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HomeMy WebLinkAbout0067 RALYN ROAD r �� ___ __ � - _ _f_ __ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , Map. Parcel ��-C' Application # Q 1 �V Health Division Date Issued $1 Z'41 y Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address Village /7 Owner J 0 hn 71h 0AS Address (P -7 ��✓i? /cP� Telephone , 7 / /Y� �'�03 5 Permit Request ,Zn_ r & /C/ Gf�lJ9,reY 2T6 IdJf hloC4e'l( Y' 710 � , �l r 144. K7 rhy-/7 ven-)�'IaLw chLhe' r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District f Flood Plain Groundwater Overlay Project Valuation /� -3� Construction Type Lot Size / Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 1'77 Historic House: ❑Yes ❑ No On Old Kind ighway A ❑ No 44. . Basement Type: ❑15ull ❑ Crawl ❑Walkout ❑ Other ems► Basement Finished Area (sq.ft.) !Ma Basement Unfinished Area (sq. ) Number of Baths: Full: existing new Half: existing n6VIV to Number of Belkooms: existing _new r> Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 0"Gas ❑ Oil ❑ Electric ❑Other Central Air: WrYes ❑ No Fireplaces: Existing New 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 of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review #. Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name / �.L� Telephone Number �, !� ' 7 79�'0/ Address 7e& in .e6411 -b1' License # agja!�j 4A& �//7 r Home Improvement Contractor# 7 -3 Email Worker's_Compensation #UMl EY_0-30/a �� ALL CONSTR CTI DEB IS ESULTING FR M THIS PROJECT WILL BE TAKEN TO �fCe1/6 )Wq 0-2, & 7 3 . SIGNATURE DATE f FOR OFFICIAL USE ONLY � a APPLICATION# � 4 DATE ISSUED MAP/PARCEL NO. -.. ADDRESS VILLAGE OWNER r' DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL P FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. z The Common wealik ofMassachusens Dgpa tmerit of Industrial,AeOdenfs Office of-mVestigatians X"Cotagress.Street,Suite 100 Boston,AM 02114-2017 wwts.mas&gov%dia Workers'Coulpensation)Ft><s4ranceAffidavit:Builders/Contractors/Electricians/Plumbers _Appi eantjnfomation Please Print I.egatily Nam (Business T er C fOrgao zationflndividua{) ��� i n8trucon Address:7913'Mid"tech Dr City/State/Lip:West Yarmouth,MA 02673 Phone :508-778-07 71 Are vou:an employer?Check the appropriate box: gype of project;'(required): t. l am a employer with. (. ❑ I am a general:contractor and I employees(full and(or part-tttzte):" have hired the sub-contractors 6. ©Mew construction ?':© I am a sole,proprie#or or parinear listed on the attached sheet:: Remodeling ship and have-no employees 'these stab-contractors have $. f-1 Demolition working :forme in any capacity, employees and have workers' [No workers' comp. insurance comp:insurance) 9. ❑.13uilding.addation required.] 5. WV area corporation and its,' 10❑lflectriGal repairs:nradditions 3 l am a.homeowner doing 4 worl officers leave exercised theirI.J.❑.Plumbing repairs or additions, myself. [NoWorkers* comp. right ofevxetnpti'on per MGL insurance required:]t: e 1 §I{4),anil eve have ni) l,2-0.Roofrepars employees.,[No)y�orkers' 131iother Weatheriza`tIdhl tnsutatrce required.) . nsu 'a ion erne app{iiantthat cheeks boy l musta:lso tilt oot tha sectian WOW Showfngthcirwcrkors':compensittion policy intomiation fi{Iflmexfwriera tivho submitttsi$ dnvit uidicaung-they doytg all��vik anti th6 hire ouuida cunt c[ox5 musrsubmit H nevi*affidavit tndiuuting such, -untraclnrs.that check this box sn40 attached an additional sheet shoving the name:of the sub-contractors and state whether ar not t}iue entities hate: employees. If the sub-contractors haee employes,tie musrp;oxide iheii «rorkcrs'comp.policy number: I rraia caaQ eatapioyer tlatrt is prosvBit$g►vorkers'cuataperrsetroat arrslman.