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Home My WebLink About0834 SHOOTFLYING HILL RD `� > � � .. ._ r .,. ,. .. a .,— ,. �, . �., -, .. ., ,h. �. f _ .., o - E • PROJECT ' - •NAME: ADDRESS: PERMIT#: .. d� � `f PERMIT DATE: I _I �wl. LARGE ROLLED PLANS ARE IN: Boo- � Data entered in 1VIA1'S pprogram on: -- q .T files/forms/arc]iive:. r. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4 Map 1l::1 a Parcel O I A lication Pp Health Division - 'Date Issued Conservation Division Application Feiolf Planning Dept. Permit Fee Cod Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 83� S H �� 1� ►y C� 1-� �-�- 'P. Village �_s✓1�"T�Ry ��-�-� Owner CDrZ_Z_C� Address 'RrD Telephone C'1�u Z 3 a C0(0 3 Permit Request � �h1C� 2►�-1C�� I.�TU 1J�f.�,� C`�lY��-f Z � C�ppw-� EA..-D cAZZ)\N13OWS 4 S to i eJ C� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District T- - 1 Flood Plain OUT' s,o r- Groundwater Overlay Project Valuation`s (o K Construction Type eRErrinOIE-L Lot Size . 68 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Iq (,o I Historic House: ❑Yes ❑ No On Old Kings-Highway: I Yes `❑ No Basement Type: Full ❑ Crawl 4Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.f '"'I�o` 'j Number of Baths: Full: existing_ new I Half: existing O 1 new _ Number of Bedrooms: 3 existingoL new .TM Total-Room Count (not including baths): existing -1 new First Floor Room Count Heat Type and Fuel: $Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes P(No Fireplaces: Existing I New C—_ Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board ofrAppeals Authorization ❑ Appeal # Recorded ❑ 'S Commercial ❑Yes 4 No If yes, site plan review# Current Use �Ry3►Or_wm i=t_ E Proposed Use 2MI>D A rr.�rP1A_ � APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name GRa^.G ncsi _ Telephone Number(i-IL-D 238 "C)(0403 Address 63u 5tiQC F� tw& H►i-t. 2n License # CEr�tt�QV►ter Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Sl�4ND._ , 1CH SIGNATURE DATE 6 ,r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION fie' ItJ t-4f l z-4Ub S Jot— FRAME � I1. INSULATION W FIREPLACE r - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL w GAS: ROUGH FINAL FINAL BUILDING ii- DATE CLOSED OUT ASSOCIATION PLAN NO. AWC Guide to Wood Construction in High Wind Areas:11O'mph Wind Zone r Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 Check Compliance 1.1 SCOPE ✓ Wind Speed(3-sec.gust).................................................................. ................................................ 110 mph WindExposure Category............................................,..................... ..............................................................B 7- 1.2 APPLICABILITY / Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story). 1 stories 5 2 stories Roof Pitch ................. ......................................(Fig 2) ... s 12:12 Mean Roof Height .... .. ....... ...............................:.......(Fig 2)............ . .............14 ft <_33' BuildingWidth,W ....................................................:...........(Fig 3).......'...:............:...:.................... ft 5 80' Building Length, L........:.......................::.:...........................(Fig 3)............,..:...............:................^ ft :580' Building Aspect Ratio(LM/) .........2....................................(Fig 4)................................................— :53:1 Nominal Height of Tallest Opening .....................:.............(Fig 4).......................... <6'8" 1.3 FRAMING CONNECTIONS . General compliance with framing connections....................(Table 2).............:................................................. IL 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 / Concrete............................................................................................................................... ConcreteMasonry.................................................................... .......:..:.................................................... 2.2 ANCHORAGE TO FOUNDATION'3 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general ...........................................(Table 4)............................................... 3 in. Bolt Spacing from endfjoint of plate.............................(Fig 5)..... ..............................Lo-III in.5 6"-12" ° Bolt Embedment-concrete.........................................(Fig 5)............................................... -1 in.a 7" Bolt Embedment=masonry.........................................(Fig 5)............................................ in.a 15" Plate Washer....:........::.................................................(Fig 5)................................ ..............a 3"x 3"x'/" 3.1 FLOORS I Floor framing memberspans checked ...............................(per 780 CMR Chapter 55 ...................... ✓ Maximum Floor Opening Dimension...................................(Fig 6)..................................................Q ft<_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)...........................:....................... 0 ft <_d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8)...................................................Q ft <_d FloorBracing at Endwalls....................................................(Fig 9)................................................................... Floor Sheathing Thickness .................................................(per 780 CMR Chapter 55)......................$-!i-in. Floor Sheathing Fastening..........:..................................:....(Table 2)..a d nails at in edge in field 4.1 WALLS Wall Height Loadbearing walls.........................................................(Fig 10 and Table 5)............:........... 'q ft 5 10' Non-Loadbearing walls .....................(Fig 10 and Table 5) ......-9ft <_20' Wall Stud Spacing .....................(Fig 10 and Table 5) I W in.5 24"o.c. :rz Wall Stor y Offsets .. . .:...... ... ...........................(Figs 7&8)............................................2=felt s d 4.2 EXTERIOR WALLS3 Wood Studs Loadbearing walls.....................:..................................(Table 5)..............................2x -_ft_in. Non-Loadbearing walls................................................(Table 5) ............................2x_-_It_in. Gable End Wall Bracing' Full Height Endwall Studs............................................(Fig 10)................................................................. 71, WSP Attic Floor Length................................................(Fig 11).............................................9_It>_W/3 Gypsum Ceiling Length(if WSP not used)...................(Fig 11)...........................................Q--ft>_0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. .. (Fig 11)... ......................................................... or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length ........................................................(Fig 13 and Table 6).................................... ft Splice Connection(no.of 16d common nails)..............(Table 6).....................::.........:........................>� AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone '. Massachusetts Checklist for'Compliance(780 CMR 5301.2.1.1)1 Loadbearing Wall Connections .f Lateral(no.of 16d common nails)......................... (T ) / Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ........................................................(Table 9).................................. 3 ft d in.<11' Sill Plate Spans .........................................................(Table 9).................................. S ft G in.<_1 ' Full Height Studs (no.of studs)....................................(Table 9)....................................................... Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans... ................................. (Table 9)..................................S ft 0 in.512' 7y/, . Sill Plate Spans.. .......................................................(Table 9) ................ 3 ft 7-in._12" Full Height Studs.(no.of studs).....................................(Table 9)........................................................ Exterior Wall Sheathing to Resist Uplift and Shear Simultaneous,y" Minimum Building Dimension,W / Nominal Height of Tallest Opening2 .... ...:..... :.... ..::................. ,..,.....:.l 6'8" Type .......................(note 4).:................................... -Sheathing T e................:...... ................ � Edge Nail Spacing.........................................(Table 10 or note 4 if less)........................ 1�in: . Field Nail Spacing ......... able 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"(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest Opening2..............,.........................................................1 6W Sheathing Type..............................................(note 4)........................:............................1% Edge Nail Spacing.....................................`....(fable 11 or note 4 if less)......................... ' in.. Field Nail Spacing.................... .......:. .........(Table 11)................................................. in. Shear Connection(no.of 16d common nails)(Table 11)............................................... ..... Percent Full-Height Sheathing.......................(Table 11)....................................................._% 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts).................... / Wall Cladding / Ratedfor Wind Speed?.............................................................. ................................................................ 5.1 ROOFS u Roof framing member spans checked?.....................::.(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19) .............['�_ft<_smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift. ............ (Table 12)...................... ..... U=.iI Of Lateral..............................................(Table 12).............................................L=�pf Shear.:...:....... ...........(Table 12)..........:........... S= plf Ridge Strap Connections,if collar ties not used per page 21... (Table 13).............. .............:.T=-tV plf Gable Rake Outlooker..................::.. (Figure 20 ft_<smaller,of 2'or U2 ( 9 ) ..:.......... Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift........................................:'.......(Table 14)...........................................;U= Ib. Lateral(no.of 16d common nails)...(Table 14).......................: — Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59) .......:.... Roof Sheathing Thickness.....................:................:.... .........:..................................._in.>_7/16" SP Roof Sheathing Fastening............................................(Table 2)..................................... .. Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. - r ro t� ZZ t,A � IT- VA.-FI � fig Town of Barnstable oFt�E Regulatory Services Richard V. Scali,Director . IAMSPABLE. ; ` Building Division BARNSTAB11 9� 639, �� Thomas Perry, CBO OARNSTAB E•RN E0.V E•9 N•HANM115 MIFSIOIiS MII15-OSTERVItIF•ME51 MiNSTA&E 1 0 1639-2014 Ar�ON`°�p Building Commissioner �Dg 200 Main Street, Hyannis, MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 August 20, 2015 Greg Myette 834 Shootflying Hill Rd. Centerville, Ma. 02632 RE: 834 Shootflying Hill Rd., Centerville,Map: 192 Parcel: 041 Dear Mr. Myette, This letter is in response to application number 201504439 submitted to do alterations at the above referenced address. Unfortunately, the application can not be approved at this time for the following reason(s): 1) Construction documents submitted are incomplete and do not include floor plans for the entire house. 2) Certified plot plan demonstrating compliance with setbacks not submitted. Please do not hesitate to contact this office with any questions. L . Respectfully, L. La on Local Inspector jeffrey.lauzon@town.barnstable.ma.us (508) 862-4034 ,, � . l T7ze Comrazonweakh of-Wassachusetfs D,eparhfre7zt erf 1ndusshza1 Acdderds Of re o Imwsti ations 600 Washuzgton Street Boston,?CIA 02111 wim masmg.ovIdin Workers' Campensatian Insurance Affidavit:Btdlders Cuntractors/Electr ians/Plumbers Applicant Infarmatian Please Print Legibly Name(Briiaes&Kkganimion&dividad)= ,f .r Q� Address: S`3 LJ SIWTF�I.YitJ Ri r��I-TTG-'0 Vl t t Z_ City/State/Zip Phone Are you an employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 6. ❑New construction 1.El I am a employes with � ' employees(full andfor part-time)-* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- Tilted on the attached sheet. I ❑Remodeling ship and have no employees. These sub-contractors have g.,❑Demolition working for me in any c employees and hate workers' s 9. ❑Building addition [N4 w rkem'Camp.insurance comp.Msuranrt�0 required] 5. ❑ We area corporation and its a 100.❑Electrical repairs,or additions 3.❑ I am.a homeoumer doing all work officers have exercised their I L❑Plumbing repairs or additions myself[No workers'camp- right of exemption per MGL 12.❑Roof repairs fin anre required.]i' c.152, §1(4�and we have no employees.[No workers' 13.El Other camp.insurance required-] ' *Any a"Bc=r&at cbecksbos#1 must also flloutthe section below showing diei wmkere compensatioupoEryintrma an- I F onteovnm s who submit ibis affid wit=&txtmg they are doing off woo}and then bine outside contractors mast submit anew of idavk indicating sudL fContmctors that cbedt this boar mast attached sa additi ad sheet shoning the name of the sub-comers mss and state whether or not those entities have employees.Ifthesulrcont=,m.sshaveempleyw%dLey=ntpmui&dLdr workers'rnmp.palicynumber. I am an empIoyvr that isprnzrif ag workers'compensaden irmirance•for my empinyees Below is the policy acid jab site information. Insurance Company Name: Policy 4, or Self-ins..Lic.