HomeMy WebLinkAbout0202 BUCKWOOD DRIVE aoa ���k�c/ fir. �
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Town of Barnstable
TKEr Building Department Services IN)l
ti
°� Brian Florence,CBO
uirxssAsr� t Building Commissionera��
M�QC
200 Mda Street; Hyannis,MA 02601
www.towmbarnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
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PST : $35.00 ✓ ������
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SAD REGISTRATION
RESIDENTIAL ONLY e'11jVs
200 square feet or Iess /,
ZO Z �c.c,li,yfiodG� �r 71�nnt•�'
.Location of shed(address) illage
Property owner's name Telephone number
Size of She Map/Parcd# '
e Da
Hyanis main Street Waterfront Historic District?
Old Ki g's Highway Historic District Commission jurisdiction? 40
You must file with Old King's Highway
Conservation Commission(signature is required)
Sign off hoiTrs for Conservation 8:00-9:30 &3:30-4:30
PLEASE NOTE: IF YOU ARE VITffiN THE JURISDICTION OF ANY OF TBE ABOVE
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
•PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM_ MUST BF ACCONTANTED BY A
PLOT'PLAN .
Q forms-shedreg h (I!L( A J'}l�`� �,' Fv(kN
REV:08/6/17
V
Legend
10,
0, Parcels
Town Boundary
271436 Railroad T
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10-
t #166 Buildings
3 Approx.Building
_._. Buildings
Painted Lines
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. . 27^1'160 unvadved
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27f1 #805 1 Driveways
2711W6 € t '� t Paved
Unpaved
JK Roads
Paved Road
Unpaved Road
S `�' ". lE _ ---',-�._ Bridge
13 Paved Median
_ Streams
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Z Water Bodies
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Map printed on: 1/3/2019 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit
adequate for legal boundary determination or representations of Assessor's tax parcels.They are
Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 02601
O 42 83 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 508-862-4624
reflect current conditions,and may contain such as building locations.
Approx.Scale: i inch= 42 feet cartographic errors or omissions. gls@town.bamstable.ma.us
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YOU WISH TO OPEN A BUSINESS? �
For Your information: Business certificates (cost$1�0.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which �?
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367
Main Street, Hyannis, MA 02601 (Town Hall)
sp DATE: Fill in please:
li�,li .Irl llrirT+�'IF,uJ+�Ir Rls„ i�v
APPLICANT'S YOUR NAME/S: 6 �.
BUSINESS YOUR HOME ADDRESgS: 20 Z
LxI P.�.rt.Y ICE`7r7d krlilff4> �S�a. f ict v n /� Z i
#JFj � +efl+)�� 'ii {(n:E;I�JITsrZ1IF
i"i `4Ni ryry { y'3f rdk'1¢ TELEPHONE # Home Telephone Number S ar -zr�C� -5 SSA
' 1NNfi'�fYli�lz+FJ Il,7P�yj9
114 l �3:. .
oZ
NAME OF CORPORATION: �S oP
OF BUSINESS �/
NAME OF NEW BUSINESS t:;% T�G,,�IJ� 21 % TYPE �� � i,�cs 5��/� ��
IS THIS A HOME OCCUPATE ? Y
ON NO
ADDRESS OF BUSINESS .z , , ' 4 :M, t MAP/PARCEL NUMBER "71 /��� (Assessing)
When starting a new business there are several things you must,do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
rmits and licenses required to'legally operate your business in this town.
Rd. & Maim Street) to make sure you have the appropriate pe
1. BUILDING COM SSI ER'S OFF CE T COMPLY WITH HOME OCCUPATION
This individu I h s n ih-Tor any permit requirements that pertain to this type of busiRULES AND REGULATIONS. FAILURE TO
ho ' ed Signatu J * COMPLY MAY RESULT IN FINES.
OM
2. BOARD OF HEALTH
This individual ha be i o rfii d of the permit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
Town of Barnstable
Regulatory Services
Richard V.Scali,Director
Building Division
HARNSTABIA
9 MASS. $ Tom Perry,Building Commissioner
s639. a�0
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Approved:
Fee:
Permit#:
HOME OCCUPATION REGISTRATION
____..._._._..-Date: I/
Name; K—S -) // a26r Phone#: 5?Io'Z Pb-S- h cI
Address: -Lo Z Village 6YN k, r
Name of Business: ZO l/� ti�i r�g
Type of Business: Gl.,.�,. r r str�/ cc Map/Lot: cz — 6�
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
`-� that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there is
no outside evidence of,such use.
a • No traffic will be generated in excess of normal residential volumes.
