ACORD name and logo are registered marks of ACORO #S1061684/M978046 AS004 l ®6££Z4£. 9 U ( 0000-899Z0 tlW 3lgtl1SN8dg _M. 'lIt/2il S3dt/3 gW31SAS 1"1NV Hz)3w 'oNvnd1 ' ONVAVI N' h3Na0N m � o.._..SS3i�tll3W i ®•° 0 >�OMMONWEgLTH OF ® ® ® o ® MASSAHUSEITS ARQ QF 5HEE1" 1 `AL `iJOR1(ER ISSUES THE "FOLLOW(N '�'(CENSE +.as a : ASTER U�RSTRlCTEp 201 CAPE$ TRAIL 1�..9ARNSTABLE MA 026 r 68 1373' { 15�513 KINLIN GRO`TER REAL ESTATE GREG & DONNA LAPSLEY {' REALTORS" 927 Route 6A,YannouthpoM MA 02675 OFFICE:(508)362-3000 x117 FAX:(508)362-8220 DONNA'S CELL: (508)280-2389 P MrER: R �FREG'S CELL: (508)280-3254 Lapsleyhomes.com / _ dlapsley@kinlingrover.com RP.a��Mflg °f1S' glapsley@kinlingrover.com R a tA- stable rvices irector �sion mmissioner ,MA 026.01 . ble.ma.us Fax: 508-790-6230 FEE: $ N s illage Telephone number C� J� OPy TION REGULATIONS s shall bear a reflective decal.The decal shallbe ce on the lower right rear ofthe vehicle but not A vehicle may have additional decals. Decal equipment unless a permit to install LP-Gas has t • / 1 �� '^ ����� �� �� a-�.e�- � S �-- d 7HETo�y� TOWN OF BARNSTABLE i BARNSTABLE. "°9 o M BUILDING INSPECTOR � ar a• APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... r'-.I.j............ .......i9..7P TO THE INS ECTOR OF BUILDINGS:The and ned hereby applies for a permit according to the following information: Location ...........!c?../.�N....f5..� .... .� ............t1.. .. .............................................................................. Proposed Use ...C�...�J... ../.. ...4 -%...../t.7�?.X........ .f`......... ..1. �?......... ..... ZoningDistrict ........................................................................Fire District .............................................................................. G. Name of Owner .... ...........��.l..,l..��.�.......Address .,,(..�.....k�.�.�:.`��.�......r�..v...�✓...�...f�-'..:4�..'�/��� Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior 1/` ...V...rl..`.1 ........ . ..../f.,✓.'&.&../.Z.6.j.......Roofing d.s..ZI/l/h.C'' V..../ ..... .�/...xv.6 6I;f . .. Gt/ ®D Floors ..v.l.. ........../.............................................Interior .....................v............................................................ Heating ..................................................................................Plumbing ................................................................................... Fireplace ....................................................................r `.. ...0.. ................................ r M�TH4 D OF I'RO�liUii`!G FUG. ' Difinitive Plan Approved by Planning Board _____SA 1TARY_VER_5UPPLY, SEWAGE DISPOSAL C�� Diagram of Lot and Building with Dimensions AND DRAINAGE IS HEREBY AO PRuV"'D0 G _ Iva J Qw 1 % TOWN OF BARNSTABLE ®� [30ARD OF IiFA► i"rl A LICENSED INSTALLER MUST OBTAIN SEWAGE PERMIT, AND INSTALL SYSTEM. Waal /� C nC96 .� r 17. / . z 7 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. � Name ..... ................... White, Hugh C 31 1970 � � 13323 add to dijelli 4/ No ................. Permit for .................................... :........