HomeMy WebLinkAbout0071 SCHOOL STREET
TOWN OF BARNSTABLE BUILDING>PERMIT APPLICATION
Map 035-- TOWN OF BAP RNSTATTE
Parcel ® ( Application # v
Health Division ? �LA
- 5 A!"', k 0 6 Date Issued
Conservation Division Application F'
Planning Dept. >�a. Permit Fee
s s i
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address Yr
Village.
P_hnd /1 3K'�j 1y �7x7�-- Address l S��fjp;�.
Telephone "2- t7 e7 0
Permit Request 9J6P1-/V-'A_ b ;1 "Iwo 'D d/9ob 4w �iil� �
Square feet: 1 st floor: existing zffigproposed 4JA41�_ 2nd floor: existing �' proposedALM®Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation ArOO Construction TypeG v IJ00R
Lot Size Grandfathered: ❑Yes - .No If yes, attach supporting documentation.
Dwelling Type: Single Family J& Two Family -❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes Ad No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ' UWalkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 77
Number of Baths: Full: existing 2, new Q Half: existing 0 new 0
Number of Bedrooms: existing 0 new
Total Room Count (not including baths): existing S' new 6 First Floor Room Count
Heat Type and Fuel: IX Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes bd No Fireplaces: Existing New 0 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:16 existing ❑ new size•00 Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes VLNo If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name Telephone Number 0s'``1�/�"���6
Address �'��-1 1'� I fs License # 1406 E
Home Improvement Contractor# IM 9 7
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOd��
i
SIGNATURE �'l' DATE
i
I
,Y
FOR OFFICIAL USE ONLY
:{ APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE -
I OWNER '
1
} r
DATE OF INSPECTION:
.FRAME
a dNSULATION►_ ,r,• s
FIREPLACE
ELECTRICAL: ROUGH FINAL
' PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT.
ASSOCIATION PLAN NO.
r
the Coanmo rnwak i of Uassachusetts
Department of l`a dusaial Accidents
600 T3rrayhington&reet
Boston,MA02111
wnhv.masmgot1dira
Workers' CampensatianlnsnrauceA fidavit:BuilderslCflntractors/Eiectricians/Plumbers
Applicant Information Please Print Legibly_
Name Musin�organizafioallndividml)_ --
Address_ 6
City/Statr_IZip: 14A f1w/'A5�E Phone 47---n
et,
Aire you an employer?Check the appropriate box: Type of o't ct(required):
4. I am a contractor and I In I
1.❑ I am a employer with ❑ 6- ❑New oonstructim
employees(full and/or part-time).* have hired the
I am a sole proprietor or partner- listed on the attached sheet 7- ❑Remodeling
ship and have no employees These sub-contractors have g_ ❑Demolition
w for mein an capacity. employees and have workers'
ork?ng y 1 9_ ❑Building addition
(No workers' camp.insurance comp-insurance.
required-]
5..❑ We are a corporation and its 10_❑Electrical repairs or additions
1❑ I am a homeowner doing all work officers ha-m exercised their 11.0 Plumbing repairs or additions
myself o workers' right of exemption per MGL 12.. Roof
insurance -]1 c-152,§1(4),an we have no ❑ repairs
13_❑Other
employees-INC'workers'
comp-insurance required..]
*Any Wlicaut that thus boa 91 mast also M out the section below shnwmg ibeir wa�c¢s'compenssiiau polity inft�rnzat
T Homeowners Who sabniit this sffidz=indicating they are doing all vrA sad they bite outside coutiactors inns#submit a new affidarit md'icaming mdi_
tContcactors that chaa this boot must attsched an additional sheet showing the name of the s*-contacUoa and ststE whether ocnot those lisve
Employees If the soh-contnictnts hate employees,they nnut provide their warkers'comp.policy number.
.,Tam an omptoyer iliac is protid&W it orke-m'compertsahon insrtrarice for nzy enrplbyeers Below is Ste pagey and job site
information.
Insurance Company Name:
Policy 9 or Self-ins.Lac.;.�_ 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 regda-ed under Section 25A of MGL c 152 can lead to the imposition of c i inal penalties of a
fine up to S1,500.00 and/or one-yearimpris t,as well as civil penalties in the.form of a STOP WORK ORDER and a fiw
of up to$250-00 a day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of f}ie DIA for insurance cm-erage veriffcatton-
I do hereby cierhfy under tke pruns andpenalfies ofperfury at the info ormation prinidd ed+above is tom and correct
Signature: Date: -!�
//yz/,V.