®
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There are no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
•- No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering.
Applicant:, Date: /
Homeoc.doc Rev.103113
c.? TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map I Parcel Application
Health Division 4- '7 Date Issued
Conservation Division Application Fee (
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation/Hyannis
Project Street Address Zo Z Dr.
Village
Owner "r wle Address
Telephone ��a6o-sSS�
Permit Request 4 t,_J:,.JU'd e-k:
Square feet: 1st floor: existing -t dd proposed Tf" 2nd floor: existing proposed Total new
Zoning District - Flood Plain Groundwater Overlay
Project Valuation//off Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other
Basement Finished Area (sq.ft.) Basement Unfinished Area .ft)
C:y p
Number of Baths: Full: existing / new 0 Half: existing Zew aa0
Number of Bedrooms: 2 existing �new
Total Room Count (not including baths): existing ` new U First Floor R om Comet
w
Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other w
Central Air: 'd Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes.!No
Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review #
Current Use - --- Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name GrL_Sory #Jle� Telephone Number sue' t�U- Ys'S S
Address -f-v Z License #
AA Ulu! Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0aa,6,&, _
SIGNATURE DATE ri/i//dq
'!s
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED —
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
i
FIREPLACE
ELECTRICAL: ROUGH FINAL '
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
S
ASSOCIATION PLAN NO.
2
' 1
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
1 Boston, MA 02111
1
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): „�Y H.
Address: -La c,
City/State/Zip: Oz,60 Phone #:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
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
ship and have no employees These sub-contractors have g• ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y P Y• 9. Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself o workers' com right of exemption per MGL
Y [N P• 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 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: /wt,.,e•,,
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: - .&-L .P�.�,li wa od Or,t;e, City/State/Zip: ,t,,.,,,( AA e76-k)
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 under thepains andpenalties ofperjury that the information provided above is true and correct.
Signature; ' Date: zz Z&I
Phone#: z ei- f 3"5�
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
I
Information and Instructions t
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07
Fax# 617-727-7749
www.mass.gov/dia
1
ENERGY CONSERVATION APPLICATION FORMFOR ENERGY EFIXCICIENC Y FOR
ON-E AND TWO-FAMMYDETACHED RESIDENTIAA'CONSTR'UCTION (Igo CMR 61.00)
Applicant Name: 1 Site Address: Lod ; � j2r
pr1rW Town:
Applicant Phone: 6__V
Applicant Signature: Date of Application; r✓5 _
VI
NEW CONSTRUCTION: choose ONE of the following tWo'0 tions
780 CMR TABLE 6107.1
PRESCRIPTS-VE ENVELOPE COMPONENT CRITERIA FOR
NEW O NE- AND T W O-FAMILY B UMDIN GS
MA�C7MUM 'MINIMUM
Slab
Ceiling or
Basement Option 1: F perimeter
enestration exposed Wall Floor Wall AFUE HSPF
U-factor floors R-Value R-Value R-V•alue . a-Vnd naeluo
R=Value
National pth
Appliancc•En
R-10, Conservation Act(NAJ
.35 R•-3 8 R-19 R-19 R-10 4 ft. 1997 as amended,mW
cater as a licablo
Note: This form is not required if you choose either of the two versions of REScheck as listed below.
: REScheckVersion 4.1:2:or later variant software analysis must be completed
❑ Option 2 780 CMR 6107.3.2
REScheck=-Web which can be accessed at htto'//www ener -Ycodes aoy/reschecly
A b73Z`X')rO1VS OR 'StAxXONS.TO E�[S
TING [TIS,b)1VG5.0 E'ER 5 SEARS OLD
*�Buildings under 5 years old must use option#1 or#2 in New Construction section above.