#: Expiration Date: Job Site Address: City/Statmaip: Attach a copy of the workers'compeusationpolicy declaration page(showing the policy number and respiration date). Failure to secure coverage as required udder Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to S 1,500:00 andlor one-year imprisonment,as vweTl as civil penakies.in the form of a STOP WORK ORDER and a Eke of up to$250-00 a day against the violator. Be advised that a copy ofthis statement maybe forwarded to the Office of Imrestigations.of the DIA for insurance coverage yerification- - .I ti`o here tc�&Wfjr �eppdn�s�ai panah!ies ofpadujy thatthe info n n a&n pratitW abm,s is hue and correct Sitmature:- c Date: / 1 b Phoned t),,ic d use only. Do not mite in this area,to be coinpteted by taty ortown ofjrciat City or Town: PermitMkense# , Issuing Authority(tdrde one): 1.Board of Health 2.Building Department 3.Citfirown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: ' laformation and Insfrucfians Massachuserts Geheral Laws chapirr 152 rtgaires all employers to provide workers'compensation for their employees. PMsuMt-to this statabt,an elrpiayee is defined as."-.every person in the service of another under any contract ofhire, express or hnplied,oral or wrfttmm.." An employer is defined as"an individual,partnership,assocdat i6n,corporation or other Iegal 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 ofthe - dvFdH g house of another who employs persons to do maintenance,construction or repair work on such dwelling house to or on:the grounds or building appurEenazrt thereto shall not because of such to be an employer." employment be deemed p MGL chapter 152,§25C(6)also states that"every stag or local licensing agency shall withhold the issuance or renewal of a ficeuse 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 requio-ed_" Additionally,MGL chapter 152, §25C(7)states'Neither the commonwealth nor any of its political subdivisions shall meter into any contract for the performance ofpublic work until acceptable evidence of compliance with the hisuran ce. requiremeri s of this chapter have Been presented to the contracting authozityf Applicants Please fill out the workers'compensation affidavit completely,by checl®.g tb a boxes that apply to your situation and,if necessary,supply sob-contractor(s)name(s), addresses)and phone numbers)along with their certificates)of h c rance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not requm ed to carry workers'compensation iasorance. If an LLC or LLP does have employees,a policy is required- 13e advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of7nmn-noe coverage. Also be sure to sign and date-the affidavit The affidavit should be retumed to the city or town that the application for the permit or license is being requested,not the Depar in.eat of Tnrin strial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' comnpematiou 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 f _ Please be sure that the affidavit is complete and prinfbd.legibly_ The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Invesfigations has to contact you regarding the applicant Please be sure to fill in the peunitlliceme number which will be used as a rerference number. In addition, an applicant that must submit multiple pemmWhcense applications in any given year,need only submit one affidavit indicating current policy inffmrmation(if necessary)and under"Job Site Address"the applicant should write"all locations is (city or town)_"A copy of the affidavit that has been.officially stamped or mam$ed by the city or town may be provided to the applicant as proof that a valid affidavit is ou file for future pmrmiis 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 (ie. a dog license or permit to born leaves etc.)said person is NOT rrxpmred to complete this affidavit The Of of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitait to givers a call The Depaifinenfs address,telephone and fax number_ ' f�au�.2an�attt�of I1�1a�acl�u�tls - _ � - . Ilepat�ment 4f 1adial Acci�onts f�it�e ref ut.� g�tio� , . E.ostau�MA G2111 T(,-1,4 617'27-49GO cot 06 or 1--9 MA.SSAFE Fax#617-727 7M Revised4-24-07 .mas,5-ga fdia I 50 2l� tS OWNL40 < e,1�4i io% o IE t7� l (c e� I _ _ . . �fJ#B� �.�-ems • .Hastai;,.A f2M ' �rr rs� paftF�srtta� a EE" ��,�lPFn,N Irrfa n Pfemle irlid Name - - --"�+o v A z S Address' N N A v 5 C- s , Ci*fsfatr�:S►A iv P W.l 61 50�g 3(0 7 - F 79 -7 Are yen an mu*yer7 Cawk t m s ziafa h= T�Pe of pz-.Cqect CxEquhmi)= etnplaycr wift - ❑ eaarplDyees{�11,andlDfpat��# haL�hti�t�e�. ❑ I am a soTe.prapximtz}r orpartatr- Ii stad an the Atac$ed s 7- � g ship mid bate na employ=s lt� 9- ❑DemaabiL Working for mE in any elnp; gees and bay wow' Q ❑ addi£iuu [Na ' Damp.jns � k=rmml 5. ❑ tie are a carparafianci ifs I4� Iectriral sEgans at additions 3-❑ I am a hom-aa e doing alI wont . of ffi s base earscised their 1 =pE:im ar ad[Fdions mlyme [NQ wad='mmF- zi4�afem=apfim per MGL no Rmufnqmas irtsrx�nr� 1-( r-15 1(4,aadw5 h nm IIB ''dap�P�the rheas bcs�I mnst alm fib.wtth`set.•tinn hc7m2'shaam�th�s-�esT mmn�tinapciTs3-ui�a¢� # zn�+s u'��Y:3ris c�d.Y;,ilac�iah`bEy:.�damg.:IIZ:�^_'i tL+1++2 oarisitT=coratetaas�st snhc�t a arc r.�d.•�mmrs*�surli ` �s Est��t3ri=_bmcmast sttsdsed ra:a,r;r;,,,,t� themeof ffie•ems�stateu9tetf�ncncufl�se�ffies5a-� et�tuy�s_ Ifthe art•+�rtr,R h.«emnTa -&they gmvide*Ar wCi3,� [aMp_pUFU:y m�bes ri urt�rz dnptx ihatisgrfrsRdir frorkers'c-at inu rrzRir¢at a far My ear�slny�ss �dotF is fhepu�ar��o6 sits or-St-ins Lt�f- (J L 7 .Q Z-- t;flz<z LE O bb Bch z.,-py of the vmrk miu:p==ti m paUL declzrstian Fes-( Q ffi=POB--Y mmff:,er sad you date-)-, Fa-7u-to sect cage as rmpirrslunder Secfim25A of MOM c- L52 can lead to the impasiii=of cami A pex,,jjir,of a fz cup to ALSO[}OD anUcx-tmL-yearimpaisomnx=t as-w,2 ar,j a p-7H in tfe frxin of a SMF WORK ORDFE$-ands:E,, cf up.to S250-00 a dsy agaiast fac viakbi- Be atfv d fad a copy of ffiis May be fr}t�tts$te Offine of Lions of the DIA€r�r insaraue-�cage�cafi�_ - .I�•��s�crr�fF r fitspttius�rn�peani#.ras r��rer�urp Srr3t$te u�t�r•ztrrriiira pramdsd alxi�e is k�ra tmtL av�'srt • , II a • �cz��a rxn� .Urr tteiF t�rifiri��iis areas far 5s ca�7r#�d b�ca�rzF fn�n u�ciaL � - • tay or Tow :r esssc L 13aard of$ea$ii 2 $ ngDTj�3.tit{FtxsErc arrk 4Tle zical ecta S.Pftnzdzin Nectar 5Cxhr-r ,acoRO' CERTIFICATE OF LIABILITY INSURANCE DATE 0 7/1612 0 1 Y) /2015JMMIDDIY 5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: (508)888-0207 Fax: (508)888-0550 - CONTACT- ryJo'Ma Anderson _ ALMEIDA 8r CARLSON INSURANCE AGENCY INC. aHonEiE_)) .888-0207 _Ijac Nol: , 888-0550 . _(A/C No Exl__508 ' _ (508)--_.- P.O.BOX 719 E-MAIL SANDWICH MA 02563 ADDRESS: manderson@almeidacarlson.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A :Travelers Casualty Insurance Company of Americ 119046 INSURED INSURER DALY suRER 6 :Travelers Indemnity Company Of Connecticut 25682 14 NAUSET STREET INSURER C• SANDWICH MA 02563 INSURERD: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 30863 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD'L�.SUBRI POLICY EFF POLICY XP LIMITS E LT LTR i —.INSR wvD I- POLICY NUMBER �—_(MMloonv�rv)_--(Mrnloonvrr)� A GENERAL LIABILITY 6803A618046 06/30/15 06/30/16 I EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY _• PREMISES(Ea occurence) '$ _ 300,000 CLAIMS-MADE �_X f OCCUR - MED.EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 1 GENERAL AGGREGATE $ 2,000,000 IGEN'L AGGREGATE LIMIT APPLIES PER: c PRODUCTS COMPIOP.AGG $ 2,000,000 I~I "- PRO- -- •_--- — _.._..L._i_POLICV`-.