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0149 OXFORD DRIVE
y7 Commonwealth of Massachusetts Sheet Metal Permit Map Parcel Date: 46 Permit 1� Ud Estimated Job Cost: $ 1 00 JUL 17��15 Permit Fee: $ Plans Submitted: YES NO a�� Rq RQlam Reviewed: YES NO Business License# Applicant License#_ tck S d Business Information: Property Owner/Job Location Information: Name: 09-S IA l d-U-0— Name: x&! lnlc. &,6A Street; t� i� StreetT9���/�/�w-G� Ok !!� City/Tawn: City/Town:, L, Telephone: 90 B 3 6® .3 7/9 Telephone; Photo I.D.required/Copy of Photo LD. attached: 'YES NO Staff In;iai avM-1-unrestricted license J-2/M-2-restricted o.dwellin s 3-stories or less andcommercial u 10 g ' p to. sq-ft./2-stories or less , Residential: 1-2 family Multi-family Condo/Townhouses Other 3 Commercial: Office Retail Industrial Educational Fire Dept.Approval' Institutional_ Other i Square Footage: under 10,000 sq. ft. V over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: "New Work: Renovation. HVAC L/ Metal Watershed Roofing Kitchen Exhaust;System Metal Chimney/Vents, Air Balancing. Provide detailed description of work,to be done: y i� 4 t t j. i - t i + INSURANCE COVERAGE: I' I have a current jiabill insurance policy or its equivalent which meets the requirements of M.G:L Ch.112 Yes(`No❑ If you have checked XM indicate the-type of coverage by checking the appropriate box below: l A liability insurance policy Other type of indemnity 0 Bond I OWNER'S INSURANCE WAIVER:I am aware.that the licensee does not have the insurance coverage required by Chapter 112 of the 4 Massachusetts General Laws,and that my signature on this permit application Wgiyga this requirement l Check One Only Owner ❑ Agent, Signature of Owner or Owner's Agent By.checking this boxO,I hereby certify that all of the,details and information I have submitted(or entered)regarding this application are true and i accurate to the best of my knowledge and that all sheet metal.work and installations performed under the permit issued for this,application will be s in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to-insulation installation:YES`. NO 4 #Mgrgs Ins ecru Lions. j Date Comments. `nsI'Ins ec�fibn, Date Comments: i Type of License:: 3y []Master r role (]Master-Restricted l ,rty/Town 061/oumeyperson' .Signature of Licensee �. Zermit# ❑Joumeyperson-Resttided License Number =ee S ❑ . Check at www.mass.aoy/dnl r nspecforSignature of Permit Approval t Town of Barnstable i s lZegulatory Services . Thomas F.Geiler,Director s639. � Building Division Tom Oerry,Building Commissioner 200 Main St we Hyannis,MA b2601 wwWaown.barnstable.ma.ns Office: 508-862-4038 Fax: 508-740-6230 Property Owner Must Complete and Sign This Section r If Using A Builder _ as Owner of the subject property hereby authorize PAx / C e- to act on my behalf, in a11.matters relative to work:authorized by this building pemut i Ox- ore( I)r;ve (Address of Job} _. Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before.fence is installed and pools are not to be utilized until all final inspections are performed and accepted. S �of*& Owner �gsrzture-.of Applicant Print Name Print Name Dat Q:F6RMS.0WNERPERMISSi0NP00LS The Commonwealth of Massachusedts Department of Industrial Accidents Off we of Invesfigations, 600 Washington Street Boston,MA 02111 ww .mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le gib Name(Busmessiorowb2tion/Individual):. Address:4 9 141i JRW 44POW City/Sta&Zip: AMW Phone A 5.06 _3f O 3%/ Are you an employer?Check the appropriate box: -Type of project(required): 1.❑ I am a employer with 4• Q I am`a general contractor and I loyees(Ertl$and/or part-time).*, have hired the sub contractors 6. [:]New construction . 2. a'sole proprietor or partner listed on the'attached sheet 7: O'emodeling ship and have no employees These sub-contractors have 8. ❑Demolition worldng for me in any capacity. employees and have workers' 9. ❑Budding addition [No workers'comp-insurance comp.insurance.$ ) S. We are a corporation and its '-0.[1 Electrical`repairs or additions required.3.❑ I am a homeowner doing all work officers have exercised their 1 LE]Pluujbing repairs or additions ` myself[No worketa'.C&ap. right of exemption per MGL 12:Q Roof repairs incnransp rimed,)t c.-152,§1(4),and we have no 13.❑Other employees..[No workers' comp.insurance required.] *Any applicant that ebecks box#1 must also fill out the section below showing their wogs'coropeosalion policy mdnrmatian t Homeowners who submit Ibis affidavit indicating they are doing ale work and Irm hire outside contractors nest submit anew affidavit indicating such. iCont=tors that check this box must attached m additional sheet showing the name of the sub conEactors and state whether or not those aatifies have employees. If the subcantractots have employees,they must provide their warless'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. asurance Company Name: Policy#or Self ins:Lic.# ExpirationDate: Sob 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 chruinal penalties of a fine tip 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 statemeut may be forwarded to the Off ce of Investigations of the DIA for inmance coverage verification. I do hereby ce the pains•and penalties ofperjury that the information provided above is true and correct S e: Date: Phone � d t� officia[use only. Do not write in this area,to be completed by city or town official City or Towne PermitUcense# lssaing Authority(circle one): I .'L.Board of Health,2.Building Department.3.City/Town Clerk 4.Electrical Inspector 5.Plumb Inspector i 6.Other Contact Person:. Phone#::. ,a COMMONWEALTH'OF MgSSACHl1SETt lb o BOARDW SHEET METAL WORKERS 1 SSU:.ES THE f OLLOWi NG L I CeENSE,_.- q5 A .iOURNEIfPI RSQN UNRESTR I'OTED ° o 49 CAPTAIN STANLEY 1 S SOU�HJ Y .RMflI�'ht'MA� 026�4 28"48 1 Assessor's'map and lot number ..................................I.......... 7N E toffy Sewage Permit number ..V.o.6 ...................................... Z BAHHSTADLE, i r House number ......................................................................... r rasa 00,0,i639, ♦� ► ON a` TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........... .t/ELc� ()!V.5 /` ........................................................................... ............ ...... TYPE OF CONSTRUCTION �� rf2/�Yj'�C ..................................................................................................................................... .........�...� ........./.............19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �j� Location ........�`:�?T.�.��..........L'7�'t�p�'c.�........�QIV�...............�o.7;;C1.��::.�f1.....�.�� ��.................. Proposed Use .......r--��^,��........ �� .............................................................................................. Zoning District 7...........................................Fire District ...... U Name of Owner (�F?Q/2�/ w. 6-4�:L V 5 Address �!� 7 d�O VT 1��0�)(� �iv . �C��2J l / ............... ............ .................... ......................................................... S ,- ._ Nameof Builder" �= ...................Address................................................. ..............:..................................................................... Nameof Architect ................... ..........................................Address .................................................................................... Number of Rooms ..............�.�:. .............................................Foundation � t� G �, (704J C. Exterior !. :....Stf/iti� S... .eC / / 1 ............Roofing .........!`� P/ L-r.................................................... f �aA/! R%v� �twY�...................................Interior ...........5�� Floors .................... .. Heating........ ��' 7`/ItC'....................................................Plumbing ................... :�,R. ......s.....may............................. Fireplace ..........C3 .............................................................Approximate Cost ............,.......,.ftG�s...................... q ) 2Cr+ C3'� /.�� /.CLZsiLc/ 7 Area �r Definitive Plan Approved by Planning Board ___________________ j - Diagram of Lot and Building with Dimensions Fee . SUBJECT TO APPROVAL OF BOARD OF HEALTH 11 I 'j 7F7- _ } OD TO /Vc 1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .......................... GALLUS, BARRY W. ✓ A=21-39 r i No .2 3.8 2 9... Permit for ,Two Sto.ry ............... Single. Fami1y...Dwellinc�............... Location ...Lot #20 149 Oxford Dr. ............................................. Cotuit ............................................................................... Owner .....Barry..W.-Gallus. . ..... .. ....................... Type of Construction .....E-KAMe........................ ................................................................................ Plot ............................ Lot ................................ e Permit Granted ..... ....ebruary 19. ........19 8 2 .. .. . Date of Inspection 19 Date Completed ......................................19 I�O V r y J ' l J Assessor's offioe (1st floor): !J �F TN E TO Assessor's map and lot number ................ Board of Health (3rd floor): ` 1, ,Sewage Permit number .........f�. ^- g �`. _ 1; 9AHd9TeDLE, S (..,. Engineering Department (3rd floor): / `°'� - n/ 'o rasa e� House numbedXf h/ y`/ os,�63I \ .....�.�.;.; ...�..... CEO YP�a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00•P.M. only TOWN -OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO Pa p..,C . .. TYPE OF CONSTRUCTION ....... An.C.'.>...n.......F..�R.,.... .............................................................. ..-_..�. )...................19..�r� TO THE INSPECTOR OF BUILDINGS: /) The undersigned hereby applies for a permit according to the following information: Location ..../ © X... ..�� .;��...... .�R. ...........�P.�t.Q .�.�..o:...MA.......................................................... Proposed ..../......... .......... ProposedUse ........PC)...R... ....( ... ..... .C. ...•................................................................................................... s ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner -.. r... ..1.1. .�.. .�..�.� .r.!....Address ..J.+ . �.CLrUI� Name of Builder !.....15./.V Nameof Architect ........ -5 ,/ �... ..............................Address .................................................................................... Number of Rooms ...../�....... rr..(.—.X..r..................................Foundation ..... 1:. .C.? ............................................. Exterior ...6J./?.Lt.,....... ......S.)?-Al.Kr243Raafing .......�. >.��,/�.l...T........................................... Floors ......001.. ................................................................Interior ........��.�1 .. .._ .��. '. ...t:........................ Heating g / ................................................Plumbin Fireplace ..................................................................................Approximate Cost ........... - Definitive Plan Approved by Planning Board _______________________________19_______ . Area .. ?. .. .................. Diagram of Lot and Building with Dimensions Fee .........................©................ SUBJECT TO APPROVAL OF BOARD OF HEALTH v rX � asp OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Construction Supervisor's License ,y... ./....... : rr McCULLOUGH, JACK A=021-039 32792 ADD PORCH & DECK No ................. Permit for .................................... Single Family Dwelling ................................................................. Location .....149 Oxford Drive .................................................... Cotuit ............................................................................... Owner Jack. ...McCullough. . . . . ........................... .. .. .... .. .... ....... .. Type of Construction ....Frame . .......................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ......A.px.il...12............19 89 Date of Inspection ....................................19 Date Completed ......................................19 TOWN OF BARNSTABLE Permit No. --------------------_ Building Inspector ,,.