�e jor my empiwees Below is the poflo'taxd.job sit €ai;#tarzraa�tavn. - :Insurance Company Aaame-AEIG Policy#or Self-iris. Lic. ;WCC5005593012007 ' 9'0/3/1� Expirab n'Date: Job Site Address., t-Y / L-. G1tyistatefZip:_ �M4 ���•S� Wit!-aefh a copy of Abe vco l{ers'corn ensataom policy detlaFatioat page{si}eowiog.tltepolicy number anti'ex iratao p n date). Failure to secure cover t as.requirt d�tnt)er�t*fiQn 25pt ofMGL.e. 152 can lead'to the imposition,of ciiminal penalties of a: fine up io 47,500..t)©attciftZr one-year imprisotunent as well as tivit penalties to the.form of.a STOP Wot4 ORDER and a>fine of up to S"250:00 a,day against the violator. Be advised thk a copy off) ststeme,i4 may be.forwarded to the Ciffiaz:br ]taxi stigations of the for insurance Covetw verl.I at on. l a Iterch, per iy nd ae pants aari peenralaes ofperjury that Ale itaforltadaion provided wbove is true 4W cot ect 5€ - -lone#: 50$ fcirt!use braly.Iota agar write iix thix real tv 8e conapieted t y city or toivra off clttl.. CRY ter Towta- _ _ feri►itiLicense Usuin g Authority(circle one); . t.7 -axe of]FIea$tla Z:Betildiug De Utlter partment 3.City/Tdwu Crone 4.]Electrical Inspector 5.plumbing Inspector 6. Contact,Person: priotae#: Wii.9iil�t�PkW M ;k,}m9�'pifl'�,9i�I� 1 #v�assachcase�is Oepi#rtrne�t�F�a .ic Saret 3t#7 HWiha§RoW Suitt 110 3oarc# #E3usld';iig f2 gWatichs and Sfatseiare3s ,8771 � NX#2f3;?0 C`omtruct on Su' cri i4f icense: CS-0690585 RICHARD,S TUPPER 'WEST YAR2NIOUT11 .; iSEE`Ai tFitSE S1C_f f U tSNATf NSktdb: Pl{IfIffAiE$�: �crt)Fr1s557t?s��€ 1213*2014 lliJwfe'C�ttrXtlj - :;_gffiee of Cmasumcr Affairs 8 Busi Kegnl Uuu License or-registration valid for individul use only WE IMPROVEMENT Ct)WRACTOR before#he:evpi da�. If.found return to; ti Office of C ffa rs:and$us}a Regulation. i li egisLration: 118434 Y ss pe xpiration: 4/1612016 LLC 10 Pa asa-Su'a 51 0 B ,MA 021 '. TUPPER CONSTRUCTiO CO,LLC- MCHARD TUPPER . w YAR Mo UTHI MA M73` tiadersecretart No tthRtit-signature � �, 0E3yDHERE:TLRE`AktNf i a Peo#tteiN+elping eop.1e. Buiista5aferWo WEM"R Richard Tupper. Tupper Coristructiori Bcaiding,Safety Professional M Mber#:81"119 Exp:4130/20/ I CERTIFICATE OF LIABILITY INSURANCE: DATE(fi9MlDDtYYYY) 12/03/2013 I` THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMAT1VELY OR NEGATIVELY:AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE:.POLICIES BELOW: THIS-CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If tha Certificate holder is an ADDITIONAL INSURED,the'policy(les)must Be endorsed, if SUBROGATION IS WAIVED,esubiect to the terms and conditions of'the policy;caftain policies may require an endorsement. A statement on this certificate does not confer'Anhts to the cerdficate.holder in lieu of such endor§ement(s). PRODUCER _ CONTACT Lora Lowe .NAME:- - Southeastern Insurance Agency, Inc. PHONE , (508)997-6061 : - . AIC:No 2731 439 State Rd. Ap FAx (508)990 O P.O. Box 79399 RE PR ll.. :CUSTOMERID#: .. - .. N. OartiTgUth, P9A 02747 INSURER(S)AFFORDING COVERAGE NA1C4 INSURED. -INSURERA: Arbella Protection Insurance Tupper Construction Co LLC INSURER e: AEIC --.:INSURER C.: CNA Surety. . . . . . - 2.7 Roberta Drive INSURER0: West Yarmouth, NIA 02673 INSURERE: ` INSURER F.: 1 COVERAGES CERTIFICATE NUMBER: 2013/14/1 REVISION NUMBER: THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE.INSURED NAMED ABOVE FOR THE POUCY'PERIOD INDICATED. NOTWITHSTANDI ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED'6 MAY.PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN NAY HAVE BEEN.REDUCED BY:PRID CLAIMS. ADDL�UBR ..POLICY EFF POLICY - -- LTR. _ TYPE OF INSURANCE _ INSR:L'NVD POLICY NUMBERS MMD MM1OD LIMRS GENERAL LIABILITY �_., 450000874 1.1I011201a 11101.12014 EACHoCcuRRENCE s _1,0OO;OD X it COMMERCIAL GENERAL UABIUTY PREMISES Ea occurrence S lOO 00 E j CLAIMS-MARE D OCCuo IMED EXP(Any one petsdn) 15. 