Complete the following formula to determine the %o of glazing:
(a) Gross Wall & Ceiling Area equals Formula: (100 x b_ a)
SF 100 x = % of glazing
'b a
(b) Glazing area equals : SF
If lazin is y 40 % rgcee••d to "SUNR00M" section
If glazing l.s_<�40 /°•use the chart below, g
780 CMR TABLE 61Q1.3
PRESCRIPTS ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING
LOW.-RISE RESIDENTIAL PUMI)INGS
MAXIMUM MINIMUM
Ceiling.and Slab Peru
Fenestration . Wall Floor Basement Wall. R-Vale
Exposed floors R-Value R-value R-Value and De
U-factor R-Value
.39 R-3 7 a R-13 , R-19 I R-10 R-10, 4
a R-30 ceiling insulation may be used in place of R-37
if the insulation achieves the full R-value over the entire ceiling
area(i.e, not com ressed over exterior walls, and including any access o enin s). '
SUNROOM—An addition or alteration to an existing building/dwelling unit where the tat
❑ glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of t
addition.
Note: Owner to fill out Cons-umer b forinafion,Form (found in Appendix 120.P)
Y
`f'own of Barnstable
tt rqf
o Regulatory Services
• Thomas F. Geiler,Director
sAxrrsrAar.E, .
M"R%9. Building Division
°TFo µat" Toni Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Fax: 508-790-6230
Office: 508-862.-4038 -
- — ^=---HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
Pi4aAL 1 r rlv4�n r
JOB LOCATION: 2.0 village
number street
"HOMEOWNER": r /7 home phone# work phone#
name
CURRENT MAMJ;0 ADDRESS: Z-Z 1 Ii d i h d
'! te
�� �f O LEA_
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 c'tinstructs 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 109.1.0
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.
will comply with said procedures and
minimum inspection procedures and requirements and that he/she
requirements.
SignatuW&f nonrcowner
Approval of Building Official
Note: Three-fanuly dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
equired shall be exempt from the provisions
The Code states that: "Any homeowner performing work for which a building permit is r
of this section(Section]09.1.1 Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such
work,that such Homeowner shall act as supervisor,"
� who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Many homeowners
Rules&Regulations for Licensing wh Construction Supervisors,Section 2,15) This lack of awareness often results in serious problems,particularly
r Board cannot proceed against the unlicensed person as it would with a licensed
whemthe homeowner hires unlicensed persons. In this case,ou
Supervisor. no 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,
rstands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
that the homeowner certify that he/she unde
several towns. You may care i amend and adopt such a form/certification for use in your community,
Town of Barnstable
Regulatory Services
UARNEMADLL*, % Thomas F. Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 ' Fax: 508-790-6
Property Owner Must
Complete and Sign This Section ,
If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for,
(Address of fob)
Signature of Owner Date
Print Name
If Property Owner is applying for permit pleas.e complete the .
Homeowners License Exemption Form on the reverse side.
I0
cyc°wr� 6J°
Town. of Barnstable
yip THE Tp�y
o� Regulatory Services
w BARNSTABLE Thomas F. Geiler, Director
9�A �9 ,' Building Division
r�o��a
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
Office: 508-862-4038 Fax: 508-790-6230
REQUEST FOR ELECTRICAL INSPECTION
ELECTRICAL PERMIT NUMBER
(Permit required in order to process inspection)
Today's Date Requested Date of Inspection
I, hereby request an inspection under Massachusetts
General
(Electrician)
Law chapter 143, section 3L and 237 CMR 4.02(3).
The installation will be ready for inspection at
(Property Location)
Type of inspection requested:
❑ Temporary Service ❑ Service Re-inspection
❑ Excavation ❑ Rough Re-inspection
❑ Service Inspection ❑ Final Re-inspection
❑ Rough Inspection for ($100.00 Re-inspection Fee)
❑ Final Inspection for
❑ Other
Owner or tenant
Licensee's name, address, and phone
License number Licensee's Signature
This section to be completed by Barnstable Inspector of Wires
Inspection date ❑Approved ❑Not Approved
This work was not approved for violation of the following Articles and Sections of the MA
Electrical Code:
Q:WPFiles:forms:e1=trcquest
Rev:4/8/08
HILLER RESIDENCE 202 BLICKWOOD DRIVE_HYANNIS-RIDGE BEAM MA Botello Lumber Company
.20092 Alicn able Stress Design LOAD TABLE MSI: 0.64
NOTE: 2 PLIES 1.750 X 11.876 LP LVL295OFb-2.OE DESIGN CRITERIA VSI: 0.44
1.THIS COMPONENT IS DESIGNED TO SUPPORT ONLY NOTE LOADS SHOWN ARE FOR INPUT LOAD CASE 1 OTHER LOAD DESIGN CONSISTS OF 2 — PLIES FASTENED RSI: 0.45
:
THE VERTICAL LOADS SHOWN VERIFICATION OF ( ) D CAS TOGETHER (REFER TO NOTES).
