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HomeMy WebLinkAbout0055 SAINT CATHERINE AVE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued °T (a 2 Conservation Division Application Fee 1 o? Planning Dept. P p Fee Date Definitive Plan Approved by Planning Board T Historic - OKH _ Preservation/Hyannis Project Street Address (Q A•z Village 4 ,., f-s Owner 41 r/V g M.A wZi. Address Telephone Ce f 7 221 3 13 3 Permit Request in a Square feet: 1st floor: existing ton proposed (-e 2nd floor: existing YOD proposed -'� Total new Zoning District Flood Plain 1U0 Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family X Two Family ❑ Multi-Family (# units) Age of Existing Structure (4t Historic House: ❑Yes XNo On Old King's Highway: ❑Yes ;qNo Basement Type: A,,Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area �sq.ft) Number of Baths: Full: existing new Half: existing knew a Number of Bedrooms: L( existing --"n`ew -' o Total Room Count (not including baths): existing new —First Floor Room CountM Heat Type and Fuel: $(Gas ❑ Oil ❑ Electric ❑ Other = x Central Air: ❑Yes CKlo Fireplaces: Existing New Existing wood/coal stove: W-Yes q No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size Attached garage:Aexisting ❑ 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 r'- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Q� Ad��� Telephone Number n8 3(c`7 q3- Address 12, 0 , _ ox 1)tb I License # D l� q Home Improvement Contractor# t 1 �� Worker's Compensation # S 7L a® k ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 9— 0 ��-- FOR OFFICIAL USE ONLY = •'` F' APPLICATION# DATE ISSUED `MAP/PARCEL NO. ADDRESS VILLAGE ' b OWNER DATE OF INSPECTION: FOUNDATIONS l FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH FINAL GAS: ROUGH FINAL I i FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i Towxa- of Barnstable .. Replatory Services g Thomas F. Geiler, Director Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyanais,MA 0260I www.town.b arnsta b 1 e-ma.= 'Officcc 508=862-4038 Pax: 508-790-623C PLAN REW 1n Owner.G✓l�l/ate Map/Parcel: 5579h ('w ,V.c. av,e- Project Address tfVixkn S M Builder 4le --ems The faTlowing UL-Mg were noted on reviewing: d 3� C�•�,ti�ev�,/ tuqGe� -7 5fwc f✓y-- G S Aoo�(' ? Reviewed by: Date: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information y A Please Print LeLdbly Name(Businessiorganizadon/Individual): l Or 0 C��. A0j\Nf Address: �: �, D ► �,® 4 City/State/Zip: Fn l q\A VjkYyPhone.#: SD`✓� .� � -y� Are you an employer? Check the appropriate box: Type pf proj ect(required):. 1.❑ I am a employer with 4. 0 I am a general contractor and I * have hired the stab-contractors 6. .New construction. employees (full and/or part time). . - 2. I am a sole proprietor or partner- listed on the-attached sheet: 7. 0 Remodeling ship and have no employees These sub-contractors have 'g. El Demolition working for me in any capacity: employees and have workers' co insurance.# 9. Building addition [No workers' comp,insurance comp. - 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. [No workers' corny. right of exemption per MGL _ 12.E]Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required] *Any applicant that chwksbox#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide:their workers'comp.policy number. I am an employer that isproviding 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: �S SA% 1l�. � rN� City/State/Zip: ets�oS~ 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 •�hiyestigations of the DIA for insurance coverage verification Ldo hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone r only. Do not write in this area, to be completed by city ar town offu iaLn: Permit/License# hority(circle one): . A,Board of Health 2.Building Department 3. City(Town Clerk 4.Electrical Inspector EIuspector 6. Other Contact Person: Phone#: . Massachusetts - Department of Public Safety. Board of Building Regulations-and Standards Constructi-on Supervisor License: CS-048086 ``+; BRADLEY PADDQ)CK P.O.BOX 1201 Forestdale MA 01644' I I• Expiration Commissioner 03/28/2014 z /e amn�wiuuealtl iePi ray c/icaeCYa. License or registration valid for individul use only Office of Consumer Affairs&Busi ess Regu ation. g OME IMPROVEMENT CONTRACTOR before the eatpiration date. If found return to: egistration: ,12<1967 Type: Office of Consumer Affairs and Business Regulation xpiration 7/3/2014 Individual 10 Park Plaza-Suite 5170 ri Boston,MA 02116 BRA EY A. PADDOCK_ - BRADLEY PADDOCK 1 1Y 4. 