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HomeMy WebLinkAbout0064 BUMPUS ROAD 1 ` i _ t 9 �I 1 I To of B • nstable Permit. I II 12egulato ex-vices Date: r SHE T P�oF oryti ; 'f*omas F. a er, i ecto 01 }k BU I DiVISIOII Fee: 3`j i SBA NSTABLE, " i. Tom P r uilding Commissione �QrEoY p.�� 200 a treet, Hyannis, MA 02601 ww. own.barnstable.rna.us Office: 508-862-4038 Fax: 508-79062I30 T N F BARNS ABLE SO ID FUEL STOVE PERMIT I Owner: J y�� ! - Phone: Sd8 °1 - 30o Install at: Village: �e o� I Map/Parcel: Date- Stove 1 I Posed 1 B. Type: Radian t C re ilatino, I C. Manufacturer: - pv,, Lab. No. AST M kt�pcj _ btA f D. Model No.: ��� Chimney A.(O/ Existing ff existing, please note date of last cleaning) B. Flue Size 4` ! t -- , C. Are other appliances attached to Flue? �p D. Pre-fab Type and Manufacturer S D yra J.�w� E. Masonry: Lined. I nlined — o ;n Dearth - , A. Materials: �,�,Q ! �.,WL B. Sub Floor Construction: - Installer Name: 4_,7 le l Address: Z Phone: Location of Installation: 167. k , L4s. H.I.0 Registration # jEt Construction Supervisor# 5�9x� OR check_ Homeowner Installing, no lic se required i APPLICANTS SIGNATUREI . APPROVED BY: Please make checks a able tojthe Town o Barnstable i *This constitutes an offrcial stove permit after inspection, photographed, and approved by the f Building Inspector } TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` Parcel { 3� Application # f It Health Division € Date Issued Conservation Division Application Fee S� Planning Dept. Permit Fee o Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Proj:e_c-_t-Str-eeatzAddress 64 UAL"4U4 h[�& rMillage— Owner """" u��e ✓'�l Q uO-k Address alephone•- SOS J�S 3(5C)Ll Permit-Re-quest � a � cu f Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Pect-Valuation �300-&o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ 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. ���6L V� YV Telephone Number 5�% �^ AL(7l L..---------- .fir - Address PC) �x ���f �L�� 014 fLicense'#-, - CIS 017S670 0290 Home Imp ovemeht`Contractor# �� v29 f Email rWorker,.'s._Compensation AL`L CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL-BE TAKEN_TO SIGNATURE FOR OFFICIAL USE ONLY APPLICATION# i v, 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. Ile Commoniverrlth of Massachusetts Department of rdldos-f ial AccddeFdirs . 600 Washington Street Boston,M4 02111 113mU:massgovIdia Workers' Campensatian Insurance Affidavit.$mlders/Cunt ra.ctorslEIectrkians/Plumbers Applicant Infat-matian Please•Print Legibt Name (Sn'ssiuess!?C�rganizationfL " ' ��}: Tc ��0�h ►�3` /� �CiylSiatel ig ������. DzS�3 phone-g- K`7j ©zs `yAre you an employer?Checkthe appropriate box: ' Type of project(required): 4. am a general contractor and I I.El I am a employes with ❑I a 6. ❑I*Iew construction employees(full and/or part-time)-* 'have hireA the sub-contractors 2.ZI am a sole 1ro3m �or"et arfner listed on the attached sheet. 7. ❑Remodeling p ship and have no employees. These sub-contractors have 8-.❑Detnolifiou a worm for me-in any capacity. employees and have workers' 9. ❑$Building addition [No workers 3 comp.insurance comp-insurance 1 required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am.a homeowner doing all work offfceas haveexercised their 11_❑Plumbing rep airs or additions myself o ' right of exemption per MGL 7 � workers'comp- 1�_❑Roafrepairs +�rrarequired-] � • irnce required]F c.152,§In aadwe have no e \ employees-[No workers' 13_ Other &PAICr/t(�f�► comp.insurance required-]i �� *Any app&carrt that checks box Ill omit also fill oot the section below showing t6ai r workers*compensation policy informadcuL #Eameawners who submit ehis af5d2cfa indirzt ag they are doing all work sad then hire outside coat moors nmst submit anew affidavit indicating sxtrfi rC•oxr=ctors that rhea This boot mast attached sa additions/sheet showing the mine of the sn contrscmrs and state whether or not those entities hive employees. Ifthesub-contxactnrshace employees,theymustpmvide their umrkers'ramp.poliU