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Home My WebLink About0056 BENT TREE DRIVE _ ., ;, �� . . . . .. _ .. .,,; rf - n _.`. - .4, � _ � � - r -. .... .. .. .. < � - ., c W �. _ � � 4I .. .. ., ,. .. �, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 FS Parcel �O� 5 Applications Health Division Date Issued Conservation Division \J 1L Application Fee Planning Dept. Permit Fee n� Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation / Hyannis Project Street AddressR� Village (,wA ew 'A e. Owner L AurI �� Address 'P�dlw��a� t,�a9r Cam,n er Vl�_ Telephone -�;OsiL- Permit Request k, Q*% A t (k-,te.,�\ 13, 11 �e Square feet: 1 st floor: existing lqo -proposed2nd floor: existing LS G proposed Total new Zoning District Flood Plain Groundwater Overlay ob Project Valuation Construction Type_ Lot Size Grandfathered: ❑Yes �9 No If yes, attach supporting documentation. Dwelling Type: Single Family M ii Two Family ❑ Multi-Family (# units) Age of Existing Structure I Historic House: ❑Yes id No On Old King's Highway: ❑Yes 14 No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) �s6 Basement Unfinished Area (sq.ft) ��Sd Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floorh�om Count i` 4 s9 Neat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other � Central Air: QkYes ❑ No Fireplaces: Existing I New Existing wood coal stove: ❑Ns ❑ No _ 4. Detached garage: ❑ existing ❑ new size_Pool: ❑ existing U new size Barn: ❑ xisting (�a ne i size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: C) Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 9 No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) t Name I Y 6� Telephone Number a Address 40 License # CA -- . 107 14 7 Home Improvement Contractor# Email ., tee. ti T* Worker's Compensation # ALL CONSTRUCTION DEBRd RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# `,.. DATEISSUED MAP/PARCEL NO. " ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL -GAS: ROUGH FINAL FINAL BUILDING 2dir Q�NTE,CLOSED OUT f A360MATION PLAN NO. �►"�i :+ �.r �. :.�.... f } } The Commonwealth of Massachuseft Department of Industrial Accidents Office of Investigations UV 600 Washington Street Boston,MA 02111 wwmmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: 5 ,�� Phone#: �� - �� 53 / t0 Are you an employer?Check the appropriate bog: 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.;!�CI am a sole proprietor or partner- listed on the attached sheet. 7. §g:kemodeling 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$ 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' 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.mmirance required.] *Any-applicant that checks box 91 must also Ell 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 contactors 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: 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p d penalties of perjury that the information provided above is true and correct � lSignature: � � Date: Phone#: t— ,S 5 3 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"'an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152;§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of 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 permitEcense number which will be used as a reference number. In addition,an applicant that must submif 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 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washiugton Street. . Boston,MA 02111 Tel.