Phone#
()0 cial use only. Do not(mite in fhis area,to be completed by cio or town official
City or Town:. Permit/Liceuse#
ISsuina Authority(circle one):
1.Board of Health 2.Building Department 3.CitVFown Cleric 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
6
Information and. Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuantto this statute,an ernployee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed TO be an employer."
MGL chapter 152, §25C(6)also states that"every state or IocaI licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance,coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,U
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their ceriincatc-(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. De advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 71}e affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant_
Please be sure to fill in the permit/license number which will be used as a reference number. In addition;an applicant
that must submit multiple permitllicense applications in any given year,need only submit one af5da.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 lice to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Depaitnent of Industrial Accidents
Office of lave, t Otions
600 Washington Street
Boston,MA G2111
Tel A 617--727-4900 W 406 or 1-8 MASWE
Revised 4-24-07 Fax 4 6I7-727-7749
www.nnassgovfdia
� ETti Town of Barnstable ,
Regulatory Services
� ' ,iE$ Richard V.Scali,Director
639. a Building Division
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, go)z oA) I-Y�41.L_ , as Owner of the subject property
hereby authorize / c7�j /__� �,j�/p�j� to act on my behalf,
in all matters relative to work authorized by this 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.
Signature of e Signature of Applicant
a
Print Name Print Name
Date
Q:FO RMS:O WNERPERMISSIOI,TPOOLS
Town of Barnstable
Regulatory Services
�aF-nte raty� Richard V_ScaIi,Director
t � -
Building Division
t saxivsT�r Tom Perry,Building Commissioner
1 �w� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Pax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: =-
JOB LOCATION:
number street village
"HOMEOWNER':
name home phone# work phone irr
CURRENT MAII.ING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of sit 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;_dawhich 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,
rules and re ations. _
bylaws, _
�
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 persons)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,RuIes &RegtiIationI for Licensing Construction Supervisors,Section 2.15) This tack 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 fb=\EXPRESS.doc
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Massachusetts - Dc?artrnent of Public Safety
Board of Building Regulations and Standards
• Ci;:icirrlctiott Sul7s:nts+i.r
License: CS-061438
,,
ROBERT T ELLSWORTH.
69 PALMER RD ?"A '
MASHPEE MA Q649
J.•G..+ �1 ,. '} leis Expiration ,
Commissio er 1'0/15/2015j
f - R
%ns 1 orAffairr�e Business
anon License or registration valid for individul use only
�•, Office of Consumer Affairs&'Business Regulation g Y _
<� _FIOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
"'— ire istration: 178522 Office of Consumer Affairs and Business Regulation
.��_. 9 Type:,� _ g
�?
%Kj xpiration: 4/23/2016 Individual' 10 Park Plaza-Suite 5170
Boston,MA 02116
ROBERT T. ELLSWORTH
ELLSWORTH
69 PALMER RD
MASHPEE,MA 02649' Undersecretary Not valid without signature
r
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 0.3" Parcel Application #r3c) `
Health Division Date Issued hs))I
Conservation Division �JI� Application FeqJ1 G
Planning Dept. Permit Fee LOV
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address 7/ .SGWoo 5-51111
Village O 7c.,-?T
Owner GOAZDoA.1 /-✓-ALL Address 7/ SC E 17'
Telephone 5-01eF- 412 g • 3 7 70
Permit Request COA1571ole-1 101CX1ZZA011. p4e_A� 12- kly�
Square feet: 1 st floor: existing/
595proposed 2nd floor: existing/09/ proposed Now Total new A/oyA�
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type Pr PAO.*-/4
Lot Size . 1.3t A. Grandfathered: ❑Yes Jil-No ' If yes, attach supporting documentation.