amaher_ I arrt art errrpLuJ r tlerrt ispro�ztiing a�ari€ers'carrrpertsrrtiart irtszirrtrtca f or trc}T enrpTay�ees Below is tltez parity,and jab site intforrrurtion. Insurance CompanyNanie: Policy or Self-ins..Lic_-,P-. RkpirationDate: Job Site Address: city/Stateizip: Af#ach a copy of the workers'campensationpolicy declaration page(showing the policy number and•espfration date). Failure to secure coverage as required.under Section 25A of MGL c. 15—can lead to the imposition of criminal penalties of a fine up to$1,500-00 and for one-Dear imprisonment,as weA as civil penalties in the form of a STOP WORK DRDERand 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 vacation. I a hereby certify render tt eprrins arrd pe alfi�zs oj`gerjut}�fhatfJte irtformatiarrptmzrl�edQabmv ig blur mid correct Bate:- - '/6 Phone i, (1j�ffciaf use only D47 itot asrke in t[tis area,to be completed by city ar ten�n oficiat City or Town.: PermitUrense# Issning Authority(circle one): 1.Board of Health 2.Building Department 3.Cityll owzn Clerk 4 Electrical Inspector S.Plurnbmg T upector 6.Other Contact Person: Phone#: - ormatzon and Instructions Mass=husetts General Laws chapter 152 regtrhes all employers to provide workers'compensation for their employees_ porm=tto this sty,as empIayee is defined as-'-.every person in the service of another under any contract ofhim,. express or implied, oral or watftm_ All ernplay8 is defined as"an.individnat par(nersbip,association,corporation or other legal entity,or any two or more of the foregoing engaged in.a Joint enterprise,and including the legal repsesentaiives 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 fire oceapant of the - dwelling house of anofher who employs persons to do mainfmance,construction or repair work on such dwelling house e sac em Io eat be deemed to be an em toyer." or on the grounds or bulZding appurtena�thereto shall not becans of b. p yin P 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 btuldiags in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance-mveragereq¢ired" Additionally,MCrL chapter 152, §25C(7)states-Neither the commonwealth nor ifiiy of its political subdivisions shall enter into any contract for the performance ofpublic work unfit acceptable evidence of complimce wriih the imuranc6.. requirements of this chapter have been presented tD the contracting aufhozity_" Applicants Phase fill obt the workers' compensation affidavit completely,by cherk;r,g$e boxes that apply to your situation and,if necessary,supply sub-ontractor(s)name(s), address(es)and phone numbers) along with their certificates) of incrrrance. Limited Liability Companies(LLC)or Limited Liability Pm-tamships(LLP)wino employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees,apolicy is regnirerL Be advised that this affidayit may be submitted to the Department of Industrial Accidents for conffimation of in wance coverage. Also be sure,to sign and date-the affidavit The affidavit should be retnmed to jhe city or town that the application for the permit or license is being requestr�not the Depement of hobo ctiial Accidents. Should you have any questions regarding the law or if you are regojred to obtain a workers' compensation policy,please call the Department at the numbez listed below. Self-insured companies should enter their self-h mince license number on the appropriate line. City or Town Officials t - Please be sure that the affidavit is complete and primed legibly. The Department has provided a space at the bottom of thin 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 permitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple pennhjUcense applications i a any given year,need only submit one affidavit indicating n�t policy inff6rmation.(if necessary)and under"Job Site A dress"the applicant should Fate"all Locations ia (cr Y or awn)-"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 futore'permzis or licenses. A new affidavit must be filled out each year.Where a home owner or cities is obtaining a license or permit not related to any business or commercial ventzre (Le. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would]ike to thank you in advance for your cooperation and should you have ray questions, please do not hesitate to give us a call. The Department's a dtimss,telephone and fax number_ -The Ca.mMMWeattir of Massach>�tts , Deparlmant of 1ndus¢iak Accidence Q c-_Qf flmestiotioA,� Bosto-u�MA Oi111 TeL 4 617'27-49QO Qx- 406 or 1-977-MASSAFE Fax#617`27 7M Revised 4-24-07 T.ma..sagavldia ATIT Guide to Wood Construction ill Higtr HrindAreas: llo fnpk IYind Zone Massachusetts Checklist for Compliance(7so UKR53011.1.1)1 Loadbearing Wall Connections ' Lateral(no.of 16d common nails).- ... ........................... Z ........_............ Non-L-aadbearing Wall Connections Lateral(no.of 16d common nails).....-----.._.._.._:...__.(Table e)._.._... _.................:..........._..._..._.. r Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans ............................_......................(Table 9)..............................:.-_ft_in.511' SIR Plate Spans ........_..._................._...._.._.........._.(Table 9).....--..---_----------------- ft in.511' 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) HeaderSpans......................_.-...._..._......................(Table 9)....................._....... _ft_in-512' Sill Plate Spans.. ._......................................._...._..(Table 9)........_...._.-............ ^ft_in.<12' Full Height Studs(no.of studs)..._..........................(Table 9)........_......................._.............. ...... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneousfy4. 4 _ Minimum Building Dimension,W Nominal Height of Tallest Open! ..................................................................._..._.... SheathingType.................................:.._.....(note 4):,.._..........................:.-_......._..... -- R Edge Nail Spacing..........................._,__.(Table 10 or note 4 if less)............._ . ` .__.... ' Feld Nail Spacing. ...... ..._.....(Table 10)...........:............._........._....__ in. Shear Connection(no.of 16d common nails)(Table 10).... ....................................... Percent Full-Height Sheathingable 10 ° 5%Additional Sheathing for Wali With Opening>6V(Design Concepts)....._............. Maximum Bu1ding Dimension,L Nominal Height of Tallest Opening2........................................:................................_s 6'6 Sheathing Type.....................0...•................(note 4)•-•--•..............:................._......:-•_ Edge Nail Spacing..........................._.._ __(fable 11 or note 4 if less)........................ in. Feld Nail Spacing _. ...:.:._.__:.. able 11 .........-.....,:......................T....... in. Shear Connection(no.of 16d common nails)(Table 11)........................._......._....................' Percent Full-Height Sheathing..._.:_._....:_....(fable 11)....... � % 5%Additional Sheathing for Wall with'Opening>5'8'(Design Concepts)_............ .. Wall Cladding Ratedfor Wind Speed?.....................................................,....._..........._.......—............................ • 5.1 fZOOFS Roof framing member spans checked?......................(For Rafters use AWC Span Tool,see BBRS Website) , Roof Overhang ...................................................(Figure 19) ....... it s smaller of 2'-or t13 Truss or Rar Connections at Loadbearing Walls fte Proprietary Connectors _._.r:._.:. able 12 ... .U= pif = Uplift..:._..._.�...::...._........ R ).................. ...................... - ...(Table 12)...._......_.,_... p Lateral.._...-•----......._...........�...... ---._._......_........L= tf Shear._.-._.-.--....._....-•••-...----•----•---(Table 12)....................:................._...5= cif. . Ridge Strap Connections,ff collar ties not Qsed per page 21... (fable 13)............................._T pif Gable Rake Outlooker...................... ................