HomeMy WebLinkAbout0171 CAP'N LIJAH'S ROAD �_
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Town of Barnstable
Regulatory Services `
�n+e Thomas F.Geiler,Director
Building Division
wuvsTnBi E Tom Perry,Building Commissioner
16 9. 200 Main Street,Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
December 12, 2012
John Tirronen
200 Atlantic Ave.
Leominster, Ma. 01453
RE: 171 Cap'n Lijah's Rd., Centerville, Map: 193Parcel: 085
Dear Mr. Tirronen:
A review of our records, including the permitting history of the property, indicates that
the above referenced address has an open building permit without the required
inspections. Permit application number 201001164 was issued on or about April 1, 2010
to construct a three season room addition and to date has not had the required inspections
(building and electric). In fact;an electric permit for the project has not been issued by
this office. Please contact this office immediately to arrange to bring the property into
compliance and arrange the required inspections. Thank you for your immediate attention
in this matter.
Respectfully,
Lai
Local Inspector
jeffrey.lauzon cgtown.bamstable.ma.us
(508) 862-4034
f
Town of Barnstable
oF1HE r Regulatory Services
Richard V. Scali, Director
BAMScABLE Building Division BARNSTABLE
MASS. A w°0.s"ans in&uz osi�aw�tONs°oniu;uaze
9c� 1639. ,�0 Thomas Perry, CBO 1639-2014
AIED"A°r A Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
June 15, 2015
John Tirronen
171 Cap'n Lijah's Rd.
Centerville, Ma.02632
RE: 171 Cap'n Lijah,s Rd.,Centerville, Map: 193 Parcel: 085
Dear Mr. Tirronen,
This letter is in response to application number 201503106 submitted to add a shed at the
above referenced address. Unfortunately,the application can not be approved at this time a
because of the following:
1) The property currently has an unresolved issue with an open building permit
(application number 201001164)resulting from electric work done without the proper
permit or inspections.
Please do not hesitate to contact this office with any questions:
Respectfully,
A'vKauzon
Local Inspector
jeffrey.lauzon@town.barnstable.ma.us
,(508) 862-4034
Town of Barnstable ,
Regulatory Services+ j' BARN,STABLE
Richard V. Scali,Director
BAJWSTABM * Building Division :4 5
1°tEoA Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
011Vi S1 N
Office: 508-862-4038 Fax: 508-790-6230
PERMIT# �3 d FEE: $35.00
SHED REGISTRATION
RESIDENTIAL ONLY
square-feet or less--__—_ _
I`tom fy-,,, o
Location of shed(address) Village
1 rI `1 d 2
Property owner's name Telephone number
Size of Shed Map/Parcel#
Signature Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
If over 120 square feet,you must file with Old King's Highway
Conservation Commission(signature is required)
Sign off hours for Conservation 8:00-9:30&3:30-4:30
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A
PLOT PLAN
Q-forms-shedreg
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SCALD -1 _ ': _DATA ^S •' ?E—
PLAN /2t¢FL,gE�/C.� : BE�niG CoT
16:45 S Ivoa/,v /,v P4.4ru &OA--
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I /�EQEBY CEQri FY 7-NA T rsYE EXI-5T-
'j.�O�aTEQ'� /NG FOUNDAT/ON 1.0C47/0N /S
AIIRV 43 SHOWN QN1J_�c_ES CO�/FO,Q /Y/TN
THE 8U/LDiN6 SET�3.4C".rE'f�JuiBEtil�,t/)'
OF rAV Town/ OF 'N57A�t
-9761
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Ld- yg-8yi - — -
6 cazo
B7�wit_i nd.i.sr si�v. ,,pig
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcef . ; Application # 1
Ct
Health Division Date Issued
Conservation Division Application Fee
Planning Dept. Permit Fee lD�.
Date Definitive Plan Approved by Planning Board pk y)111b;Q
Historic - OKH —Preservation/ Hyannis V
Project Street Address IT C
Village ZG Te- '
Owner Address
Telephone�� '�
Permit Request Hov-SR
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation So 01-It3 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 �kr3 Historic House: ❑Yes KNo On Old King's Highway: ❑Yes 6&No
Basement Type: ull ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) L3 cra Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing_ new Half: existing L Z- new
Number of Bedrooms: Z existing _new
Total Room Count (not including baths): existing (o new First Floor Room Count
Heat Type and Fuel: 66as ❑Oil ❑ Electric ❑ Other
Central Air: ❑Yes to Fireplaces: Existing YL, New Existing wood/coal stove: ❑Yes JS No
Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ n w size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: n fj
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ cc co
Fes+
Commercial ❑Yes No If yes, site plan review#
Current Use s—% o- Proposed Use S1I.V
rn
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
� �1 P
Name • 0 Telephone Number
Address Cstfj: L rS,0, ft4 License#
��^ ✓_� f ®2_6 3 ZHome Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE " l� ��
FOR OFFICIAL USE ONLY
APPLICATION#
ti
DATE ISSUED
Ir
MAP/PARCEL NO.
ADDRESS ` VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME 'GS/Z.Sl�IoAiZ
INSULATION TtO Qz-1tAt
FIREPLACE
ELECTRICAL: ROUGH FINAL fi V
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING J
Flok—
DATE CLOSED OUT
ASSOCIATION PLAN NO.
Vie Corrzrnonweairth ofMassachusetU
aC ccidents
• rzdustt z ,4
.1�e artrr-zeal o I
Office of rrzvesdgatiorzs
600 Washington Street
< 13ostazz, AL4 021J i
I_pww,m ass.gov/dia
Workers' Compensation fnsixrance Affidavit: Builders/Contractors/EIectricians/Plumbers
Applicant Znformatioli Please Print Legibly
NaILlle (Business/Organization/Individual): c1iD� '��a rron+�-►.7
Address: t 'l 1 (2s"C—I soil. t2a
City/State/Zip: Phone:#: S'67)
Arc you an employer? Check the appropriate box:-, Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor ands 6. 24ew construction
employees (full and/or part-time).* ��'c wed the nib-contractors
listed on the attached sheet 7. ❑Rcmodeling
2,❑ I am a•sole proprietor or partner- ,
These sub-contractors have S. bemolition
ship and bavc no employees
employees and have workerS'
working for mein any capacity. 9. [] Building addition
[No woxkcrs' comp, insurance �mP• insarauce.t
5, [] We are a corporation and its 10.[]•Electrical repairs or additions•
rcquircd.]