-- t_JECT�. I LOC I---- ---- -- $ - --- AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT--. (Ea accident) $ t ANY AUTO i - .I�I BODILY INJURY(Per person) $ ALL OWNED SCHEDULED - •BODILY INJURY(Per accident),I $ __1AUTOS AUTOS _ HIRED AUTOS NON-OWNED - - I PROPERTY DAMAGE $ AUTOS (peraccident) UMBRELLA LIAB r OCCUR - EACH OCCURRENCE — $ _IExcess LIAR I CLAIMS-MADE AGGREGATE $ IDED i 'IRETENTION$ - __ _ $ B I q S IMITTU. OTH WORKERS COMPENSATION U83A775482�� I O6/30/15 06/30/16 jOR LIMITS ER $ — AND EMPLOYERS' LIABILITY YIN EACH ACCIDENT I $ 100,000I .ANY PROPRIETOR/PARTNER/EXECUTIVE IN _ OFFICER/MEMBER EXCLUDED? I •1 NIA E.L.DISEASE-EA EMPLOYE $ 100,000 '(Mandatory in NH) -•---I I —_— If yes,describe under DESCRIPTION OF OPERATIONS below _ i.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) T CERTIFICATE HOLDER CANCELLATION - I . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Myette Masonry 8r Design,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 524 ACCORDANCE WITH THE POLICY PROVISIONS. West Barnstable,MA 02668 AUTHOR12E0 REPRESENTATIVE V� Attention: myettemasonry@aol.com — vu — Maryjo Anderson ACORD 25(2010105) @ 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 'town Ot-Barnstabie Regulatory Services J ` `oF Richard V.Scab,Director f Building bivWon " r Tom Perry,Building Commissioner 16. 200 Main Street Hyannis,MA 02601 f wvO town barns(able mans Office: 508-862-4038 Fax: 508-790-6230 HOMIiOWM MEM EXEMMON DATE:W��/ l3�,015 .' �1PieasePtinE<< '' JOB LOCAIIOAL• t�3N � ILL.S}-�fF 1v Ny N t R� C�errE.AV F numbs sheet vMBP came _ home phone# wo phone 0 CURRENT MAUING ADDRESS 7— city/town state ap code The current exemption for"homeowners"was extended to include owner-occupied dwellings of sir 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 superyisor- DES~Y MON OFH014MWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which their:is,or is intended to be,a one or two- family dwelling,aft e-hed or detached structures accessory to such use and/or farm structm-es. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such`hameownm"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be meonsible for all such work performed under the bmiding permit (Section 109.1.1) The undersigned"homeowner"assames iesponsilility 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 ofBainstable Building Department minimum inspection ' Pro and requirements and that helshe will comply with said procedures and requirements. Sigaatnte a meowncr ApFaval 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 HOMEOWMMIS EMAMON The Code states that: "Any homeowner.performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor _. (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often_ results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is c ultimately responsible. To ensure that the homeowner is My 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 Lune is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q3VPMEMRMS1bm7dmg pmmk h=UDa RESS.doe Revised 061313 Town of Barnstable r Regulatory Services F ' AJW ` Richard V.Scab,Director xe� Buffffi D"itiII Tom Petry,Bmldi ng Commissioner 200 Main Stems Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 property Owner Nlus't Complete and Sign.This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behal� in all matters relative to worst authorized bytbis building permit application for. (Address of job) *Pool fences and alarms are the responsibE7of the applicant.Pools = are not to be filled or utgized before fence is installed and all"final inspections are performed and accepted Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:owNMHRMl MIe00I S i• `�' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �t Map 1q o� Parcel �I I Application # 2 G 15_ Health Division Date Issued L30 It5 Conservation Division Application Fee.9 106. b D Planning Dept. Permit Fee Me , q-0 Date Definitive Plan Approved by Planning Board {� Historic - OKH _ Preservation/ Hyannis Project Street Address e_23 1 5�-+p=t'—Lt /t r`►C—p H\L_L. Village \o -E: Owner G/RE G Mye' IT Address !SHQC51_F ,/qaG L,L Rp Telephone Permit Request 'D�`�Ct--��U 28 �c 2 L4 C AF—A 61 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 134y FT Project Valuation'i$3" ,000 Construction Type Lot Size • Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout Other 31 to F� Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new O Half: existing new S) Number of Bedrooms: existing 0 new Total Room Count (not including baths): existing new 1 First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes 0 No Fireplaces: Existing New Existing wood/coal stove: ❑Yes No Detached ❑ existing `garage: g new size— ❑ existing ❑ new size _ Barn: ❑'existing ❑-new ,size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: =F . Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ W Commercial ❑Yes (X No If yes, site plan review# Current Use Proposed Use '4_R50F,4>glr APPLICANT INFORMATION - -- (BUILDER OR HOMEOWNER) Name (Z)RFc, Telephone Number(!-19 )Z 3F, "G 40(03 Address 8y� <`3�Oc�TFl_ytwC� I-tiLL RO License # C E ARV IL_L-r— Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO N RLx ' SigN SIGNATURE DATE b� FOR OFFICIAL USE ONLY 4 APPLICATION# N DATE ISSUED MAP/PARCEL NO. ' I ADDRESS VILLAGE E, OWNER t DATE OF INSPECTION: FOUNDATION JJ FRAME LY ZSII6 INSULATION .} FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL A� GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. �_ ; ; . Town of Barnstable Regulatory Services aka Richard V.Scali,Interim Director $ Building Division BARMAJIM ' Tom Perry,Building Commissioner MASS. �� 200 Main Street, Hyarinis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:juI y yn,a t71g JOB LOCATION: Q13`-1 S H CC3T7F'1 ► WZ 14%L.t_ R n C�.EtV Tt IRV►LLE number street village "HOMEOWNER": C7 RXCG MV C TJE (1"1 y3?_3 A -q(o CO3 name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department mini pection procedures and requirements and that he/she will comply with said procedures and re firemen Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. AWC Guide to Wood Construction in High Wind Areas:I10 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 0 Check Compliance 1.1 SCOPE ✓ Wind Speed(3-sec.gust).......................................:.......................... ............. ................................... 110 mph �— WindExposure Category.................................................................. ......:......................................................B 1.2 APPLICABILITY ✓ Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story)�_stories _<2 stories TRoof Pitch ...........................................................................(Fig 2) ........................................... ?n 12 5 12:12 MeanRoof Height ..............................................................(Fig 2)................................................2N ft 5 33' —�._ BuildingWidth,W ...............................................................(Fig 3)................................................I&ft <_80' i BuildingLength, L...............................................................(Fig 3)..................................................!�ft <_80' V Building Aspect Ratio(L./W) ...............................................(Fig 4)................................................ I.-IS :53:1 Nominal Height of Tallest Opening2 ...................................