&..build garage...................................... / ti 10 Brealwater Shores Location ........... ................................................... Hyannis S J Hugh V7hite 1 ti� Owner .................................................................. Q �V Type of Construction ...........frame............................... r ................................................................................ 1 Plot ............................ Lot ................................ 1 r ,n- Permit Granted ......September. . .. ...... 3 ....19 70 e...... . .. .. Date of Inspection 4 :C;�—z. 1970 Date Completed ......................................19 PERMIT REFUSED .................................. .. .. . + ............................................................................... ................................................................................:.................. Approved ................................................ 19 ............................................................................... ............................................................................... mop SHE.Tp� Town of Barnstable Permit# Expires 6 months from,issue date Regulatory Services Feer;—� _____ IARNSYABLE, Thomas F. Geiler, Director v Mass $ gp i639. a,� Building Division - Tom Perry,'CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.banistable.ma.us Office: 508-862-4038 Fax: 5087790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY /`` r 7Not Valid without Red X-Press Imprint Map/parcel Number13V `f` Property Address �`�© 1 1Jr`, _ 2� -- Residential Value of Work . 1 Minimum fee of$2S.00 for work under$6000.00 Owner's Name &Address (—tT/lG,_ (` 1ev1I—L� j/VC i o'V Telephone Number Contractors Name _ C6 (ilfll C Home Improvement Contractor License# (if applicable) �� XWorkman's Compensation Insurance PERMIT Check one: ❑ I am a sole proprietor SEP 2 41008 ❑ I am the Homeowner 0 I have Worker's Compensation Insurance ® N OF BARNSTABLE Insurance Company Name Work.man's Comp. Policy# Copy.of insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping, Going over existing layers of roof) ® Re-side Replacement Windows/doors/sliders. U-Value:M 3® (maximum M) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,.Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors.License is required. I j , STGNAT'URE: 4 Q:\WPM ES\FORMS\building permit forms\EXPRESS.doc T?,*n,)n i op The C0mtn0.ntvearfh of Massachusetts Department ofJndustrialAccidents Office of Investigations 600 Washington Street Bostoli, M14 02111 1 WVW.m.ass.gav/dia Workers' Compensation XnsiaranceAf5davit: Builders/Contr-actors/E7ectricians/Plumbers A,.pplicant WormationaV Please Print Legibly . Naf, (BusincssJOrianization/lndividaan: �EG(26—j/ r��sT�U�jr _m • Address: %fro�R/ N' - , City/StatelZip: � �5 1�2� jf`1�/AC AP o Phone.#: 5 Are you an employer? Check the appropriate bwc Type of project(required): am a e toy cr with 4; ❑ 1 am a general contractor and 1 6 ❑New consuction Svc wed the shb-contractors . employees (full and/o part-tint..* tr . 