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,E] Roof repairs
in.s„rancc required J t c, 152, §1(4), and we have no 13.[] Other .
employees. [No workers'
comp. insurance required.]
+Any applicant that checks box#I must also fail out the section below showing their workers' eomsztl
pcnot,policy information.
t Homeowners who subroit this affidavit indicating they arc doing all work and tbm hire outside ccniracior5 insist submit a new a$idavitindiu-ing such.
Contractors that check this box must attathcd an additional sheet showing the name of the sub-contrsctars and stair whether or not those cntiticshave
t
m-nployers, It the sub-c�ontractorr have employees,they must pravidb their workers'comp.policy number.
I= arc employer thrd is providing workers'cotnpertsali.on insurance far my employees BeLov is the pot I cy and job site
informatlort
Insurance Company Dame: .
Policy# or Sclf--ins, Lic,#:. Expiration Date:
rob Sitc Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page_(sbowving the policy number and expiration date).
Failure to secure coverago as required under Section 25A ofMGL c, 152 can Iead to-the imposition ofrrimirial penalties ofa
5nc LiP to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and 2 fine
of up"to S250.00 a day against the'violator. Br, advised that a copy-of this statemcrit maybe forwarded to the Ot�cc of
Investigations ofthe bIA for insurance covera- e veri icition.
X do hereby certi u er the pains•and penalties of perjury that the information provided above is true and corTert,
Si afore: Date;
Phone#: S 1 ^ ��j
Official use only, Do not write in this area, to be compieled by city or town officiaC
City or Town: Permit/License#
Xssuiog Authority(circle one);
1. Board of Health 2, Building Department 3, City/Town Clerk 4. Electrical Inspector S, Plumbing Inspector
6, Other
P lion'eth
JUf0� afi0n aid I�����.ud' 'Ions
litres all em to ers to provide workers' compensation for thcir.emPloyecs;
chapter 152 r P Y act of hiro,
exal Laws n contract Massachusetts Gcn P
pursuant to this statute, an employee is defined as ,...every person in the sezv�cc of another under any
o written
or• lie z
express unp d, oral
i oration or other legal entity, or an y two or more
An erreplDyer is defined as "an individual, partnership, as corp rp
of the forcgoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the o
artnersbi association or other legal entity, employing eployecs. However flit
receiver or trustee of an individual,P P�
owner of a dwelling house having not raorc than three apartments and who resides therein, or the occupant of the
wr
dwelling house of another who employs persons to do maintenance coxutruc4olo°r eat be deemepair work od to ben such dan employer-"
or on the grounds or building appurlcnant thereto shall not because of such ernp yin
MGL cbaptcr 152, §25C(6) also states that"every state or local Licensing agency shall Idthhold the issuance or
rear-W2l of a license or permit to operate a buslness or to construct
buildings in
the e n age rnmo required.'
for AMY
applicant who has not produced acceptable evidence of comp
y Of if
Additionally,MGL ohaptcr 152, §25C(7) states 'Neithezk c °0n calth norble cvidencc of compliznee with the in:utancc
enter•into any contract for,tho pexfoxmance of public w p
rcquircmcnts of this chapter have been presented to the contracting authority.
Applicants
Please fill out the workers' compensation affidavit completely,by chcckin the boxes that;apply to your situation and,
accessary, supply sub-contractors)name(s), address(cs) and pbonr nuxnber(s) s oLg with 7 P their C�oY�ss other than the
insurance. Limited Liability Companies(LLC) or Limited Liability Parts p ( )
members or partnerp, arc notxcquircd to carry workers' compensation insurance. If an LLC or LU does have
cmployccs, a policy is rcquized. Pc advised that this affidavit may be submitted ,date th Daffida entt. f ndustr tWshould
Accldcuts for confirmatiDzi of iusnrancc coverage. Also be sure to sign
and be retu mcd to the city or town that flit application forthe permit or license is o ara rng quuired to obtain.aeworTkcrnt of
industrial Accidents. Should you have any questions regarding flit law oz if y �l
cozvpeusation policy,please call the Department at the nurgbcr listed below. Self-insured comPanics shou]d cntcr their
solf-izasuran(�c license number on the a zoPzi2to luc.
City or TovYp Officials
e bottom
Plcasc be suzc that the affidavit is'complete and printed legibly. The Department has p�roo die aiding thcapplicant
of the, affidavit for you to fill out in the event the Offco of Investigations has to contact y g
Pleaso be sure to hll in the permiVhccusc number nhic v ll been edar,n cd only sub fOrcucc tong affidcr. In avit indicating current
that must submit multiple permit/licensc apphcatio y!n
policy infbrmation(if Accessary) and under`lob Site Address" Ilia applicant should write ,all Iota b pro ided to the
or
town):"A cbpy of the aff davit that has beta bEa-cially stamped or masked by the city or town may ' p out Oach
applicant as proof that a valid affidavit is on file for future o °t A t related to any in ss or commet bo ercciial vcnhuue
year.-Whoro a home owner or citizen is obtaining a he p.
(i_e. a dog,liccnsc or'permit to bum leaves etc.) said persaA is NOT required to complete this affidavit
f Invcsti abons would ar,to thank you in advance for your cooperation and should you have any questions,
:z ha Office o g
plcasc do not hcsitato to give us a call
The DcP .artoient's address, tcicphone•and fax number:
Gs .
The,, Commoziw�al.th o�Nlassaclaustr. .