24 DEBBIES LANE MARSTONS MILLS, MA 6) 648 Undersecretary j Not valid wit t signature A TVC Gi de to Wood Coristruction in Hi,;,h Wind Areas:110 tnph Wirrd Zone Massachusetts Checklist for Comp.liance (7s0 C.A,IR 5301:2.1.1)' Check _ Compliance 1.1 SCOPE Wind Speed(3-sec. gust)................................................. ..........:................... 110 mph Wind Exposure Category............................... ...............................................B Wind Exposure Category ..Enginee6ng Required For Entire Project 1.2 APPLICABILITY +/ Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) _.stories 5 2 stories Roof Pitch....................:............:.........................................(Fig 2) ............................................L4Q.k` s 12:12 .... Mean Roof Height ..............................................................(Fig 2)...................... ....... .. 5... ft 33' _Building Width,W ...................................: .... ...(Fig 3).......... :.............. ... <so, (i Building Length, L .............. ............ .... . .......(Fig 3 .............................................. 15 80' Building Aspect Ratio(L/W) .................... ..........:.............(Fig 4)........... ... i./5 3:1 Nominal Height of Tallest Opening2 .............................:.....(Fig 4)............................................. ..W, s 6'8" 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(Table 2)................................................................ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete............................:.......................................................................................... ...... ConcreteMasonry...:.............................................................................I................................:................. 2.2 ANCHORAGE TOFOUNDATION"3 5/8"Anchor Bolts=imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general ........_...............:.................(Table 4)............................................... ,[�olt Spacing from endi)oint of plate .... .:...(Fig 5)..................................... It Embedment concrete.........................................(Fig 5)........... ti[� ��--°).�O in.>_7" Bolt Embedment-masonry......................................... .............. ..... .........._....(Fig 5).....:............. in. Plate Washer.................................:..............................(Fig 5)..........._..................................>_3"x Y x Y� 3.1 FLOORS Floor-framing member spans checked ..... ........(per 780 CMR Chapter 55)......... Maximum Floor Opening Dimension......... . . ....... P 9 . ..(Fig 6)............ <<-12' c/1 Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall (Fig 6)... ......... ....... .4s....: Maximum Floor Joist Setbacks Supporting Loadbearing Wail's or Shearwall................(Fig 7).......................................................—ft s d I/ Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall.................(Fig 8) ......... .............._...... . . .......... ft 5 d . Floor Bracing at Endwalls....................................................(Fig 9)................................................................ .:. Floor Sheathing Type (per 780 CMR Chapter 55)...........:....................... 17 Floor Sheathing Thickness .... . ... ....(per780 CNJR Chapter 55).... ............... in. Floor Sheathing Fastening ... . ... .: ....(Table 2).. d nails at in edge/ field 4A WALLS Wall Height Loadbearing walls..........:.............................................(Fig 10 and Table 5)...........................JJft <_10' All, Non-Loadbearing walls .................................................(Fig 10 and Table 5),........................ ft'S 20' Wall Stud Spacing ....... :................:(Fig 10 and Table 5) ............_ . in.-24'o c. Wall Story Offsets F s 7&8 ft s d 4.2 EXTERIOR-WALLS' Wood Studs Loadbeadn walls .......... .... (Table 5 .......2x - ft Non-Loadbearing walls .........(Table 5).....I............. Gable End Wall Bracing' Full Height Endwall Studs........................ .....(Fig 10)..................................................................... WSP-Attic Floor Length....... ... ...............................