(Fig 4)................................................ L-S :5 6'8" 1.3 FRAMING CONNECTIONS / General compliance with framing connections....................(Table 2)............................................................... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 t/ Concrete.........................:.................................................................................................... ConcreteMasonry.................................................................... .............................................................. 2.2 ANCHORAGE TO FOUNDATION"' 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general ..........................................(Table 4)............................................... in. Bolt Spacing from endfJoint of plate.............................(Fig 5)....................................V. 12 in.<6"-12" Bolt Embedment-concrete.........................................(Fig 5).............................................. Z in.>7, Bolt Embedment-masonry.........................................(Fig 5)............................................Q in.z 15" PlateWasher................................................................(Fig 5)..............................................>_3"x 3"x'/4" 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55)................................... / Maximum Floor Opening Dimension...................................(Fig 6).................................................�ft:5 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)..................................................4�ft <_d Maximum Cantilevered Floor Joists / Supporting Loadbearing Walls or Shearwall................(Fig 8)...................................................Qft 5 d (/ FloorBracing at Endwalls....................................................(Fig 9)................................................................... Floor Sheathing Type ........................................................(per 780 CMR Chapter 55)................................. Floor Sheathing Thickness .................................................(per 780 CMR Chapter 55)......................,3-in. Floor Sheathing Fastening........................................:.........(Table 2).J�_d nails at <�in edge/[Z_in field 4.1 WALLS Wall Height / Loadbearing walls........................................................(Fig 10 and Table 5)..........................Q�Jl ft <_ 10' Non-Loadbearing walls............................... ...........:.....(Fig 10 and Table 5)........................... -11 ft <_20' Wall Stud Spacing ........................................................(Fig 10 and Table 5)................... I(o in.<_24"o.c. Wall Story Offsets ........................................................(Figs 7&8).........................................."ft 5 d 4.2 EXTERIOR WALLS3 Wood Studs / Loadbearing walls........................................................(Table 5)..............................2x_-2B ft O in. ✓ Non-Loadbearing walls................................................(Table 5)..............................2x_-N:ft 45 in. Gable End Wall Bracing' Full Height Endwall Studs...................................:........(Fig 10)............................................... WSP Attic Floor Length...........................:....................(Fig 11).............................................. ft>_W/3 Gypsum Ceiling Length(if WSP.not used).:.................(Fig 11).:..........................................-0-ft>_0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. .. (Fig 11)............................................................. or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length ........................................................(Fig 13 and Table 6).................:..................8 ft Splice Connection(no.of 16d common nails)..............(Table 6)..................................................... AWC Guide to Wood Construction in High Wind Areas:I10 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 Loadbearing Wall Connections / Lateral(no.of 16d common nails)......:.........................(Tables 7)..................................................... Non-Loadbearing Wall Connections ��11 Lateral(no.of 16d common nails)................................(Table 8)....................................................... -c Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) / Header Spans ........................................................(Table 9)..................................�ft6 in.<-11' Sill Plate Spans ........................................................(Table 9).................................a-ft c t in.<-11' Full Height Studs (no.of studs)....................................(Table 9)....................................................... Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans.............................................................(Table 9).................................. 3 ft in.<-12' Sill Plate Spans...........................................................(Table 9).................................. 3 ft&-in.<-12" Full Height Studs(no.of studs)....................................(Table 9).......................................................e— Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension,W / Nominal Height of Tallest Openingz .............................................................................. 6'8" / SheathingType..............................................(note 4)..................................................... Edge Nail Spacing.........................................(Table 10 or note 4 if less)........................V in. Field Nail Spacing..........................................(Table 10)................................................. in. Shear Connection(no.of 16d common nails)(Table 10)....................................................... Percent Full-Height Sheathing.......................(Table 10)...................................................._% -5%Additional Sheathing for Wall with Opening>.6'8"(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest O enin 2 .......................................... <6'8" SheathingType..............................................(note 4).....................................................UZ Edge Nail Spacing � 9 P 9.........................................(Table 11 or note 4 if less)........................ in. i Field Nail Spacing..........................................(Table 11)................................................. in. Shear Connection(no.of 16d common nails)(Table 11).....:................................................._ Percent Full-Height Sheathing.......................(Table 11)...................................................._% 5%Additional Sheathing for Wall with Opening>6'8°(Design Concepts).................... Wall Cladding Ratedfor Wind Speed?.............................................................. ............................................................... 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...........................................,.......