D(,'paTtmf-At Of Jadus>r 0 A.cciderUts
Offxco of uivcstiptiorzs
600 Was&)n Wu St-t`,et
Boston, MA. 02111
Tc1; # 617--727.4W.0 exta06 Qr 1-V7-MA SSAFE
Fax# 617-727-7749
Rcviscd 11-22-06 vr-ww.mass..gov/dia
Town of Banastable
ywv of rNe ry�
Regulatou ;ezv>,ces
Thomas B. Geiler, Director
t BARNSTA9t.E, -
MASS. Buildiag.Division
s679•
PrFo MA�A Tom Ferry,$uilding Corninissioner
200 Main Street, Hyannis.,MA 02601
�rFy��.to�'n.barustable.ma.us •
Fax: 508-790-6230-
Office: 508-862-4038
)3oA4Eowl\`>✓R LICENSE
EYE11dPxrON
plense Print
DATE: o
JOB LOCATION: e
sheet Village,
number
"HOMEOWNER �r+ —��!o - home Phone
one N work phone It
name
CURRENT MAILING ADDRESS: o ^
(ram an d.1d.R r^" "7-6 -
state zip code
city/town
or less
The current exemption for"horneownerS"Was extended to include owner-occupy d dwellinded that the owner act�a
to allow homeowners to engage an individual for hire who does not possess a 1 ,
supervisor. DE)'INIT10N OF Hot jEo)VN'ER
person(s) who owns a parcel of land on'which he/she resides or tceessoo reside,
to�sdueh useand/or farm structures.�A ed to
be, a one or two-farnily dwelling, attached or detached structuresrY
person who constructs more than one homer fficial ona-yrar peririn acceptable shall l ri Ioto the Buit be dlding Offciel; that he/she shall be
"homeowner shall submit to the Buildr g
responsible for all such work performed under the buildiDR perrriit. (Section 10911)
e with the State Building Code and other
The undersigned "homeowner"assumes responsibility for complianc
applicable codes, bylaws, rules.and regulations.
The undersigned "homeowner
certifies that he/she understands the Town
rno]13 Withsaid procaduble 8res�and ent
minirn inspection procedures and requirements and [hat he/she till p y
require e s,
Si lure f 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.
FioJt�EOWN R'S EXEMPTION•
The Code slates(haC "Anyhomcownerperforming work for which a building permit is required shall be exempt from the provisions.
of this section(Section 1 o9.1,1 -Licensing of construction Supervisors);provided that if the homeowner engages a"pason(s)forhire to do such
work, that such Homeowner shall act as supervisor," arc Many homeowners who use thisctio Sulocrvisorsn are n SccU'oaware n 2t 15)y7his lack of gwarcnesooftenlresults in serious sproblems,parti ulix�arly
Rules &�Rcgula•tions for Licensing Con p
when the homeowner fiires unlicensed"persons..in this case,our Board cannot proceed against the unlicensed person as it would Ndth a licensed
Supervisor. The homcowncracting as SuperYisor is ultimatclyresponsiblc•
To ensure[hat the h"omeOwDcr is fully aware os his/her
ress of a Supervi or.many
the lasl�pagc oftlhisaispuc io atform"currently used by
that the homeowner certify that he/she understands the r p
scvrral imvns: You may care t amend and adopt such a fom�ccriificalion for usc:in your community,
y
�0FrHsro�ti Town of Barnstable
Regul2tory Services
RARN Thomas F, Geiler, Director
hose.
�Ara63rg. Building Division
Tom Perry, building Commissioner
200.Main Street, 14yannis, MA 02601
www.torwn.ba'rnsta b]e.me.us
Office: 508-862-4038 Fax: 508-790-6230
Prpperty Ownev Must
Complete an.d. sign This Section
ff Using A Builder
X , as Owner of the subject property
to act on to
hereby authorize y behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit please complete the Homeowners License
Exemp6011 l?orn71 on th*c reverse side.
- (� -�n /
H OF�,A`•�y ��.. � 7��Ll�CJK
\�q��� `780 CMR; STATE BOARD OF BUILDING REGULATIONS AND STANDARDS ''f ! L1 j�{{ KD
ICHELE \�`11� iE MASSACHUSETTS STATE BUILDING CODE I /
*L,�_e
STpUCTUR ri 37r4 >,'; AWC Guide to Wood Construction in High Wind Areas;110 mP h Wind Zone
,tl.
Massachusetts Checklist for_ Compliance(780 CMR 5301.2.1.1)1
1, Check
1.1 SCOPE
Compliance
r ,
Wind Speed(3-sec.gust) ....... 110 mph _
Wind Exposure Category ...
. ......... B
1.2 APPLICABILITY -
Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story)
stories s 2�stories ~ '
Roof Pitch .... (Fig 2) .......,. � 12:12.
Mean Roof Height ..... . ..... (Fig 2) . . . ..... ...^'12 ft s 33
Building Width,W : (Fig 3) I ft -s 80' _
Building Length,L .... ... ..' .• ..(Fig 3) ft s 80'
Building Aspect Ratio(L/W) (Fig 4) s —c-s 3:1
....
Nominal Height of Tallest Opening' ...... ,. (Fig 4) ... .`.. ,. fL s 6'8"
1.3 FRAMING CONNECTIONS
General compliance with framing conpections"". (Table 2)'
2.1 FOUNDATION r: .4
Foundation Walls meeting requirements of 780 CMR 5404.1
Concrete ...
.. ..:.,.. .. •. ... ...........
Concrete Masonry --..
2.2 ANCHORAGE TO FOUNDATION'•'Anchor Bolts Bolts imbedded or%"Proprietary Mechanical Anchors as"an alternative in concrete only
Bolt Spacing-general ...... .. ...(Table 4) y in.
Bolt Spacing from end/joint of plate . .. (Fig 5) 1. in. s 6 -12" —
Bolt Embedment-concrete.............. (Fig 5) �7 in. 2 7
Bolt Embedment-masonry.., . (Fig 5) in:t 15`'
Plate Washer . ..... ... (Fig 5) ..... z 3"x 3„x t�.,
3.1 FLOORS —
Floor framing member spans checked ......... (per 780CMR 55.00 `
Maximum Floor Opening Dimension.......... (Fig 6) . P ft s 12'
Full Height Wall Studs at Floor Openings less than T from Exterior Wall(Fig 6)
Maximum Floor Joist Setbacks
Supporting Loadbearing Walls or ShearwalP. (Fig 7)
_ftsd _ ..
Maximum Cantilevered Floor Joists —
Supporting Loadbearing Walls or,Shearwall . (Fig 8) ft s d
Floor Bracing at Endwalls
(Fig 9)
Floor Sheathing Type .... .(per 780 CMR 55 00) .
Floor Sheathing Thickness (per 780 CMR 55.00)Table : 3 m.
