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Home My WebLink About0167 BUCKWOOD DRIVE i i i i i V L�/-r I-J/ C L-�c e UlLb S A L)wo tf C— Fkib C /+v s F-6 { No A-P 7- t-I CC—)S TO c o2kC--C-7e-t'N Ha L)L_-E7 psi-DE�4C TOWN OF FARINISTABRE 14 YALLLl S 5 1 o Fri s i y .v. ' p� -- �- - 1� �u r � � ` 7 �`� ax10 F� Csz-v�tv � ) <G � �c � � � '► 1 � '. r i l�� f (� ' i.tt Lr�CV'S r� 20 a�4 OD PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT - 200 MAIN STREET HYANNIS, MA 02601 DATE: 08/17/12 TIME: 15:45 ------------------TOTALS----------------- PERMIT $ PAID 50.00 AMT TENDERED: 50.00 AMT APPLIED: 50.00 CHANGE: .00 APPLICATION NUMBER: 201205023 PAYMENT METH: CHECK PAYMENT REF: 1276 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7l Parcel V�J Application$ -"40 -' Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis -ProjecV8 -et Addr.srt too vv er /1 Ad d re'-s s7 6 r� Telephone'' .0, ®'Yf7 Pe mit Req 7'; D �1'b at✓ 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 /9bS Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ULFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)� - c CD t �_ Number of Baths: Full: existing 0? new Half: existing news -. Number of Bedrooms: existing _new 1� Total Room Count (not including baths): existing 3 new First Floor Room!Count Heat Type and Fuel: 9.Gas ❑ Oil ❑ Electric �❑ OOtt r Central Air: ❑Yes No Fireplaces: Existing !� New Existing� p g g wood/coal stove: ❑Yes d�No Detached garage: ❑ existing Anew 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 ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) t ivame .° ou e Tel'ephone..N mberr,. -��.g Address License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ZSIGNATURE6� DATE-- r 1 ~ FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. a ADDRESS VILLAGE OWNER 1 DATE OF INSPECTION: ' FOUNDATION i FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1• TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ( Parcel '�f Application 4y l�JgJ3 Health Division , Date Issued Conservation Division Application Fee J Planning Dept. t Permit Fee a Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project St et Address =1 7 D Village Owner �. Z Address Telephone 19 7 Permit Request If X 90 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ff d� Project Valuation 7N 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: btFull Crawl ❑Walkout ❑ Other `:V `' Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) r Number of Baths: Full: existing— � g new Half: existing new i Number of Bedrooms: existing _new - w/ . Total Room Count not including baths): new First Floor Room Count ( g ) 9 Heat Type and Fuel: f 1 Gas ❑ Oil ❑ Electric PNew ( Central Air: I0 Yes No Fireplaces: Existing Existin wood/coal stove: ❑Yes No �- P 9 r g � } r a , AVV_ Detached garage: ❑ existing .new size_PoI 61: ❑ 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 ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION , (BUILDER OR HOMEOWNER) L Name O ou e Telephone Number �� 7 f ' t Address C License# O 0 Home Improvement Contractor# Worker's Compensation #ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO. SIGNATURE / DATE 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 DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 " www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ENam� iness/Organizationdn 'vidual): le Add dress:_ / 7 `,City-/S t_ate/�Z-ip: P I Phone#: '� ��/' Are you an employer?Check the appropriate box: Type of project(required); 1.❑ 1 am a employer with 4. [] I am a general contractor and T 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. ❑Remodeling shipand have no employees These sub-contractors have 8, Demolition working for me in any capacity. employees and have workers' com insurance.$ 9. ❑Building addition [No workers' comp.insurance comp. required 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 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 01 must also fill out the section below showing.their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire*outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the 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$1'500.00 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 the pains altie perjury that the information provided abo is tr a and correct. �Si afore: t~Date: Phone#: .o-:.. Official use only. Do not write in this area, to be completed by city or town officEa City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electricalector 6. Other Contgct Person: Phone#: I ATYC Gi de to Wood Construction in Hi,;h Wind Areas:J10 tnph f nd Zonie Massachuset s Checklist f0' r Compliance (7so cn-fRs3o12.,.l)' : C�Ch=k 1.1 .SCOPE Compliance. Wind Speed(3-sec. gust).......... ................. ..............:.........:........... Wind,Exposure Category...................................m .........:... -....._...._............... 110 mph Wind Exposure Category................En eenn Re uired For Entire Project 12 APPLICABILITY Number afSbries(a roof which exceeds 81n 12 slope shall be,considered a story) stories _<2 stories RoofPitch...................:.........