(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 naffs)...(Table 14)....................................._L= . lb. Roof Sheathing Type_..:....._._.:.._..._.-....._......:__....(per 780 CMR Chapters 58 and 59)............ Roof Sheathing Thickness..................:........._._......................._.........................._in.i'7l16-WSP Roof Sheathing Fastening.........................................:(fable 2)_............................................ _......... Notes: -1. • This checklist shall be met in its entirety, excluding the specffic exception noted in 2,to comply with the requirements of 780 CMRM0121.1 item 1.If the checklist is met in ifs entirety then the following metal straps and hold downs arr.not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 2b Gage Straps per EfgurE 11 c Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure iBa and Figure lab 2 'Exception:.Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full height sheathing requirements shrnm in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade. ' AFYC'Guide to Wood Consirucfzorr ur Hf,;lr IrindAreas:110 tnph «ndZone Massachusefts Checklist for Compliance(78o nfrz53o1•2.I.I)' C�Ch'=k . CompGanco 1.1 SCOPE Wind Speed(3-sec.gust)_......................................_......._.._........_ ------- ....110 mph WindExposure Category...._..............................__........_.............................._.........................................e Wind Exposure Category................Engineering Required For Entire Project........................................0 12 APPL_ICABILrfY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories _<2 stories RoofPitch._........_.._..:__......._......_..._..........._...:.... . .(Fg 2) ......_.. . ................... 512:12 ..... . .......... ... MeanRoof Height-_......._.._........_..............._.................._(Fig 2)_...._............_.._....................._ ft 5'33' Building Width,W............._........._.........._.........._...... • .(Fig 3)............. . ....................._.._ ft 980, Building Length,L ..........._.._.................._..........._ . . •(Fg 3)-....................... =ft c 80, Building Aspect Ratio ..._.(Fig 4 < ( -...._.._Z........................._. ( 9 ). ..............._._......_..---•---...... _3:1 Nominal Height of Tallest Opening ...................:�._..,_..(Flg 4)...._........._.........................._. 5618' 1.3 FRAMING CONNECTIONS General compliance with fr-amirig connections................_.(Table 2)............................................................ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Conrsete.....................................................:........................................................................... ConcreteMasonry--........_._._..._.._..._........._....................._.........._......:....._.............__..__................. 22 ANCHORAGE TO FOUNDATION 5/8'Anchor Bobvimbedded or 5/8'Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general..................................._.....(Table 4)................................_......._._ in. Bolt Spacing from end(oint of plate..._......._.........._...(Fig 5). ,.-.._...................... in.:5 6'-12'. Bolt Embedment-concrete.........._....._.._..._.............(Fig 5)..................................---.__... in.z 7" Bolt Embedment-masonry..........................._........._(Fig 5)............t.................-- -_... in-Z is" PlateWasher..:......................................................(Fig 5).._.-•- --..:........................__'3"x 3'x K 3.1 FLOORS Floorframing member spans checked ..._........................(per 780 CMR Chapter 55).........._......._....... Maximum Floor 9 Qimension._:.................__....._...Opening (Fig 6 fts 12' ( )....._.....•.........._..._...--------........... Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)..:....................... ......... Maximum Floor Joist Setbacks Suppoiling Loadbearing Wails orShearwall...............