5,00 A PERSONALSADVINJURY r 1,000,00 GENERAL AGGREGATE S 2,000,,0 GEN'L AGGREGATE:LIMIT APPLIES PER:- !, PRODUCTS-COMPIOP A.GG S: -2,0004 0' POLICY 'ET —1 LOC j) S AUTOMOBILE LIABILITY - - - 56662406002 12101/201.3 12/01/2014 COMBINED SINGLE LE1g1T - .. (Ea amdent).. . . 3. 1,OOO., 11 ANY AUTO _� . .. BOOM INJURY:{Perperson) S ALL ONMEO AWTOS BODILY INJURY.(Peram ident) S X 'SCHEDULED AUTOS 11II. PROPERTY DAMAGE X I MREDAUTOS (Per accident) 3 I C X NON-OmEDAUTOS' UMBRELLA UAS X OCCUR .460005830 1:110112013 11/0112014 iEACH OCCURRENCE 5 1,000100 EXCESS UAB CLAtMs•MAOE I'. �: AGGREGATE S ,.j DEDUCTIBLE: . ... I) ;RETEWIO(v.:5. .. .... - _. .. .. .. S j WKERSCMPuSAI Or WC500559301200A.101031201;.3 10/03/2014 X our COMPENSATION YIN RY X F9R ANY PROPRIETORIPFRTNERIEXECUTIVE RICHARD TUPPER IS E.L.EACH ACCIDENT S 1,000,00 S OFFICER1 BASER EXCLUDED, NIA. (MandatMin W D CLUDED FOR WC-COVERAGEE.L.rasEasE-EA EMPLOYEE sIf yw,desTmbe under, I DESCRIPTION OF OPERATIONS helm E.L DISEASE'-POLICY LIMIT 5 Z OOO 00 j OESCftiPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 01,Addrt onal RemaAca Schedule,it more apace'(a requireU) "CERTIFICATE HOLDER _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL :BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, For Information Purposes Qnl,y'� Tupper Construction to LLC AUTHORI2EOREPRESENTATIV,E V Roberta Drive W Yarmouth, FAA 0267:3;,- Lora Lowe ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25:(2069109) The.ACORD name and logo are registered marks'ofACORLI OWNER AUTHORIZATION FORM (Ownees Name) owner of the property located at 7 A (PrbP rtY ss) (Property Address) hereby authorize U (subcontra r an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. e ign #ure Date I f v 0414 01:35p Tupper Com 15087785010 p.1 �sb . C®NSTRUCTION CC. LLc 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 VVkAAN.TUPPERCO.COM Town of Barnstable Thomas Perry CBO 200 Main Street Hy annis M a02 60' TrWd AN (508) 790-6230 fax Re: Insulation Permits Dear:Mr.. Perry This affidavit is to certify that all work completed for permit application # -.01 o g Issued on has been inspected by a-certified Building Performance Institute (BPI) inspector All work performed meets or exceeds Federal and State requirements. Sincerely, Permit #: Address: Richard Tupper l License # CS-69058 4. 13 0 7 5 6 r oFt ram, Town of Barnstable *Permit# pExpires 6 months from issue date Regulatory Services Fee ,5 L • BMMSTABLE, « v� 1659. ,0� Richard V. Scali,Interim Director PER ATfD��p ' Building Division Tom Perry,CBO,Building Commissio ��� 200 Main Street,Hyannis,MA 02601 �C1 3 V 201 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 500VjYL((S230 EXPRESS PERMIT APPLICATION - RESIDQ;jj�e r Map/parcel Number Not Valid without Red X-Press Imprint � Property Address i/1'1 e z> i I jResidential Value of Work$ 5611Y0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address J--yL TU f-t `9-7J S cNy Contractor's Name �jj 2Cr=,_ CC-, J Z.P__ Telephone Number Home Improvement Contractor License#(if applicable) l b'7 ��yC Email: Construction Supervisor's License#(if applicable) 9013 ❑Workman's Compensation Insurance Chec e: am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �'✓�/nSS.4: ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value a 30 (maximum.35)#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 HH7 Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\buil Ping permit forms\EXPRESS.do Revised 061313 ..- - -- .... rr the Commoyrweah*of Iassachuseffs Deparhnent ofbddmstrial Accidents r U,yce of Investigations s 600 Washington Street r Boston,AM 02111 wnnn rrross.gaWdia Workeis' Compens:atialnInsurance Affidavit:Builders/ContractoisMectricianslPlumbers Applicant Information Please Print Lepribly Name(BusiDetalOfganizationlIndin.deal)= �g . ,4yz c,_ Address_33 4 lhAV/ e OC—. City/Stat&Zip. Q,/ \,41<? 