(Fig 11)............................................... ft zW/3 Gypsum Ceiling Length(f WSP not used)....:............:.(Fig 11)............................................. ft-0.9W and 2 x 4'Continuous Lateral Brace @ 6 ft. o.c. ..(Fig 11)................................. . ............. ........ or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or.truss bays Double Top Plate SpliceLen ........................................................(Fig 13 and Table 6)...................................._ft AWC Guide to Wood Construction in Hi�h !-!rind Areas: 110 inph 1-Ynd Zoiie Massachusetts Checklist for Compliance (7s0 C 1R5301.2.1.1)1 Loadbearing Wall Connections Lateral (no.of 16d common nails)................................(Tables 7)........................I............................ Non-Loadbearing Wall Connections Lateral (no.of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings (record largest opening but check all openings for compliance o Table 9) HeaderSpans ........................................................(Table 9)...................................�ft_in.5 11' Sill Plate Spans ..:.....................................................(Table 9).................................. _in.5 11 a% Full Height Studs (no. of studs).....................................(Table 9)....................................................... jo Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) �. Header Spans.............................................................(i-able 9)..................................JA�ft_in._< 12' SillPlate Spans...........................................................(Table 9).................................. ft_in.5 12" Full Height Studs (no. of studs)....................................(Table 9).................................. .. ..... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously / Minimum Building Dimension, W �/ Nominal Height of Tallest Opening2 .............................................................................. 5 6`8' SheathingType..............................................(note 4)...................................................... \ ✓f Edge Nail Spacing.........................................(Table 10 or note 4 if less)......................... Field Nail Spacing — in. ............................:.............(Table 10).................................................Shear Connection (no. of 16d common nails)(Table 10)................_........... .........................._ Percent Full-Height Sheathing.........'.........:...(Table 10).........:.......................................... ° 5%Additional Sheathing for Wall with Opening > 6V(Design Concepts).................... ✓' Maximum Building Dimension, L Nominal Height of Tallest Opening2........................................................................ 5 6'8' �- SheathingType..............................................(note 4)..................................................... it v Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................_G i - _ Field Nail Spacing.......................................:..(fable 11)..................................................__C�L in. Shear Connection (no. of 16d common nails)(Table 11)......................................................._ V_ Percent Full-Height Sheathing.......................(Table 11)..................................................... 5%Additional Sheathing for Wall with'Opening> 6'8'(Design Concepts).............. .. Wall Cladding Ratedfor Wind Speed?.............................................................. .............................. 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool, see BBRS Website) v Roof Overhang ...................................................(Figure 19 ft_<smaller of 2'or U3 c/ Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors / Uplift................................................(Table 12)............................................U= 103Plf (� Lateral.............................................(Table 12)..............................................L= t7(oplf Shear...............................................(Table 12)............................................S= 2'7.Plf. Ridge Strap Connections, if collar ties not used per page 21... (Table 13).... T= plf _AZ Gable Rake Oudooker..........................................