#.617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749. www.mass.govfdia � &1 e ar�vrrwruaea o A �oaac��eC�i: 1 z� Office of Consumer Affairs&Business Regulation 1 ME IMPROVEMENT CONTRACTOR I egistration: Type xpiration:__4/30/2'a16 DBA FERLI LO REMODE LJ'NG , MICHAEL FERULLO �'K. 4! 40 GRISTMILL PATH MARSTONS MILLS, MA 02648 Undersecretary zom j u Massachusetts ,Department of Public Safety. 'Board of Building Regulations and Standards I Construction Supern ismLicense: CS-107347 `` r.II, MICHAEL FERUL-LO 40 GRISTMILL PATH Marstons Mills MA 02648�� Expiration Commissioner. 09/09/2017 WE T Town of Barnstable Regulatory Services • s • 1�F AARNn"M i M+ss. Richard V.5cali,Interim Director Y 1639- Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete.and Sign This Section If Using A Builder I, p 1�i�, G�Cs�r ,as Owner of the subject property hetebp authorize to act on mp.behalf, ' in all matters relative to work authorized by this building permit " (Address of Job) **Pool fences and alarms ate 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. Signature of Owner Signature of Applicant t aa Print Name Print Name Date fI' - s Town of Barnstable .' Regulatory Services �tME r, Richard V.Scali,Interim Director ti °-� Building.Division ztwxrrs�+xi� Tom Perry,Building Commissioner 9� 1 �� 200 Main Street, Hyannis,MA 02601 'tiEo INAi�' www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6250 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB-LO(ATION: 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 strictures 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 require nts and that he/she will comply with said procedures and requirements. ign a of Homeowner Appioval 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 (sge 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 $i oceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ,r�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. n.snrocrr�esrnn��fcll,n;i�i;,,o nPrrnit fimmclFXPRFSS-doc . r License or registration valid for individul use only .before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 s Boston,MA 02116 - 4•I Not valid without signature - i- - y ` Massach.usetts Department of Public Safety Board of Building Regulations and Standards ' •, Construction SuperN isor License: CS-107347 MICHAEL FERUL-LO ;• I . 40 GRISTMILL PAA TH IP Marstons Mills WA 02648 Expiration Commissioner. 09/09/2017 ,i _ -- 1 LOT 38 15,338 S.F. eA� N n• oFc r szs,� n�c s� RF •� �s°o w OF ROBIN °sG MULA. dWILCO. �r No. 31341 N & o cSTER� Si�N�C l0D SAP TO THE BEST OF MY INFORMATION, "EXISTING" PLOT PLAN KNOWLEDGE,t AND BELIEF THE �, BARNSTABLE, MASS. • STRUCTURES, SHOWN .ON THIS PLAN LOT 3811 L.C. 31043 A HAS BEEN LOCATED ON THE GROUND, DATE MAY 23, 2014 SCALE 1" = 30' AS INDICATED. JOB 7407-00 CLIENT FERULLO 5 23L4 ��-✓ SWEETSER ENGINEERING 203 SETUCKET ROAD DATE PROFESSIONAL LAND. SURVEYOR PO sox 713 SOUTH DENNIS, MA 02660 rr t. off. 508-385-6900 fox. 508-385-6991 J ^ C. �S8`PRO✓\7401-00�dwg`7407—CPP.DWG 02014 SWEETSER ENGINEERING �tHWE Town of Barnstable ��4rmftt # Expires 6 mo tths fron is,u date �7 Regulatory Services Fee snnxsresi.E, II , 9 MASS.i639. Richard V..Scali,Interim Director � �0 Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY /,,� Not Valid without Red X-Press Imprint V Map/parcel Number 5 Property Address St N:n'Sc re�e_ ��. (,ev�t�(t/`AR o � Residential Value of Work$ dJ d > Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address L �m r t Q tg Contractor's Name r(t C, aac �erJAo Telephone Number �sd�-553 Home Improvement Contractor License#(if applicable) 111'R 9CI Email: a,fQ; A,\-,. Construction Supervisor's License#(if applicable) LS a b7 2> t 7 ❑Workman's Compensation Insurance liar Check one: X- I am a sole proprietor ❑ I am the Homeowner FEB 2 5 2014 ❑ I have Worker's Compensation Insurance Insurance Company Name STABLE TOWN 0 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 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side k.Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows. #of doors: 3 ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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&Construction Supervisors License.is required. �✓ , SIGNATURE: Q:\WPFU,ES\FOP MS\building permit forms S.do Revised 061313 . I_ c; The Cammanweaftli ofMassackmseny Department of lnrlrrstrial Accidents Office ofInvestigations 600 Washington Street Boston,MA 02111 n+wkk:mas&gov/dia Workers' Compensation Insarauce davit: BuilderslCon ns/Plumbers Applicant Information Please Print LeeiiblV �-�"IV3tII6�n��cli)raaniTafi0il/I�[4'7dDa1)_ ityf5tbelp: Phone Az e you an employer?Check the appropriate bom Type of project(required): 1.❑ I am a employer with 4- I am a general contractor and i 6. New construction employees(full and/or part-time).* have hiredthe sub-canhuctors 2-�I am a sole proprietor or partner- listed on the attached sheet 7- ❑Remodeling ship and have no employees These sub-contractors haze g- ❑Demolition working for me in any capacity- employees and.have workers' 9. Building addition . [No workers' comp-irGr=e comp.Msurunce l required-] 5- Q We are a corporation and its 10_0 Electrical repairs or additions. 3-❑ I am a homeowner doing all work officers have exercised their 11_[]Plumbing repairs or additions 1£ o workers' _ right of e7emption per MGL 2��nce retlnuad.]F� c.152,§1(4�andwe havego 1s_❑Roofrepairs employees-[No workers' 13.0 Other. comp.insurance required.] ''Amy appHcmr that cheds box#1 mast also fill out the section below showing theaworkere compensatimpolicy uAmmatiam. I Homeasvnem who submit this aflida it indicating they are doing adl wash and the,hire outside contractmrs must submit anew affidaeit indicating such- lComtractors that check this baac must attached an additiomid sheet shooing the name of the sab-contractm and state whether or not those entidu bwe employees. If the sub-cantrectors have employees,they num provide their workers'tomp.policy number. I not an employer#Itat is protmditag tvorirers'canrlrerrsation insurance for pry cnrpIoy�ees. Below is the policy and job.site iafarmaham I»ce Company Name: Policy#or Self iris.Lic.#: E�puation Bate: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number.and expiration Mate). 