Floor Sheathing Fastening 2 A
( )sad nails at�in edge/ ?in field .
4.1 WALLS ...
Wall Height
Non walls (Fig 10 and Table 5) ,. �.... ft s'!0'
Loadbearing walls ...,*.....' T _
g .. .{Fig 10 and Table 5) .......... =ft s 20'
Wall Stud Spacing .......... (Fig 10 and Table 5 ' '(. g ) in.s 24"o.c.
Wall Story Offsets .. ....... (Figs 7&8) . d
4.2 EXTERIOR WALLS'
Wood Studs
Loadbearing walls .. ..
(Table 5) '�ST..y �2 c�_ _ft_in.
Non-Loadbearing walls (Table 5) 2x_-_ft in
'Gable End Wall Bracing' —
Full Height.Endwall Studs ........P....°.. (Fig 10) "
WSP Attic Floor Length ........... (Fig 11) .. ft z W/3`
Gypsum Ceiling Length(tf WSP not used)(Fig 1 1) ft a 0.9W-
and 2 x 4 Continuous Lateral Brace cat 61t.o.c..,
or 1 x 3 ceiling furring strips U 16"spacing min,with 2 x 4 blocking C➢4 ft.spacing in end
joist or truss bays
Double Top Plate --
Splice Length:..t............ .. (Fig 13 and Table 6) ..t�t� CPU ft
..
Splice Connection(no,of 16d common nails)(Table 6) . ., ., ,
.....
m
1054 780 CMR-Seventh Edition 12/28/07 (Effective 1/I/08) '_
p� Ag1r,MEt1: �� 780 CMR: STATE BOARD OF.BUILDING REGULATIONS AND STANDARDS� 7 L t St�1 I
z CLII]ILO �1
NO. 34774 °`I _ APPENDICES
>>tLT �ILLct
STRUCTIIP.At Loadbearing Wall Connections
Lateral no.of 4
( 16d common nails ..,
, I
(Tables 7)
Non-Loadbearing Wall Connections
src t�t_F ,�ys Lateral(no,of l6d common nails) (Table 8) .. n..-
Load Bearing Wall Openings(record largest opening but check all openi�.. for compliance to Table 9)
Header Spans .. :. (Table 9) ...... . . .. . —ft—in.
Sill Plate Spans .. .. (Table 9) .. .......i. .. :. _ft . in.
Full Height Studs(no.of studs) . (Table 9) (
Non-Load Beating Wall Openings(record largest opening but check all Openings for compliance to Table 9)
Header Spans...... ....... ... (Table 9) f..... _ft in. s 12'
Sill Plate Spans.... . .... ............. .. (Table 9) ft_in, s,12" _
Full Height Studs(no.of studs) .. (Table 9)
Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously'
Minimum Building Dimension,W i u
Nominal Height of Tallest Opening?. ... •I
.. (ems
. . . . 6'8"
Sheathing Type . .... . ., note 4 —
( ) _
Edge Nail Spacing •,:,,(Table)0 or note 4 if less) .....` 3 in.
Field Nail Spacing .. .. ............... (Table 10)
Shear Connection(no.of 16d common nails)(Table 10) ......
Percent Full-Height`Sheathing . (Table 10),.....
5%Additional Sheathing for Wall with Opening>6'8"(Destp}t Concepts).. . ...
Maximum Building Dimension,L �' _
Nominal Height of Tallest Opening2 6 8`
Sheathing Type (note 4}.; t S
Edge Nail Spacing (Table-I I'or note 4 if less) ... 3 in.
Field Nail Spacing .... ..... .. :.... (Table 11) I in.
Shear Connection(no.of 16d common nails)(Table 11)
Percent Full-Height Sheathing .. ..... ... .. (Table l l)
5%Additional Sheathing for Wall with.Opening>6 W'.(Design Concepts)..,,. . .
Wall Cladding _
Rated for Wind Speed? ..... s
.. ..... .....
5.1 ROOFS
Roof framing member spans checked? (For Rafters use AWC Span Tool,see BBRS Website).
Roof Overhang.. ... ......... I... (Figure 19) ... ft s smaller of 2'.or U3
Truss or Rafter Connections at Loadbearing Walls
Proprietary Connectors
Uplift
..... ........ ...... .... .. .. (Table 12) ... . U=_&plf R '
Lateral ... .. (Table 12)
L=J](
Shear.. ........ ... (Table 12) ....... S— Plf
1.
Ridge Strap Connections,if collar ties 1sE used er age 21 Table 13 _ plf
P`
Gable Rake Outlooker .............. . .., (Figure 20) .. t.s smaller of 2'6rU2
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 58.00 and 59.00) ..
Roof Sheathing Thickness ............ ........... .7J&in. z 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 there 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 l 1 `
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 percenrfull-height sheathing
requirements shown in Tables 10 and 11.
3. The bottom sill late i �4
p n exterior walls shall be a minimum 2 in.no
minal thickness pressure -
create #
d 2 ade.