FOR PATTERN LIVE LOADING ARE CHECKED AS REQUIRED.
LOADING,DEFLECTION LIMITATIONS,FRAMING (DIMENSIONS MEASURED FROM LEFT END OF SPAN OR CANTILEVER.) LIVE LOAD = 30 PSF
METHODS,WIND AND SEISMIC BRACING,AND OTHER DEAD LOAD = 15 PSF
LATERAL BRACING THAT IS ALWAYS REQUIRED IS DISTRIBUTION SOURCE TYPE TOP/SIDE LOAD FROM TO LOAD LDF TOTAL LOAD = 45 PSF
THE RESPONSIBILITY OF THE PROJECT ENGINEER FT—IN—SX FT—IN—SX
OR ARCHITECT. UNIFORM ROOF . LIVE SIDE 360 PLF 00-00-00 15-00-00 1.15 ROOF LEFT SPAN CARR. 12.00 FT
2.PROVIDE RESTRAINTAT SUPPORTS TO ENSURE UNIFORM ROOF DEAD SIDE 180 PLF 00-00-00 15-00-00 0.90 ROOF RIGHT.SPAN CARR. 12.00 FT
LATERAL STABILITY. UNIFORM BEAM WEIGHT 12 PLF 00-00-00 15-00-00 0..90 - -
3.DO NOT CUT,NOTCH OR DRILL LP LVL. DEFLECTION CRITERIA
4.SHIM ALL BEARINGS FOR FULL CONTACT. WARNING NOTES: • LIVE LOAD DEFL: L / 240
5.VERIFY DIMENSIONS BEFORE CUTTING LP LVL - ` TOTAL LOAD DEFL: L / 180
TO SIZE. THIS COMPONENT DESIGN IS SPECIFICALLY FOR L-P ENGINEERED WOOD PRODUCTS.
6.THIS LP LVL IS TO BE USED AS A ROOF BEAM ONLY. USE OF THIS DESIGN FOR ANYTHING OTHER THAN LP LVL OR LP LSL OR LP I-JOISTS IS ' - CODE COMPLIANCES
MAKE PROVISION FOR ADEQUATE DRAINAGE. STRICTLY PROHIBITED.ANY MODIFICATION OF THIS DOCUMENT REQUIRES REVIEW _ REPORT #
7.COMPRESSION EDGE BRACING REQUIRED AT BY A DESIGN PROFESSIONAL - ICC—ES ESR-1254
EACH END OF COMPONENT. - L.A. City RR-25167
MINIMUM BEARING SIZES ARE SUFFICIENT TO PREVENT CRUSHING OF THE LP LVL HUD 1214f
ATTACH THE TWO PLIES WITH 2 ROWS OF 16d BEAM AS DESIGNED.IT IS THE RESPONSIBILITY OF THE PROJECT ENGINEER, CCMC 11518—R
(3-1/2")NAILS AT 10"OC.STAGGER ROWS. ARCHITECT OR DESIGNER TO VERIFY THAT THE SUPPORT STRUCTURE FOR THIS -
NAILS CAN BE DRIVEN FROM ONE FACE OR HALF BEAM IS CAPABLE OF SUPPORTING THE REACTIONS. _
FROM EACH FACE. NAILS MAY BE COMMON OR
BOX NAILS WITH A MINIMUM SHANK DIAMETER ANCHOR LP LVL ROOF BEAM SECURELY TO BEARINGS OR HANGERS.