Dwelling Type: Single Family 9 Two Family ❑ Multi-Family (# units)
Age of Existing Structure //2 Y S Historic House: ❑Yes !S No On Old King's Highway: ❑Yes ® No
Basement Type: ❑ Full ❑ Crawl M Walkout ❑ Other
Basement Finished Area (sq.ft.) 0 Basement Unfinished Area (sq.ft) /`t27
Number of Baths: Full: existing 2- new ii/O, 1,r Half: existing O new 1tiyyC
Number of Bedrooms: existing O new
Total Room Count (not including baths): existing new a First Floor Room Count
Heat Type and Fuel: aGas ❑ Oil ❑ Electric ❑Other
Central Air: ❑Yes U No Fireplaces: Existing New O Existing wood/coal stove: ❑Yes ❑ No
Detached garage:ram existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed:W existing ❑ new size _ Other: 'I
Zoning Board of Appeals Authorization ❑ Appeal # Recorded 0 =: a
Commercial ❑Yes X No If yes, site plan review#
-i Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name RO&AO.47' r Telephone Number Jr® "2 7q. 1O Z6
Address __ A 9 VX,4RA 12 R_PD License # C5 04./Y3 0
Z6g9 Home Improvement Contractor# % 7 6 S2-2o
Email /Yl e,,/G 20 16 e-0M"57,.A/ST Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO '®y
SIGNATURE ��/2%� DATE
�7
` FOR OFFICIAL USE ONLY
S
APPLICATION#
DATE ISSUED
l - -
` MAP/PARCEL NO. p'
• 1
ADDRESS VILLAGE
OWNER a "
DATE OF INSPECTION:
FOUNDATION
FRAME F
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING f0 1,W
DATE:CLOSED OUT
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affiidavit.,Builders/Contractors/EIectricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Oro nization4 div : %ZMAXT 04-7 !
Address: 6 9 - PI Lm CK R.D.
City/State/Zip: S11A Q Phone#: ®� 7 -
Are you an employer?Check the appropriate box. C Type of project(required):
1.El I am a employer with 4. []I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. New construction
2.g�I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling
ship and have no employees 'These subcontractors have g, ❑Demolition
working for me in any capacity. employees and have workers' 9. Buildingaddition
[No workers'comp. insurance comp•insu ance.t ❑
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no 13.LK Other U&
employees. [No workers'
comp.insurance required.]
*Any applicant that cbecks box#1 must also fill out the section below showing their workers'compensation policy informalioa.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
(Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp,policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: 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$1,50-0.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of pe ' that the information provided above is tru and correct
Si ature: Date. 7 2-1 1,
r
Phone#: ..7 -08- 2 Zy- 3,52
Of use only. Do not write in this area,to be completed by city or town of cial
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
-Information and Instructions '
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152;§25C(t7 also states that"every state or IocaI licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance.coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance.,
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
f
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call. .
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts `
Department of Industrial Accidents
Office of Xnvestigations
600 Washi4ou Sfteet
Boston,MA 02111
Tel,#617-727-4900 ext 406 or 1-877-MASSAFE
Fax 9 617-727-7749
Revised 4-24-07 www.mas5.gov/dia
r a
Massachusetts oc)artment of Public Satety
Board of Building Regulations and Standards
C+iiistrtiction Suiaer' %()1'
License: CS-081438 /
f'i l
ROBERT T ELL7VOR
69 PALMER RD w ,
MASBPEE MA 62649,
''; t� Expiration
• ` ��� a.J—,.(,.,,.�1�G�• a . 1019512Q15
Conirnissioner
r�/c`fr�ai/t��rrnuJec/lf/r o�n,ll�c;,;�iclrr�e/f; ', •
\. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: r
11 jegistration: 17g522 Type:' Office pfConsumer:Affairs and Business Regulation
xpiration: 4/23/2016 Individual 10 Park Plaza-Suite 5170
^ !. Boston,MA 02116
ROBERT T.ELLSWORTH:
ROBERT ELLSWORTH
69 PALMER RD
MASHPEE,MA 02649 Undersecretary, - Not valid without signature
ires1 JLJLO L[LU1G
Regulatory Services
MA&- p Thomas F.Ger7er,Director
Building Divmon
Tom P Banding C�'r'9, ommirsioner ,
• 200 Main St vet;Hy=tms,MA 02601
wwwAmn.barnstable.ma.us
Office: 50$-862-403$ Pax: 50$-790-6230
Property Owner Must
Complete•and Sign This Section
t4 L-i Min .A Bl-iUd L 4 '
• d
I, 2 D 0/1/` as O•wnet of the mbjectpropert
hereby authorize t �.�
{ rf
to act on rby b In all matters relative to.work authorized by this building peulZit
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant Pools r
are not to be filled or utilized before fence is installed and all final'
inspections are performed and accepted..