0a4-2!� Phoneme �� zPFO y -5C7 Are you an employer:'Check the appropriate box: Type of project(required): am a contractor ❑ 1._El I am a employer with 4_ ❑ I general and I 6- New lion ees(fu11 and/or part-time)* have hired the sub-contractors. 2. am a sole proprietor or partner- listed on the attached sheet. - ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition. working for me in any capacity. employees and have workers' _ ❑Building addition [No workers' comp.insurance comp_insurance-1 5. ❑ We are a corporation and its 10..El Electrical repairs or additions 3.❑ I am a homeowner doing all work officers Have exercised their 11_.❑Plumbing repairs or additions myself. [No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance required.]I c- 152, §1(4),and we have no employees-[No workers' 13.0 Other- comp-insurance required.]' *Airy applicant that checks box#1 must also fill out Ilse section below showing their workers''compensation policy infbrmatian l Homeowners who submit this affidavit m cmtmg thzy an daing all work and then hire outside contractors mm sub=a new affidavit mdirating mill 1Coutcactors thmt check this boo[must attached an additional sheet duming the mmne of the stvlreo ors and state whether ornot those entities have employees. If the suk-contractots have employees,they must provide their workers'comp.policy number. lam an employer that is prmidiag workers'compensation insurance for my employees Below is Ste policy and job site informahon. Insurance Company Name: Pultcy:ff or Self-ins_Lac#: ExplrationDate: (/�//�� /� _ /� .may� .1�- Job Site Address: 6 -7 /�(� ! �// C1ty"Stateiziga/ KI I 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 ofrr;minal penalties of a fine up to$1,50G.00 and/or one-yearimprisoument,as well as civil penalties in the form of a STOP WORK ORDIR and a fine. of up.to$250.00 a day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of fin estigations of the DIA for insurance coverage verification_ I do tacrreby certify under thgPains a pens es of perjury that the information prmab~is bus and correct Si tore: Date: Phone Official use ant,}. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Anthwityr(circle one): 1.Board of Health 2.Binding Department 3.Cityll`own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 x Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other 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 of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an.employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance-coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdlvlsions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their teat.ficate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required_ Be advised that this affidavit may be submitted to the Department of Indus'uri.al Accidents for confirmation of insurance coverage. Also be sore to sign and date the affidavit. 'Tile affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtali:a workers' compensation policy,please call the Department at the number listed below. Seli insured companies sa.ould enter their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. ' Please be sure to fill in the permit/license number which will be used as a reference number. In ad-d i'dou,an applicant that must submit multiple perrmitllicense applications in any given year,need only submit one auid-a.vit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A neW-affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusctt Depadment of Industdal Accidents office offkvestigations 600 Washingtaa Street Boston,MA.02111 Tel. A 617-727-4900 W 406 or 1-877-MAS E Revised 4 24 07 Fax 9 617-` 27-7 749 www.mass_govfdia F TF4E 1p� Town of Barnstable O t Regulatory Services 9anxhUss E . � Thomas F. Geiler,Director 16.39. & Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us . Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 14/yS 691 as Owner of the subject property hereby authorize Quj to act on my behalf, in all matters relative to work authorized by this building permit. (Addless 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. c Signature of Ow er S tune of Applicant U61-1 WP J 5&W Print Name Print Name . Date ' QTORM&OWNERPERMISSIONPOOLS 62012 F' pfIHE Town of Barnstable ~°^ Regulatory Services Thomas F.Geiler,Director 9�iDTE0 r3,to�t"`0� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 /ax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village :H OMEOWNIEW': name one phone# w k phone# CURRENT MAILING ADDRESS: city%town Vforl tate zip code The current exemption for"homeowners"was extended to iner-occu. ie dwellin s of six units or less and to allow homeowners to engage an individual for hire who does not poense, r ided that the owner acts as supervisor. DEFINITIONMEO R Person(s)who owns a parcel of land on which he/she resides to re 'de,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to d/ r farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeow ` meowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible1 s h work erformed under the building permit.-(Section 109.1.1) The undersigned"homeowner"assumes responsibility for comps' ce with the to Building Code and other applicable codes, bylaws,rules and regulations. The undersigned`bomeowrier"certifies that he/she unders ds the Town of Bamsta e Building Department minimum inspection procedures and requirements and that he/she will comply}Frith said procedures and requ ements. Signature of Homeowner / Approval of Building Official /P J Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to co ply with the State Building Code Section 127.0 Construction Control. % HOMEOWNER'S EXEMPTION The Code states that: "Any outeowner performing work for which a building permit is quired shall be exempt from the provisions of this section ection 109.1.1-Licensing of construction Supervisors); provid that if the homeowner engages a person(s) for hire to d uch work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibiIi 'es of a supervisor (see appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack o wareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our B rd cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Sup e isor 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. C:\Users\decollik\AppData\LocallMicrosoft\\d7indows\Temporary Internet Files\ContenLOutlook\QRE6ZUBN\EXPRFSS.doe Revised 053012 +_�m \v\assacnusetts -Uepartment of Public Safety `✓ Board of Building Regulations and Standards ' C'ot�'truction Supenienr b License: CS-009013 j GREGORY M CA}JLEY f 33A BAXTER AV *,. W YARMOUTH IVIA 027�3 ` r Expiration . �wCommissioner 05/11/2014 � ' ' F ": �e�a��aa�eoazuEear!l/r.,o��la J�rc�cc�eCtt Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR L s z egistration: •173822 Type: y r _ xpiration: 11/19/20.-14 , Individual _ GREGORY M.CAULEY GREGORY CAULEY. 