4. a. Fr omTables l0and 1 1 and
Sr'
location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height
Sheathing and Nail Spacing requirements
y. 12/28/07 (Effective
1/1/08j 780 CMR-Seventh Edition'
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel. .'Applicati0h # la
C2 .2
Date Issued ued
Conservation D' ision ' 'Applicati6 ri Fee
Planning,Dept: Fee
Date Definitive Plan Approved by Planning Board
i/s�i o n
Historic = OKH Preservation Hyannis
itA
Project Street Address Cpve
-"3 Z_Village 6
g 6_0 N Address 0,tj Owner
Telephone 650 0) gs4
Permit Rbquest J, s
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
—
Zoning District Flood Plain— Groundwater Overlay
Project Valuation Socw> Construction Type
Lo,t Size Grandfathered: LJ Yes '*b(No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family Ll Multi-Family (# units)
Age of Existing Structure 3 'Ar- Historic House: Ll Yes 1!(No On Old King's Highway: LJ Yes WNo
Basement Type: Full Q Crawl Ll Walkout LJ Other
Basement Finished Area (sq.ft.)- VooA Q.s Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing. new Half: existing Ile _nn�
Number of Bedrooms: existing new
Total Room Count (not including baths): existing (0 new First Floor Ro Count
Heat Type and Fuel: X Gas LJ Oil U Electric Ll Other
Central Air: L1 Yes VENo Fireplaces: Existing V New Existing wood/co I stove,_1 Y6`s-cgN0
Detached garage: Q existing LJ new size_Pool: J existing Ll new size Barn: LJ exis ng LJ new size
Attached garage: Ll existing Ll new size —Shed: LJ existing Ll new size Other:
Zoning Board of Appeals Authorization Ll Appeal # Recorded Ll
Commercial LJ Yes �No if yes, site plan review #
Current Use jp�,-XN Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name. r Telephone Number
'Address (-#e4 6_Kok License #_
YYxA bjj&�z Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
W-le
SIGNATURE DATE 7-
I/,z
y
FOR OFFICIAL USE ONLY N
APPLICATION#
j DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
t
V • i -
DATE OF INSPECTION:
€ FOUNDATION
FRAME
INSULATION
FIREPLACE r
ELECTRICAL: ROUGH FINAL`
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address: 11i 1 C" p1 L-77AV, '?-A
City/State/Zip: C-e-iL,,'Aiy- rf,,A r>zG37_ Phone.#: (560 5 r,- -&�
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a Y emp to er with 4. ❑ I am a general contractor and I
6. New construction
employees(full and/or part-time).* have hired the sub-contractors
2. listed on the attached sheet. 7.. ❑Remodeling
0 I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in an capacity. employees and have workers' "
g Y P tY f 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.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.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 statemerit may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify u der the pains andpenalties ofperjury that the information provided above is true and correct
Signature: `�'��'� Date: _
Phone#: 'S zR 11 `IV,
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#:
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 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 11-22-06
www.mass.gov/dia
F1Aa,. Ilol`L
780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDA D 14 bSO RD
MICHELE E MASSACHUSETTS STATE BUILDING CODE
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STRSTRUCTURALI� AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone
l..A
� ' Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)'
ei.
:•s;o,�A' 0 Check
1.1 SCOPE Compliance
Wind Speed(3-sec.gust) ............. ........ ..., 110 mph —
Wind Exposure Category .. .............. B _
1.2 APPLICABILITY
Number of Stones(a roof which exceeds 8 in 12 slope shall be considered a story)
stories s 2 stories _
Roof Pitch .. (Fig 2) -rZs 12:12
Mean Roof Height •................. ...... (Fig 2) . ...,.... .. ,.. ....... ft s 33' —
Building Width,W ...... .. .. .........,. (Fig 3) ... ..... ........ Z ft s 80'
Building Length,L ....................... (Fig 3) ....... .... ..... . ft s 80'
Building Aspect Ratio(L(W) (Fig4 s 3:1
Nominal Height of Tallest Openine .......... (Fig 4) "
1.3 FRAMING CONNECTIONS
General compliance with framing connections... (Table 2) ..•.. ... ... _........ ...........
2.1 FOUNDATION
Foundation Walls meeting requirements of 780 CMR 5404.1
Concrete
Concrete Masonry ... .. ... .................... ........ .................. ..
2.2 ANCHORAGE TO FOUNDATION'•'
Anchor Bolts imbedded or%"Proprietary Mechanical Anchors as an alternative in concrete only
Bolt Spacing-general......,.... (Table 4) .. �l,y . `
Bolt Spacing from end/joint of plate ....... (Fig 5 ;_2" —
Bolt Embedment-concrete.............. (Fig 5)...... ........I ........ .7 in. 2 7".
Bolt Embedment-masonry.............. (Fig 5) ......... — in. 2 15" _
Plate Washer . ........................ (Fig 5) ..,. ...... 2 3"x 3"x t/4" _
3.1 FLOORS
Floor framing member spans checked (per 780 CMR 55.00 _
Maximum Floor Opening Dimension........... (Fig 6) ,,,..., ft s 12'
Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6) ......
Maximum Floor Joist Setbacks
—
Supporting Loadbearing Walls or Shearwall . (Fig 7) .................... . —ft s d
Maximum Cantilevered Floor Joists
Supporting Loadbearing Walls or Shearwall . (Fig 8) .... ................•,; ,ft s d
Floor Bracing at Endwalls .................. (Fig 9) ........ —
.................. . .
Floor Sheathing Type .:.. ..................(per 780 CMR 55.00) ...............\y1 . � —
Floor Sheathing Thickness ......... ....... (per 780 CMR 55.00) .......,......3 in.
Floor Sheathing Fastening Table 2 _
•••••••••••••••••• ( )s�dnailsat�,inedge/�Zinfield
4.1 WALLS
Wall Height
Loadbearing walls ..................... (Fig 10 and Table 5) .. ..... _ft s 10'
Non-Loadbearing walls ............... . (Fig 10 and Table 5) ..�. '-
••... _ft s 20' _
Wall Stud Spacing ................... ..... (Fig 10 and Table 5) ....... _in, s 24"o.c.
Wall Story Offsets ........................ (Figs 7&8) .......... fv d —
4.2 EXTERIOR WALLS'
Wood Studs t
Loadbearing walls •.....:....'... (Table 5) T6>51---?
Non-Loadbearing walls ................. (Table 5) ...... . ....2x_- ft_in.
Gable End Wall Bracing' —
Full Height:Endwall Studs ............... (Fig 10) . ...... _
WSP Attic Floor Length ................ (Fig I l) ...... ......., _ft 2 W/3
Gypsum Ceiling Length(if WSP not used)(Fig 1 1) _ft a 0.9W _
and 2 x 4 Continuous Lateral Brace 0 6 ft.o.c...(Fig 1 1).......
ur I x 3 ceiling furring strips 0 16"spacing min.with 2 x 4 blocking 4 ft.spacing in end
joist or truss bays ..................