Sgn3;ti a G'wues' Signature of Applicant'
C� aal .3. t ILL
Print Name Print Name
Date _
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BARNSTABLE
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Table 1. Common preservative treatments and retention levels (pcf)
for sawn lumber in ground contact.a
Species ACQ-B ACQ-C ACQ-D CA-13 CuN-W
Southern Pine 0.40 0.40 0.40 0'.21 0.11
Douglas Fir-Larch 0.40 0.40 NR 0.21 0.11
Hem-Fir 0.40 0.40 0.40 0.21 0.11
Ponderosa Pine 0.40 0.40 0.40 0.21 0.11
Red Pine 0.40 OAQ Q,40 0.21 0.11
Spruce-Pine-Fir NR 0.40 NR NR NR
Redwood NR NR NR 'NR NR
a Preservatives and retentions listed in Table 1 are based on the American Wood Protection
Association(AWPA) Book of Standards. NR=Treatments Not Recommended.
DECKING REQUIREMENTS Decking not meeting these requirements may be
All decking material shall be composed of dimension substituted when the product has been approved by the
lumber(2" nominal thickness)or span rated decking in authority having jurisdiction.
accordance with the American Lumber Standard
Committee Policy for EvG luati(?n of Recommended JOIST SIZE
Spans for Span Rated Decking Products (November 5, The span of a joist is measured from the centerline of
2004). Attach decking to each joist with 2-8d threaded bearing at one end of the joist to the centerline of bearing
nails or 248 screws. Space decking boards at the other end of the joist and does not inc ude the
approximately `/g" apart. See Figure 11 for decking length of the overhangs.Use Table 2 to determine joist
connection requirements at the rim joist. Decking may span based on lumber size and joist spacing. See Figure
be placed from an angle perpendicular to the joists to an 1 and Figure 2 for joist,span types.
angle of 45 degrees to the joists. Each segment of
decking must bear on a minimum of 4 joists (or 4
supports). r
Table 2. Maximum joist Spans (Li_
Joist Spacing (o,c,)
Without Overhangs' With Overhangs up to L,/42
Species Size 121' - l6" 24" 12" 1611 24"
2x8 .13' -8" 12'-5" 10'- 2 10'- 9" 10'-9 10'-2"
Southern Pine ; 2x1_0 IT -5" 15' 10" 13'- 1" 15'-6" 15- 6" 13'- 1" -
2x12 18' -0" 18'-0" 15'- 5" 18'-0" 18' - 0" 15'-5"
2x8 12' 6" 11'- 1" 9' 1" 9'-5" 9'-5" 9'- 1'
Douglas Fir-
Larch, Hem-Fir, 2x10 15'- 8" 13'- 7" 11'- 1" 13'-7" 13'-7" 11'- 1"
SPF3 2x12 18' -0" 15'-9" 12'- 10" 18'-0" 15'- 9" 12' -10"
Redwood, 2x8 11'- 8" 10' -7" 8'- 8" 8' -6" . 8'-6" 8' -6"
Western Cedarsd 2x10 14' - 11" 13' - 0" 10'- 7" 12'-.3" 12'- 3" 10'-7"
Ponderosa Pine ,
Red Pine 4 2x12 17'-5" 15'- 1" 12'-4" ' 16'-5" 15'- 1 12'-4
1.Assumes 40 psf live load, 10 psf dead load,1_/360 deflection,No.2 grade,and wet service conditions.
$ee Figure 1B.
2.Assumes 40 psf live load, 10 psf dead load,L/180 cantilever deflection with 220 lb point load, No.2
grade,and wet service conditions.See Figure I and Figure 2.
3.Incising assumed for refractory species including Douglas fir-larch,hem-fir,and spruce-pine-fir.
4.Design values based on northern species with no incising assumed.
American Forest&Paper Association
i
-; F-I IFTE oil PI MITTIM1717410 MY lipi
Figure —
g e 1A. Joist Span Deck Attached at House and Bearing Over Beam
op ' al overhang existing wall
-=311�3;_=7C==]
rim joist Foist hanger
beam (flus
tight bearing) jol ledger oard
post
U/4 maximum Joist Span (L# see Table 2.
overhang
Figure 1B. Joist Span =:JoistsAttached,.at,House�and:to:Side of Beam -7
joist existing wall ----►
beam* joist hanger joist hanger
*Note: beam depth must be
equal to or greater than joist ledger board
depth if joist hangers are used
post
1
Joist Span (Li): see Table 2 R
Figure 2. Joist Span —Free Standing Deck
option overhang tional overhang
rim joist r joist
be %h '
— bea ,-(flus ht joi (flush, ht
bearing) post bearing) post
U/4 maximum Joist Span (Li): see Table 2 U/4 maximum
overhang overhang
American Wood Council
4
PRESCRIPTIVE RESIDENTIAL WOOD- 1 1 1GUIDE *
`'BEAM SIZE &ASSEMBLY REQUIREMENTS , Joists shall not frame in from opposite sides of the same
Deck beam spans shall be in accordance with"fable 3 ,
beam. See JOIST-TO-BEAM CONNECTION details,
and can extend past the post centerline up to LB/4 as Figure 6.
shown in Figure 3. Joists may bear on the beam and' Where multiple 2x members are used,the deck's beam is
extend past the beam centerline up to LJ/4 as shown in assembled by attaching the members identified in Table
Figures I and 2, or the joists may attach to the side of 3 in accordance with Figure 4. [Table R602.3'(l)]
the beam with joist hangers as shown in Figure 1 B.