& F Cash ---------------------- -- iml OCCUPANCY PERMIT Bond _.-- Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ......................................................1 19........... .................................................................................................................. Building Inspector A, Assessor's'-map,and lot number ... .................... VNE Sewage Peemit-nAber ..............o6 , , ............................................. 7 SEPTIC SYSTEM MUST I STAXLE, OMPLIANC t 33MIN - wl�Z,7 NAM House number ............. ........................................................... -,-,ANSTALLED IN C ate, WITH TITLE 5 1639- A. CURE AND 0 TOWN OF. :-BA B 11 o i boN is c BUILDING "ANSPECTOR- APPLICATION FOR PERMIT TO• ........... ..................I.......................................................... . ................. ... 'TYPE OF CONSTRUCTION !V On ts..-..;.bel3w.C- ....................I................... ................................. ....................... 7...........19..e:R TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: C-0?-(j /7- Location ......... Fore I VC- ............... ........... ..................... . ..............................................rg ........... . ProposedUse ........ . . . ...... .. . .. ........... ...................................... ..................................................... Zoning District ..............(ef 1 .............7 ............................................Fire District ....... ...................................................... 2 A L Name of Owner ......—..............L...LI....S ..............Address (.(<...AO...... Name of Builder' .................!S A-rk L-� ......................................................... ...................................................Address ........................ Nameof Architect .................................... .............................Address. .................................................................................... Numberof Rooms ...............::.?7............................................Foundation ... ........ . . ........................... Exlerior ...........Roofing ........... ��r................................................... Floors ........0 A K.... V!.A-'.Y.(.................................Interior ............ ............................................................ Heating ..... ..4r;- ............. ... Plumbing ...................N !�R ............................... .................... .. .. .. . ... ... Fireplace ........... ...........................................................Approximate Cost ......... ... ... Definitive Plan Approved by Planning Board 173 . r e ..� ........... 1-7-------------- Diagram of Lot and Building with Dimensions Fee .... ............................ SUBJECT TO APPROVAL- OF BOARD OF HEALTH bD Wo-1 70 01 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable'regarding the above construction.. Name ....JAO ..7. .............e. ........ .. ....................... "GALLUS, SARRY W. 1' 23323 Two Story No ................. Permit for .......................... ...... , Sincrie Family Dwelling............ I Location .Lot. #20 14.9..'Oxford. Dr S .. •e Cotuit ........ ...... .............................. .......... Owner Barry K.....Gallus e '- a -�. ._ � Type.of Construction ......Frame.................................... .........y.............. .................. +� Plot ................. .. Lot.. , Permit Granted ...Februa:`y 19, 19 82 Date of Inspection,5...�e:71�-<.2�.�......a ' .:1 9 -.., Date Completed ......... ,t'_ v ��` 4 � ' .wry •� � +Lr^` ! � • Y -.. r .<^''r-. �I `► r'v, ? SMOKE UETECTORS iEVIEWED _ /P AA :'E3dfLITlNGAEpT. DATE j FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING ,'. i 1 kTr I CI WAIK IN L -5 eP � 4� —r tio..o... 149 (�a Fo2p pa�� 2vD "rt•-oo2 ZW� Z FISM• IBA T" 8+ 14' Z.ovwr NET w J . I �`��✓. ter.• � \ f___ _.._ r _ �F� M ilea' MOF C KIM HA�2 Ti•f Iv9 OXFORD DRiVC G0,U�T lM Jt Ex,er �LoOR D1.-WJ �2 APV~2p 4 na oFt�E, Town of Barnstable 'Permit# _ � Expires 6 months rom issue date Regulatory Services Fee * BARNSTABLE, Richard V.Scali,Director pIFDMA'lA .1m ��� Building Division r�� Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 0.2601 MAY-0 5 2015 www.town.barnstable.ina.us TOWN of 111'CC Office: 508-862-4038 Fax: 50 '63�O/� �BL� EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ©02 0 ?Q Not Valid without Red X-Press Imprint Map/parcel Number f J 7 Property Address d 10i, 1Ji AResidential Value of Work$ 7, 060; Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /V Q v rl Coe 40/, Fft S1 1,n t% SOa Tci U-17779�7 . 114*. d.?;Z86 Contractor's Name 1� Telephone Number 5 �V Home Improvement Contractor License#(if applicable)/2 342C2 Email: Construction Supervisor's License#(if applicable) (��%� ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I 4M the Homeowner have Worker's Compensation Insurance Insurance Company Name;?Vez" Workman's Comp.Policy#7?am 291 19yf �' Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles).All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ®'Replacement Windows/doors/sliders.U-Value 930 (maximum.32)#of windows } #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the a Improvement Contractors License&Construction Supervisors License is .«�. r quired. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRES c ` Revised 040215 _- E CI .Tree Comtrrotinwealtle of rassachimetts _ D4mrtrnfflzt of Indratiial Accide & 600 Washingtan Street - Boston, 02.111 Workers' Compensation Insurance Affidavit: Builders/ ntractorsslF�Iectii nsfP'lumnbers Applicant Inf"mation Please Print Legibly Name(Busine mizan,onllmdiyid,3m): Address=2� g:�N Citytst-a&zip phone A- �/ �?Are you an employer?Check the appropriate box: T! of Project(re quired): 1ramaemployervitf oqq— 4. I am a. contractor and I 6. ❑New construction,employees(fall andfor part-time).* have hired the sub-contactors 2,❑ I am a sole proprietor or parWer- listed on the attached sheet. 7. ❑Modeling ship and have no employees Them sub-contractors have 8. Deniolitic in w far me in an i employees and have workers' or3rt� �'capacity. �. �Building addition [No workers'comp.insurance comp.insura�e_$ 1U�. Electrical cu additions required.] 