(Figure 19):............CL_ft-<smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls / Proprietary Connectors Uplift................................................(Table 12)............................................U=cZ If Lateral..............................................(Table 12).............................................L=(/eo plf Shear...............................................(Table 12)............................................S. " Of Ridge Strap Connections, if collar ties not used per page 21... (Table 13)...............................T=j%L plf Gable Rake Outlooker..........................................(Figure 20) ............._ft<-smaller of 2'or 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:4lb. Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59) ............ Roof Sheathing Thickness........................................... .............................................l/in.>-7/16"WSP Roof Sheathing Fastening............................................(Table 2)........................................................._ Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110,mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c.' Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner 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. Ile Comrizorrwrealth of 1Vassachusetts Deparfinent cof Indushial Accidents office of lniestigations $ 600 Ffashingfon&treet Boston,-41A 02111 wivty mass govldia "Tarkers' Campensafian Insurance Affidavit:BB.udlder-.lCuntractars/Flecfr cianslPlumhers Applicant Inf6rmatian Please Print Le�iIilY Nr7fYit(aisim mizitioneadivi ufl): naq o•f 11 64.L4 Address- B`� LJ S'l-60TFIfy1li h l-f U-., G L & CiWState(Zip= Mom-- Are Are you an employer?Checkthe appropriate box: ' Type of project(required): I.Q I am a employes vTHth I am a general contractor and I 6. Q New construction employees(full and/or part-time).* 11av a 11ired the sub-contractors 2.Q I am a sole proprietor orpaifner listed on the attached sheet: 7. ❑Remodeling ship and have no employees. These sub-cantrac#ors have g•.Q Demolition wod-ing for 7'Cie in any capacity_ employees and have wot-ers' 9• Building;addition. [No worlaets'camp.insurancecomp-mcitra^tee 1 . required-] 5• ❑ We.are a corporation and its 10.Q Electrical repairs,or additions 3.Q I am.a homeoum-er doing all warlc officers have exercised their IL Q Plumbing repairs or additions set£ o woskus' right of exemption per Pv GL �' � - 12.Q Roof repairs . insrtrancerequiredj i C. 152, §In and we have no Ia s' 13.Q Other employees. camp.insurance required.] 'Anyapplicantthatchecicsboxis1y= also iM out the section below shassing their workers'compensation policy information- Somzoynten who submit dais af6dnTir indicating they are doing all wal and then.hire outude coat maosmast st*nut anew affidavit mdic=ng such.. fConhactors that check This boa must attached as additional sheet showing the name of the sub-contwaGm and state whether or not those entities have employees.I€the anb-contmctors hive employees,they moutpmuidetheir workers'comp.policy number- Iinn an t ttnp£a}�rr final is pro�zding markets'cattperesafionn insziraRca f ar rri}*enrpin} es ffe£osv is the podgy and jah site itnformatiom Insurance Company Nance: Policy 44 or Self-ins_Lic_4 Ekpiration Date: . r Job Site Address: City/StaW2l p: Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and eViration date). Failure to secum coverage as required.under Sw ion 25A of MGL c-152 can lead to the imposition of criminal penalties of a fine up too$U00.0G and/or one-year m4msonmenf,as welt as cMI penahies.im the form of a STOP WORN ORDER and a fine of up to 0.00 a day against the violator. Be adidsed that a copy of this statement maybe farwarded to.the Office of Imtest gaions of the DIA for insurance covers;e verbcation_ I tl`o£seret!_11 un tha pains an penahies of pnr ajy that the ire,fbnna#iairprm fW ahm a is bars and correct Signature:. D ter 7 6 Ile , Phoneme Official use an£J. ,Do etat tvrke in titis area,ter be cvenp£eted by city ortoorn o,fficiat City or Town.: PernutUcense## Issuing Authority(circle one): " L Board of M21th Wding Department 3.�,�Fosen Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 2UtSoWgL4U 6 ewe► 4 • �. lc pf - i ''fix'Worke& CwogaisaficnEmmmm avit:$wlderslcm* ,p�cfrFcza� lP�u�irers �Ir$ar - P� e ' iu Name - :Tl!Z�►^h.i�5 p pr l�u( Address: 11-1 N A v s C`r;, s T -, :.. LiLyfstlt :5►4t tv P W L L" MA 6 Z5�G 3 Pbone;9- 5,0 8 • 36-7 - F7 I -7 :. . Amy=m employer?Cauk m�bas I�a Typeof pEciect cam= L I auz a emplayis ❑ EL ge�ai ct�acfirsrZTeW P��6pP.GT�84�OC..�,•i-i:�..aS ak �'�iLE+�'�E S.. ❑ I.2=a sole grapnafr arparfm fisted as IEm dbrhad shte F_ nX�t� ==d 9ng ffii End h3 m no employs Them sob-- ha-m :g_ ❑nemnaiDa - @To33cing Thr me II7 wy capactT MMplayam fiadf]ave wag1"€' �- ❑ $dddaan 1 5_ ❑ We are a corpou6anan&h; 10-0 RICd1 iMl MpliM ar addifiam 3_❑ I am a hom,. vmer doing au wos3;_ crfirers have C= wed facT 11-0 Phg ntpzcim or addiiians my-cff [No'wDd='=Mp- rsghtafCM=pfidM per&fGL �I 1 aadwe,hme.m . 1�$nafrepam; empIapees.[I�Fa ` *Buy ffipH-at ffi2f che b=01=stalsa fin o f th_sedan b9o-w6=mg ffiPaw�cers'mamea auperf�} E3 iTcb�2'S1n'S u�'7s dare dE'�:9'_�' g:��'^'L.�•^�'� lice Gmtaffe COM=ACE==St Siff aIIfw EIIEd.4vhi-�- 4 \ ZCostonms Est ch�Y thi<box mgst srhsd ca �;n 1T 4t s tb eAaf&� S mm i�na m3stslP cr]�tf�otxar�sges5ac= _ff43�e Suhcasz Iv-�ram7apee,they gmai&&!h7 wad gyp.pDEZY giber- ir�rr au. x rFcictispras g arTseas'�a zg�ssr a iasrtra=fa{t$�+ea�afnyess BelotF Lz$te paw a jefi PoELT:9 cc seff-iw-� U S 3 A-7`7 5'-f.8' f tidal 3Q lob A:Uzch a copy of tEr---Tv=fmr'cox¢peusat xm pv}ir-y decbmafian page-(--tow mg thv pflBzy amaber and tz �Dm, Fame to seat cue as zzndes Secfbn25A ofMM c-I52.ran lead to ffie impos:Bina of"cj-;miiTaI guff=of$ E=ug to$L_ DD QD antVor mL-yeariu m ffie fmin of a STOP WORK ORD:M and a f= c f Bp•fay Q_EIQ a day against the violator- Be advised 1#9 a copy aftbis s maybe wed tff the OffrrP-of Emo=ig�iom of the DIA€nr mow=cage I eta.��p ticspraas�r�pea�rar ufcrp ffiat$te u�vrnzu�iaa,pravu�£aba've is�rind�x� ._. .. _ I _ _ .• 3}ate_ � 1✓ . . sss mbf Do-"t wri bria ffds crei4 to bit=yIeW by cdp ar ftx=ref ci¢I . Cog ar•£a�a; ;r-rare� , L Sward YfHeaft€r 3.Rdiffingl I ta-�{FawuO=k 4I_Fe�fricallasgeckrr �.Pf bin { r a • iao-Dion aixu .R a i a Lj- ut,..t. uka L,. [ eral Laws I52 regr�es aL e�glopers to provide�' 'r�ensation fur ih emplope�s `' fiis sty an=playee is defined as a-ZMY person in the service of 4mother nndcr any conEt-art of hire, express or iimplied, offal or " An an piper is defm ed as inttividrial,par shm,assocrafron,corporation or other legal�fY,or any two or mare the j a decrased employer,-or the of the fi�gning engaged in a Jor�eazil�pzlse,and inr�g legal of. receiver ctr tans of an mff dml,partu=sbip,association or other legal cEW,eurploymg employees H0- ves the owner of a d_wmTmghouse havmg not more than three apartmea:dm and who resides thraeio,br the occupant of the . dwtMag house of another who employs persons to do mice,constuction,or repair work on soda dwc1lin g house or on the grounds or building appuzrbm m thereto shall not btcaust of such eanployment be deemed to be-an enPIoy er." 2,19L d apt rz 152, §25CCt7 also states the¢every state sin or local licensing agency shall witbJioId the