Table'3.'Deck Beam'Spans(LB)'16r idists F:ramiing:from'One`Side'Only`-7
Joist Spans (Li) Less Than or Equal to:.
Species Size 6' 8' 10, t1i2l 14' 16' 18'
2-2x6 7' - 1" 6'=2" 5' -6" 51 -011 4'-8" 4'-4'.' ti 4 - 1"
2-2x8 9' -2" -7'- 11" 7' - 1" 6'-6" 6' -0" 5' -7 5'_-3"
2-2x10 1V- 10" 10' -3" 9'-2" 8' -5" T -9 7'.-3" 6'- 10"
Southern 2-2xl2 13'- 11" 12'-0" 10'-9" 9'- 10" 9' 1" 8'-6" 8' -0"
Pine 3-2x6 8' -7" 7'-8" 6'- 11" 6' -3" 5'- 10" 5' -51'' 5' -2"
3-2x8 11'_-4" 9'- 11" 8'- 11" 8' -1" 7' -6" T -0" 6'-7"
3-2x10 14' -5" 12' - 10" 11'-6" 10' -6" 9' -9" 9'- 1" 8' _7"
�' '3-2x12 17' -5" 15' - 1" 13' -6 12--�4'R-; 11' -5" 10' -8" 10' - 1"
3x6or2-2x6 5'_=5" -4' -8" 4' -2" 3'- 10"` 3' -6 T- 1" 2'-9"
3x8or2-2x8 6' - 10" 5' - 11" 5' -4" 4' - 10" 4' -6" 4' - 1" 3'-8"
Douglas �
Fir- 3x10 or 2-2x10 8' -4" 71-31f 61 -6,1 5 - 1111 51 -611 51 - 1" 4' -8„
Larch 2, 3x12 or 2-2x12 9'-8" 8' -5" 7' -6" 6'- 10" 6' -4" 5'- 11" 5'-7"
Hem-FV, 4x6 6'-5" 5'-6" 4'- 11" 4'-6 4' -2" 3'- 11" 3' -8"
SPF2, 4x8 8'-5" 7' - 3" 6'-6 5'- 11" 5'-6" 5'-2" _ 4'- 10"
Redwood, �_ �� � _ ,� � ,� � �r _ � � � �
Western 4x10 9 11 8 7 7 -8 7 -0 - 6 -6 6 - 1 ' 5 -4
Cedars, 012 11' -5" 9'- 11" 8'- 10" 8'- 1" 7'-6" 7'-0" 6'-7"
Ponderosa 3-2x6 7'-4" 6'-8" 6'-0 5176" 5' - 1" 4'-9" 4'-6" '
Pine 3, Red 3-2x8 9' -8" 8'-6" 7' -7" 6'- 11" 6' -5" 6' -0"
Pine 5' -8"
_
3-2x10 12' -0" 10' 5" 9' -4" 6' -6" 7'- 10" T-4" 6' -11"
3-2x12 13' 11" 12'- 1" 10'-9" 9'- 10" 9' - 1" 8'-6" 8'- 1"
1. Assumes 40 psf live load, 10 psf dead load,L/360 simple span beam deflection limit,L/180 cantilever deflection limit,No.2
grade,and wet service conditions.
2. Incising assumed for refractory species including Douglas fir-larch, hem-fir,and spruce-pine-fir.
3. Design values based on northern species with no incising assumed.
4. Beam depth must be equal to or greater than joist depth if joist hangers are used(see Figure 6,Option 3).
Figure 3: Beam Span Types'
joists above optional overhang (may
FA occur at each end)
IVI IVI IV 1V1
IAI [At IA: IAI
t t
L----
beam beam splices at interior
post, typical post locations
' �--
1-9/4 max. beam span (Ls): see Table 3 beam span (Le): see Table 3 Ls/4 max..