5- ❑ We axe a corporation and its ❑ repairs 3.❑ I am a homeowner doing all work officers have exercised M 11.❑Plumbing repairs or additions inyself [No workers'comp. right of exemption per MGL 12.❑hoof repairs insurance required.]a c..152, §1(4X and we have no employees- o workers' an Other comp.insurance required.] ;Any appXcW atat ckec s box#1 mast also fill rout the section below showing their wooers'compensation policy infaamati= Homeowners who submit ibis affidaw m&c=1 they axe daring all,-we 8t mil dies hue outside connectors mast snbmtit a new affidavit indicating sudi lCoxtractors that cheek Uns box mast attached an additional sheet showing the name of the sub-coutzacmerrs and state Whether or not those entities hzve employees. Ifthe sib-MMvaetars pace employees, =ustpmvide their workers'romp.policy number. lam an employer that isproviding workers'ca ngmisaiion insurance fair mya enrptoy�em Below is the policy and job:site informadvit. ' Insurance Cotn�panyName: Policy 4 or Self-ins-Lnc.#: ia X26-2 J 2 5D—? Exptaxtiotn Dante: Job Site Address:,z �U CitylStat&Zip:Co /f- A tach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Sectioxn 25A of)St GL c. 1552 can lead to the imposition of eriminal penalties of a fuse 4p to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forn of s ST41P WORK ORDER and a fim of up to$250.00 a,day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIAr for imm ge verifi ation- I do hereby certi P r ider t padnSall "aims ofpeduty gnat`.-the informa&n provided above[1S.hwe and correct Si tune: Date: Phone#: afficial use only. Do not write in this area,to be completed by city oarh"Vil official City or Town.: PermitlLicense. Issuing AathGrity(drele ane): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: * BARNSTABLE + ' ' 9� 16 9. ,�� Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder ` I /y< as Owner of the subject property hereby authorize 2 CQ,. )Ley to act on ray behalf, n in all matters relative to work authorized by this building permit application for: (Address of Job) w Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services s P�°FtHe t � Richard V.Scali,Director Building Division M * * BARNSTABLE, * Tom Perry,Building Commissioner MASS. 16g9• ��� 200 Main Street, Hyannis,MA 02601 lEn �A www.town.barnstable.ma.us - Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number ' street village "HOMEOWNER": name home phone# work phone# . CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code 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)fo"r hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,.that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fomms\EXPRESS.doc Revised 040215 Unrestricted-Buildings of any use group m hich contain less than 35,000 cubic feet(991M )of enclose d space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.-mass.Gov/DPS' t Massachusetts -Department of Public Safje Board of Suilding;Reulati nsand t S Construction Super-risor License: CS-009013 GREGORY M CAAEY 33A BAXTER AWIN WYARMOUTHRA 6 34 Jam.{..+ �r1,A� ExpiraCommissioner: 05/11/2 Ofree of Cons mer Affairs a�Sin esSR g hLu HOME IMPROVEMENT CONTRACTOR Registration: F.173822 Expiration: 1=1/19>2016 Type. t Individual GR GORY M. CAIJLEY�j�- GREGORY ;' 33A BAXTER AVE." ' W.YARMOUTH,MA U673 Undersecretary ,.. use only tion valid for return to* f._ or egistra 1f found a ulation License Lion date. Business R g before the"I i er {fairs and Office of Consu Suite 517� 10 p ark plaza Boston - 1 MA 91116 , ith(oiult/sn`atur`'-/ Not valid v'. =?Ra CERTIFICATE OF LIABILITY INSURANUt PRODUCER (S08)997-6061 FAX (S08)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 439 State Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Gregory Cau ey INSURERA Arbella Protection Insurance PO Box 63 S INSURERS: Travelers Hyannis, MA 02601 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE S 11000,0001 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S 100,0001 PRFAAIqI CLAIMS MADE FXJ OCCUR MED EXP(Any one person) S 510001 A PERSONAL 3 ADV INJURY S 1.000100( GENERAL AGGREGATE S 2,000,00( GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S 2,000,00 POLICY PRO-JECT Loc 8500015641 07/24/2014 07/25/2015 F-l AUTOMOBILE LIABILITY COMBINED SINGLE LIMB S (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per Pam) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S i DEDUCTIBLE S RETENTION S S — , WC STATU OTH- WORKERS COMPENSATION AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S 100,00( B ANY PROPRIETOR/PARTNER/EXECUTIVE 7PJUB7875A19503 9/24/201 09/25/2015 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEd S 100,00 N yes,describe under E.L.DISEASE-POLICY LIMIT S S00,00 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS For any and all operations performed during the policy period CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE JOAN MARTIN ACORD 25(2001/08) OACORD CORPORATION 1988 91:Z_CVD 1/�M * TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0--24 Parcel 039 Application # e7� ��/ ��� Health Division Date Issued �h1/13 Conservation Division Application Fee Lk 66 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address. 