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 ORDERand a Rine ofup to$250-00 a day against the 4zolatm Be advised that a copy of this statement may be forwarded to the Office of Ervestigatiow of the DIA:for insurance coverage verification. Ida hat^aby cerlrfj�Wrtder the its and penah[ios of pRrjury Heat the t'nfonrrafion prmd nbot�s is trueand correct Si Date: r 7 Phone#: f " 3S -3,t�- Official axe only. Do not write in this.area,tv be completed by city or town o,�ScnvL City or Town: Permiff icense# rssning Authority(circle one): 1.Board of Health 3.lading Department 3.Cityfrown Clerk 4.Electrical Lnspector 5.Plumbing inspector 6.Other Contact Person: Phone#: oxTME Town of Barnstable _ Regulatory Services XAM tE,g+ Richard V.Scali,Interim Director o;a�&1e Building Division Tom Perry,Building Commissioner r 200 Main Street,Hyannis,MA 02601 - www.town.barnstable.ma.us 0 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete:and Sign This Section If Using A Builder I, 4 e /1.4 0 as Owner of.the-subject property hereby authorize _ �' to act on my behalf, in all matters relative to work authorized by this building permit 7-1-,ea Dr. Carle t y 11e, M!4- (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. Signature of Owner Signature of Applicant Print Name Print Name F - Date Town of Barnstable ' Regulatory Services / pUtH*E ra Richard V.Scali,Interim Director Building Division snxxs-rastE. f Tom Perry,Building Commissioner 1 � 200 Main Street, Hyannis,MA 02601 D MPS www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6250EOW MNER LICENSE EXEMPTION ; ' Please Print DATE.. . l, oif JOB.LOCATION: ~ + number street village "HOMEOWNER": name ome phone# work phone# CURRENT MAILING ADDRESS: cit 7/town state zip code The curreat,exemption for"homeowners"was extended include own cu ied dwellings of six units or less and to allow homeowners to engage an individual for hire who does no a icense,provided that the owner acts as supervisor. ION OF HOMEOWNER Persons)wh_o o . arcel of land on a she reside or hitends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or etached stractuies accesso.y t slic�``we auW'Li f4:'n-stnicture"s `?�person who�.onstrnc s roorP than one home`in a two-year period shall not be considered a homeo r. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be res on ble for all such work performed under the buildingermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for comp ce with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the own of Bar"nstabl'e Building Department minimum inspection procedures and requirements and that he/she will comply with said p cedures and requirements. Si ature of FlomeownerL ` Appioval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTIO 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 persons)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:\WPFHM\FORMS\building perry:,forms\EXPRESS.doC 4 ( Massachusetts - Department of Public Safety �/e�po�rvrnoruoea�l/ s aaoac/zaaea Board of Building Regulations and Standards I Office oiConsumerA=ifa"irs&Busi'ess'Regula`tion: f ME Construction Suhcrnisur IMPROVEMENT CONTRACTOR' F License: CS-107347. 6eglstrafldiii. 99 Type: \�. xplratlon 4/ I)2014 DBA ' MICHAEL FERUI�Y O FERIJ .LO'F2EMODE�MT y > 40 GRISTMILL PATH H E� _ r � t i � a s Marstons Mills� 02648 � �� MI'CHAEL 'FERULLO� ,� : a t r ` 40,ORISTMILL PATH Expiration iMARSTONS MILLS, MA 0 48— a �t r ✓. �J- -� p Undersecretary. Commissioner 09/09/2017 l License or registration valid for indrvidul'use only, G before the expiration date:.If found returrt to: Office of Gonsumeir Affairs and"B'usmess')te ulation 10 Park Plaza-Suite S170 g Boston;MA 02116 Not valid without signature `oft