overhang overhang
JOIST-TO-BEAM CONNECTION clips used as shown in Option 2 must have a minimum
capacity of 100 lbs in both uplift and lateral load
Each joist shall be attached to the beam as shown in directions. Joists may also attach to the side of the beam
Figure 6. Joists may bear on and overhang past the beam with joist hangers per Option 3. Joists shall not frame in
a maximum of Li/4. Use Option 1 or Option 2 to attach from opposite sides of the same beam. See JOIST
the joist to the beam. Option 1 shall only be used if the HANGERS for more information.Hangers, clips, and
deck is attached to the house with a ledger(see mechanical fasteners shall be galvanized or stainless
LEDGER ATTACHMENT REQUIREMENT'S)or as steel(see MINIMUM REQUIREMENTS).
shown in Figure 23. Mechanical fasteners or hurricane
Figure 6: Joist-to-Beam Detail
3-8d threaded OPTION * OPTION.2** OPTION'3**
chanica
toe nails m and "Dist
fast er or top of beam 1
(2 on one side, joist must be at same'
1 o e other)\ hurrica clip han er
9 elevation
*Option 1
shall only be
used if deck
is attached beam
to house Xt
**see manufacturer's recommendations for additional requirements
JOIST HANGERS,� Figure 7: Typical Joist Hangers
Joist hangers, as shown in Figure 7, shall each have a joist hanger with inside flanges
minimum download capacity in accordance with Table
3A. The joist hanger shall be selected from an approved
manufacturer's product data based on the dimensions of ° ° °
the joist or header it is carrying. Joist hangers shall be ° ° ° °
galvanized or stainless steel (see MINIMUM °
REQUIREMENTS). ° ° °
Use joist hangers with inside flanges when clearances to o °
the edge of the beam or ledger board dictate. Do not use °
clip angles or brackets to support joists. °
°
°
Table 3A: Joist Hanger Download Capacity
Joist Size Minimum Capacity,.Ibs
2x8 600
2x10. 700
2x12 800
POST REQUIREMENTS notching the 6x6 as shown in Figure 8 or by providing
All deck post sizes shall be 6x6 (nominal) or larger, and an approved post cap to connect the beam and post as
the maximum height shall be 14'-0" measured to the shown in Figure 10. All 3-ply beams shall be connected
underside of the beam. Posts shall be centered on to the post by a post cap.All thru-bolts shall have
footings. Cut ends of posts shall be field treated with an washers under the bolt head and nut. Attachment of the
approved preservative(such as copper naphtliemte) beam to the side of the post without notching is
[R402.1.2]. The beam shall be attached to the post by prohibited(see Figure 9).
American Forest&Paper Association
;,a;
r • • r r • • r
'Figure 14. General Attachment of Ledger Board to 13and Joist or Rim Board ¢f
remove siding at ledger
exterior sheathing prior to installation
existing stud wall threshold carefully flashed and
caulked to prevent water intrusion
existing 2x band joist continuous flashin
or 1"minimum 9
EWP rim board extending past joist
hanger
2"min. deck joist
1-5/8"min.
5"max.
2"-min. 1/2"diameter lag
2x.floor joist, screws or
wood 1-joist, through-bolts with
or MPCWT washers
joist hanger
existing -
foundation wall 2x ledger board; must be greater
than or equal to the depth of the
deck joist and no greater than the
depth of the band joist'
Figure 15. Attachment of Ledger Board to Found ton Wall(Concrete or Solid Masonry)
embed anchors per manufacturer
re mendations
to res corrosion and decay,
—this area uld be caulked
dUU ist
exis" concrete
or solid sonry
wall n .
1/2"diameter
approved expansion,
oxy, or adhesive
and rs with washers
• joist hanger
2x ledger board;must be gre er
than or equal to the size of the jo' :
Figure 16. Attachment of Ledger Board to Foundation Wall (Hollow Masonry)
embed anchors
per manufacturer to resist rosion and
recommendations ' decay,this a should
be caulked
exis 4 hollow deck joist
masonry li
/2"diameter approved
block cells filled e y or adhesive
with grout or .anch with washers
concrete at
anchor locations joist hanger
(new construction) 18"
2x ledger board;must be greater
block wall than or equal to the size of the joist
minimum
American Forest&Paper Association
i r r r r r r r
Y
FREE-STANDING DECKS EXISTING HOUSE FOOTING IF LOCATED
Decks which are free-standing do not utilize the exterior. CLOSER THAN 5'-0" TO AN EXISTING HOUSE t
wall of the existing house to support vertical loads(see WALL(see Figure 2 and Figure 12).For houses with
Figure 21); instead, an additional beam with posts is basements,a cylindrical footing(caisson) is
provided at or within L/4 of the existing house. THE reconunended to minimize required excavation at the
ASSOCIATED DECK POST FOOTINGS SHALL BE basement wall. Beam size is determined by Table 3.