Double Top Plate —
Splice Length......... . ............... (Fig 13 and Table 6) ...f�:t7 .,LPL({.�ft
Splice Connection(no.of 16d common nails)(Table 6). ..,.... _
1054 780 CMR-Seventh Edition 12/28/07 (Effective 1/1/08)
ZH or MASZ 1
C., OIL
,MlCH6+- cn\ 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARD ( 7j �y(�t�
CUDILO J`.
o Ha.34774 APPENDICES (�rl _v1LLE1�
U
STRUCTURAL Loadbearing Wall Connections I
q �u� Lateral(no.of 16d common nails) ......... (Tables 7) .I `.
gfiGisr6P ��' Non-Loadbearing Wall Connections _
Seat E% Lateral(no.of 16d common nails) ..,.. ,• (Table 8) • al _
Load Bearing Wall Openings(record largest opening but check all openi gs for compliance to Table 9)
Header Spans.. ....................... (Table 9) .. ... _ft_in. s 11'
Sill Plate Spans .......:................ (Table 9) ..... _ft—in.s 11' —
Full Height Studs(no.of studs) ............ (Table 9)
Non-Load Bearing Wall Openings(record largest opening but check all penings for compliance to Table 9)
Header Spans...... ..................... (Table 9) ft_in.s 12'
Sill Plate Spans.... ..... . . .............. Table 9
.... _
Full Height Studs(no.of studs) ........... Table 9 _
Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously'
Minimum Building Dimension,W 1 a
Nominal Height of Tallest Opening...... ras „
Sheathing Type ................. ..... (note 4)......... ... .. .... ..... _
Edge Nail Spacing ................... (Table 10 or note 4 if less) .. ...... .in.
Field Nail Spacing ................... (Table 10)......... . .... . ... ...•
Shear Connection(no.of 16d common nails)(Table]0) .. .......... .. _
Percent Full-Height Sheathing ... .•..•.. (Table 10)........ I . ...... ..._%
5%Additional Sheathing for Wall with Opening>6'8"(Desi Concepts).. ........
Maximum Building Dimension,L '
� 4
Nominal Height of Tallest Opening....................
... ( s 6'8"p
. .. ..........
Sheathing Type ......... ............. note 4 — S Edge Nail Spacing .... ............... (Table I I or note 4 if less) .. ..•.... 3 in. _
Field Nail Spacing ................... (Table 11).......... ...... Lin. _
Shear Connection(no.of 16d common nails)(Table 11) ........... ............ ..... - _
qO
Percent Full-Height Sheathing .......... Table 11 .
5%Additional Sheathing for Wall with Opening>6'8"(Desi Concepts).'. .. ...
Wall Cladding
Rated for Wind Speed? .......:.
5.1 ROOFS
Roof framing member spans checked? (For Rafters use AWC Span Tool,see BBRS Website) _
Roof Overhang.. . ........................ (Figure 19) ...... .�_ft s smaller of 2'or U3
Truss or Rafter Connections at Loadbearing Walls —
Proprietary Connectors
Uplift ..... .. ........ .............. (Table 12
pff
Lateral ...... ...................... (Table 12)................ .... I=�plf
Shear.............................. (Table 12)............... ..... S=�plf
Ridge Strap Connections,if collar ties*used per page 21(Table 13)............. T==pif _
Gable Rake Outlooker .............. ..•..•. (Figure 20) ..... ft s smaller of For U2
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 Typ` ...................... (per 780 CMR 58.00 and 59.00) .. ... .... _
Roof Sheathing Thickness .......
7f�in. z 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 I: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-grade.
4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height
Sheathing and Nail Spacing requirements
12/28/07 (Effective 1/l/08) 780 CMR Seventh Edition
- 1055
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Town of Barnstable
"o Regulatory Services
BARNSTABM ; Thomas F.Geiler,Director
MAM
Building Division
ArED MA'I r.
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 a
Please Print
DATE:
- r
JOB LOCATION: �v)1 �S �y`I� tid >y n
number street village `
� 0
"HOMEOWNER": �_vsL r. (tow) q��1
name home phone# work phone#
CURRENT MAILING ADDRESS: CG�M
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 unde "homeowner"certifies that he/she understands the Town of Barnstable Building Department
minim minimifn inspec ion procedures and requirements and that he/she will comply with said procedures and
require ents.
Uignatlri� f 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 states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 1093.1.-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 tamend and adopt such a form/certification for use in.your community.
QAWPFILES\FORM SVromeexempt,DOC
THE Town of Barnstable
Regulatory Services
BARNSTABLE,
MAS& Thomas F.Geller,Director
�Fp �A�O 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
i Property Owner Must .
Complete and Sign:This Section
# - If Using A Builder. +
I, , as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner _Date--
s,
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:OWNERPERMIS SION
1
opstiie,otr• Town of Barnstable *Permit vs
��. Ecpires 6 nr. nth r I issue dale
Regulatory Services Fee
Y
+ BARNSPABLE,
67S. Thomas F. Geiler, Director
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
�j
Nfap/parcel Number 173
Property Address _- f C iA tin i a�t h �n v►i �(�fl C�Z_t S
❑ Residential Value of Work ��e Minimum fee of$25,00 for work under$6000.00 -
Owner's Name& Address
-r ��,�1, . __��n ..i,i let M
Contractor's Name _ _ Telephone Number
I tome Improvement Contractor License# (if applicable)__
Construction Supervisor's License#(if applicable)
❑Workman's Compensation'Insurance Check one: , `
tip
�
❑ I am a sole proprietor
(9 I am the Homeowner OCT 2 0 Zoo
❑ I have Worker's Compensation Insurance
Insurance Company Name
ToVq ! OF BARNSTA5L.
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request (check box)
Re-roof(stripping old shingles) All construction.debris will be taken to Lt. ,e
❑ Re-roof(not stripping. Going over existing layers of roof)
Re-side
'SA Replacement Windows/doors/sliders. U-Value h .p,-vA_ (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc.
'"Note. Property Owner must sign Property Owner Letter of Permission, u
A cop of the Home Improvement Contractors License is required. :01 - Z !1p 800Z
3-1SV1.�`N��j q j t = 1 t
� f:z ,
SIGNA`I'UREi
Q:'Wl'fIL.F b S\PORMS�. uildi �liei fonns\EXPRESS.doc
Revised 100608
t
1
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations •
a 600 Washington Street
�< Boston,MA 02111
MIwrvw.mass.gov/die
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeVibly
Na111ej(Business/Organization/Individual): �h\Nti .ctr o
Adoress: 4,111-1 CACT
City/State/Zip ' c+��.tn�.��. YID 0 Z62 Phone.#:
Are.you an employer? Check the appropriate box: .Type of project(required):.
1.❑ I am a employer with 4. [] I am a general contractor and I
* have hired the sub-contractors 6. []New construction .
employees(full and/or part-time).