Town of Barnstable *permit# Expires 6 months front Issue dare ,� I • aau�rsrestis. Regulatory SeI'V1CeS Fee NAM Thomas F.Geilers Director Building Division Tom Perry, Building Commissioner 200 Main Street,.Hyannis,MA 02601 X-PRESS PERMIT Office 508-862-4038 Fam 8-790-6230 J U L 2 5 2005 V` EXPRESS PERMIT APPLICATION - RESIDENT1M*@* —Not vaUwWwutRedxPresslraprint F SARNSTASLE ap/parcel Number •cperty Address Ilesidential Value of Work �+ e J 0 °`�'' Minimum fee of•$25.00 for work under$6000.00 wner's Name&Address (;P-o0✓N NO,nA,,tJ t!e 1— V'57' :oatractor's_Name . Telephone Number (ome Improvement Contractor License#(if applicable) :onstruction Supervisor's License#(if applicable) ]Worktnan's Compensation Insurance Check one: I am a sole proprietor I an the Homeowner I have Worker's Compensation Insurance asurance Company Name Vorkman's Comp.Policy# 'opy of Insurance Compliance Certificate must be on file. 'ermit Request(check box) ® Re-roof(stripping old shingles) All construction debris will betaken to ®Re roof(not stripping. Going over existing layers of roof) �Re-side [ Replacement Windows. U-Value (maximum.44)- *Whererequire& Issuance of this permit does not exempt compliance with other tows department regulations,Le,Historic,Conservation,etc. ***Note: Property Owner must sip Property Owner Letter of Permission. Home ovement Contractors License is required. F Signature QFormt:expn*g Revise063004 The Commonwealth of Massachusetts Department of Industrial Accidents z Office of Investigations • 600 Washington Street Boston,MA 02111 ,.' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/0rpnizatiow1ndividual)• Address: _ Phone#: City/State/Zip:. Are you an employer?Check the appropriate box: Type of.project.(required) 4. ❑ I am a general contractor and I 1.❑ I am a employer with 6. ❑New construction employees(full and/orpart-time).* have hired the sub-contractors listed on the attached sheet.$ 7• ❑ Remodeling- 2.❑ I am a sole proprietor or partner- ship and have no employees - These sub-contractors have, 8. ❑ Demolition workers' comp.insurance. 9,-❑ Building addition working for me in any capacity. o workers' comp. insurance 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their right of exe lion per MGL 11.❑ Plumbing repairs or additions 3 I am a homeowner doing all work myself [No workers' comp: - c.-152,§1(4),and we have no ❑12. Roof repairs - insurance required.] t employees. (No workers' 13.❑ Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp—policy-information. Jam an employer that is providing workers'compensation insurance for my employees. Below is the policy an-d job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500..00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. VI erebyce nder thepains andpenalt' s of perjury that the information provided above is true and correct ore: Date: 0 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 • on: Phone#: Contact Pers Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. in the service of another under any contract of hire, Pursuant to this statute, an employee is defined as ...every person . 