191 ®X r rd Pr/ ye— Village eo�y j '— Owner MQ U Y- C & O o- t.I Address 160 J o a- z 5 -, ��b 2 7?!,c/n7M Telephone — O 23 !K 78o Permit Request L 1�f� CY4t'l�la Q� A t a C e_57 Square feet: 1 st floor: existing roposed 16Xnd floor: existing proposed 5id—'7vAbtal new Zoning District I` Flpo4 Plain Groundwater Overlay Project Valuation- Construction Type ' Lot Size D� t� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes �lo On Old King's Highway: ❑Yes ,VNo Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new f� Total Room Count (not including baths): existing 23 new First Floor Room Count C_'!5� Heat Type and Fuel: *Gas ❑ Oil ❑ Electric ❑ Other Central Air: )SYes ❑ No Fireplaces: Existing New Existing wood/coal stove:OYes ❑ No l Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage). Pexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name - Telephone Number Address a3� � 'I License #— Or, 9CY-3 IVA- 9 Home Improvement Contractor# Email Worker's Compensation # ,,3 Ue !2�12 5_A122 ALL CONSTRUCTION BRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATEr ���� FOR'OFFICIAL USE ONLY &APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME ' INSULATION L tsIS . FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ACORD. CERTIFICATE OF LIABILITY INSUKAN(;h PROD,CER (SP8)997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 439 State Rd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 79398 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC III INSURED Gregory Cauley INSURERA Arbella Protection Insurance PO Box 63 S INSURERS: Travelers Hyannis, MA 02601 INSURER C: INSURER a. INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRJIM so.", TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE >i 1 000 00� X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED : 100 00C CLAIMS MADE OCCUR MED EXP(Any arm parson) t S'00C A PERSONAL A ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 POLICYF_j jECT LOC 8500015641 07/24/2014 07/25/2015 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea seek d) _ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS r (Per Parson) S HIRED AUTOS BODILY INJURY f NON-OWNED AUTOS (Pw sodden) PROPERTY DAMAGE S (Per mm") GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG S EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE _ S DEDUCTIBLE 3 RETENTION = : WORKERS COMPENSATION AND - " WC STATU OTH- EMPLOYERS'LIABILITY 1 WITS B ANY PROPRIETOR/PARTNER/EXECUTIVE 7PIUB7875A19503 9/24/201 09/25/2015 E.L.EACH ACCIDENT $ 100 00 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE S 100 00 NSA deoWbe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S S00 00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS or any and all operations performed during the policy period ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LWBIUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE • p ]OAN MARTIN ACORD 25(2001/08) CACORD CORPORATION 1988 tration valid for individul use only Office of Consumer Affairs&Business Regulation License or regts HOME IMPROVEMENT CONTRACTOR Type. before the expiration date. If found return to: Registration: _ -1.73822 office of Consumer Affairs and Business Regulation Expiration 11/19/2016 Individual 10 park Plaza-Suite 5170 Boston,MA 02116 GR GORY M.CAULEY 1-7. I GREGORY CAULEY . ER AVE �kcji W.YARMOUTH,MA 02673 UndersecretaryNot vaid-without signature�., L (z Ji Unrestricted-Build ings of any use group a�hich contain less than 35,000 cubic feet(991m3)of enclosed space. Failure to possess a current edition of Code is cause the Massachusetts State Building - use for revocation of this license. • For DIPS Licensing information visits. www.Mass.Gov/Dps. F Massachusetts -Department of Public S Board of Buildin afety 9 Rd9uiatfons'and Standards Construction.Supen*isor License: CS-009013 GREGORY M CA Jt#E s 33A BA}[TER AW W YARMOUTHA Commissioner. Expiration.-.' 05/11/2016 . p r P cu `. _ yv AWC Guide to Wood Construc6ii iri High. Wind Areas:-11, fnph hVind Zone ' Massachusetts Cheddist for Compliance(7so Gt1R530i.Z:1.1)i Loadbearing Wall Connections Lateral(no.of 16d common nails)............................. .(fables 7) . ................................ ........ Non-Loadbearing Wall Connections Lateral(no.of 16d common nails) R• )...........__. able 8 ......... ....... .......................... Load Bearing Wall Openings(record largest opening'but check all openings for compliance to Table 9) Header Spans .... ... ..-_(Table 9)..................... -- _ft-in.5 11' SIR Plate Spans ................ .(Table 9)...._... ="'ft_in.511' Full Height Studs (no. of studs) ......... .............(Table 9)............ .._. ....... ........ Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9), ` Header Spans................ ............... ... ........(fable g) ... ...... ..... _ft_in.512' 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 ' Nominal Height of Tallest Opening2; ... ......... `. .. 6'B' .. .... Sheathing Type................... .(note 4)_,. .......... ......: Edge Nail Spacing ... ........: . (Table 10 or note 4 If less). # in. Feld Nail Spacing......................................... .(fable 10).. ... •• . ... in. a Shear Connection(no.of 16d common nails)(Table 10) - Percent Full-Height Sheathing.. _ (Table 10) %' ' 5%Additional Sheathing for Wall with Opening>6'87(Design Concepts) .. Maximum Building Dimension,L Nominal Height of Tallest OpeningZ ........... ... . Sheathing Type............ ...... ......(note 4)....... . .: ..... .. ' Edge Nail Spacing..........................................(fable 11.or note 4 if less) ...... ......., in. Feld Nail Spacing. .(Table 11)......................... in., Shear Connection(no.of 16d common nails)(fable 11). . able 11 Percent Full-Height Sheathing... ..............(T ). ....... --... ;.... 5%Additional Sheathing for Wall with'Opening,>6'8'(Design Concepts) ........ ......... Wall Cladding Rated for Wind Speed?..... :a . ..:.... ........ 5.1 ROOFS Roof framing member spans checked?.........................(For Rafters use AWC,Span Tool,see BBRS Websrte) Roof Overhang ...... ....(Figure 19) ft s smaller of 2'-or L/3 = t Truss or Ratter Connections at Loadbearing Walls Proprietary Connectors Uplift.......... ............... .... .. .. --(fable 12). . .... .. .l1 pit,° .. , " Lateral ...(fable 12 ...L— pff Shear........................... .................(Table 12).-... :S= plf Ridge Strap Connections,if collar ties not used per page 21... (Table 13) ...... .:.......T Of Gable Rake Oudooker.........................................(Figure 20) ...... ft s smaller of 2'6r,L12 Truss or Rafter Connections at Non-Loadbearing Walls ,. Proprietary Connectors Uplift................ .... -.(Table 14).. _-•-- ... ..U= Lateral(no.of 16d common nails) .(Table 14).: ...... ....... . L Ib. Roof Sheathing Type.........._....-...................... (per 780 CMR Chapters 5B and 59) ....: Roof Sheathing Thickness.............. in >7/16'WSP Roof Sheathing Fastening... ......... ......... . .. ......