2-❑ I am a sole proprietor o p r- listod on the attached sheet 7. ❑RUmodeling ship and have no employees These sub-contractors have S. ❑Demolition wanting for Mn in any capacity. employees and have workers' 9. ❑Building addition • . [No workers' �p�.;n�rraneo We a t a-cornet• l0. Elcctrieal rc airs or additions 5. � We am a corparat'ton and its � p rCgaurcL] ofEcers have cx�rcised their 11.0 Plumbing repairs or additions 3.❑ 1 am a homeowner doing all arork right of myselE [No workers' cam. "exemption per lvlCrL 12 ❑ goof repairs incnr3nce r t c_ 152, §1(4), and we have no egwred] employees. [No workers' 13.❑ Other comp, innirancc required *Any applicant ticat ebeekr box#1 rust ako fill out the section below showing their warkcrc'eompauafion policy informabon- t Honxnwners who submit this a$davit in6caEug tbey arc doing all work and then hire outside eontract�rs must rul?mit anew affidavit ixidicatmg such tContraetors that eberk this box Truitt attached an additional sheet sbowing the name of the subcaot<attnrs and.statc wbctbex or not thoco entibts have crnployers. If the sub-eonhradon have eraploycca,.tbcy Mud ptovi&their wcrrkeR'comp.policy numbcr- I nun an employer that is providing workers' compensation insurance for my employees Below is the polity and job sife Information Insviancc Camp any Namc:�;tl�Ll C6Z SC i F/FGC L Policy#ar Sclf--ins.Lic.#: ? Expiration Data =1S - .2 ola Job Site Address: Zy ,l3fL h/ r l S r�� � % r,got//f c. statc/zip:A/W 0910/ Attach a copy of the workers' compensation policy declaration page(showing the policy nnraber and expil anon date). Failure to sc=r- coverage as required undrr-Section 25A of MGL c. 152 can Ieaa to the imposition of n inal penalties of a fines tip to $1,500.00 and/or one-year roaprisonmcnt, as wc11 as civil penalties in the form of a STOP WORK ORDER and a fir of up to $250.00 a day against the violator. Br advised dial a copy of this statcmcrit maybe forwarded to the Office of Inycstigatims of the DIA for insmrncc coverer c vcrm-cation I do hereby cer-6 der the a' and penalties of perjury that the inf rmntion provided above is true oral corracL Date: PhonC O ftcinl use only. Do not write In this area, to be compleeed by city or town ofjxIaL City or Town: PermitJLicense# Isstdag kuthority(circle one): 1.Board of Health 2.Building Department 3. City/Tovrm Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other. -000- 11:BOA FRCIM:SCHLEGEL SCHLEGEL IN 1SCto771�1603 T0:15508 7906230 P. 1 All' ACO CERTIFICATE OF LIA IIL.IT -INSURANCE ""�('�`"°"""" p 69 T1 I 09/11/2008 PRODUCER - S C 1 ICA ED AS A - F I SC=GEL INSURANCE ONLY AND CONFE,t�(S NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER FICATE DOES NOT AMEND, EXTEND OR 34 MAIN ST ALTER THE COVERAC3! AFFORDED BY THE POLICIES BELOW. WEST. YARMC7U7H, !� 02673 INSURERS.AFFORDINOC'VERACiE NAIC* elR1REa INSURER A: FIRST FINAN LAT, Adilaon S®golini D.B.A. Segolini Construction NsuR[RD GRANITE gTA 111 Minton Lane INSURER C: INSURER 0: - - West Barnstable, MA . 