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 dEeiiloY� " 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 buildingsin-the commonwealth for any: applicant who has not produced acceptable evidence o_f compliance with the insurance coverage required." ter 152, 25C 7 states `Neither the commonwealth nor any of its`political subdivisions shall Additionally,MGL chap §.,. ( ) 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-contractors)narne(s), address(es)and phone numbers)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 orLL-P 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 Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia . .. r , :.I. '' _1 - '-' 14.=Gelieral Attachment of Letl er Board to Ban Ja - .. - .. .. _,_ Fl9ura 8 d ist or Rlm Board .. I _ - .: i- _. - .., 1 . . < -,' . .- ,_ - _ - .. 'axdhe sheathlhg rem Ledger _ .".. . ..- %.. _ - ..- - paO!to lneteCBibn __ .. -.... - .. : : B%I§Ilpg Bled Wall .. . :Ihfeshpld dAie(d Ile.'...'. �. :...:: :. '�� .. _ ... ,gS shed And - . ... �' 'caulk§U Id prBL'69 I weterdnlNe •:.. - - 9 9exleWg2xbendlolel ... bn % . % .or4•:mlydnlum.. ':'6pnilhdhuI lYe, ..:.:.. < 9.. . IR � .. - .. rhn.boaN. - axlerglrg pesl'lol§t _ _ ., .. - - _ 9. [1 7'1L� . 51 max. ar me.lxauemlaa ` '4_ _.. MC®laClaVill113�@�Ia.1RllLD�t. .. - : .. .. a .vaaa�AauLv1.9"IfiIm, ery an: tox scAEwab . ° 2kllowla6q.' % WHITE'S.'PATH.. ":wand l: le. . . w .. n. : -. -9. . 9 . . SOUTH'YARMOUTH,- . . rorA1P{awc . .. . . . . . .:. lalat hengdi.s"r'AgN a sie SE MASSACHU 02884' exisiin:.. . .�: ' .. . . 9. - .9 . .. .-OUTUNE:OF EXISTING HOUSE. . ,'. %'fOgpppaOh Well' .axle LaOOERMUai aE OREATEa., ;,, ON FRAMED WALL tt Or DIRild 10(no death or Ina. BAbk ;'. % � (088''3�.883 4.. ;- . .. - .2X10 PT LLEED0GER FASTENED //r 2 ROWS. _ ,_ IBlofortd rm gromaf thah the...• .. (.. ) 00 . °. o a -. ... . .• :. OF'LEDGERLOKFASTENFJ25.2' KROM..TOP --aeplfi of the fiats Joist.' ' .. o ... - :.... .: h BOTTOM.EDGES®'16•.D.0 <' .- 4 .. fax(608) 78Q-�5800 .. . -. e:.. .� - -1 .: METAL'FRAMING HANGERS .. .. . .. .. - Flgure25;Guard Poet to outsidedol3l Exempla,'. .:,. :. ?. - " ' .. - 'see' ,. ..:. - '. FIOURE.Y4 for guard:I. '..M.oeLa ran 66 Installed de . - : .. .. : . :: - - .. component 6llaonmenI*- 'shown In Flgwe 26 o6tweeA lol§I9) . ..-.: .- � . -. _ _ . Iowa q edtier eWe.. <. _ -.. .. '_ requkemenle?. di hloeking:4q InsleOed as shown below . .. s19 9W Imrg no _ , .. ,.1 - -.. I r ach aide of the pool . - : oi.tne'ealsldeaaau:: 9.. - ' _ I r PR aLOrdtlnlemN. rovMa 2x�blxRin'at ua' OP :. .... .. - ...r : .. 4?Y_p.. 9..9 ttl Poste uard!at DECK E 9....P .... .. wi1H ligltldowfi'ahchora;:alletli Nlacklh with 1tltl'� . 2X1 PT J01 TS 16 O. ... ,. - ..°: '' 1 hireatleA halle.top end b: '..'.IslU6 - .. :..':... ". to lhru-';', .. 2®2 10 T. : - - - :'. bo119 and"all ou1sIE9-lot§[ TYPICAL EX'T-. POST CAP . �. OPTION �, oo .; I£?�.. - O. 10 A. : - '' 2-1k'min.:endn ihek,. .. NOT N SCALE . . : '. - . G L+ 1 _..I. : ; - 2s:mle..: 56 : :. .:" : - - - .. utaldebL1.et $EC7TON - RI pdBL -.... - .. . .- % guard PIJW VIEW - ::..;' . . . BEN.To `T,REE -.. 11__ - .12"DIAM. SOHO TUB D RIVE V E. :' ,.r_ LIt®1' .. . W/5BX6 PT.POSTS`TO GIRT .: .. .. .. ... a .. _ --: ' % / _ - Figure 24:Example Guard Dalalf1.- `7,� - - .-. .. ,, r .. w«sN hvJ ru 202X12-PT GIRT-' -- ..- -W/H2.5 CLIP®-EACH JOIST - T - , . . 9 9 17 -.. - .. _ xwe aaewa -h .:.. -. .1 ram° .. - :. - _.:.: at c.Lm lam... . < ° _.; knq 0 : .. : - M A. G . - PROPOSED >DEC.K 'FRAM.ING PLAN. �., a.,°�mb,, ,,«nfrt.-..«aIm . .. . - -...:. O .::' - : . - . m,r.w,.n- - 'wmR A NOT lo'.esm . - _. .. .. .. ... 