issuance or renewal of a .license or permit th operate a business or to construct bUildmgs in the cnrnmonwealth for anp applicant Who has not produced acceptable evidence of cD' liance with the iasura =coverage requu-ed- . AAdki an�,MGL chapter 152,§25C(7)states=Neifherthe commonwealthnor any of itspolitical subdivisions shall enter jntD asp=A art for the performance of pubTrc worir tmtil acceptable evidence of complia;a=wiih the in smtmm rerprir-emeants of tills chapter have been prEsented to the row-��c a�ority' Applicants Please fill out the workers'compensation affidavit completely,by cherlmig the boxes that apply to yc�rr sihlation and,if net escarp, supply sUb-confra�mr(s)name{s), sddr�ss(es)andphone mmmber(s)along with their crr-ducafc�s) of insurance. Limited.Liability Companits CLLC)or LimitEdLiabilrty Partnerships CLU)wfhno employees other than the eusation in srrrance_ If an LLC or LLP does have members or partners,are notrequired to carry workers'comp employees;a policy is requir uL De•advised that this affidavitmay be suhmitted tn'the Departmeazt of Industtial Accidents for confirmation of Tncnrance t ovemg$. Also be sure to sign and date the affidavit The affidavit should be returned tD the city or town that the application for the p= it or lic®se is being requested,not the Department of Industrial'Accidents. Should you have any questions regmRmg the law or you are r�gnsed to obt�;n a v*orkers' compensation:policy,please call the Depm tn=t at the number listed below. Self insored companies should,enter their self-m�=license number on the appropriate line. City or Town Officials Please be slice fiiat t$e affidavit is complete and prigi�b legibly TSe Department has provided a space et the bol a - of'the affidavit for you In fill out is the event the Office ofInvmligatians has to contact you regmTling the applicant Please be side to fit m.the P=h/Jicense number width vM be used as a refeieuce mmnber. In addition,an applicant that must submit multiple peniLWEcense applinafions in any given yem,need only snhmit one affidavit indicxfi og cm:rmt info) nation if n and under'Job Siff$Address"the a' licant should write'all locations in. Ccity or policy ( ecessary) town."A of the affidavit thaf has been officially stamped or marked by the city or town may be provided the SPY . .. applicant as proof that a valid affidavit is on fiat for futnr.pmm:d s or licenses. A-new affidavit must be filled out each year.Where a home owner or citizea .is obtaining a license or permit not related to any business or commercial veniiae i_e.a dog license or pmmif to bnm leaves etc.).said person is NOT required to complete this affidai'it 'Ihe Office of Iavast gaiions would bike to thank you in advance thryour eoopegation.and should you have any.gnestions, lease do not hesitate to ns a call_ p . I� The Depadmenfs address,telephone and fzxnumber- a�f OMMOaW Ia OfMassach Tel..#f I7-727-49-QO Q�±4766 4r I-&77 MASSATE F=4 6I7-727-7745 wised 4-24-07 f ACC CERTIFICATE OF LIABILITY INSURANCE DATE (MMDDYYYY) 07/16/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: (508)888-0207 Fax: (508)888-0550 CONTACT Mary' Anderson ALMEIDA 8 CARLSON INSURANCE AGENCY INC. NAME:PHONE 508 888-0207 FAx 508 888-0550 P.O.BOX 719 A c,No,Ex0_(_) _ I(A C,No): ( ) E-MAIL manderson@almeldacarlson.com SANDWICH MA 02563 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A :Travelers Casualty Insurance Company of Americ 119046 INSURED - -" INSURER Travelers Indemnity Company of Connecticut 25682 THOMAS DALY Y P Y 14 NAUSET STREET INSURER C SANDWICH MA 02563 INSURERD: INSURER E �+ INSURER F COVERAGES CERTIFICATE NUMBER: 30863 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L SUER I POLICY EFF POLICY EXP VTR I_ TYPE OF INSURANCE INSR WVD I ,.POLICY NUMBER -(MMIDD1YYYY)_I_(—nr(YYY)_I_. •- LIMITS A I,GENERAL LIABILITYj �6803A618046 06/30/15 16131116 EACH OCCURRENCE $ 1,000,000 - I X I COMMERCIAL GENERAL LIABILITY t ..DAMAGE TO RENTED 300,000 _ PREMISES(Ea occurence) $ -_I__j CLAIMS-MADE -X I OCCUR ,�. f I MED.EXP(Any one person) $ o 5,000 PERSONAL 8 ADV INJURY I $ * 1,000,000 { GENERAL AGGREGATE $ 2,000,000 EN'L AGGREGATE LIMIT APPLIESPER: PRODUCTS-COMP/OP AGG $ _ 2,000,000 11llhh------- PRO- ---- — =- POLICY��JECT-� LOC _ ��.---- .T_.$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ iL. ANY AUTO BODILY INJURY(Per person) $ j... ALL OWNED SCHEDULED I AUTOS BODILY INJURY(Per accident)I $ IL - AUTOS ' HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS ' (peraccident) $ 1 4 UMBRELLA LIAB T OCCUR EACH OCCURRENCE $ Excess uAe i ;ICLAIMS-MADE . AGGREGATE $ DIED I IRETENTION$ $ . r WORKERS COMPENSATION 06/30/15 - 06/30/16 WC STATU- OTH B `AND EMPLOYERS' LIABILITY UB3A775482 „�, —1 TORV LIMITS II_ER $ j ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $' 1.00,000 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $. 100,000 If yes describe under DESCRIPTION OF OPERATIONS below ,+ E.L.DISEASE-POLICY LIMIT $ 500,060 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - a CERTIFICATE ' HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Myette Masonry 8:Design,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 524 ACCORDANCE WITH THE POLICY PROVISIONS. West Barnstable,MA 02668 AUTHORIZED REPRESENTATIVE Attention: myettemasonry@aol.com Maryjo Anderson ACORD 25(2010/05) @ 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD kh t.i a o `v m c, icy `• O �n1 � Z { V•. � t 1050, `-s AD p 1-k'i OhlUl 4 5 z vNNr Hz BUILDING CODE l ^VZ MA 8th EDITION RESIDENTIAL CODE UP wLANDG` INTERNATIONAL BUILDING CODE-2009 J� _ 5DOOR -0"X6' 3 RISERS" 7:9 RISE 42 X 42 ENERGY CODE INTERNATIONAL BUILDING CODE-2012 U 10'-9$" z STAIRS: 01 W 13 RISERS �> z 3f� CONCRETE SLAB 7.9 RISE w°U S E- • 71. W�wZM W - PITCHED 2" 18'-1 9'-3" NA BACK TO FRONT 3 ®p DOWN 24 — _ w W01 Q „ 3'-0"X 6'-8" DOOR o C w U) CL WO D02 O CL D01 D01 4'-6" O .k 8' RT _5_RT L. _ s 16' Rio.s wrB >- 4 5 G �,rS — 28 } o >mowuj DOOR SCHEDULE (' U) I-- NUMBER1 CITY I FLOOR DESC0.IPTION MFR MODELN w Z DOI 2 1 GARAGEOVERHEAD CLOPAYCOACHMANCOUECTIONL— M w D02 2 1 13/4"X T-0"X 6'.8"ENTRY 9 UTE 0 DO U GROUND LEVEL FLOOR PLAN WINDOW SCHEDULE QTY FLOOR DESCRIPTION EN 40)S RIES RO 1TL��T—DLL d 1 DBLHUNG ANDER6ENaWSERIE51W2636 4 2 2 DBLHUNG ANDERSEN 400SERIFSTW2636 3 2 DBLHUNG ANDERSEN 400SERIES TW3046 3'-21/8"Xd'-878' Z ry Ilk 2B' Ilk HZ Ago — — — — — — — — — — — — Wwz ANCHOR BOLTS J� CORNERS 3-0 DOOR 1'IN FROM , 3,_$„ I I I I _ II iI U Z .. a P.T. 2X6 BOTTOM PLATE oo I w W I I oLL W F of Z�M ' I I • I I N�LL`m! �Nnm W Uutn ai ru. 8"CMU FOUNDATION WALL .4"-5"SLAB I 16"X 10"CONCRETE FOOTING, PITCH 2"DO BACK TO FRONT I MIN 48"BELOW GRADE W TO BOTTOM OF FOOTING < a w o 1'_Y 7" I 0 o I ' . 3-0 DOOR 1_7" I I I 4'-6" � I — 8-0 OVERHEAD 8-0 OVERHEAD— __— 2 _ — — — 8-6 - - - -8.6 - - 56 Z < 2'-3" J LLJ FOUNDATION PLAN o w - t BOTTOM EDGE ROOF RIDGE LINE DORMER RIDGE' � BOARD EGRESS 2x10 CLG JOISTS 16"O.C: QUALIFYING p WINDOWS a w w Z w O Vs O i' I R f` IE Q U Z V W U LL U T-88 a 6 IEJ w 3'-6" � E9 FR / Q (D 3 ` I W10x30 STEEL I BEAM 1" 1'-2" 1 T-7" 18'�2 0 O 3 3-1/2 IN LALLY COLUMN J a T-87" 3-1/2 IN LALLY COLUMN. 6-14 3'-8Z8" o $ - 2xl0 FLOOR JOISTS 8 d @16"O.C. I 9'-118 0 • Q ° O J_ r _ U Q Z � 3-1/2 IN LALLY COLUMN k I. J 24X12 CONCRETE LALLY COLUMN� T� w ~O -� PAD WITH 2-#4 BARS EACH WAY ��J// ;.