PLACED AT THE SAME ELEVATION AS THE
Figure 21. Free-Standing Deck
rim* t
rim \�
joist \ \•,,�''y /�,/- � I
-joist overhan
i existing-house
foundation wall
beam,J ~�
posts 1 deck footings must be at.
i —joists same elevation as
install diagona sting house footing
Per Figure 22
DECK STABILITY
Decks greater than 2 feet above.grade shall be provided
with diagonal bracing.
Figure 22. Diagonal Bracing Requirements
provide blocking when
joists do not align
with posts
0
cV.
iv beam 21
beam
2'
- joist at post
ca
2x4, typical (1) 3/8"diameter locations E
thru-bolt with o
washers,.typical �t
TJ
;BRACING PARALLEL TO BEAM "BRACING-PERPENDICULAR TO•BEAM
American Wood Council
.
GUARD POST ATTACI3M�NTS jciisis shall be attached to the i itn joist in accordance ��
Deck guard posts shall be a minimum 4x4 (nominal) with Figure 26. Only hold down anchor models meeting
with an adjusted bending design value not less than these minimum requirements shall be used.Hold down
1,100 psi. anchors shall have a minimum allowable tension-load of
1,800 pounds for a 36" maximum rail height and be
Guard posts for guards which run parallel to the deck, installed in accordance with the manufacturer's
joists shall be attached to the outside joist per Figure 25. instructions.
Guard posts for guards that run perpendicular to.the deck
Tigure.25. Guard Post.to Outside-Joist'Example
see FIGURE 24 for guard *guard posts can be installed as
component attachment shown in Figure 26(between joists)
guard posts may be requirements if blocking is installed as shown below
located on either side , within 12"of each side of the post
of the outside-joist
at first interior bay, provide 2x blocking at guard posts
guard post with hold-down anchors; attach blocking with 10d
threaded nails top and bottom, each side
(2)1/2"dia. thru-
bolts and washers � outside-joist
2" min. - t�
2-1/2" min. and 5" max.
2"min. -
outside joist
SECTION guard post* PLAN VIEW
/ Figure 26. Guard Post to Rim Joist Example-
see FIGURE 24 for guard hold-down anchor
component attachment
requirements joists
guard post
guard post align guard
post at joist
locations '
rim joist
hold-down anchor rim joist rim joist
joist
minimum (2)1/2" = 2"min.
hold-down anchor
diameter thru- 2-1/2" min. and 5".max.
bolts and washers 2"min.
at joist location between joists
SECTION PLAN VIEWS
American Wood Council
zo.I roaf 6`7
VIKE Town of Barnstable *Permit#
Expires 6 m m issue date
Regulatory Services Fee
' RARNSMBLE, - -
asAss. Thomas F. Geiler,Director
�TED MA't a
Building Division
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.b arnstab le.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
Not Yalu!wit/rout Red X-Press Imprint
Map/parcel Number 3_��O.
Property Address 1 SGi1t3ol 5t . (0'1 �K l t e TM
N1131esidential Value of Work minimum fee of$35.00 for work under$6000.00
Owner's Name& Address �!
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) °tTS PERMIT
❑Workman's Compensation Insurance
Check one: AP
❑ .I am a sole proprietor TOWN OF BARNSTABLE
['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(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
#'of doors
❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i,e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License & Construction Supervisors License is
required..
SIGNATURE:
Q;IWPFILES\FORMSIbuilding permit fOrmslEXP S.doc
NThe Commonwealth of Massachusetts
I Department of Industrial Accidents
I I
MC I,,, rf Office of Investigations
600 Washington Street
Boston, MA 02111
f- www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: -71 SlA'A'60 51
City/State/Zip: +� '� d 2�0 , Phone #:
Are you an employer?Check the appropriate box: Type'of project(required):
1. ❑ I am a employer with A. ❑ I am a general contractor and I
6; ❑ New construction
have(fill] and/or part;time).* have hired the sub-contractors
2.ElI am a sole proprietor or partner- listed on the attached sheet. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working forme in any capacity workers' comp.insurance. g; ❑ Building addition.,
[No workers"comp. insurance 5. ❑ We are a corporation and its
officers have exercised theirIO.❑ Electrical repairs or additions
3. equired.]
am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c,,152, §1(4), and we have no 12❑ Roof repairs
insurance required.] t employees. [No workers' ]3.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing theirworkers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ,
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
i information.