OF 0.131". 16d SINKERS(3-1/4")MAYBE
USED,BUT HALF MUST BE DRIVEN FROM r
EACH FACE. -
180 } zp j O EI,!r�
{ { € E
SUPPORT REACTIONS (LBS): 11.875
MAXIMUMS E AR I NG NUMBER
1 2 1.750
DOWN 4139 4139 T1 3.500 -
UPLIFT --- --- .
CROSS SECTION
MIN BEARING SIZES (IN—SX)
3— 8 3— 8
MAXIMUM DEFLECTIONS
CALCULATED ALLOWABLE
LIVE LOAD 0.39 0.74"
.DEAD LOAD 0.31" 15— 0— 0
TOTAL LOAD 0.60" 0.98" •"•THIS DRAWING IS NOT TO SCALE•••
Handling&Erection Miscellaneous Information LP LVL,LP LSL and CTR,LP I-Joist Specifications Software Provided By:
07/20/09 IBC
Temporary and permanent bracing for holding component The use of this component shall be specified by the designer of the •Supports and connections for LP LVL,LP LSL,CTR and UPI to be specific applications. LP Engineered Wood Products
plumb and for resisting lateral forces shall be designed and complete structure.Obtain all the necessary code compliance approval and•Common nails driven parallel to glue lines shall be spaced a minimum of 4•for 10d Suite 2000
tSu Stree
,,
installed by others.No loads are to be applied to the instructions from the designers of the complete structure before using this and 3•for ad. Nashville,414 Union St 37219Su component until after all the framing and fastening are component.If the design criteria listed above does not meet local building 'Do not cut,notch,drill or alter LP LVL,LP LSL and CTR.LP(Joists except as shownTIN
completed.At no time shall loads greater than design loads code requirements,do not use this design.When this drawing is signed in published material from LP any use of LP LVL,LSL and CTR,LP IJoists contrary Local 909.463.6460
be applied to the component. and sealed,the structural design is approved as shown in this drawing to Me limits set forth hereon,negates any express warranty of the product and LP Fax 866.753.4369
based on data provided by the customer.LP LVL,LP LSL and CTR,LP disclaims all implied warranties including the implied warranties of merchantability National Wets 800.515.7570
Design Criteria I-joists are made without camber and will deflect under load.Wood in direct and fitness for a particular use.
The design and material specified are in substantial contact with concrete must be protected as required by code.Continuous
conformity with the latest revisions of NOS and AITC.• lateral support is assumed(wall,floor beam,etc.).LP does not provide DWG #
Dead load deflection includes adjustment factor for creep. on-site inspection.This drawling must have an Architect's or Engineers seal•A COPY OF THIS DRAWING IS TO BE GIVEN TO THE INSTALLING CONTRACTOR
Total load deflection is instantaneous, afixed to be considered an Engineering document. SHEET #
LP is a registered trademark of Louisiana-Pacific Corporation. '
File:CAProgram Files\LP\Wood-E Design\2009.2\WOODE.SPX
f �
�v.
F
E
k
F
i
w
0i,IHE r°� To` n of Barnstable *Permit#
�. Expires 6 montds from issue date
Regulatory Services Fee 415
BARNsrABLE, +
v� 6;S. Thomas F. Geiler, Director
AIfD MA'S A 9.
Building �—
Division
Tom Perry, CBO, Building Commissioner
200 Main.Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Off ice: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number_
Property Address _ 'eJ.Z B4Ar k t*1&0d e-�+ rj
Minimum fee of$25.00 for work under$6000.00
1Residential Value of'Wot�� �
Owner's Name & Address -Z --erm.rerrc
Oq,,/
Contractor's Name� , Telephone Number S`G,P- Z1U— 5`5"6
1 Ionic Improvement Contractor License#(if applicable)
Construction Supervisor's License # (if applicable)
❑Workman's Compensation Insurance -PRESS PERMIT
Check one:
❑ l am a sole proprietor MAy 2 6 ZOD9
I am the Homeowner
❑ I have Worker's Compensation Insurance ` OWN OF BARNSTA13LE
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
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum .44)
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home.Improvement Contractors License is required.