---••----..I..................................(Fig 2) ............................................. 12:12 , Mean Roof Height.......... ............... .. (Fig 2).. ......................................... Building Width,W........:..........................................•-•-•. •(Fig 3)...._........ _ 1 Bulding Length, L .................................. _...............:...........(Fig 3)................................................. A 5 80' Building Aspect Ratio(LAY) ...............................................(Fig 4)... ..._......:............ .............:.. <_3:1 Nominal Height of Tallest Opening2 F 4 < • .-; ( 9 )............:_.........:...........•-........... _68 1.3 FRAMING CONNECTIONS General compliance with framing r�nnecuDns................._.(Table 2).............. .2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.....:...................... ........................................ ............................................................. Concrete Masonry.:..........................................•...................... . 22 ANCHORAGE TO FOUNDATIDN''a 5/8'Anchor Boltsvimbedded or 5/8'Proprietary MechanicaFAnchors as an alternative in concrete only Bolt Spacing—general..........................................(Table 4).............. in. Bolt Spacing from endroint of plate....:...........:....... (Fig 5).. .............. ..... in.:5 6 —12', Bolt Embedment—concrete................................... (Fig 5)................--..................:------ Fi in.>_T : Bolt Embedment—masonry...................:...........6.........(Fig 5 j .. in._>15' PlateWasher..........................................:. .-..............(Fig 5)........_.....----.._...... .. .: .L3'x 3'x'/' 3.1 FLOORS FJoor•framing member spans checked: :........................._...(per 780 CMR Chapter 55)............................. Maximum FloorDpening Dimension..........:........................(Fig 6)............._..................................... ft 12' Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6):........ . . Maximum.Floor Joist Setbacks Supportng Loadbearing Waffs or Sheanvall...._..........(Fig 7).................... ... ft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls'or Shearwall................(Fg 8)........ ..:....... ft s d FloorBracing at Endwatls....................................................(Fig 9).... ;._...:__............... Floor Sheathing Type _.......(per 780 CMR Chapter 55)............0................. ................_........._:.._.------. Floor Sheathing Thickness .:........::.:............:..:...._......_.::....(per 78O CMR )55 ..............Chapterin. P ._. Floor Sheathing Fastening....................::..........:.....:.......:...(Table 2).. d Waifs at in edge/ in field 4.1 WALLS. . Wall Height Loadbearing walls... ........ ....(Fig 10 and Table 5) ft <10' Non-Loadbearing walls . (Fig 10 and Table 5) _ft ....... ..... Wall Stud Spacing .........-:----...........:.............................(Fig 10 and Table 5 _in.<24 o.c. Wall Story Offsets 4-2 EXTERIOR-WALLS' Wood Studs Loadbearing walls:....................................... (Table 5}.............................2x -_f{ Non-Loadbearing walls................................. ...........(Table 5).................... ......2x Gable End Wall Bracing' — — — Full Helght Endwall Studs..... ......................................(Fig 10).... ............. - .............................�........ . WSP-Attic Floor Length................ ...................._..._..:(Fig 11) ....... .................................: ft zW/3. Gypsum Ceiling Length(rf WSP not used)....................(Fig 11)............. ft_0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c.. (Fig 11). ...................... _ r or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ...s ...... in end joist or truss bays Double Top PlatE Splice Length .: ......:................. .(Fig 13 and Table 6) Splice Connection (no. of 16d Common nails). ......... (Table 6)............... RTVC Guide f0 Wood Canstrucdori hi High Wirt Areas: I10 Frtph end Zane AlassAchusetts Checklist for Compliance (7s0 CA4R5301.z.I 1)i Loadbearing Wall Connections - Lateral(no.of 16d common nails)................................(Tables 7)........_....._............_.................._.._.. - Non-Loadbearing Wall Connections Lateral(no_of 16d common nails)......................_.........(Table B).......................................................... Load Bearing Wall Openings (record largest opening but check all openings for cornpriance to Table 9) Header Spans ................................ ....(Table 9)..._.............................. ff in._< 11' SillPlate Spans .._......•..............•--.............................(Table 9)..........:......................... 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 9) Header Spans............................. ....(Table 9)............................ 5 Sill Plate Spans.......................:......................................