(Fig 7).............:.........._._.._.._......__......_.. ft 5 d Maximum Cantilevered Floor Joists T Supporting Loadbearing Walls'or Shearwall...._..........(Fig 8)_..................................._._:...:..... ft s d FioorBracingat Endwals...........................................:._(Fig 9)_.___._.._............__.-_.........._.................._. Floor Sheathing Type .................................._............_....._(per780 CMR Chapter 55).................._:_.__......._ Floor Sheathing Thickness.........._._..........._............_:..__(per 780 CMR Chapter 55)..................... in. Floor Sheathing Fastening_............_.. ........................:.(fable 2)__d nails at in edge/ in field 4.1 WALLS Wall Height Loadbearing Ovals. _...........:_........._...........:.._.. .(Fig 10 and Table 5)..........---.._...... _ft s 1 T Non-Loadbearing walls.._...__.-......._. ..(Fig 10 and Table 5 ... ft's 2T Wall Stud Spacing .....__...............:............_.........._._(Fig 10 and Table 5).................._In.:5 24'o.c. Wall y Offsets ..(Figs 7&8 5 Story ...._..:_.,......._.:........................_.: )_.....__..............._..._......_._... ft d 42 DCTERIOR WALLS' Wood Studs Loadbearing virally.............................:............._..-.......(Table!�)...........................-.2x_-_ft_in. Non-Loarmearing walls._._.__..............._.........._...._:(fable 5)._....... .............2x _ft_in. Gable End Wari Bracing Full Height Fsdurall Studs..._..:..._..._.........._._...........(Fig 1 D)_........_................_---------- _.........:._:...._ WSP40c Floor Length.____._..::......__:..:..._.__. (Fig 11)__..._............_.:_._......_..._ Gypsum Carling Length(if WSP not used)....:._.........:.(Fig ft>_0.9W - and 2 x 4 Continuous Lateral Brace @ 5 fL o.m_(Fig 11)..............................._...... __.._....._;._ or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ft.spacing in end Joist or truss bays Double Top Plats Spfrce Length .._.._....._:._...__..._.......__._,___..(Flg 13 and Table 6).....--_---:....__...._....._._ft Sprite Connection(no.of 16d common nalls)........._....(Table 6)_._.._........................_..:_......-.... _ l AfYe Guide to 1)'ooJ Corrstrrrctiorr hi High 1*?ndArreas: 110 ntph f•Yttrd Zone Massachusetts Checklist for Compliance (790 CMR 5301 1.1:1)' 4 . a. From Tables 10 and 11 and location of wall sheathfng and Building Aspect Ratio,determine Percent Full-Height . Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: I. .,Panels shall be Installed with strength axis parallel to studs. n. All horizontal joints shall occur over and be nailed to framing. 111 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 attachment of lower panel shall be made to band joist and lower attachment made to IDWest plate at first floor framing. v. Horizontal nal 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.26 or north of Rte.6) b)vertical addition—not required unless there is extensive renovation to the first floor c)replacement windows—needs energy con servatlon compliance only(chap 93) 6.Wood Frame Construction Manual(WFCM)for 110 MPH, Exposure B maybe obtained from the American Wood Council (AWC)website. YdiE?MMEDGEREMON F RAUU tG USE Ed WAS AT6-to l d t -� • i -• ii it o . - , i Al Ii91 CL ut �, ti o i t i i i I FRAMING WEMBEMtill i EDGE WERAED ATE I i L` 11 . u 119 S JJ u t, .I ,.S tl.it .. , 1 Z - t I I1LCi t o146 „ if bwol EEDME STAGGEFED tJA1t�SPACkJG ' WA4 PATTERN P/WHLi �- PAW—Ea E Lt GDuYEum_s GESPAcm DETA- See IJetail on Next Page .. Vertical and Horizontal Nailing De1311 • for Panel Attachment Vertical and Hot¢onfa!Nailing for Panel Attachment Town of Barnstable 0 ` Regulatory Services yMASS. Richard V.ScaIi,Director 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis;MA 02601 www.town.barnstable.maaus Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section k If Using A Builder I v L ) ' ` `Jy�R�t.