9 .. .. :. ,. -:.... ., :. .. SCALE t 4'_;I'-O' - - - 1.P .1.R.of oJN_CD.. . I .11. .: Anrcrlcin Wood Co II PUPo S .SCRED V«bk«m hvahENW.M.. -g- . : -. O. -_ : �I - - .. .. ,:.�:. vntN:a�xlaNA�i irecrs' .. -. .. .. '.'A a•PFAMi.SEAN`T Oa•CANaIaUCnON SET" O .. .. :. . .. .. ..:.' ..-.:. .d- .. -.. .. . - . . . .. .- .. ... ' _ DRANINGS- ,. .. - �. s°.v s .. _..... .: � 1' _ 91 ' ':-.' � .FI Figure 22-Ole � OPIN6�G�lEO�O�el m�uv�RF-sw�lEoo__ .. :» .. _ Requirements . :, - ., � 9 9onal.Bracing `'.' : :. :.. .. .... . - , Provide blocking FF .. �.. - .. - '.'., .: �. �:�: .. .. .: - -. � .. ,.. OC n When OR ANY,PIeFPo��CEPT WPMFTMIaI INC NO T Ef41We YPoIABITIFN.. % .. ., -.. _ .. - .. ._ - �.. •' � .. : _' Is doth 1 align p _.: _ TYF?LCAL .EXT. . .POST. CAP: . : . ., 2 . OPTION: B .. . - : . .., '.. ` r beam DATEE15SUED 107 . NOT TO SCALE _. .. ...a. ..: .._.peam . . 91 s with � -. . . .. . ... 'lotsl el post - REVISIONS: L. - (1)316'diameter :�.� ;.��: -locadona :.:. .. - .. I .. ._ : _:... - .. _ ru-bolt with.. ALL DECK` CONSTRUCTION SHALL BE IN. COMPLIANCE WITH' weaher9,Jyplcal �o I'll 4 F HE ,PRESCRIPTIVE RESIDENTIAL: WOOD DECK. CONSTRUCTIONrGU.ID � . 1 . . � - E '"' ' BASED .ON THE 2009 INTERNATIONAL CODE:. . . . . .. . . ` .. BRACING PARALLEL TO BEAM BRACING.PE , . % • -. ,.. .. RPENDICULAR TO BEAN : ... .. > , ' An er4en WaoO,Cuhndi :PERMIT SET .. : . .. - '- :PROGR �;`PRI - � Ak ��' "' TYRICAL' NOTES. FRAM ING NOTES 1. ,^.t:. .. : 8X6 PT POST -. : -..:. `Q .. 1..THE ARCHITECT SHALL NOT BE RESPONSIBLE FOR THE:VERIFICATION OF •.ALL FRAMING LUMBER.SHALL BE HEM.FIR GRADE N0:2.OR,S.P.F.(SPRUCE-P(NE-FIR)_GRADE N0..1.AND.2. . - Q ':' -. - . :, - . - : ..- ...THE CONDITION.OF ANY EXISTING-STRUCTURE,-.EQUIPMENT OR -. .. OR APPROVED EQUAL(UNLESS OTHERWISE-.SPECIFIED_AND.SHALL MEET ITHE'REQUIREMENTS.OF THE' .:�. .. ) . %s' - I - 9 . - APPLIANCE AS PART'01"BASIC SERVICES UNLESS IT IS PART OF -- . . . ERICAN FOREST AND PAPER`ASSOCIATION.:THE MINIMUM ALLOWABLE BENDING.STRESS F.b SHALL '' f :.� * to . .. - CNTECT'S SCOPE STATED IN THE.AGREEMENT.AND:VERIFICATION IS- - BE"A050 P.S.1:'-THE MINIMUM_ALLOWABLE COMPRESSION:STRESS Fc'SHALL BE.400:'P.S:1:(THE•MINIM Mi. `.,. 130. F- MADE'ONLY BY VISUAL:OBSERVATION..:IF " S.I. . .. ' 'U' n O`-' ITHE ARCHITECTS DOCUMENTS ALLOWABLE MODULUS OF.ELASTICITY E::SHAL BE 1,40b,000 P.S.I. - !- . a .: O .'.REQUIRE CHANGES DUE TO'CONDITIONS NOTVISUALLY:OBSERVABLE' '. . .. .. (.) - -: :.. . MJ . rJ�T; 1. ' - i ® `. - AT THE TIME'OF PREPARATION'OF'THESE DOCUMENTS THE SERVICES 2:..TALLHE LVLMINIMUM 0 B ALLOWABLE L CASCADE OR I-LEVEL.WEYERHAUSER VERSA-LAM.3100FTd',OR.APPROVED EQUAL. ; '.. .. YA y .. _ 1. '' :THE MINIMUM ALLOWABLE.BENDING STRESS.Fe 'SHALL BE 3100 P.S.I. ALL'...LVL.POSTS iOBEVERSALAM - J ._ - O - .. --.. � .WILL:BE.AODIRONAL SERVICES. •.. ( ) - � O' .../� cp 1 - .. 7 2650:FB,,1.4E PARALLAM PA OR APPROVED:EOVALNETALL LVl_S IN.A000ROANCE WITH THE 1` .. - i ._ .. ABUVG ., .. :.: .'MANUFACTURER'S IN : V .. 2. STRUCTURAL ENGINEER:.OR ARCHITECT SHALL PERFORM FRAMING'INSPECTION STRUCTIONS. . ,, ... -. :WHEN FRAMING IS COMPLETE AND PRIOR IN '. - .-. - - ::_ POST BASE : TO ENCLOIU. BY INTERIOR 3. USE 3/4.TONGUE AND GROOVE STRUCTURALGRADE,FIR PLYWOOD FLOOR•.SHEATHING.1 8•.:EXTERIOR:,, 9 ' l •':i S`'P WALL PLASTER BOARD NISH. 1.