Insurance Company Name:
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State/Zip.-
Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties'in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the in providedrr rrabove is true and correct'
Signature 1����y Date:
Phone#.*
Official use only. Do not write in this area;to be completed by city or town official
City_or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2,Building Department 3. City/T.own Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
v—,,.,. Phone#:
a
W
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as."an individual,partnership, association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on.such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §2-5C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary,supply sub-contractor(s)name(s),addresses)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy isTequired. Be advised that this.affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc,)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts. ,
Department of Industrial Accidents
Office of Investigations'
600 Washington Street
Boston, MA 02111
Tel. # 617-727--4900 ext 406 or 1-877-MASSAFE .
Fax # 617-727-7749
Revised 5-26-05
www_mass.gov/dia
,l
j�
Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
ems. g
16Sp. Building Division
Tom Perry,Building Commissioner
200 Matti-Street,_Hyannis,MA 02601
w"Jo wn-b arnstab l e.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
HOIS�OWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: 1 I 5 C\(Lt to 1 COT"
v1 I�
number street village
I ,1 t Q,
.'HOMEOWNER": 1��" � \ \ Sb L4 7,77D
Sb8^L4-7�--5�V
name me(� 2 ho phone# work phone#
CURRENT MAILING ADDRESS: O 6O�C 13 3.0
C i fi (Y 021o3
eityhown state np 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.
DEFRUMN OF HOMEOWINIFR
Person(s)who owns a parcel of land on which he/she resides or intends to reside, an which.thcre 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 constr4cts more than one home in a two-year period shall not be considered a bomeowncr. Such
"homeowner"shall submit to the Budding 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 Budding 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 .
reamrements.
Signature of Hom as
Approval of Buslding,Ofrtcial
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.
EfMfEOWNER'S Exy-m bN .
The Code states that: "Any hgrnrowncr perfomvng work for which a building permit is required shaD be exempt from the provisions
of this section.(Section 1 D9.1.1 -Liccnsing of canatruction Superyisors);provided tha t if the homeowner engages a pc son(s)for birc to do such
work,that such Homeowner shall act as supervisor.,.
Ivfany homeowners who use this exemption art unaware that they arc assuming the responstbi'lities of a supervisor(sec Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awanmess often results in serious problems,particularly
when the homcownar hirrs unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Superrisor is ultimately responsible.
To ensure that the homeowner is My aware of his/her rtsponatbilitics,many communities require,as part of the permit application,
that the homcowmer certify that he/she understands the rrspansibilities of a Supervisor. On ahe last page of this issue is a.form currently used by
several towns. You may care t amend and adopt such a formlecrtification for use in your community.
THE - Town of Barn-stable
a
Regulatory Services
• stixxsrAar�
v � g Thomas F. Geiler,Director
i63� �8
�Fo J�6 Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 509-862-403 8 Fax: 508-790-623 0
- Property Owner Must
Complete 'and Sign This/Section
If Using A Builder
T as e of the subject Own r ro
J P PertY
hereby authorize. to act on my behalf,
in all matters relative to work authorized by this building permit application for-
(Address of Job)
signature of Owner. Date `a i P
Print Name
If Property Owner is applying for permit please complete. the
Homeowners License Exemption Form on:the reverse side.
y
oft
PERCENTAGE OF LOT COVERAGE }
LOT AREA 59335f S.F. - � ,}t
F
EXISTING STRUCTURES 4.0%
EXISTING PAVEMENT 2.3%
TOTAL COVERAGE 6.3% p
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z` PLAN REF: 163-15 (F2) 82-123`
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m DEED REF: 2705-105 r: L —� ASSESSOR'S MAP: 035 016
p ZONING: RF a
SETBACKS: 30'-15'-15'
rn N A.FLOOD ZONE: X• a
" PANEL NUMBER: �25001C 0752 J
DATED: 7/16/14
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O mobs, PORCH YANKEE LAND SURVEY . CO, INC.
1 ,119 ROUTE 149
S� s PARCEL B GRAPHIC SCALE M AR STON S M I LLS, MA
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.• '0. •.r '. TEL: (508)428 0055 FAX: (508)420 5553
•: NOTE, yankeesurvey0comcast.net www.yankeesurvey.net
CZ, SEPTIC SHOWN PER TOWN 'RECORD. 1 inch = 40 ft. SHEET 1 OF 1 JOB#: 55052 JM ,
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