` as Owner of the subject property. herebyauthorizekU,�D O CpVA LI�7G50f,3 _ to act on my behalf, in all matters relative to work authorized by dais building permit application.for. �� 1Jy�Py �`�7 cA►iy ,ryiS �,� -I(CIO 5 (Address of Job) Pool fences and'alaxms are the responsibility of the applicant. Pools are not to.be filled or utdized before fence is installed and all final I are perfo ad and accepted. u tore of Owner . Signature A Applicant Print Name Print Name ( t. Date. l Q:FORMS:O WNERPERMISSI02QPOOLS Town of Barnstable Regalatory Services of rory,� Richard V.ScaIi,Director 4 Balding Division t R6RNF-I'ARTR: : 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 LOCATIOK numbcr shcct vMagc "HOMEOWNER:': name; homc phone# work phone# 7 CURRENT MAIIJNG ADDRFSS: city/town state zip coda The current exemption for"homeowners"was extended to include owner-occupied dwellings of six emits 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 OR 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 tyro- 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 th.e 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 ofBamsiable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowncr Approval of Building0$cial 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 HOAMMI iER'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 109.1A-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\WPFmEMRMS\bm1dmg permit fDr=MPRESS.doc Revised 061313 78/12/15 MM/DD(YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(jes) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: United Insurance Agency, Inc. PHONE FAX / No: 199 Main Street E-MAIL ADDRESS: P.O. Box 1013 INSURE S AFFORDING COVERAGE NAIC# Buzzards Bay, MA 02532 INSURER A:Hartford INSURED INSURER B: Rudolph W Nelson INSURERC: PO BOX 1141 INSURER D: Sandwich, MA 02563-114 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPEOFINSURANCE IN V4M POLICY NUMBER M/DDIY MM/DD/YYYY LIMITS GENERALLIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Ea o rren $ CLAIMS-MADE OCCUR ME EXP(Arty one person) $ PER SONAL&ADVINJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OP AGG $ POLICY 7 PRO- LOC $ ECT AUTOMOBILE LIABILITY COMBIINED Sdrt)INGLE LIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALL 0 WNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED I PROPERTY DAMAGE $ HIREDAUTOS _ AUTOS eraccident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION UB-4444P158-13 11/6/14 11/6/15 X WC I IMIT OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTNE NIA E.L.EACH ACCIDENT $ 100,000 OFFICERMIEMBER EXCLUDED? y (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yyes describe under DES�RIPTIONOF OPERATIONS below E.L.DISEASE-POLICYLIM IT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regui red) Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA AUTHORIZED REPRESENTATIVE Tammy Buckley ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: aaP t fi. SZ d r' ie: ci f P l A Poll <<c v4 \tea 4,4 Ala s a .. Ak e 'a "I n Y M e ? twoMAN �.._ m goo. 0 Or Y � ti a. yval* O YM yn i„ �L e WS a RIM a >a a�, ✓fie -�o;,>mo�uoeal//a oo��,./�c�oaeliuoeCta 1.. Office of Consumer Affairs&Bdsiness Regulation - License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR ! before the expiration date. If found return to: Registration 152971 Type. Office of Consumer Affairs and Business Regulation > Expiration; 10/23/2016 Individual 10 Park Plaza-Suite 5170 - Boston,MA 02116 t RU OLPH W NELSOI�k [ - = - I RUDOLPH NELSON: 107 QUAKER MEETfN hOLJSE R g VNIid SANDWICH, MA0256Undersecretary ithout signature f Massachusetts - Deparf�ent ct Public Safety ` ' Board cf Building Regulations and Starda;c3s. i - C zstt-u ticn Super-itor . Ljdensa: CS-093670 RUDOLPH W NEL=SON ' PO BOX 1141 = t ' - SANDWICH MA 02563T- -- =.' ration r_.csZ;�:s;vnar 09/22/2015 Urjrestricted.-Buildings of any use group which contain less than 35,000 cubic feet (991m3)of enclosed space. --Fail ure-to-possess-a-current:edition of_the Massachusetts \ - State Building Code is cause for revocation of this license., For DPS Licensing information visit: www.Mass.GoJJDPS, y