33A BAXTER AVE. W.YARMOUTH,MA 02673 Undersecretary License or registration valid for individul use only t + - before the expiration date. If found return to: 3, Office.of Consumer Affairs and Business Regulation ' 10 Park Plaza-Suite 5170 ' Boston,MA 02116 Not valid without gicgraftre 02/07/2012 10:46 endless mountains (FAX)5708205993 P°004l004 i r ASA.Engineering Shrewsbury,Ma February 5, 2012 To: John.Piteavage Endless Mountains Solar Services Re: Solar Array installation 396 Cotuit Dr. Cotuit, Iola Per your request,I have performed a site inspection of the existing roof structures and.framing system, at the above referenced project, This evaluation,was conducted,to determine if the existing roof structural system'has the load carrying vapacity to support the additional proposed loading for the solar array system. Based on the review of the roof structural components and configuration(2x12 rafter,with spacing at 12"O.C),.based on my best.pr6fessional opinion,I have determined,.that the existing roof system have adequate load-carrying capacity to support the proposed solar array'and the loading is within the,limitation of current local'building codes.(Ground.Snow Load of 35 Psf j The roof connection system for the solar panel shall be.in conformance with.the system installation manual, in order to resist the uplift forces due to basic wind speed as determined by,' the"current building code(120 MPH). I also recommend staggering the attachment of the rail to the roof at alternating:roof rafters between the.upper and lower rail, to avoid.concentrating.loads on a single rafter. Each lag screw must also be centered on and fully penetrate the 2".x 1.2"wood rafter(min 2"embedment). In.particular the installation is designed to confirm with.ASCE-70 wind limitations and Endless.Mountains Solar Services shall confirm that the system designed will be installed accordingly,. Pleasc call me at 979-377.5084 if you have further question regarding this report. Sincerely j x*.A AA aid od A �tH of a� fde:?°1MOppTy AZIZI r cIV • s N 14.1 $ � 'Oy► FO �Q' _ t Town of Barnstable of e Permit# Fxpires 6 months from issue e Regulatory Services Fee BAMSTPABt.E W 9. Thomas F.Geiler,Director rED MA't A , Building Division .Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508=79,0-6230 EXPRESS PERMIT APPLICATION - RESIDENTUL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 4 7 R Ct l Lly1 Ca co+u - (Residential Value of Work/✓6 -` Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 16 1\n V I 7 G flfl Contractor's Name Qca�-6'-kG ���— Telephone Number 2 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) C�5�-" 1 d J� I IT❑Workman' Compensation Insurance _CRESS PERM Ch�k one: � X , [`�'7"'I am a sole proprietor e _ Of am the Homeowner JUL.o 6 2012 ❑ I have Worker's Compensation Insurance Insurance Company Name Q;VI �1"r X�� CU !TCANBARNSTABLE. Workman's Comp.Policy# I rl C C Copy of Insurance Compliance Certificate must accompany each permit. Permit Req t(check box) = [ Re-roof(hurricane nailed)(stripping old shingles)*All construction debris will be taken to 13&u(1,4- �AVI VU( I ❑Re-roof(hurricane nailed)(not stripping. Going over . existing layers of roof) Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows' ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc..- ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvemept Cont tors.License&Construction Supervisors License is req ' SIGNATURE: C� Q:\WPFILES\FORMS\building permit forms RESS.doc Revised 053012 i the Co'mmonreeakh ofMassadruseft Dgwft exit of In&strial Accidents Office oflam igations 600 Washington.Street Boston,MA 02111 irl: :tna�gov�dia. Workers' Compensation Insurance Affidavit:Bmldei-s/ContractorsMectricians/P"bers Appheant Information pease Print Lezib�y Nine{Busmetsiorgantzahonmuliviidnau: 1Lcn, Zki f, eft �\ �ty�/sta /zAd&ess- CQ k 31 Phow O S 2a Are you an employer?Check the appropriate box: Type of project(required): . I..❑ i�xm a employer with 4. ❑ I am a general contractor and I loyrees(full and/or part-time). have hired the sub-contractors 6- ❑New constnxfiou 2. tam a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling.. ship and have no employees. These:sub-eontrac#ors have g. ❑Demolition working for me iu any capacity. employees and have workers' [No workers'comp.insurance. comp.iustuance Y 9. El Budding addition required.] $- ❑ We are a corporation and its 1D.