(Table 9)..........................:......._ft_in. 12' Full Height Studs(no.of studs)....................................(Table 9)....................................................... Exterior Wall Sheathing to Resist Uplift and Shear SimultaneDusly4 Minimum Building Dimension, W Nominal Height of Tallest Opening ...............................................:............................... 5 61B' SheathingType..............................................(note 4)..._..........................................._..... -Edge Nail Spacing .........._(Table 10 or note 4 if less)............. Feld Nail Spacing................... ....(Table 10)..................._............................ Shear Connection(no.of 16d common nails)(Table 10).............:........................................._ Percent Full-Height Sheathing........:..........:...(Table 10)................_............_....._....._...._:_... % . 5%Additional Sheathing for Wall with Opening> 6:6`(Design Concepts).............. .. Maximum Building Dimension, L Nominal Height of Tallest Openin?.......................................................................... 5 SIB. _ Sheathing Type..............................................(note 4)............................................ . Edge Nail Spacing................................_.......(Table 11 or note 4 If less) in. Feld Nail Spacing.......................................:..(Table 11).................................................... in. . Shear Connection(no.of 16d common nails)(Table 11)................................................ .:.:... Percent Full-Height Sheathing.......................(Table 11).................................................... ° 5%Additional Sheathing for Wall with*Opening>SIB'(Design Concepts).................... Wail Cladding Ratedfor Wind Speed?.............................................................. ...............................-............._._.............. 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Toot,see B.BRS Website) Roof Overhang •..................................................(Figure 19) ............. ft<smaller of 2'or Lf3 Truss or Rafter COrneCODng at Loadbearing Walls Proprietary Connectors Uplift........................................•.......(Table 12)........ ...................................U= plf Lateral.............................................(Table 12).............................................L= plf Shear...........................:..................(Table 12)............................................S= pIf Ridge Strap Connections,if collar ties not used per page 21... (Table 13)...............................T= pif Gable Rake OutiODker..........................................(Figure 20) ............. ft 5 smaller of 2`or L12 ' Truss or Rafter Connections at Non-Loadbearing Walls . Proprietary Connectors Uplift.........................................-•-.--..(Table 14)............................................U= lb. Lateral(no.of.16d common nails)...(Table 14)................. _ Roof Sheathing Type................:..................................(per 780.CMR Chapters 56 and 59)............ Roof Sheathing Thickness in.>_7116'WSP Roof Sheathing Fastening......................................... (Table 2).........I................................................ '�IDteS: - 1. : This checklist shall be met in its entirety, excluding the specific exception.noted in 2, to comply with the requirements of 780 GMR•5301.2.1.1 Item 1. If the checklist is met in its entirety then the fallowing metal straps and hold downs ant riot 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 1 Ba and Figure lab 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. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated f#2-giade. d �4FYC Guide to Wood C.orrstructiorr hi Hialr 1 ndAreas: 110 rnph frindZone Massadiusetts Cheddist for Compliance (790 cnIR 5301 -1:1)' 4• a. From Tables.10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percer)t Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7116"and be installed as follows: 1. Panels shall be installed with strength axis parallel to studs. iii. All horizontal joints shall occur over and be nailed to framing. It On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attadhment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists, and girders shall be a double row of Bd staggered at 3 inches on center per figures below=Vertical and Horizontal"Nailing for Panel Attachment 5. Glazing protection: a)new house or horizontal addition—required if project is 1 mile or closer to shore(generally,south of Rte.28 or north of Rte.6) b)vertical addition—not required unless there is extensive renovation to the first floor c)replacement windows-needs energy conservation compliance only(chap 93) 6.Wood Frame Construction Manual(WFCM)for 110 MPH, Exposure B.may be obtained from the American Wood Council (AWC)website. . � —NlfiEN'LTiISIDGERFSTSON . FfiAMNG USESd NAILS • ATb'ac I t {1 , u - • 11 il, it ` LI 11 II : , It J.l 1 t1 u it `1 Ir g I cl 1 .o .t 1 r � t - 1 I' FTiAIdIIVC+.I�tEMBE�S � '1� i t1t EDGE L1 1 p It t ,� - I II •� .5 GaMa) 3`ktl�l NAIL SPAGkJG p — l NA4 PATTBW PRhlC3 F'_ AtdEI ? 