(fable 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-5301.21.1 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° z b. 20 Gage Straps per Figure 11 C. Uplift Straps per Figure i4 d. All Straps per Figure 17 K_ e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2 'Exception:Opening heights of up to 8 fL shall be permitted when 5%is added to the percent full-height sheathing ' 'requirrerrients shown in Tables-10 and 11. 3. The bottom slGplate in exterior walls.shall be a minimum 2 in.nominal thickness pressure treated#2-grade. A WC'Grcirle to Wood Constructio»imr Hi;h Wind Areas:110 mnph FWimrd Zone Massachusetts Checklist folr Compliance(7so CnT115301:2.1.1)' Check . Compliance 1.1 SCOPE Wind Speed(3-sec.gust)......................................................................................................,.......... ..110 mph WindExposure Category....................................................-....--..............:.............:..................................:...B Wind Exposure Category g Re................Engineerinquired For Entire Project........................................0 • 12 APPLICABILITY Number of Stories(a roof which exceeds,8 in 12 slope shall be considered a story) stories 5 2 stories RoofPitch...........................................................................(Fig 2) ........................................... 512:12 MeanRoof Height..............................................................(Fig 2)................... ft 5'33' Building Width,W .. Fl 3 .........................................................._, ( 9 ).............................. Building Length, L ....(Fig 3 ' ( g ). ft 5 80 Building Aspect Ratio(LIVID•............................................(Fig 4).•......................................... <3:1 Nominal Height of Tallest Opening ............... ..:M .(Fig 4)..................................................................... 5 618' 1.3 FRAMING CONNECTIONS General.compliance with framing oonnections......._...........(fable 2).............................................................. 2.1 FOUNDATION - Foundation Walls meefing requirements of 780 CMR 5404.1 Concrete....................................................:........................:................................................. ConcreteMasonry................_.......__......................................................:....................._....................... 22 ANCHORAGE TO FOUNDATION" 5/8'Anchor Bolts�imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only BoltSpacing-general..................................._.....(Table4)............................................... - in. Bolt Spacing from endroint of plate.............................(Fig 5)..................:..:.............. In.:5 6"-12', Bolt Embedment-concrete.........................................(Fig 5)................................................. in.?':7' Bolt Embedment-masonry.........................................(Fig 5)...........I............................ in.a 15" PlateWasher..:................................................... ..(Fig 5).....................0......... ............z 3"x 3'x'/' 3.1 FLOORS Floorframing member spans checked ..............................(per 780 CMR Chapter 55)............................. Maximum Floor Opening pimerision....................._......._,.(Fig 6)......... ...................... . ft 512' ............ 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 5 d Maximum Cantilevered Floor Joists T Supporting Loadbearing Walls'or Shearwall................(Fig 8)....................................-.....:...:....._ft 5 d FloorBracing at Endwalls....................................................(Fig 9)..,......... :.....:.........._.�.................... Floor Sheathing Type .......................................................(per 780 CMR Chapter 55)................................... Floor Sheathing Thickness ...........................................:.....(per 780 CMR Chapter 55)....................... in. Floor Sheathing Fgsfening_............................................:.(fable 2). d nails at in edge/_in field 4.1 WALLS Wall Height Loadbearing walls............................ .......................(Fig 10 and Table 5)............_........... ft -<10, Non-Loadbearing walls............:...................................(Fig 10 and Table 5).................... ' It'S 20' Wall Stud Spacing ...... F! 10 and Table 5 .-In.5 24'o.c. WallStory Offsets ..................0...................................(Figs 7 8:8)........................................................................... ft s d 4.2 E)CTERIOR•WALLS' Wood Studs Loadbearing walls..............:.........................................(Table.5)..............................2x_-_ft_in. Non-Loadbeanng walls...............................................(Table 5).............................2x _ft_in. Gable End Wall Bracing Full Height Endwail Studs............................................(Fig 10)......................,........................................... WSP•Attic Floor Length._._-..,.: 11)�.......:........................ .......... ft zW/3 'Gypsum Ceiling Length(if WSP not used)...................(Fig 11)............................................_ft Z 0.9W and 2 x 4 Continuous Lateral Brace @ 5 it.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 - Sprice.Length ................:.................................._..(Fig 13 and Table 6).................................... it Splice Connection(no.of 16d common nails)..............(rable 6).............:.......................................... r` AWC Gristle 10 Wood Constructiorl in High 13,7nd Xreas 110 mph hVimd Zone' Massachusetts Cheddist for'Compliance(7so CNIR 53012.1'1)" 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent FulWeight Sheathing and Nail Spacing requirements-, F k b. Wood Structural.Panels shall be minimum thickness of 7116"and be installed as follows: . 