(Figure 20) ............._ r of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U= lb. �. Lateral(no. of 16d common nails)...(Table 14).......................................L= lb. Roof Sheathing Type................:..................................(per 780 CMR Chapters 58 and 59) ............. Roof Sheathing Thickness.....................................:.....:............................................ ?7/16'WSP Roof Sheathing Fastening............................................(Table 2)......................................................... Notes: 1. . This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of 780 CMR.5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are.not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5% is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-gr6de. OF"VE� , Town of Barnstable Regulatory Services MA-Qa g, 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 . C-A) as Owner of the subject property hereby authorize 2 @�, P (�1 ��p�� to act on my behalf, in all matters relative to.work authorized by this building permit. (Address of Job) **Pool fences and alarms'are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed,and accepted. Signa e kkwner, Signature of Applicant Awl 1 Print Name Print Name Date J Q:FORMS:OWNERPEFMISSIONPOOLS 6/2012 THE ram, Town of Barnstable Regulatory Services RIMST,BLE, Thomas F.Geiler,Director s Mas . 9q,A 1639. �.� Building Division . rfD MA'I A 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: number street. village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include`owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code sta e t s 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:forms:homeexempt Zvi i Y � � � '� "i •�l r ��9���W� `4�Y'�0.- ;Atmm .are..� �� '. vTi oll Se tit its sit • 't •- _ - .�... ...... _..;�.,..--.�.. ".., sh....__.q:,,,w.a..y,.....,..w........,.«,�.. ,f."� xir...r..,.�. .......� _ "�';� mow,: s ,.arp,.,•sc.;�,rw.,»..#w.+a,4...- �:.:st�;�r�K»-...ryif.... ��,.s.,w.W-mr« ...si,;��w,wa..f. ..w-wii,..r. ,i 1171771 � � 4 f �V , J I - w �-.._.-•m - - �iWNaaNw'Ma\bp.. 'g .ewe�K•iM:-�IP�..'#uMA^.kw..:.++w•�. � 1{ " r # ,.AA, 3 S r : 1 i r � � 1 I t � 5 � d fi f 3 VIJ iA vQ :, s f r y M • CIrt `' � 1 v COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY OF 1010 COMMONWEALTH AVE. MAW .SS. r •' MASSACHUSETTS BOSTON 02215 LICENSE 05/31./1993 CONSTR. SUPERVISOR ' EXPIRATION DATE RESTRICTIONS 5 EFFECTIVE DATE LIC N0, 6 1 C+ 1 & 2 FAMILY HOMES 0 /01/1990 054103 _ MARGARET A FREITAS � . PIS BOX 8��1 WEST FALMOUTH MA 0257 PHOTO(BLASTING OPR ONLY) FEE: HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY STAMPED•OR•SIGNATURE OF THE COMMISSIONER THIS DOCUMENT MUST BE (- CARRIED ON THE PERSON OF ATSRPLICENSEE THE HOLDER WHEN ENGAG- OTHERS RIGHT THUMB PRINT ED IN THIS OCCUPATION. T,I r'� I ( 1 AI_ITH. O�e HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building R( s@ulations and Standards One Ashburton Place Room 1301. Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRAC"IOR Registration 107388 Expiration 07/1- 1/94 Type -- .a B A T2. HOME IMPROVEMENT CONTRACTOR Registration 10739E Mass Bay Construction Type - OBA Margaret A . F'r ietas expiration 01/31/94 8 Colonial Way W . Falmouth MA 02574 . Mass Bay Construction Margaret A. Frietas 8 Colonial Way ADMINISTRATOR �I, Falmouth MA 02574 f ,a Assessor's office(1st Floor): ,,�/� Assessor's map and lot number ti�w'f`�2-e ���i' e S TMt toy` Conservation e� Board of Health(3rd floor): `. • Sewage Permit number t ssassrant,a � rua Engineering Department(3rd floor): =, �o .eso. r• 0 H use nwrber Definitive Plan Approved by Planning Board 19` r APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1.:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT To LAC' S�- //VGA �S° /�O�F' )4 TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordingto the following information: Location Proposed Use I Zoning District Fire District Name of Owner ^� f�i-C S Address 5a,,w(! Name of Builder / 5 Y` 60,Q i&&W*dress) f Bair Pee OL/1z`&4tq Name of Architect Address Number of Rooms Foundation Exterior Roofing ��� �s ,, /'� Floors Interior Heating Plumbing Fireplace Approximate Cost lroo Area Q �£ e?6 7 Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the abov struction. Nam Construction Supervisor's License,"--to 5 '7/d _ WEICHELS, RITA No'A' 35401 Permit For REPLACE SHINGLES ON ROOF Single Family Dwelling Location 55 Saint Catherine Avenue Hyannis Owner. Rita Weichels Type of Construction Frame , Plot Lot Permit Granted September 28; . 