SICNA.'ruizE:
Q.`W PI-ILLSU ORM,S\building permit forms\EXPRESS.doc
Revised 100608
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations'
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
'davit: Builders/Contractors/Electricians/Plumbers
Workers' Compensation Insurance Af
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): u L/
•Address: �.�z, /.ice���,.�� d �J�
City/State/Zip: /�,G w 13 111 ,. U-16 yl Phone.#: r4-ZA0 M-11
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-tiros).* have hired the sub-contractors
2: listed on the attached sheet 7. .0 Remodeling
I am a sole proprietor or partner-'
ship and have no employees These sub-contractors have g_'❑Demolition
working for me in any capacity. employees and have workers' 9 Building addition
[No workers'..comp.•insurance comp. insurance.$
requre -
5. [] We are a corporation and its 10.❑Electrical repairs or additions
id]
I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
self. [No workers' comp. right exemption per MGL 12.[]Roof repairs
q
insurance required]t c. 152, §1(4),and we have no
] employees. [No workers' 1311 Other
comp.insurance required]
'Any applirant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors-and state whether or not those entities have
employees. if the sub-contractors have rnrptoyecs,they must provide their workers'comp•policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.M Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure io secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimuial penalties of a
finq tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a-STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage veriticauon.
7do hereby certify under the pains•and penalties ofperjury that the information provided above is true and correct
signature: Date: S 2G U —
Phone
Official use only. Do not write in this area,tb be completed by city or town official.
City or Town: Permit/License#
Issuing.Authority(circle one):
1.Board of Health '2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more
of the foregomg engaged in a jomt-en rpm inclu�m`gg leg -represen LiiTe 6f the
receiver or tiustee 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(1)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 inssuramce
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-conti-actor(s)name(s),addresses)and.phone number(s) along with their certificate(s)of
insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in'the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in (city or
town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that'a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture
(ie.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone-and fax number:
Tht:Commonwealth of Massachusetts
Department of Industrial Accidents
F� .
Office of Investigations
600 Washington Street
Boston, MA 02111
TO. # 617-727-4900 ext-406 or 1-877-MASSAFE
Revised 11-22-06 Fax# 617-727-7749
www.mass_gov/dia
Town of Barnstable
y'"��of TliE 1•p�y�
Regulatory Services
Thomas F. Geiler,Director
R l R/JCTAR_
'MAS q
� ibsq `�4f Building Division
PrEO Tom Perry,Building Commissioner
. .200 Mairi.-Sircet,—Hyannis;MA---O 6-01 _.._. . . _._.._.....
w w.town_barnstable_ma us
Office: 508-862-403 8 Fax: 508-790-6230
HOTl:EOV NER LICENSE EXEMPTION
Please Print
DATE: S11 6/ j
JOB LOCATION: 'ItiZ /✓lAcGtwy� a I�i• /al�,r,r� J
number / street village
"HOMEOWNER.': 6rG'k'i V �, ��/�P,- Z,f-0 - 5 9Yj ,1 c
name —T home phone# work phone#
CURRENT MAILING ADDRESS: ��L Z Bk c�sroa Or
eity&wn state zip code
The current exemption far"homeowners"was extended to include owmer-occupied dweD ngs of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided fhat the owner acts as
supervisor.
DEFINMON OP HOMEOWNER
Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to-
be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structur6s. 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'assures responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regviations.
The undersigned."homeowner"certifies that-be/she understands the Tpwn of Barpstable•Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
i/
Signa ' Tomcowncr
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 boin=wner per brining work for which a building permit is required shall be txcrrtpt from the provisions
of this section(Section 1D9.1.1 -Lieuu g of construction Supervisors);provided that if the homeowncrcngages a persons)far hire to do such
work,that such Homeowner shall art as supervisor."
Many homeowners who use this exemption are unaware that they arc assuming the rrsponsrbilitirs of a supervisor(sec Appendix Q,
Rules&Regulations for Licensing Canstrvetian Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hurts uriliccnsed per=m In this case,our Board cannot proceed against the unlicensed Priori as it would with a licensed
Supervisor. The homeowner acting as-Supervisor is ultimately responsbir.
To ensure that the homeowner is fully aware of hiArr resp=-biIi6cs,many communities require,as part of the permit application,
that the homeowner certify,that hdshe understands the rrspa='bihties 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 sunb a forrr✓certi5cation.f0r use in your community.