1. Panels shall be Installed with strength axis parallel to studs. ri. All horizontal joints shall occur over and be nailed to framing. GI. On single story construction,panels shall be attached to bottom plates and top member of the double tDp plate. iv. On two story construction,upper panels shall be attached to the top.member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing of double top plates, band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment S. Glazing protection:a)new house or horizontal addition-required if project is'f mile or closer to shore(generally,south of Rte.28 or north of Rte.6) b)vertical addition-not required unless there is'extensive renovation to the first•flODr c)replacementi0idows-needs energy con nservation compliance only(chap 93) 6.Wood Frame Construction Manual(WFCM)for 110 MPH, Exposure B may be obtained from the American Wood Council (AWC)website. YHiET MO EDGEFEM ON F�YAAl16rG MEWNALS •ATsb c It l 1 • 1 ,,cc t1 I 1 l 1 It Q t Z°L it ii i a t' 1• 1. A. �''�I I1 9.1 1 1' 17 :I l i p i FRAWNG MMABOM t 1 W ii r I'-' ; F• , ; I ®GEWERWEDME 1 , s ;sue , It ii 3-slim i t DDU9lF STAG 31MWL NAIL SPAckJG ; rua PATTM PAMR. RAt EDGE Lr" DOUBLE NAILEDGESPAMM DETAL See Detail on Next Page Detail Vertical and Horizontal Nailing t • • for Panel Attachment. Verfical and Horizontal Nailing, , for Panel Attachment s Town of Barnstable ; o� Regulatory Services t ' NAM Richard V.Scab,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.townbarnstablexna.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder y� L / '/aV il I #�76 V as Owner of the subject property hereby authorize 6 2 e 1 C �J�ec to act on my be}ialf, in all matters relative to work authorized bythis building permit application for. (Address,of Job) "Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. f o Signature of Owner rgnatitue Applicant Print Name' - rmt Name -Da QT RMS:OwNERPERMISSI0Ie00I S I own or-uarnstabte Regulatory Services �oFe roiyy Richard V.Scab,Director Baffling Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www town.barnsiable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION --- — — —Please Print DATE: JOB LOCATIOR number street villager `fiOMEOWNER": . name home phone# work phone# CURRENT MAU NG ADDRESS: citYAMM state rip code The current exemption for"homeowners"was extended to include owner-occupied.dwellinFs 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 buil jug permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Buildmg Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and.requirements. Signature of Homeowner Approval of Building Official Note: Tbree-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Budding Code Section 127.0 Construction ControL- i HOMEOWNER'S EXE WnON 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. b 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:\WPFIIES\FORMS\bufi&gpermitfo¢m MTRESS.doc Revised 061313 ' Depmrtitrent oflndurti-ialAcridex& , D.Twe oflme*affonr 600 WkshbVton Street ' Boston IYA 02M >. . • : www.mtrss grrvlda _ . Workers' Compensation Insmrance Affidavit.Btnlders/CoifraebrsMectdci=Xl-mnbers Please Applicant Information Print _ LegibA. Name Pusfirsslorg oaaofflvuni): ,C 4-Y - Address: /� .. ;� � iy .. x City/&awziP Phan.#: !E] an employer?Check the appropriate bo�c Type ofprof ect(req�ed) [2. ❑I am a gcoeral cauftudw and Impinpees(full and/or part time). 6• Newv r-=*uctim * havehired$e suh-contractorsam a sole proprietor or partner- listed.on the attached sheet 7. ❑Ranode Iiag ° ship and have no I c: These sub-� tcxs hwm °3` 8. ❑Dcmolftim woridag far me in any capacity employees and have workers' 9. Burl 7,,, addition [No Workers'comp.imitr_aaw comp.7Y su anrr.t ❑ �5 �edj S We are a t�rporaiinn and its I0.❑Elet:tricalrepairs or additions 3.[] I am ahnmeowner officers have exercised their ❑ mgrepaizs or additions work 11. Plumb' myself [No wogs'comp. r, right of exemptitm per MGI. instsance required.j t a IA§I(4),and we have no �❑Roof repairs ' M44yees.[No workers' 13.❑Outer camp.insmamce requfiinsi] *Any applicmmt that am m box#1 amst also IM ontthe section below showing thoirwo�oompeosstioa Pnlic9�miation t Hnmeown=who submit this affidavit indicating they=a doing zU work and thm hire outside eo&actnn;must submit anew affidavit indiefg snrh $Coahartou that check this box mast attached on addibnmil sheet sbmingthe nsne of the and state whether or not those dities have employees,If the sab-matmeto-have cmpby=s� thY mlpt Pmride thcs WMk='camp.PAY=mba - I am an employer thud is providing workers'compensation buzcrance for M emPloyee� Below it the po&cy and job site Insurance Compaq Policy #or Self-ins.Lie. rob Site Address: :7� �� �"� ¢ ► , Attach a copy of the workers'campeasation policy declaration page(showing t11e policy:mmber and e=piratian date), Fafm e to swum coverage as rega red under Section 25A of MGL c.152 can lead to the imposition of aI penalties of a. fine np to$1,500.00 and/or One-year boprisamn-eni;as well as cif penalties in the fi r 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 st =am±may be forwarded to the Office of ; Investigations of the DIA for instnmmce c vt�cation. , 'I do hereby the p - nfP6 jruy that the A¢ormatidn provided above is b-me and correct S' Date_ >/5 ' Phone# Oflyd fuse 0?* Do not write in this area,to be complied by city orf6mVffl tat . My or Town: permit/f,irrn,ce# Tss�g 9 nthorifp(circle one)- L Board of Health 2.BtoldingDepaurtorent 3.Citp/Towu Clerk 4-Elerixical Inspector S.Plumb' - -.. .. ._. ..._,... _. 