02668 INSURERE: COVERAGES _ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T'O'THE INSURED NAMED ABOVE FOFI THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF,ANY CONTRACT OR OTHER DOCUMENT WIN RESPECT WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TTE TERMS,, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ISM AWL LT" wane TYrEaFWRURANce raucY wumm DAYS�DM" wt6(6BilOiY+Y)FECTIVISN- - were - . A GEteRALUAe+un 491FOO4606 05/24/2008 05/24/2 09 EACHOCCURRENCE f 1,000,000 X COhMFRCEAL GENERAL LIABU Y PREMISES(Ei ocu+erce) f 5O,OOO CLAIMS MADE a OCCUR - MED DCP(Arty cm Perm) f 5,00a -PERSONAL a ADY INJURY 31,0010,000 GENERAL AGGREGATE f 2,000,.000 GENL AGGREGATE LIMIT APPLIES PER: ( PRODUCTS,-COMP/OP AGG- f 2.,OOO,OOO I. POLICY JET AUTOWJULB UASIUTY - COMBINED SINGLE LIMIT f (Ea nCddwt) ANY AUTO ALL OWNED AUTOS BODILY INJURY - 3 (Per P.r ) . SCHEDULED AUTOS HIRED AUTOS' - BODILYINJURY f NON-OWNED AUTOS i (Pw rcddetd) . - PROPERTY DAMAGE (Per .Nett) f GARAGE LIABILITY I AUTO ONLY•EA ACCIDENT f i ANY AUTO i F- E4CEtwumaRELLAHER THAN EA ACC f - TO ONLY: ADD 3 UAIXUTY - II( EALHOCCURRENCE -- f OCCUR ElCLAIMS MADE I AGGREGATE f' s. i DEDUCTIBLE I 3 REn noN s B OR WILE"CoxramATONAND WC 874-48-33 05/05/2008 05/05/2ip09 X TCRVLMITs ER e?P wyetvuAmury e.L.encHACcIDErrr $100,000 ANY PROPRIETOR/PARINERUFXECUTIVE I OFFICENMEMBER EACLUDED7 EL,DISEASE-EA EMPLOYEE f 100,000 Ifyce,de W.alUe uat' EL DISEASE-POLICYLIMIT sf— "C.Q SPECIAL PROVISIONS baloW _ OTHER Da9mrnm OF OPERATIC"I LOCATIM3/VBiCiE9I EXCLUSIONS ADDED MY ENODR30AEIR I SPECIAL PROVISONS - ^�`-.� ✓ .� . ADILSON SEGOLINI IS EXCLUDED FROM HIS WORKERS COMPENSATION POLICY I PROPERTY LOCATION 31 WHITEHALL WAY HYANNIS, MA 02601317 i C!J • N CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE eHouLD ANY oP THE i DEW ad SEPOR11 THE EIUMRAMON M 206 MAIN ST _ DATE THEREOF, THE INIA RE II ENOrrA E 21 OAY>• vvaTTmiHAYNN-IS,MA 02601 MOnCE TO THE CERTIFICATE N" TO THE FAIWRE TO DO 00 R(ALLIMPOSE NO OsuGAnaN 6uTY OF ANY O UINAIRIA .ITS AGOM OR REPRESINTATR/FA - FAXt# 508-790-6230 AM40mm ILETREAw j/—'40 AC0RQ 26(20M M) 0 AC75M CORPORATION 1984 i I / ,per �\ Board of Building Regulations and Standards License or,registration valid for ndividul use only HOME IMPROVEMENT,CONTRACTOR I before the expiration date. If found return to: Registration 159597 Board of Building Regulations and Standards I One Ashburton Place Rm 1301 4`. Exgratwn =5/15/2010 Tr# 268223 !! Boston,Ma.02108 it Type DBAA t+ ii SEGOLINI CONSTRUCTION ADILSON SEGOLINIt i y� , va ature 117 MINTON LANE"l ;;f Q a ..` WEST BARNSTABLE, MA'02668 Administrator lid without sign Not Op'{HE r, Town of Barnstable Regulatory Services N "$ '$ Thomas F. Geiler,Director 019. ,� ArFb �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 This Section. If Using A Builder T A-1 Cr-4w (�Z-' , as Owner of the subject property hereby authorize `�e © to act on my behalf, in all.matters relative to work authorized by this building pernnit application for: (Address of job) 0� Signature of Owner Date V rkoW//Z Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Foam on th:e reverse side. i� Town of Barnstable �v o�YHe ram,a Regulatory Services y saxrtsrwsr.E, Thomas F. Geiler; Director MASS Building Division TFD � Tom Perry,.Building Commissioner . 