❑Electrical repairs or additions officers have exercised their 3.El Lama homeowner doing all vr�oik 11_❑Plumbing repairs or additions myself[No workers'comp. right of ememption per MGL 12.❑Roof repairs insurance ]l c.152, §144? and we have no employees.[No workers' 13..❑ Other c insurance- required,]] Any applicaIIc far checks box C Empt also fill out the section below showing their der'uompensafmn policy infornixtim Aa®eawaers who submit this sffidm it m cxmg they ace doing sip croak sod dum him outside contactors==submit a new affidavit indicating such- f Gontactors'dist check this ban must attached as additional sheet showing the name of the sub-conuacmrs and:state whether ornot those entities haves employees. If the.sub-coa=cton base employees,they roust provide their workers'comp.policy number. I am an employer that ispror+fding workers'compensadan:insurance for my emptos�eax Below is the policy and job:site infotmatiorr. Imsurance Company Name: Policy#or Self ins.Lic.#: Expiration Date: Job Site Address City/State/zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c- 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250-DO a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for:i surer-ce coverage verif cation.. I do hereby certify ander thre ns and a f ry that the informaflorip,rm ded above is hue and correct Si mate: Phone#: a Official use only. Do not write in:this area,m be completed by city or town official, City or Town: Permit(License# Issuing Authority.(circle erne): 1.Board of Health 2.BuMing Department 3.City/Town Clerk 4..Electrical Inspector S.Plumbing inspector 6.Other Contact Person: Phone 1h 6 pU TFIE - • sARN&rABL6 • 9� MAS& Town of Barnstable 10Tea� Regulatory Services Thomas F.Geiler,Director Buildings Division ' Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 " 1 Property Owner Must Complete and Sign This Section If Using A Builder I, 611j1 /[V e-V 1 e , a's Owner of the subject property hereby authorize �e��C,C,kC � �o� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) _r 7- 6 Si Lute of Owner Date - j nvl\r,) Nevi Ie- Print Name If Property Owner is.applying for permit;please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doC Revised 051811 �t Town of Barnstable Regulatory Services BnnxsrnB14 ' Thomas F. Geiler,Director `bAr 163 p.�► 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 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)for hire to do such work,that such Homeowner shall act as-supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit formS\EXPRESS.doC Revised 051811 ri • . � , t e Office of Consumer Affairs&BJA ess Reg HOME IMPROVEMENT CONTRACTOR Registration:��172472 Type: l • Expiration: 014 _ individual P ICK CLIFFO�t I IN r` PATRICK CLIFF i5t^Mf< ,R! 12 BALD' DENNIS,MA 02638 "i 4 -�� +.. Undersecretary it License or regisfratiorrval►d for indwtd"ul use only before the expiration date If found return toulation I Office of Consumer Alfa►rs and Business Reg II 4 l0 Parkplaza Suite 5170 Boston,1VIA02116 I t II ;I i outsgnature (I Not val►d w 1 Massachusetts -'Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License: CSSL-105951 . 1:1.\ PATRICK CLIFF9'RD 12 BALDWIN ROAD 1 Dennis MA 0263� I W`' Expiration 06/02/2016 Commissioner �i �. _ ,. ��� , � �- ar. p •t ..,' •� ,. ..«... pay cr � ., �__. ,. �s,.w ..a -... .�...` .. .:. � .. _� i` .. `' .: <, _, -� �. � .f� _ _ s .. .- _ {.. ' '..::: ... :: j � _ _ �� � � {i11 � ��� ! 1lrs�T � r,,,'iP� _'>��-*�i , ,�M � dam'. �� ..r'� L��.£6 f -' 3 .1� -� ink �F f T � -� � � }} 1 ��..77 t3#!q� ' _. _ �• r ,�ec,� Woof inS-l� lle