4 \ FAtt�EDGE WUBLENAILBY--ASPAQVGDMY- ' See Daldll on Next Page Vertical and Horizonlal Nailing Detall . for Panel Attachment Veftal and Horizontal Nailing_ for Panel Attachment . EVE� Town of Barnstable Regulatory Services yBAM M Thomas F.Geiler,Director . �''°rFo;�•�"�0 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Compl to and Sign This Section. I sin A Builder as O ner of.the subject property . hereby authorize to act on my behalf; in all matters relative to work authorized by this b ding pe t. (Address of ob) *Pool fences and alarms are he responsibility of the applic nt. Pools are not to be filled or utilized b for fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:F0M4S:0WNERPERNflSSI0NP00LS 6/2012 Town of Barnstable P Regulatory Services " Thomas F.Geiler,Director sAaxsTAst.e, � . MASH p i639•t a,�� Building Division rFD MA' 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 t DATE�i J JO_B LOCATION: _ , street ' village „HOMEOWNER I&W name home p ne# work phone# CURRENT MAILING ADDRESS\ ! GtJOU 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 requireme ts. S ure o H caner...+ Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor. . Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fomi/certification for use in your community. Q:fom,s:homeexempt . t 1 Town of Barnstable Regulatory Services snxxernsi.e •` MASS g Thomas.F. Geiler,Director , s639 ♦0 639 A 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 August 28, 2012 Mr. and Mrs.Jason Houle 167 Buckwood Drive Hyannis, MA 02601 Re: 167 Buckwood Dr. Dear Mr. Houle, On August 17, 2012 application was made to construct a garage with storage above at the above referenced property. Based on the paperwork submitted, a permit cannot be issued. The Wood Frame Construction Manual checklist which controls much of the construction detail was not filled out;there was no engineering data regarding the LVL ridge or elimination of collar ties;the garage door opening has no APA Narrowwall Construction detail; the stairs. show no run, rise, guard, or handrail information;the floor joists are over spanned;fire separation may be a factor also.A structural engineering assessment may be the most economical approach to address these issues because so much of the building has already been built. Please be advised that the STOP WORK which was issued on August 10, 2011 is,still in effect and will be until the issuance of a building permit. If you feel aggrieved by this decision or have any questions, please contact this office. Sincerely, aul Roma Local Inspector } BAR 78511 NAME OF OFFENDER TOWN OFp ADDRESS OF OF NOE �J _ I17 BARNSTABLE CITY,STATE,ZIP CODE 1/ P`a41HE rM 1 M IMB REGISTRATION NUMBEfl BARNSTABLE. s.' , 1t�. ., � 1 1� C d MASS. LU IME AND OAT V LA W �L TIQ�F V ATION''. W ' NOTICE OF A. ./ P.M.)ON ;20 t I'' G t11. IGN U OF EN flS ' - E RING EPT ADGE NO. VIOLATION - CD uj OF TOWN I HE EBY CKNOWL GE RECEIPT OF CITATION X' ORDINANCE able to obtain n t e of of a der. ;THE NONCRIMINAL FINE FOR THIS OFFENSE IS 3 L J Date mailed LU W OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINALUj DISPOSITION WITH NO RESULTING CRIMINAL RECORD. REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, a Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense.charged,and enclose payment in the amount of$ Signature I - U.S. Postal ServiceTM CERTIFIED MAILTM RECEIPT (Domestic Mail Only No Insurance Coverage Provided),, For delivery information visit our website at www.usps come ?� %Oz :1c � � ITl1L 11/ I. / .. Via. .` PS Form 3800,August 2006___ _ .'See Reverse for Instructions_ Certified Mail Provides: a A mailing receipt e A 5nique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Imp4rtant Reminders: a Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 COMPLETE •N COMPLETE,TWF..,1:CTION ON DELIVERY, ■ Complete items 1,2,and 3.Also complete A. Sign r `item 4 if Restricted Delivery is desired. ❑Agent ■-Print your name and address on the reverse X O Addressee. so that we can return the card to you. g. �iPiinted e) I C.,Qat of elive ■:Attach this card to the back of the mailpiece, �p 1) or on the front if space permits. D. Is delivery address different from item 1 ❑Yes. 1. Article Addressed to: If YES,enter delivery address below:, ❑No rhr, -f- mpt), Jolson -Hou. - Le Q9 00 3. Service Type h Certified Mail ❑Express Mail ❑Registered J10 Return Receipt f ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2, Article Number (Transfer from service label) F7 012 1010 0000 2851 2149 ' PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 I I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid j USPS I Per it No,G-10 ., f • Sender: Please print your name, address, and ZIP+4 in this box • TOWN OF BARNSTABLE BUILDING DIVISION I 200 MAIN ST. HYANNIS, MA 02601 I I I I i �n ho l i V b1c , NAME OF OFFENDER D A D78511 8511 D n TOWN OF ADDRESS OF OFF NOE " a^ BARIVSTABLE CITY,STATE,ZIP CODE p1F ►qk, f t M /MB REGISTRATION NUMBER �6yq. ,e�' pF ENE `�4 1. �' LLj O rf0 AM'1► - J TIME AND DAT F v OL ON. '" - L J CATIO OF V ATION Z NOTICE OF : (A. ./ P.M.)ON 20 j I SIGN tU E OF EN R A RSO RCING�DEPT. T i BADGE NO.