200 Main Street, Hyannis, MA 02601 www,town.b arnsiabl e.ma.us Office: S08-862-1038 Fax: SOS-790-6230 HOn1EOWNER LICENSE EXEMPTION Please Print DATE: !OB LOCATION: A�� number street �i 7~7(� village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is urtended 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 izyspection rocedures and requirements and that he/she will comply with said procedures and require ants, Si afore 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 )fOMEOWNER'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 lom'.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 responsrbilities 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 ease,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 heshe 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 forn-Vicertification for use in your community. 44 3 �AM Q 'IrK C; -,-at 1, RO 0 L � x CQ x 3 O MICHELE -F/ t� CUDILO.. . 46f. CT L ti RU URA � Los No 34774 / ST'EP G� S�ONAL also! tl -71-77 Cje OD" QL n v► x I - �C h lz t 0 � �S R AP I I 00 ~ uJ I�OOGV$ e �� O — d 1� a ,41 — _ i O -5 rr oil 4 i I�eeati�e vr vJi �I� O -\H OF MqS MICHELEUDILO you, o RUCTURAL � No 34774 Q ----- _ --- A �4 SSIONAL�G\ l Re 1(2QAte _ � � y\ ��c � t20O�"► iuJ i PJoOWLS F�Ot/a e I $4A UE I Q P)oov-00A { A3 DEC- � �x iS��P✓ ��� `o walle � ----� Igo be 12e•uoverl Tom, I� s Q O N0- b i { � ASH OF Mq { MICHELE q�y CUDILO N STRUCTURAL s 5 No 34774 { SON l ENS' VE s OReAv' { i/ .6) /6 tic -r k �OL k , W U v s q F-,e,,0e iN roe �tl t K/ C e Afe,-T - 30'' loll s-1 o 5,0 � n 716 % 7a Pp Tc+- BALL 6fgrys� ��� /VOTF I New F p-)1 M�au To (5Q w XiST iA) OO / LSD 2 OtiJ( I O Fi t2SPOp Q �? T2 w pR� A insv a(. J� � O O y +o Rena r o _ I r S+A LL 3/LI s,, POD t, w/tioou��' � be go-4QAce u1IMo0 ,5�7G��1(Tl�) O - a �ze�•�e� �o Dl� � � aa�h on G/oo� -- STeP(X-)cI., ;. . ,/^� v `ZNOFMgs� co pG PAJI' c 114/ MICHELE y�N _ ++ CUDILO 5Q Y � � No 34774AL y b o 1 N9 FQIST IV L -I T w i tiJn01,c9S � U k F,2am e. � H�I��J A u; /X / f _ o �P�20p� p�J al Not) A)ew CLO csc 20 � x i rQ o ® Lz l a _-- - �a4 hROom '!6 : �SNOFMgs MICHELEs�cya CUDILO o TRUCTURAL ca No 34774 38 O G/STs N L s O G 9 { � A I s iD u Lowe -_._.L�_vq I } ac o it s kJ'}LLS way 00 �� Zx¢ 4ew Z� 6 - s�� R 3$ C�i I r'�p , � See0n !-lOpe �/e�'�lE'2s ►24 Lv�(GLv-W) l3j 2 Z r > r S1Mp b I OCK-W 6�1-54 Cs b ,-7.+wc) bc(L/.s Q AL� C' /::::w 'V'P F — Pmlll le so ?/ Awl 42) 06?lLI v R/Gw 4 ;57 1 F 100Q lt¢" C1ziL i/V6 d=�iG ,Fj , ''� UGC - r�J12 LvL r �i R Ofae �� . Z C�W/45 «)I� LAG 1 a d2Al2IAJG WALL t32 LouJ bl� I N i I v OUel2hKRA,P o.0OFMA qcy r` CS 10 s cvRAL co 3a-174+ v NO -12 A� SSIONA P��� p C BIB- Sups Mat, k s C SMOKE DETEC ORS REVIEWED i BARNSTABLE BUILDI DEPI DATE q FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITING w HELE -- _— — CUDILTUR O m oU347 4AL CIO 90 OISTEA� SIGNAL -13 , 1'Q �-v -70 f ^ d T)e-D of t a('0 Y � 1, i lit I C LQ trlOD tz FI t`f It,,S All ��cKes -Sod �s aee l/ COQne)�s ate �-- ill Ca-s��/ ,s ��c�v��' ✓✓� � 7x 1 FeOtl-1 �r O iOU.6 1.5 C lqr ) 604-2 CT A PVC Pcrd, E( a zyecr,,4/ Zr 1� 1"� Mtk�N �200 n 12: NOFMgSs F. qc � ICHELE ICHELE CUDILO yG�, ' N S UCTURAL c. p 34774 NAL ter. ii� i f u �6 IL-Gt'2c �3T lZ LASACV FloodCY = - -Q-T- DP- 4_ 21 i t - S{ Poo 2 _. --- _ -- : _