6 Other _ Inspector ConiactPexson: Phone#. ' Information and Instructions ' 7yfaccar_lmetts Geheral Laws chapter I52 mgahm all employers to provide workers'compensation fbr then'c Ioyees. pmsuant-to this siaufe,an w9loyee is defined as"...every person.in fire service of another under may contact ofbnr., express or implied,oral or wiften." An enpfoyer is defined as"an individual,pmineaship,association,corporation or other legal cEft or any two or more of the foregoing engaged in a joint enfer�and including the legal represe r afives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other Iegal entity,employing employees. However the owner of a dwelling horse having not more iban th=apartments and who resides therein,or the ocapant of the - dw Mug house of anoher who employs persons to do maintenance,construction or repair work on such dwelling house or oa the grounds or budding appurtenant thereto shall not bemuse of such employment be deemed to be an employer." MOL chapter 152,§25C(6)also sI es 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 w•ho has not produced acceptable evidence of cdmpL-mce 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 conned for the pmfozmance ofpublic work until acceptable evidence of compliance viRh the insurance. requirements of this chapter have been preseniud to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by chmldng the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone mzmber(s) along with their certificate(s)of insurance. L>mited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno employees other than the members or part=s,are not required to carry workers'compensation ins ranm If an LLC or LLP does have employees,apolicy is required. Be advised thatthis affidayitmaybe 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 re[umed to the city or town that the application for tine permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the Iaw or if you are rcg=d to obtain a workers' compensation policy,please call the Department at the member listed below. self-insured companies should eater their self-insurance license number on the appropriate line. City or Town Officials ti � - "Plewe 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 refer once number. In addition,an applicant that must sabnut multiple peimit/licrose applirafions is any given year,need only submit one affidavit indicating curreat policy information if access and under"Job site Address"the applicant should write"all locations in (city or P � �Y) " the-affidavit that has been,officiallyed or marked the or town may be provided to the town A co of stamp b3' �Y )- PY applicant as proofthat a valid affidavit is on file for future permits or licenses A new affidavit must be filled obt each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license or permit to bum leaves etc.)said person is NOT required red to complete ibis affidavit, The Office of Investigations would bke to thank you in advance for your cooperatioa and should you have any questions, please do not hesitate to give us'a call The Department's address,telephone and fax number:" T1 e�o�xan atttE of Massachusetts- . Depa iMMt cif Industrial Accidents mice of JAVMttatiom 604asbingtan Stc BaADI,M&02111 Tel,#617-'27-4900 mt 406 or 1-977-MA.SSAFB Fax 9 617-727 7T49 Revised 4-24-07 -massgogidia Assessor's offioe (1st floor): _ � �� qJ-�_tp=SMEM MUST B' Q�OF THE Assessor's ma and lot number ....40.Q.1. .©. ./...........' .: Board of Health (3rd floor): NsT � L�NC fO� ♦� Sewage Permit number ......... 'F-.j. �.t. ,J. ...... �� � 2 BAR33TLUB E. Engineering. Department (3rd floor): 'oo 1639. •� CODEA House number ............................... X V ........ .. .. ,f/,.... TOM feel" 'O�Fo V0Ar � APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF "BARNSTABLE BUILDING ANSFIECTOR APPLICATION FOR PERMIT TO ....... .......... TYPE OF CONSTRUCTION ....... ........E.R_A.M..F................................................................ -......J...6................... TO THE INSPECTOR OF BUILDINGS: The undetsigned hereby applies for a permit according to the following information: Location ....1' .�........ ...... C ProposedUse ........ ... ...C.. .................................................................................................... ZoningDistrict .............................................................................Fire District .............................................................................. Name of Owner . . .. .... „<Y.1.a. Address .... .. ...-.•.. >.....��:L..4��. Name of. Builder p-,I.v.iD.. ...1J.A..R.A .`.C,OA..IAddress'...? .. .0./ <�[..1.....�r.l1F.�.. �.?.�1....-. Nameof Architect ........-S. .F .�..�..............................Address .................................................................................... Number of Rooms .... ....... ,CG�:..........:...................Foundation ....B.4.o.!c-K...r............................................. Exterior ....C.AffDAlQ......SAI/V.6-IF3Roofing :......z4 )9,4,7./ .L.. ............................................ Floors ......©lv..d/.....:...........................................................Interior ........�7.. �r—.. .. ��.. s�, ..i,........................ Heating ......./..Jl.. .l.Il. :�.................................................Plumbing .................................................................................. Fireplace .................... --.....................................................Approximate Cost ........... F... /.. . . ..................:............ Definitive Plan Approved by Planning Board ------------------------_-------19-------- Area ..e:?1✓.1. .................. Diagram of Lot and Building with Dimensions Fee C J®..®.................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I_oT.2o G oo p \ m - " OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam .... . c . ............... /y Construction- Supervisor's License o.�so.. '. ....... MdCULLOUGH, JACK No 32792 Permit for ....Add—PPK.gh/,Rabuild Deck Single.. Family._.Dwell .. Dw .... ....... ..... ........... Location ...1.4.9....Ox.f.or.d... .............. .... .. .... Cotuit . ............................................................................... Jack Mc ul Owner ..................... ......lo.!4.g1l........................ Type of Construction ......................... ............. ................................................................... Plot ............................ Lot ................................. April 12, 00 Permit Granted ........................................19 US, Date of Inspection ....................................19 Date Completed ............... ......19 . . ,.�.,.:�j'.�,.�.,�,1_"t�!'-��I--o��,�,,.."..,,I.A,���,P,_,,..'i.-,-�.�V;,,'e-,,:,,�,,—�t�,,i�,.,;,:,I"-4.:,�,.-,I,I.N,,�-.,4 L,��I�.;�*�",,7.�-`,,t-I.-,;A,:, I 1..I,..:.,�..,1Z—.I).�.,�'-,,,t:.I.,,.I. ,,,It'�,-.- ., r. v. • . 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