1
Q:fonns:homccxcrrrpt
s
' V
z r ti Town of Barnstab e
Regulatory Services
`yYAARILam$; Thomas F. Geiler,Director
A61 Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town-barnstable.ma.us
Office: 508-862-403 8 Fax: 509-790-623G
Property Owner Must
Complete and Sign This Section
If Using ABuilder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by binding permit application for:
.(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
05/02/2005 11:22 5087789312 BARNSTABLE. HOUSING PAGE 01/01
{
ZONING "VERIFICATION
z
rTC : l:.inrla Edson
FRS At: Robert Hooper, Leased 11ousiog Coordinator
RE Legal Rental Unit Verification
Dal �,�/ os-
.Adt Tess: d D i� K c3 c� prr ✓C
Vi.11 ige: 144 -- .
Uni Type: Sj o t j.z Vie,,., ,, ' Bedroom Size:
Ma ) & Parcel No.: ,-2 7 -� 7
The owner of the above listed property is entering into a W S
cony pact with us for the rental of the property as listed '.
abo' e. Gt C:C
Pies ;e verify by signing below that the unit is legal and o }
Mee s all zoning.requirements for a rental in the town of
Bar istable. If it does not, please list reason here:
Tha you for your,assistanre in this matter.
Sign iture Print name
o
Date
VIA FAX: 790-6230 MRVP Seci;on s
Rm,1/05
TOWN OF BARNSTABLE,BUILDING PERMIT APPLICATION
.. ....7-7
Map- Parcel.'.• ;:Application,#
Health Division tate Issued
On Conservation Division ;A
pplication Ap . Fee
p cati
-Permit Fee,
Planning Dept: 0
"C, 6,
Date Definitive Plan Approved by Planning Board
Historic OKH Preservation Hyannis i
Project Street Address 20 z- 191_11'z-y_Illd or,16,L
Village
Owner y Address
4W
Telephone 1-o k- -tio
Permit Request o
Z.
/1/,LL., r4� Lll< AG -v ,k/i_,/-kon Ae A /A Square feet: 1 st floor: existing proposedexisting proposli Total new
Zoning District Flood Plain Groundw; ater'Overlay
Project Valuation /J'
"ItIV Construction Type
Lot,Size Grandfathered: Ll Yes _V No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family Ll Multi-Family (# units)
Age of Existing Structure Historic House: LJ Yes L3 No On Old King's Highway: Ll Yes LJ No
Basement Type: I Full LJ Crawl Ll Walkout Ll Other
Basement Finished Area(sq.ft.). Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing � —new 0
Number of Bedrooms: existing'-Y=,new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: $Gas LJ Oil Ll Electric Ll Other
Central Air: )J Yes LJ No Fireplaces: Existing / New Existing wood/coal stove: Ll YesU(No
Detached garage: Ll existing L] new size—Pool: LJ existing LJ new size Barn: L3 existing Ll new size
Attached garage: LJ existing L] new size —Shed: Q existing Ll new size Other:
Zoning Board of Appeals Authorization Ll Appeal # Recorded Ll
Commercial LJ Yes Jd No If yes, site plan review#
Current Use- ,P,-,"T Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name Gr p A 'Telephone Number
'Address Tv A4CICW(14G� License#
1// Home Improvement Contractor# .
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
"SIGNATURE DATE
y
•e 4
FOR OFFICIAL USE ONLY
APPLICATION#
E DATE ISSUED
MAP/PARCEL NO.
ADDRESS- VILLAGE
4
OWNER
_I •
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
I
ELECTRICAL: ROUGH FINAL
.PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE
CLOSED OUT
ASSOCIATION PLAN NO.
-------------
Z
Y
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
ppUcant Information Please Print Legibly
Name(Business/Organization/Individual): ,/
Address: 2 v z dam, L�Gz dr,
City/State/Zip: a,, 67"/" Phone.#:
Are you an employer? Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. Q I am a general contractor and I
6. Q New construction
employees(full and/or part-tim.e).* have hired the sub-contractors
2.0 I am a sole proprietor or partner-' listed on the attached sheet. 7.. ❑Remodeling
ship and have no employees These sub-contractors have g• 'Q Demolition
working for me in any capacity. employees and have workers' 9. Q Building addition
[No workers'-comp.-insurance comp. insurance.
required.] 5. Q We are a corporation and its 10.Q Electrical repairs or additions
i h ffi ocers have exercised.their 11.❑Plumbing repairs or additions
3.�'I am a homeowner doing all work P
myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.)
*Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
xContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
lam 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 fo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine:
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for instua ice coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Date:
(Phone#:
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 1.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
4
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 tiustee 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
o.r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall .
enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-conkactor(s)name(s),address(es)and.phone number(s) along with their certificate(s)of
insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
.Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or
town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture
(i.e.a dog license or permit to btim leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone-and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations,
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-877-NIASSAFE
Fax# 617-727-7749
Revised 11-22-06
www.mass.gov/dia
ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR
ONE- AND TWO-FAMILY DETACHED RESIDENTIAL'CONSTRUCTION (780 CMR 61.00)
Applicant Name: �,� Site Address: Zuz /-?wQkk,�d
pr—jam Town:
� /Li�6 oZ�yj
Applicant Phone: Ol ��SSS
Applicant Signature: /r Date of Application:
NEW CONSTRUCTION: choose ONE of the following two'o lions
780 CMR TABLE 6107.1
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA.FOR
NEW ONE-AND TWO-FAMMY BUILDINGS
MA.)QMUM MINIMUM
Ceiling or Slab
Option 1: Basement
Fenestration exposed Wall Floor Perimeter
U-factor floors R Value R-Value R-Value wall R-Value '�UE HSPF SEER
R-Value and Depth
National Appliance•Encrgy
3 5 R-3 8 R-19 R=19 R-10 R-10, Conservation Act(NAECA)of
4 ft. 1997 as amrndM,minimums or
eater as applicable
Note: This form is not required if you choose either of the two versions of REScheck as listed below.
❑ _Option 2: RES check Version 4.1.2 or later variant software analysis must be completed
780 CMR 6107.3.2
REScheck--Web which can be accessed at http•//www(-,ncrgycodes.goy/rrscherk/
ADDIT OIS:OIt ALTI;RATTONS.TO ENIS'TING BUILDING$"O�RE ` YEARS OLD* :
*)Buildings under 5 years old must use option#1 or#2 in New Construction section above.
Complete the following formula to determine the % of glazing:
(a) Gross Wall & Ceiling Area equals Formula: (100 x b_ a)
SF 760 = 0�5 % of glazing
100 x d
At a
(b) Glazing area equals 'F0 SF
If glazing is' ' -"40%.uge the chart below. - . If glazing is > 40 %proceed to "SUNROOM" section
780 CMR TABLE 6101.3
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING
LOW-RISE RESIDENTL4L BUILDINGS
MAXIMUM • MINIMUM
Fenestration Ceiling and Wall Floor Basement Wall Slab Perimeter
U-factor Exposed floors R-Value R-value R-Value R-Value
R-Value and Depth
.39 R-3 7 a R-13 . R-19 R-10 R-10, 4 feet
a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling
area(i.e,not compressed over exterior walls, and including any access openings).
'
SUNROOM—An addition or alteration to an existing building/dwelling unit where the total
glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the .
addition.
Note: Owner to fill out Consumer In ormation Form found in Appendix 120T
Town of Barnstable
"o Regulatory Services
sAMSTABLE ; Thomas F.Geiler,Director
9q,A039. a`�� Building Division
rEu � Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: 20 Z k w.G"! 4or
number street village
„HOMEOWNER": Gr o Ji�-V rl I� ��C� � rw6-S-J`-5-4 st)�-2110- , S-yi
name home phone# work phone#
CURRENT MAILING ADDRESS:
GtiniJ AA clZdGl
aity�n state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to
be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signatde gAomeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:\WPFILES\FORMS\homeexempt.DOC
i
Town of Barnstable
Regulatory Services
SAR1«SBl a' "Mass. Thomas F.Geiler,Director
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
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this b ' g permit application for:
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit please complete the .
Homeowners License Exemption Form on the reverse side.
Q:FO RM S:0 W N ERP ERM IS S I ON
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