® .. . STRUCTURAL GRADE FIR(C.D.X.)'PLYWOOD ROOF.,SHEATHING,AND 1/2-.EXTERIOR'STRUCTURAL GRACE < <' O - - .'Q-- : 3 'FIR(C.D.X.)AT'WALLS.Ali JOINTS SHALL BEBLOCKED NTH LUMBER:OR-OTHER,:,APPROVEO SUPPORTS:. - .. - : CONTRACTOR SHALL SCHEDULE AND PROTECT FROM-WEATHER ALL . .. 1 ,.., ,. - -' - EXISTING.HOUSE COMPONENTS'AND INTERIORS DURING CONSTRUCTION .4. PROVIDE.SOUD'BLOCKING BE N ISTS"UND R . I ` I '. TWEE.FLOOR JOISTS AND/OR%DOUBLE ALL JO E EACH. ` ., AND CONSTRUCT TEMPORARY STRUCTURES. NCLOSURES'AS MAY BE: PARTITION.am. .- . _ .. - NECESSARY TO INSURE SUCH PROTECTION. ` ' - .. _ _ -SCALE f/4�.1'a Al5. USE FULLY NAILED METAL CONNECTORS(TECO;'SIMPSON,�OR:EQUAL),'JOIST,-OR BEAM HANGERS WHEN 11 .p 4. -O AGTOR'SHALL SITE INSPECT ALL: JOISTS OR BEAMS FRAM .. PST CAPS N r. _ EXISTING VS-PROPOSED. E INTO OTHER JOISTS DR BEAMS.PROVIDE METAL O. ,. A D BASES FOR , .. . . ...,� S PRIOR'TO'AN N .ALL-POSTS.. 0.:.i 2 4 .. 9 ' QjNAIP7Ry7I} D DURING CO STRUCTION AND NOTIFY'ARCHITECT - a.' . .. �'r'o+A+" Or'.AF1Y •ESCREPANCIES AND OR•CHANGES THAT MAY NOUN : : : ': . . . ; . ./... BE ENCOUNTERED.TERED. B. F .. THREADED ROD.'SET IN TO I - b . . . _ - OR lVL BEAMS'OR HEADERS..PROVIDE SOLID 4X4 LA_MINIMUM,POST SUPPORTS FOR-DOUBLES AND - 'UNLESS'OTHERWISE NOTED:- _ .. .TUBE OR FOOTING 24". 5 I . . SOLID 4%6 OR LVL MINIMUM POSTS FfNt'TRIP.. BEAMS.OR'1HEAOERS.OR.AS OTHERWISE SP.ECI.q ' .. CONTRACTOR SHALL CONSTRUCT AND MAINTAIN TEMPORARY WA •ON.THE.PLAN.:- SHORING ETC.TO MAINTAIN/PROTECT EXISTING.HOUSE AND STRUCTURAL. I I SHEET NO. -`. .. - , - f INTEGRITY:OF EXISTING.HOUSE'. . .: ° '.SONO,TUBEOR' - : ?FALL'PLYWOODFLOOR'SHEAhI1NG SHALL BE.CLUED TO SUPPORTING WOOD FRAMING:MEMBERS USING . '.. .r ., FOOTING/. .0 :. ,:AMERICAN PLYWOOD - .. :. :: ., ° -,. (/ , tt. `. 6.._CONTRACTOR.SHALL SITE INSPECT/VERIFY ALL EXISTING VS.PROPOSED: - YWOOD ASSOCIATION(A.P.A.).GLUED FLOOR SYSTEM.WOOD GLUE TO BE COMECH,:INC. - O.. a. . .:'...° .,.` ' : �j,. .f ,..�c: N PL400 SUBFLOOR.CONSTRUCTION ADHESIVE OR.APPRO .EQUAL." ... ° :. _:.° ,...0... o ,.b'1�(n I.�r ,V. CONDITIONS PRIOR.TO AND DURING:CONSTRUCTION AND MAKE ADJUSTMENTS . . .. a LJ .;4-. AS NECESSARY'TO ENSURE COMPLIANCE'MTH .-. .. : - ,gp•L .7, DESIGN PARAMETERS AS.., .. o -°,o � - Yy�` !PROGR S ..a-BUILT--UP BEAMS(3 PLY MAXIMUM USING CONVENTIONAL FRAMING LUMBER SHALL BE FULLY SPIKED .. . O - _ }V j E SES: .- - TOGETHER WITH 2-10D NAILS AT 12'O.C.L PLY MAXIMUM)-TO'BE'.THRU-BOLTED.WITH 1 2 TOTAL.NUMBER OF SHEETS, - - - - .: VL BEAMS'(4 )_ .. ./+� - : INCH DIAMETER:RTRU�OCTS OR EQUIVALENT POWER SCREWS STAGGERED•TOP.AND BOTTOM AT 98 ,r - - :f 7.,DASHED U14ES INDICATED EXISTING CONDIRONS.TO'BE REMOVED/ALTERED. -. - ' � : O.C:OR.AS OTHERWISE'REOUIRED BY THE MANUFACTURER. -' ' /l yryynT,{t . f1' IN SET �' � � ': '• � �' ....r .- 8..WHERE AN ITEM IS REFERRED TO IN�SINGULAR NUMBER IN THE CONTRACT.. :. "� � � - � `� -� - . _ - OCUMENTS..PROVIDE AS.MANY SUCH 9; - ... '' .r" : .: .. CH ITEMS AS'ARE NECESSARY TO COMPLETE,- ALL.MANUFACTURERED'FLOOR I-JOISTS TO BE DESIGNED THE SUPPLIER/MANUFACTURER.SUBMIT '. " T YP I.0 A.L.: E X.T.' P O.S TI.' B A S E 4 f woRK. . . ' . -SHOP DRAWINGS-ANO CACWLATONS'TO..THE ENGINEER PRIOR•TO FABWCAITON THIS SHEET INVALID .. _ O. Nor To SCALE ._ ... ...- _� ..'. : _ _.UNLESS-ACCOMPANIED''BY��- . . . ... :.... ..' '. .: ' . . - - - - ,:,.1 9. . : : .. _ . •�. '�- I � ,._ .., � '�9. .'A'QOMPLETE SET OF::.� ` '' .WORKING DRAWINGS