//�� VIOLATION '� ; f �,/' U OF TOWN � o I HEREBY ACKNOWLEDGE RECEIPT OF CITATION X a ORDINANCE Unable to obtain�sjgnat�lre of offender. < THE NONCRIMINAL FINE FOR THIS OFFENSE IS $Date mailed -IQ w W R YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w REGULATION a (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, ly before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. d 2)If you desire to contest this matter in a noncriminal proceeding,yyou may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST U xr NSTABLE DIVISION,COURT COMPOUNID,MAIN STREET,BARNSTABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. 1) (3)If you fail to pay the above offense or to;request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the _a hearing to be due,criminal complaint may be issued against you. 111 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME OF OFFENDER - BA.R -785.11 - TOWN OF ADDRESS OF OFFU t - ^ C I CITY,STATE,ZIP CODE. BARNSTABLE yF IHf lq,. t M IMe REGISTRATION NUMBER Uj CL 11AN\til'API.F;, s.' / � (/1 CD LLI IME AND BAT V LAYOJiF, LU Z'i!(+�j NOTICE OF A . P.M.)ON 20 -' —� — IGN U OF.ENF RS - E R ING)DEPT. r. / ADGE NO. _ LU 1 - VIOLATION 11— o I{ OF TOWN ~ �' I HE EBY CKNOk GE RECEIPT OF CITATION X LU i ORDINANCE able to obtain n t , of of a der. THE NONCRIMINAL FINE FOR THIS OFFENSE IS OR Date mailed _ LU III YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL 'w I REGULATION DISPOSITION WITH NO RESULTING CRIMINAL RECORD. (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 .M.,Monday through Friday,legal holidays excepted, a P.M., _ before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money:order or postal note to Barnstable Clerk,P.O.Box 2430, -1 i Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. CL �2)If you desire to contest.this matter in a noncriminal proceeding,you mayy do so by making written request to DISTRICT COURT DEPARTMENT,FIRST r &UNSTABLE DIVISION,COURT COMPOUND,MAIN STREET ARNSTABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any,fine determined at the - ;1 hearing to be due,criminal complaint may be issued against you. 1 ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ �! a Signature a,. I "} Town of Barnstable *Permit# Expires 6 the front issue date X-PRESS PERIVII Regulatory Services Fee Thomas F.Geiler,Director JAIL 3 D 200? Building Division TOWN OF BARIVST Tom Perry,CEO, Building Commissioner ABLE 200 Main Street,Hyannis,MA 02601 www.town.barmstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address eA ze [Residential Value of Work d� Minimum fee of$25.00 for work under$6000.00. Owner's Name&Address Z Sn/! •� 0�1�� A, c,�,ctq Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ 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 (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Z,,A/,;,opy;of the Ho e rove Contractors License is required. SIGNATURE: Q:Forms:expmtrg w Revise061306 I ' The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations 600 Washington Street d Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information + Please Print Le gib NaMe(Business/Organization/Individual):. J0 ✓I � Address: Aev City/State/Zip: 9,OJ Phone.#: Ste" 5W 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 am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition workingfor me in an capacity. employees and have workers' Y P t3'• $. 9. []Building addition [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions •3.VI am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'camp. right of exemption per MGL 12.[]Roof repair insurance required.]t c. 152, §1(4),and we have no .J employees. [No workers' . •13.(�Other comp. insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the 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 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 Investi.yations of the DIA for insurance coverage verification. I do hereby certify Oder the in -and nalties of perjury that the information provided ab v;is ue acid correct Si ature: 141ZDate: Phone#: Official use only. Do not write in this area,tb be completed by city ar 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 complfauce 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 certificates) 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 the city or town that the application for the ermit or license is being requested,not the Department of be returned to ty pp p g 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 Massaeh=tts Department o£Ind-Qs6a]M-Ci tints Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.rnass.gov/dia ` I i • �� o� _ _ 132 .1 � 272-067 137 1 V2�721078 .� 272-0$6 =. � _ 48� _145 272 136 205 272-02 474 27.2-085 �:: 272--077 153 - ! . 271 4fi8 272-029 27 Ill 271Z8 , .. S ►161. , -"x°. _ ' 158 j 271-035 _ _ _ ! #11E�7 t ,. 271-110 271-162 am 271-029 # 829 168 '� 452 . - !