19, 92 Date of Inspection 19 w Date Completed 19 1 , e+t ' �1HE Town of Barnstable *Permi{ �1Vq Expires 6 months from issue date Regulatory Services Fee BMMSTABM --- 9� 65 MASS. ArFO , Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 026.01 www.town.bamstable.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 C) Sf-I C. ,,p Property Address G Residential Value of WorkTpO Minimum fee of$35.00 for work under$6000.00 L Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) wPRE❑Workman's Compensation Insurance SS PERMIT Check one: ❑ I am a sole proprietor JUN I am the Homeowner ��12 - ❑ I have Worker's Compensation Insurance TOWN OF BARN Insurance Company NameTABLE Workman'.s Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) �Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to c© �r�2; ❑Re-roof(hurricane nailed)(not stripping.'Going over existing layers of roof) Re-side #of doors ❑ Replacement Windows/doors/sliders..U-Value - (maximum.35)#of windows • *Where required: Issuance of this permit does not exempt compliance with other town department regulations,Le.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A"copy of the Home Improvement ractors License&Construction Supervisors.License is required. SIGNATURE: �Q:\WPFILES\FORMS\building pe t forms XPRESS.doc Revised 051811 i rA T ie Commontrafth of Massarhuseth Department of IndusbiaiAccidei<rts Office of Invest gadons 600 Washington Street Boston,AM 02111 n�vmv mas&govrdia Workers' Compensation Insurance Affidavit.Builders/ContractorSJElect6cia3ds/Plumbers 1pPli-ant Information Please Print Legill Name mEess�'�C)rga usnn atioaandiviiduaU: �tw Ny\ 0.vv`�`r city/stag : Pie#7 -2 77I 13 Are you an employer?Qur7€the appropriate b Type of:project(required): 1.❑ I am a employer with 4. I am a general contractor and 1 6. ❑New constuction employees(full and/or part-time).* ue hired the sub-contractors 2-❑ I am a sole Proprietor ar partner: listed on the attached sheet. 7- ❑Remodeling slip and have no employees. These sub-cooiracturs have g_ ❑Demolition working for mein any capacity. employees and have workers' [No workers'camp.insurance COMP.insuranee.i 9. ❑Budding addition r:egnired] 5- ❑ We are a corporation and its 16.0 Electrical repairs or additions 3.❑ I am homeowner doing all-work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'camp. fight of exemption per MGL 12.NRoof insurance retluimd_]1' employees- §1(4),and we have no employees.[No workers'. 13.KOther : h comp.msuzaam required.] •�iay a�plisa Est cheda boa#tl mast also fill out the section below shriving the workerC wmpensatiaa Policy inksmadan- Iiameoam ens trhn submit this aflid war mdcatmg they ne doing all work and then hue outside contracwts mast submit anew affidavit ind catmg sack. 1Conaactors'that check this boot must attached an add]tiunal sheet showing the mane of the sub-contrzam and:state whether oruot those enlitks ham employees. If the sub-contractors have employees,they must provide thdr workers'romp.polity number. I am an employer that is providing workers'compensation insurance for my ewrplaywes. Beloit is the policy and job site i►rforma ort. Insurance Company Name: Policy#or Slelf-ins.Ltc.#: Fxpirat ion Date: Job Site Address: ' Citylstate 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 ofMGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imlu sotm eat,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,ziolator. Be advised that.a.copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification.. ' do hereby cerh;,a t pains and . s thatthe information provided above fs.true and correctSi tune: L Date. �►'���- �7 11D Official use only.. Do not wrfte in this area,to be completed by city or town offiickl, City or Town Permitffikense g Issuing Authority.(circle.one):: 1.Board of Health 2.Budding Department 3.C�#yfTotsn[;leek d.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 • snatvsresi.E. 9 r Town .of Barnstable Regulatory Services Thomas F.Geiler,Director Building:Division . Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must --Complete and Sign This Section If Using A Builder as wner of e subject property hereby authorize to act on my behalf, ' in all matters relative to work authorized by this b��penmit a lication 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. i Q:\WPHLESTORWbuilding permit forms\EXPRESS.doc Revised 051811 �tHE rj 'Town of Barnstable Regulatory Services iaxivastE Thomas F. Geiler,Director 1639. 0� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: Please Print l57 sT JOB LOCATION: ST �; ���"tt l `c��h OA 1 - number 11 street village HOMOWNER": W_N\\CA._%,,� 4�c- ( ( 7 7)( 3135 4"- name home phone# ll work phone# CURRENT MAILING ADDRESS: 3 7 �\s�v ,,,c �u y\Cc✓� tOY�j (;VVI�\�� a 62 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" fies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requireme and at he/sh will comply with said procedures and requirements. ignature of o o e 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\building permit forms\EXPRESS.doc Revised 051811 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance'Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: P. City/State/Zip:raj GQ SA_-C1&i��M A Q Phone#: 6D y 6'y3 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 i 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance. 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ officers have exercised their I am a homeowner doing all work 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 i comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site.Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP,WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: e LEACHING AREA (12 29'W X 36.48'L X I.9'D) 633 FTC Bottom:(12.29'X 36.48)= 448 f 2 Sides:2(12.29'+36.48)X 1.9'= 185 IF TOTAL LEACHING AREA CAPACITY (AREA X RATE) 468 GAL./DAY -� aSSESSORs iAR : ��� TEST HOLE LOGS RESERVE LEACHING CAPACITY N/A 'ARCEL : NOTES: PROVIDE: 8 -H-20 ADS ARC-50 UNITS WITH 4'STONE ALL AROUND IN AN 12.29'X 36.48'X 1.9'TRENCH FORMATION :LOOD ZON: WO 1 h EYA4UAj0R r� ! . ����5�� �{"� 1) The installation shall comply with Titl:: V and".V, ofPotu'ne Board of' ,;EFERENCE G � O G A1� .. <-- Dl 0� Health Regulations. PEq- b ATF:: .�-- Z. 1 I 2) The installer shall verify the location of utilities, sewer inverts and septic .,-� / ; `' components prior to installation and setting base elevations. TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first ��v 1 two feet out of the d-box to the leaching shall be level. - tICL 4) This plan is not to be utilized for property line determination nor any other Purpose other than the proposed system installation. ' S 5) All septic components must meet Title V r-)ecifications. , > q: 1 '7 c' , s I �b d' AGAI 6) Parking shall not be constructed over H10 septic components. LOCATION MAP 7) The property is bounded by property comers and property lines. `�.f� c `✓'yi l� g) The Property owner shall review design considerations to approve of total design flow,and number of bedrooms to be considered for design. Receipt P V1 1 t.; 2 38 of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material .► t� DC� per Title V abandonment procedures. Those within the proposed SAS shall I 1 � be removed along with contaminated soil and replaced with clean sand per ._..:., _ _. _- Title V specs. . -- �Co ' 10)System components to be )Q,felt,frpn}water,line., Sewed lines c1'os$ing thg ., wafer line'sll'be sleeved with 4 inch NCH 40 PVC with ends grouted if SEPT I C SYSTEM DES I G N applicable. The proposed SAS is beinginstalled below the water service line. The line is to be sleeved as aforementioned and maintained in place. FLOW ESTIMATE 11) If garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. BEDI:OOMS Al- I ID GAL/DAY/BEDROOM - GAL/DAY 12)The installer is to take caution in excavation around the gas line if such exists. C r oc SEPTIC 'rA1VK 13)The installer shall verify the location, quantity and elevation of the se%vc:r i lines exiting the dwelling prior to the installation. GAl /DAY x 2 D S - 5?0 GAL SE;` GAL SEPTIC TANK (,ok. . SO I I.'. AB;,ORPT 10!V SYSTEM SIDE AREA: Zx gn t 12,��t P� BOTTOM AREA: X t2,Z__V X O ji 0 � �1, ; ,, I=C SYSTEM SECT I-ON M _l y t N 6ID 0 e o o 17 SEP C TANK d o u b lr.. fr_ n r � ti __ -r-1 . t4� 2 _ j I vor c 7G __ SITE AND WAGE PLANINQ LOCAT ION : �65 ��1� CAT�MWFAVE � M PREPARED FOR : �1LL'IA'AA SCALE• I Ll DAV I D B . MASON R 1D � S . N S DATE: Z ZOCI� DBC ENVIRONMENTAL DESIGNS y -- EAST SANDWICH . MA 3 DATE HEALTH AGENT ( 508 ) 833- 2177 Zoo 7V Q�c'�11 !�(117 �`7 T•`tr' K Sr Z -2 ---------------------- -7-- //_ 'In . -, 0 >�i � � � p