2.❑ I am a•sole proprietor or partner- listed on the-attached sheet Remodeling7• ❑
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,$
5. [] We are a corporation and its 10.[]'Blectrical repairs or additions
required.-]
�3I am a homeowner loin all work . officers have exercised their 1L[]Plumbing;zepairs or additions
g right of exemption per MGL �- �fr us
myself,[No workers comp. 12 Roofrepays
:— t- c. 152 §1(4), and we have no
urance requized.] ,�3y❑_Otfier�`-.�;..doves �•"
~" employees. [No workers
comp,insurance required.]
*Any applicant that checks box#i 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.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have
employees, if the sub-contractors have employees,they must provide their workers,comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site.
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date).
Failure,to secure coverage as.required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK,ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy-of this statement maybe forwarded to the Office of
Investi ations of the MA for insurance coverage verification.
I do hereby certify un the a' a allies of perjury that the information provided above is true and correct.
Date: 10Vo F —
Phone#:
Official use only. Do not write in this area, to be completed by.city or town official
City or-Town: Permit/Liceiase#
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#:
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 hiie,
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 bean employer."
MGL chapter 152, §25C(6)also states that:"every state or local licensing agency shall withhold the issuance or
renewal of a Iicense or permit to'operate a business or to construct buildings in the commonwealth for any
applicant who has not pro.ducedacceptable 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 compl%ariee with,the insurance
requirements of this chapter have been presented'to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s)of
insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members*or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit.or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line..
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be.sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city'or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to 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:.
• t�Cozx ()11"W th of Massarhwetts
D�partmi nt of WAIMal Accidents
Offtce of Invesdigatious,
600 Wasl i gtoli Street
Boston,MA 02111
TO-. ##f 17-727-4500 ext 40b or 1-877-MASSAFE
Fax#6.17-727-7749
Revised 11-22-06
www.matss.gov/dia
Hof t�rq��
Town of Barnstable '
Regulatory Services
ML
tST" Thomas F.Geiler,Director
MASS.
1639 .`0g Building Division
rfD MA'1 A
Tom Perry,Building Commissioner
200 Main-Street, Hyannis,MA 02601
vs'ww.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
D"ANTE �O�Z�/D
row cnTloN�:----a1'7! CA•� ��� Tz-d ��K�y,/JE 1�7i�
number 1 ` street village
HOMEOWNER—tea �t�x7 ��r•pa��
name home phone#1 / work phone#
CURRENTMAIL-ING-ADDRESS
city/town state zip code
1 ,
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-licerise,provided that,the owner acts as
supervisor. t
DEFINITION OF HOMEOWNER
Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to
be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm 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) r
I A J .� 1 j
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 D.epartrrient.
minimum' pection procedures and requirements and that he/she will comply with said procedures and -
requirem n •�
E
gnatu �of-Homeowner -
"f ..
Approval of Building Official j
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 pemdt 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 fomt/certification.for use in your community.
Q:fornu:homeexempt
�Herg,�a Town of Barnstable
Regulatory Services
ZARNSTABLF,
y MASS. g, Thomas F.Geiler,Director'
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: S08-862-4038 Fax: S08-790-6230
Proper"y ner'�Must"
Complete and Sign This Section
If Using ABuilder
n
I, D�1-10 A as of the subject property
hereby authorize to act on my behalf,
in all matters relative to work auth d b building permit application for:
Address o ob)
�a zn
S• tur of er a - "
Prin'Name
C, I"f Pro erty�Owneris-applying for_pernut;p ease complete the
Horne-owners LicenseExempton Formon the reverse side.
Q:FORMS:OWNERPERMISSION-
'Town of Barnstable
oFt► ,
Regulatory Services
Thomas F.Geiler,Director
Building Division
w A i
M� �g Tom Perry,Building Commissioner
t63.q. 10
'°rEo p�21► 200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Approved:
Fee: a15 100
Permit#: '7 3 70c
HOME OCCUPATION REGISTRATION
Date:
Name:. c-r h� f'1 Phone#:S T6 V1 517 -`7 W Q .
Address: l Z ( ^c ro t-, 5hti. Z� Village: C, v���
Name of Business: c &A4-� 0 C)_4E co
Type of Business: GCS,IvO l ° Map/Lot: q 09&'
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
• Such use occupies no more than 400 square feet of space:
• There are no external alterations to the dwelling which are not customary in residential buildings,and there is
no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,'
odors,electrical disturbance,heat,glare,humidity or other objectionable effects, .
• There is no storage or use of toxic or hazardous materials,--or flammable or explosive materials,in excess of- -
normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not-to exceed one ton capacity,,and=one•trailer not to exceed 20 fee6n.length-and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the-Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit. .
I,the undersigned,have re d and agree with the above restrictions for my home occupation I am registering.
Applicant: Date:
Homeoc.doc Rev.5130103
TO ALL NEW BUSINESS OWNERS
DATE: 1Z iff ;
Fill in please: mmm
APPLICANT'S YOUR NAME:—, �rc�
BUSINESS W® YOUR OME ADDRESS: 1'i t C�4 �5�1, c
ls-T') 5 11--%8V4 win .c^ v,1L2 rr, 0 Z 'Z
TELEPHONE T le hone Num er Home 4 51-1
NAME OF NEW BUSINESS I y a . (2 1J CWC 0'6 TYPE OF BUSINESS %X5
IS THIS A HOME OCCUPATION? CYES NO
Have you been given approval from the building division? YES= NO
ADDRESS OF BUSINESS MAP/PARCEL.NUMBER
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of.
Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures,
listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first
you MUST go to the following office to make sure you have.all the required permits and licenses..
GO TO 200'Main St. -(corner of Yarmouth Rd. & Main Street) and you will find the following offices:
1. BUILDING COMMISSIONER'S OFFICE
This individual ha _ een inf mOd of any permit requirements that pertain to this type of business.
ut orize ignature**
COMMENTS: e^ r�-�-�-
2. BOARD OF HEALTH
This individual has be n informed of the permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
3. CONSUMER AFF RS (LICENSING tensi
HORI
This individual has a nformed of the li rements that pertain to this type of business.
ut orized Signature *
COMMENTS:
Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must
do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various
tr departments involved.
**SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY.
•
QACONSUMER\Lois\CA Forms\newbusfrm.doc
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7,L oil p��oQ- /NG FOUNDAr/ON 40C47-/ON /-5OVZ
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OF TN TOWN OA ;-3,4r/l/
9761 ---
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G;iZO u/ELC. � T�YGO/2 Co.L�
l _
i�saeor's•map'and lot number
SEPTIC SYSTEM MUST BE
Sewage-.Permit number ......7...��5 ....:......... .....::..... :' INSTALLED IN COMPLIANCE
WITH ARTICLE 11 STATE
THE P E iVD TOWN
To��, TOWN OF BARN , JL '
BAUSTADLE, i y.
u,
" ` BUILDING INSPECTOR
90� i639•
c4MPY
APPLICATION;FOR PERMIT TO ........ ............. .... ..................................................... ......
.. ..... ....
TYPE OF CONSTRUCTION ......:.....:........ .. .:....... ✓ ... .
ry : ... ... .... .......//........................................
�K .... <. ..........oz. .......10�
y
TO THE INSPECTOR OF BUILDINGS:
The undersigned he eby applies for a permit according to the following information:
Location .... . p./............:/.....;?..............................................................................................................................:.......
Proposed Use ......�......
............ SY.............................................................................................................................
Zoning District ....... ..1... .....Fire District � .}`l
��
Name of Owner . ...... ...E ... .. ....'o
. ..c;!e..v.-.T.Address ....................., .....................................
Nameof Builder ......... , L '........ ..............:...........................Address ......................���r. Fit..................................
Name of Architect ....... .. � �' ........................Address ..................../�,. , es�1 14 i.:.................................
Number of Rooms ......Co........................................................Foundation ...............
:tr:•:.c?: c Ga. z':........
Exlerior ........7......................:..........................................Roofing ...............„a
Floors ........ ............./.1'r ........................................Interior ............... ......... x!. ..............................
Heating ............. .....�.."t...................,..Plumbing ...:....//�......441 .....................................
Fireplace .................................... ............................................Approximate Cost ........ .........:........
.....
............
// s.
Definitive Plan Approved by Planning Board --------------------------------19--------. Area �P. ........ ...-...........
Diagram of Lot and Building with Dimensions Fee o"............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
r"
t
,S
i
hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ....... .... ..... . . ........LK........ .... ..........
Tellegen-Ferro ne Associates
18576 1 1/2 story,
0 ....... Permit for ....................................
single family dwelling
.................. .......................... ...............................
Location ........Capt.I ...Lij.a h Road...................... ...... . ...... .... .........
Centerville
.. ...............................................................................
ly
Tellegen-Ferrone Associates
Owner ....................................................
Type of Construction .........fr.ame........................... ......
...........................................................................I
Plot ............................ Lot #16
................................
A4gust A 76
Permit Granted ........................................19
'Date of Inspktion ...... . .. ....19
tx`
Date Completed .... e{�..........19
PERMIT REFUSED
................................................................. 19
r +// , !rf _ �� ^_ x
. .......................I.............. .....................................
........................................;....................................
...............
......................... ......................................................
Approved .................................................. 19
.............................................................................
............................................................................
(�J43
IN E
TOWN OF BARNSTABLE
2639.
M 1�' BULDING INSPECTOR '
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Name of Architect J
Diagram of Lot and Building with Dimensions Fee ............ ...............
SUBJECT TO APPROVAL OF BOARD OF HEALTH
�
| hereby agree. to conform to all the Rules and Regulations of the,Town of *Barnstable regarding the above
construction. '
Nome .......;�..:�?���===��..��:-- .
. ^~�
XX
Tellegen-Ferrone Associates A=193-85'
18576 1 1/2 story,
6N 0 ................. Permit for ....................................
single...family...dwelling
.. .. . . ............. ..........................................
t.�Ljah Road
Location �.p........... ................................
............................Center ille...............................
Owner . TpllegenXferrone Associates
....... ....... .. ..........................................
Type of Construction ...........f.TATP.......... .........
..................................... . .... ....... .........
Plot ............................ Lot .........
�A
...A g
Permit Granted ... ....................................19
t 10 76 a
s
.... .........................19 Lw
uz
Date of Inspection
Date Completed .... .........................I.......19
IRMIT REFUSED
........................... .................................... 19
.........................1.....................................................
. .............................. ........................................................
. ...... .
...............................................................................
Approved ..............................A. ............... 19
CJ
. .........
......... 44P
...... ..................................................
Bid/Dept.
`"200 Main U.S.POSTAGE>>PITNEY BOWES
Hyannis, Ma. 02601 i�mG
= ZIP 02601 $ 000.450
02 1 VV
0001.3614.75 DEC. 12. 2012,
John Tirronen
t ' 200 Atlantic Ave.
Leominster, Ma 01.453 _
_ .ETURN TO SENDER _
N V T ii i i..: L:AB=i ='A`a a-ay.'rr°ii�a 3'�v
t� 1:1'.i N.l -L L. E
�� Vrap�A U/�qh F.�. r. ✓�, ��� n6.,7 11 93t@@itii9t 4�,$4 i•9!€9€ ii4 3s.i3tdA
Y
€, i€iF.
Town of Barnstable
Regulatory Services
�FfHE Thomas F.Geiler,Director
Building Division
BAMSPABLE, : Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
�prFD MA'S A
Office: 508-862-4038 Fax: 508-790-6230
December 12, 2012
John Tirronen
200-Atlantic Ave-. - --- --
Leominster, Ma. 01453
RE: 171 Cap'n Lijah's Rd., Centerville, Map: 193Parcel: 085
Dear Mr. Tirronen:
A review of our records, including the permitting history of the property, indicates that
the above referenced address has an open building permit without the required
inspections. Permit application number 201001164 was issued on or about April 1, 2010
to construct a three season room addition and to date has not had the required inspections
(building and electric). In fact, an electric permit for the project has not been issued by
this office. Please contact this office immediately to arrange to bring the property into
compliance and arrange the required inspections. Thank you for your immediate attention
in this matter.
Respectfully,
WrLoLauzon
Local Inspector
Jeffrey.lauzongtown.barnstable.ma.us
(508) 862-4034