$ O > TOP AND BOTTOM _ = Lu 0ERSfN i CIJI M LLI 373 (D co U SECTION A a�� AL 4 3 16' ` 911. Z V-72" � VW 12 �Z 4 U N=(� n 7a' / 12 W r✓.11 12 J� DBL 2X10 HEADER , TYP ALL WINDOWS } z w 3. 2X12 RAFTERS 16"O.C.,7_g 4 - z�=� w U^^ w NOTE-STAIRWAY SHALL a E y m HAVE 10 INCH TREADS_ 6" SEE SHEET 5 DETAIL 1 w LL y m m AND 7 INCH RISERS. FOR THIS CONNECTION \ZZ74 < u5 - 2x10 FLOOR JOISTS @ 16"'OC 2.10 FLOOR JOISTS @ 16"OC 23'-718" g . / 52 #1 CLEAR WC SHINGLES - C9 1-2 OVER AMOWRAP, Q � a M�< OVER "OSB C¢9 3 `O 3-0X6-8 ZIP SYSTEM SHEATHING ma Lu El ENTRY 3„ 10'-7-3" Lu DOOR HEADER:. 9'-118 4 0 -7 3 2X10's d 210"WX1'THK 0 o EXTERIOR PLYWD a BETWEEN EA 2X10 O • T_8" 8 Q 'X 8'CLOPAY 0 COMPOSITE HEADER COACHMAN FOR STAIRWAY OPENING COLLECTION -J_ USE 3-2X10BOARDS OVERHEAD = GARAGE DOOR Z Q LLI >- LLl r- LL J 13'-6" LLI F- J 5 112, > O > 24' i". 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LU F- -I ENSURE SPACING DOES NOT >- p > 24' INTERFERE WITH JOISTS. U H 3-1/2"LALLY COLUMN WITH PLATE- � v w SECTION C-C W10x30 STEEL IBEAM WELD PLATE TO I BEAM (9 000 U 24X12 CONCRETE LALLY COLUMN PAD WITH 2-#4 BARS EACH WAY 4°=1�-011 I-BEAM JOIST DETAIL TOP AND BOTTOM (not to scale) . 5 C9 NZ Wry W l J® a w Z 0> S. y T z y o=¢r-mm Ql�o LU 2' 811 1 _ Q C - - O a Q a 9'-118 7-10- 0 $ T-1�" 2- 1 o Za W > LL '_6 " J J� J[_ 1'6" LL 2'-6" '�--- 8' g---'fL -- saw O 28' J*OF uwss p map = u FRONT ELEVATION VIL w CDPBE pa T u _ NO 373 (7 oo C 4 "=1'-0" 6 Z ry WW XZ Ago 12 FF U 2 , W W m z W 74 Z�=� W p0Ou N~K N m V " W Uu_mQQ au ae. 22'-11$" w • O ¢ c� w U) O CL 0 7777777 . . O , -- 10-98 O ¢ r- UJ LEFT SIDE ELEVATION o w 1 n_ n 4�`tx ov w,q4 ' w Iq W S ROBE1 T L. C9 00 U 8ER IL 3 I fOMAL E� Z W wZ Arco J 8" � _ Z K W • W ZW�oi FF w O Vss O i N O S o R \- F W U W Z m n ELW Ell] W U LL N m 8" 26-8" �' w t9 Q Of C7 o w ' O a O J Z Q H J O X REAR ELEVATION \ 11I— 1 11 BERS!N W 4 — —O CIVIL CO U 739 a� R . .. Z XZ w 12. Wo ps¢rmm . 74 - Wa�uS vmi • - LU U 17'-7" 1 w 0 FE O T-102" �. o 3' g" f 5'-112 F w > ui 13'_6" £ w -°t } 0 LU RIGHT SIDE ELEVATION ` e`VIL ssi (D 05 v 373 x 111=1'-011 • 0 • V' Z 13'-4" W MOP- - - - 5'-114" 5'-114' J..-Z - - - - - - ^WZ J� ® 01 FW071I NDG 9' - I 42 X 42 I I Z N W r Woc=ipLL. mo�o� WUWZMc^i . FW01 W 24' WO 3-6 p Y 4'-9-43-" U O - a O 12' I Q - O J W > W 28' UJ J O > OCC ':-;:ate• _ W Faa 2ND FLOOR PLAN- �...- .� ln_11_011 -!> R08ERTL p d W o BER L C7 � V 4 � 3 � d 10MAL 10 Z Wry . „ VW 30-314 Z LINE OF DORMER ROOFwz h=(' WNJ1 LINE OF J® 3 IS R LAr G I GABLE WALL s 7 R E 2 42 ( $ z N �— OFFSET OF o TAIRS: DORMER WALL _ �o °sue 13 RISERS FROM GABLE WALL W U W Z M 7.9 N� Nmm LINE OF =`~mm W U LL N m u� DORMER SIDE WALL w C9 1 LINE OF DORMER ROOF 26'-34„ Q c� 0 w U) O CL O a 3'- 2ND FLR CLG JOISTS 2X10 0 .1 .1 [4 J_ IfF I Q z g U J J ''R BELU RTL C9 <=p F- ROOF FRAMING PLAN '�r BE37 C M w 37 (� c0 („) �gMAI 4 11 Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services ®P IT Thomas F.Geiler,Director Building Division AUG 3 0 2005 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLE 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 Map/parcel Number �� O Property Address 93`i i ✓� �� • inimum fee of$25.00 for work under$6000.00 dResidential Value of Work Owner's Name&Address Contractor's Name �—' Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: VI am a sole proprietor am the Homeowner ❑ I have Worker's Compensation Insurance ra Insurance Company Name C.-, Workman's Comp.Policy Copy of Insurance Compliance Certificate must be on file. N; Permit Request(check box) ^; Re-roof(stripping old shingles) All construction debris will be taken to cr,❑Re-roof(not stripping. Going over existing layers of roof) � dRe-side Q/Replacement Windows. U-Value (maximum.44 *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. SIGNAT Q:Forms:expmtrg Revise071405 The Commonwealth of Massachusetts Department of Industrial Accidents N. Office.of Investigations a 600 Washington Street Boston,MI 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): Address: City/State/Zip: UJ4fkVU W2, A- Phone#:' �.. 9 Are you an employer? Check the-appropriate box:. Type of project(required):- 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I 6 ❑New construction employees (full'and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed'on the attached sheet $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. g• ❑ Building addition [No workers' comp.insurance 5. ❑.We are a corporation and its equired] officers have exercised their 10.❑ Electrical repairs or.additions 3. I am a homeowner doing all work right of exemption per MGL VIRR umbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have nQ12. oof repairs insurance required.]t employees. [No workers 13.�Other S -6)C} camp.insurance required.] Any applicant tbat checks box#1 must also fill out the section below showing their workers'compensation policy information: Homeowners who submit this affidavit indicating they are doing all-work and then hire outside contractors must submit anew affidavit indicating suck Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp:policy information. am an employer that is providing workers compensation insurance for my employees.'Below is the policy and job site, nformation. - :nsurance Company Name: ?olicy#or Self-ins.Lic.#: Expiration Date:- rob Site Address: City/State/Zip: Utach 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,SOO,.OU and/or one-year imprisonment, as well as civil penalties in the form of a STOP-WORK ORDER and aline )f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to.the Office of . [nvestigations of the DIA for insurance coverage verification. i do hereby certify under tf pains and penalties of penury that the information provided above istrue and correct Signa Date: ko Phone#: J `U Q ` @ 71 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#: Op THE Tp� Town of Barnstable Regulatory Services anvsTnsne. : Thomas F.Geiler,Director ,�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �j Please Print DATE: �� w JOB LOCATION: (/� JV '4" '-� 1 "Vn k( e'—d- nnumber streetQ village "HOMEOWNER"-. ALQ-n n-kkf5J �+ I name home phone# work phone# CURRENT MAILING ADDRESS: ,1 ,I d-CJ� I l�-t lle-r city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be. responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. ature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 169.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt 209.72' w . 00 LOT AREA 58.8 38,679 Sq. Feet EXIST: GARAGE y O O _ Q0 co .. .. .. CD .cl co .° . .: .. .. V • N : o EXISTING SEPTIC c ° FROM AS BUILT °� EXISTING DWELLING CARD DATED r---1 2-13-2004. ° .I . ° i ® 1� 9 !-- w 183.30' DCE #16-114 EXISTING BUILDINGS PLOT PLAN 834 SHOOTFLYING HILL ROAD PREPARED :FOR: LOCATION CENTERVILLE, MASS. GREG MYETTE SCALE 1» _ 30' DATE APRIL 19, 2016 REFERENCE E : ASSESS. MAP 192 PCL. 41 HEREBY CERTIFY THAT THE STRUCTURES SHOWN ON THIS PLAN ARE LOCATED ON THE GROUND AS SHOWN. HEREON: �TH OF M,gssgc off 508-362-4541 o? DANIEL. . tiG� fax 508.362-9880 . o q m� OJALA NG � FM .,� , do wn cope en gln eerin g, Inc. ` CIVIL ENGINEERS R� LAND SUR VEYORS 0� — I& '1 I 939 Main Street — YARMOUTHPOR.T, MASS. DATE : REG. LAND SURVEYOR